![]() ![]() The lateral malleolus provides key stability against excessive eversion of the ankle and foot. (See "Overview of tibial fractures in adults" and 'Indications for orthopedic referral' below.)ĬLINICAL ANATOMY - The fibula is a non-weight bearing bone that originates just below the lateral tibial plateau and extends distally to form the lateral malleolus, which is the portion of the fibula distal to the superior articular surface of the talus (talar dome) ( figure 1 and figure 2). These injuries are generally unstable and require urgent orthopedic consultation and operative intervention. įractures of the tibia and fibula sometimes occur together. Rarely, complex injury mechanisms that stress the lateral collateral ligament of the knee can result in an avulsion fracture of the fibular head. Tibial plateau fractures are associated with a proximal fibular fracture in approximately 60 percent of cases. Injuries to these structures may have greater significance than any fibular injury. Major trauma and crush injuries can cause fibular fractures, but in such cases, the clinician should expect concomitant injuries of the tibia, neurovascular structures, the ligamentous attachment between tibia and fibula (tibiofibular syndesmosis), knee, and ankle joints. (See "Ankle sprain in adults: Evaluation and diagnosis".) ![]() The approach to the patient with ankle pain due to an injury, including guidelines for obtaining radiographs, is presented separately. Thus, a fibular fracture should be suspected whenever there are clinical findings suggestive of ankle sprain. Lateral ankle sprains that result from forced inversion of the foot cause lateral ankle pain and swelling that may be difficult to distinguish clinically from a distal fibular fracture. ![]() Skiers often fracture the proximal third of the tibia and also the fibula, whereas snowboarders are more likely to sustain isolated fractures of the distal third of the fibula. These are more common in snowboarding than skiing, and fracture patterns are different for each. Participants in downhill winter sports have relatively high rates of fibular fractures. In youth soccer, approximately 54 percent of fibula fractures occur with contact and 46 percent without. Typical examples include American football, soccer, and rugby. Īthletes engaged in sports that involve cutting, particularly those associated with contact or collision, have a higher incidence of fibular fractures. Cigarette smoking is another important risk factor for fibular fractures. However, one prospective study found no gender difference among patients with fibular fractures near the ankle. Most studies show that women experience the greatest number of fibular fractures among older adults. (See "Risks of bisphosphonate therapy in patients with osteoporosis".) Case reports describe fibular fractures associated with prolonged bisphosphonate treatment. While not considered a "classic" osteoporotic fracture, clinicians should consider screening for osteoporosis when a fibular fracture occurs in the setting of unexpected weight loss, significant sarcopenia, poor diet, or a strong family history of osteoporosis (see "Screening for osteoporosis in postmenopausal women and men" and "Osteoporotic fracture risk assessment"). Factors that reduce bone mass had greater impact than overall health status or other risk factors for falling. In older adults, the key risk factor for fractures of the fibular or tibial shaft appears to be bone mass. Fibular fractures may also occur as the result of repetitive loading and in this case they are referred to as stress fractures. Isolated fibular fractures comprise the majority of ankle fractures in older women, occurring in approximately 1 to 2 of every 1000 White women each year. (See "Ankle fractures in adults" and "Ankle sprain in adults: Evaluation and diagnosis" and "Stress fractures of the tibia and fibula" and "Tibial and fibular shaft fractures in children" and "Ankle fractures in children".)ĮPIDEMIOLOGY AND RISK FACTORS - Fibular fractures in adults are typically due to trauma. Ankle fractures and sprains, stress fractures of the fibula, and fibula fractures in children are reviewed separately. The diagnosis and management of fibular fractures is discussed here. Initial management is often provided by primary care and emergency clinicians, who must therefore be familiar with these injuries. INTRODUCTION - Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. ![]()
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