Fibular Fracture
(Redirected from Fibular Shaft Fracture)
Other Names
- Isolated fibula fracture
- Fibula Fracture
- Mid Shaft Fibular Fracture
- Proximal Fibular Fracture
- Maisonneuve fracture
- Dupuytren's Fracture
- Frenchman's Fibular Fracture
Background
- This page refers to acute proximal head and neck and mid-shaft fractures of the Fibula
- Lateral Malleolus Fractures (distal fibula) fractures are discussed separately
- Fibular Stress Fracture are discussed separately
History
- Maisonneuve fractures are named after French surgeon Jules Germain Francois Maisonneuve[1]
Epidemiology
- Very little literature on the epidemiology of isolated fibular fractures[2]
Pathophysiology
- General
- Isolated fibula fractures are rare
- Etiology
- Fall
- Direct blow or blunt trauma (sports, MVC)
- Penetrating trauma (gunshot wounds)
Maisonneuve Fracture
- Fracture of the proximal fibula associated with a Syndesmotic Injury, Deltoid Ligament Injury and/or Medial Malleolus Fracture
- Mechanism: ankle pronation or supination with external rotation; force vector is transmitted through syndesmosis to proximal fibula
- Sometimes referred to as a high weber C fracture
Associated Injuries
- Knee/Leg Injury
- Ankle Injury
Pathoanatomy of the Fibula
- Connected to Tibia via Interosseus Membrane
- The distal component becomes the lateral malleolus which helps form the Ankle Joint
- All 4 compartments of the leg have fibular attachments
- The Common Peroneal Nerve bifurcates
- Superficial Peroneal Nerve which innervates the lateral compartment
- Deep Peroneal Nerve which innervates the anterior compartment
Risk Factors
- In geriatric patients[3]
- Osteoporosis, Osteopenia
- Tobacco Use Disorder
- Lack of physical activity
Differential Diagnosis
- Fractures & Dislocations
- Muscle and Tendon Injuries
- Neurological
- Vascular
- Other
- Pediatric Considerations
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis
- Toddlers Fracture (Tibial Shaft Fracture)
Clinical Features
- History
- Some type of trauma to the leg should be obvious in the history
- The patient will be tender over the fracture area
- Physical Exam: Physical Exam Leg
- Inspect for any lacerations, soft tissue injuries, open fractures
- Typically tender to palpation over the fracture location
- Important to perform thorough neurovascular exam
- Assess Superficial Peroneal Nerve, Deep Peroneal Nerve
- Important to examine the ankle and knee
- Special Tests
Evaluation
Radiographs
- Standard Radiographs Tibia Fibula
- Sufficient to make diagnosis
- Generally should image the knee and ankle as well
- Shaft Fracture Findings
- Disruption of osseous cortex
- Proximal fractures/ Maisonneuve
- May show a fracture of the medial malleolus, widening of the medial ankle joint
Classification
- There is currently no classification for mid-shaft or proximal fibula fractures
Management
Nonoperative
- Indications - Shaft fractures
- Majority of cases
- Absence of complications or co-injuries
- Indications - Proximal fractures/ Maisonneuve
- Stable syndesmosis, ankle joint under stress radiographs
Operative
- Indications
- Most Maissoneuve fractures
- Technique
- Most fibular fractures do not require fixation
- Repair any ankle injuries, syndesmotic injuries
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications and Prognosis
Prognosis
- Needs to be updated
Complications
- Complications in isolated fibular fractures are uncommon
- Nonunion
- Superficial Peroneal Nerve Injury
- Deep Peroneal Nerve Injury
- Acute Compartment Syndrome
See Also
References
- ↑ Maisonneuve, J. G. (1840). Recherches sur la fracture du péroné. Paris. France: Loquin & Cie.
- ↑ Pankovich AM. Fractures of the fibula proximal to the distal tibiofibular syndesmosis. J Bone Joint Surg Am. 1978 Mar;60(2):221-9. PMID: 417086.
- ↑ Kelsey JL, Keegan TH, Prill MM, Quesenberry CP Jr, Sidney S. Risk factors for fracture of the shafts of the tibia and fibula in older individuals. Osteoporos Int. 2006 Jan;17(1):143-9. doi: 10.1007/s00198-005-1947-8. Epub 2005 Aug 9. PMID: 16088362.