Fibula Fractures

Etiology

A truly isolated fracture of the fibula, one that has no other associated ligamentous or other bony injuries, are quite rare. They are typically the result of a direct injury to the leg, usually a fall or direct blow or blunt trauma like a sports injury or motor vehicle accident. Gunshot wounds are another mechanism from which an isolated fibula fracture can be sustained.[4]

Epidemiology

As stated earlier, isolated fractures of the fibula are quite rare, and not much literature exists on the frequency of their occurrence. While tibia fractures are most common in young males and elderly females, it is likely that most isolated fibula fractures are in the younger population, based on the injury responsible for these fractures. Young athletes, especially those involved in contact sports, and those individuals involved in motor vehicle accidents and pedestrian versus motor vehicle accidents, are likely at the highest risk.

History and Physical

A thorough history and physical are important to ensure a proper diagnosis. As stated earlier, isolated fibula shaft fractures are rare but, when they do occur, commonly are the result of direct trauma to the leg. A patient presenting with a history of recent trauma to the leg with tenderness to palpation, especially over the fibula on the lateral leg, should be considered capable of suffering fibula shaft fracture. It is also pertinent to examine the skin for any lacerations, abrasions, or bruising that would be consistent with trauma to the leg. The entire extremity should be examined for any signs of trauma, including range of motion of the joints above and below the area to rule out any potential intra-articular pathology. The quality of pain is likely to be acute and sharp, not longstanding, or have qualities more consistent with nerve pathology, like burning or shooting pain.

Evaluation

It is important to perform a thorough evaluation of isolated fibular shaft fractures to ensure they are, in fact, isolated. As in most orthopedic injury evaluations, it is good practice to check one joint above and below the injury. The knee should be checked for any ligamentous instability, and the ankle should be evaluated for any injury. Dedicated films of the knee and ankle are especially important to rule out other fractures in addition to lower-leg x rays. A fracture at the fibular neck without any other fractures in the rest of the fibula or tibia is pathognomonic for a syndesmotic injury and is termed a Maisonneuve fracture. This, by definition, cannot be an isolated fibula shaft fracture due to ligamentous involvement and will require different treatment. Likewise, a fracture of the fibula within 15 cm of the ankle joint is likely to have either bony involvement of the tibia, ligamentous injury, or both.[5]

Treatment / Management

In most instances, the treatment for isolated fibular shaft fractures is nonoperative. Since the shaft of the fibula is not a weight-bearing portion of the bone, patients can be treated with a weight-bearing as tolerated restriction, and some practitioners may utilize a walking boot for comfort.[6]

Differential Diagnosis

• Osteoid osteoma
• Ewing sarcoma
• Osteosarcoma
• Osteomyelitis
• Muscle spasm
• Ankle sprain
• Tendon rupture
• Compartment syndrome
• Nerve entrapment

Prognosis

Patients with an isolated fibula shaft fracture typically have promising outcomes. These are often treated conservatively and symptomatically. There are seldom long term limitations, and patients often go on to union between 6-8 weeks if they have minimal comorbidities. 

Complications

Complications that are related to fractures of the fibula shaft are rare but do exist. Case reports exist of damage to the superficial peroneal nerve. There have also been reports of arterial damage and compartment syndrome in patients with isolated fibula fractures.[7][8][9]

Nonunions may also present and may be symptomatic, in which case a compression plate and autogenous bone grafting is the gold standard treatment. These plates can be left in place for life unless they become irritable. Removal is usually delayed until at least 12 months.[10][11]