Fibula fractures occur less in isolation and more commonly occur with associated tibia fracture. Therefore, if a displaced fracture fibula is encountered, fracture of tibia bone must be suspected and looked for.
At the either ends of the bone, the fracture may also occur with ligament injuries.
The fibula and tibia are the two long bones of the lower leg. Joined together at knee and ankle joints.
The fibula is the smaller bone of the two.
Know more about anatomy of fibula.
Tibia is main non weight bearing bone of the two. The fibula bone is expendable for most of its part except in distal third of the leg where it forms important part of ankle joint.
Causes of Fibula Fracture
As noted, isolated fibula fractures are rare. Most of them accompany tibial fractures which are often caused by high energy trauma.
Isolated fibula fracture may occur due to forceful landing after a high jump or direct injury on the outer aspect of the leg.
Distally, ankle sprains may be associated with fibula fractures.
Types of Fibula Fracture
Depending on the region involved the fibula fractures may occur in proximal fibula, shaft of the fibula and distal fibula.
Different fibular fractures may be seen as
- Lateral malleolus fractures – When the fibula is fractured near the ankle.
- Fibular head fractures – Upper end of the fibula near the knee
- Avulsion fractures of the fibula may occur proximally and distally at the site of ligamentous attachment
- Stress fractures may occur due to repetitive stress, such as running or hiking
- Fibular shaft fractures may occur following direct injury such as blow
Pain, swelling, and tenderness are some of the most common signs and symptoms of a fractured fibula.
Patient is may be unable to bear weight on the affected side or weight bearing is painful.
In open fractures, there could be bleeding and wound.
Swelling at the fractured site may be present.
Numbness of the feet or motor weakness may be present especially in the fractures near fibula neck [where common peroneal nerve passes]
The site is tender and deformity can be noted, especially when there is associated tibia fracture present.
Imaging of Fibula Fractures
Most of fibula fractures require this imaging investigation only. If fracture of the tibia dictates an investigation, it is done but in cases of isolated fibula x-ray generally suffices.
Sometimes, the stress fractures or pathological fractures may be required to be investigated for the pathological process and the needful imaging as required must be done.
AP and lateral view of the leg including both the joints should suffice.
X-rays reveal fracture site, fracture pattern and any associated injuries.
Treatment of fibula Fractures
The treatment of the fibula fractures depend on the region of the fibula broken, whether associated fracture of tibia is present or not and whether the fracture is open.
Treatment of Open Fracture Fibula
If open fracture is in distal fibula [open lateral malleolus fractures], it is again a surgical emergency and patient is taken for debridement and suitable external or internal fixation.
When open fractures are associated with tibia fractures, it is a surgical emergency where wounds are debrided and required internal/external fixation is done for tibia. Fibula may or may not be included in fixation.
Antibiotics will be administered to prevent infection. A tetanus shot will also be given if necessary.
Fractures of Distal Fibula
If the fracture is isolated and undisplaced, and the ankle joint is not subluxated, the patient just needs immobilization.
Surgery is required if the ankle joint is subluxated or there is widening of joint space.
Such fractures require anatomical reduction and good fixation to regain ankle function back.
Displaced distal third fracture of fibula are treated surgically.
Fractures of Fibula other than distal third of fibula
If fracture is associated with fracture of tibia, the tibia fracture is treated and fibula is often assumed to treated along both in conservative or surgical treatments.
If the fibula fracture is isolated, it just requires immobilization.
The patient is put on to rehabilitation after 6-8 weeks in case of conservative treatment ar as it is deemed right after the surgery.
This includes mobilization and strengthening exercises.
Complications of Fibula Fracture
Fractured fibula often heal without an issue. Compartment syndrome or common peroneal nerve injury may lead to their own complications if they occur.