■ ■ ■ Description

Fibular fracture is a complete or incomplete break in the smaller of the two leg bones (fibula), between the knee and ankle. Fractures of the fibula are not uncommon. Displacement (misalignment) is seldom severe. Fractures of the fibula sometimes accompany severe ankle sprains. It can occur anywhere within the fibula, although this discussion is only about fractures that do not include the ankle joint. This injury is not as severe as some other fractures of weight-bearing bones, because only 17% of body weight is transmitted through the fibula.

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■ ■ ■ Common Signs and Symptoms

• Moderate to severe pain in the leg

• Tenderness and swelling in the leg or calf

• Bleeding and bruising in the leg

• Inability to bear weight on the injured extremity

• Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal leg contours

• Numbness and coldness in the leg and foot beyond the fracture site if the blood supply is impaired

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■ ■ ■ Causes

• Injury causing a force greater than the bone can withstand, usually due to a direct blow

• Weakening of the bone from repeated stress, resulting in a stress fracture that progresses to a complete fracture

• Indirect stress caused by twisting, turning quickly, or violent muscle contraction

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■ ■ ■ Risk Increases With

• Contact sports, such as football, soccer, or hockey

• Sports in which a twisting injury to the ankle is possible, such as skiing and basketball

• Bony abnormalities (including osteoporosis), tumors of bone

• Metabolic disorders, hormone problems, and nutritional deficiencies and disorders (anorexia, bulimia)

• Poor physical conditioning (strength and flexibility)

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Strength, flexibility, and endurance

  • Cardiovascular fitness

• Wear proper protective equipment, such as shin guards for soccer.

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■ ■ ■ Expected Outcome

This condition is usually curable with appropriate treatment. The fracture usually takes 4 to 6 weeks to heal.

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■ ■ ■ Possible Complications

• Failure to heal (nonunion)

• Healing in a poor position (malunion)

• Compartment syndrome due to excessive pressure within the leg, causing injury to the blood supply to the leg and foot and injuring the nerves and muscles to the leg and foot

• Shortening of the injured bones

• Arrest of normal bone growth in children

• Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis), need for further surgery

• Prolonged healing time if activity is resumed too soon

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medications, elevation of the leg, and ice to relieve pain and reduce swelling. Treatment includes walking with crutches. A plastic stirrup-type brace, cast, or walking boot is often recommended. Surgery to place a rod, plate, or screws to fix the fracture is occasionally recommended. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to the injury and the immobilization) are necessary. These may be done with or without the assistance of a physical therapist or athletic trainer.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), are used to reduce inflammation. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur. Other minor pain relievers, such as acetaminophen, may also be used.

• Narcotic pain relievers may be prescribed by your physician for severe pain. Use only as directed and only as much as you need.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• The following occur after immobilization or surgery (report any of these signs immediately):

  • Swelling above or below the fracture site

  • Severe, persistent pain

  • Blue or gray skin below the fracture site, especially under the nails, or numbness or loss of feeling below the fracture site

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)