Are you a football fan? Have you ever noticed that when a defender tackles his opponent, he often will
grab him by his ankle, and then roll over while he is still gripping the ankle? I used to wonder why this
happened until a former player told me that this is strategically done to inflict pain on the opponent and to compromise their effectiveness during the game. This type of tactic can result in several different injuries, the most common being a fibula fracture. To learn about fibula fractures, read the information below.
What is the purpose of the fibula bone?
● The fibula is a long slender bone located on the outside of the lower leg, underneath the knee and extends down to form the outside of the ankle joint.
● The fibula bone plays a minor role in bearing about 15-20% the weight of our bodies when we walk, and transfers forces as the ankle hits the ground during walking.
What is a fibula fracture?
● Fibula fractures can occur at the knee joint, at the shaft of the fibula bone, and at the ankle
joint.
● Fibula fractures are common fractures seen in the ER because they are the most common
injury in athletes that play contact sports such as soccer, football, basketball, rugby, and
lacrosse.
● The rate of these fractures increases in these sports: downhill skier, snowboarding, and skiers.
Causes
● Direct blow to the outside of the leg from twisting the lower leg awkwardly
○ Severe twisting can cause a fracture around the ankle and the energy travels up the
leg and exits near the upper part of the fibula.
○ Common injury in the NFL
● Elderly: slip and falls are the main cause of fibula fractures due to reduced bone mass.
● Important risk factor is smoking
● Severe ankle sprain can cause a fibula fracture
Signs and Symptoms
● Pain
● Swelling
● Tenderness
● Inability to bear weight on the injured leg
● Bleeding and bruising in the leg
● Visible deformity
● Numbness and coldness in the foot
● Tenderness to touch
Diagnosis
● Physical examination:
● X-rays are used to see the fracture and bone displacement.
● MRI may provide a more detailed scan and can generate detailed pictures of the interior bones and soft tissues.
● Bone scans
● CT Scans may be ordered to make a more precise diagnosis and judge the severity of the
fibula fracture.
Treatment
● Key to healing is to allow healing time because the fractures can become worse, if stressed too soon.
○ Upper fractures allowed to heal on its own.
○ Lower fractures require surgery.
● Immobilization: either CAM Walker boot or surgery with screws and plates.
○ Depends on the distance between the fractured fragments.
○ The larger the distance between fractured fragments the more immobilization is required because healing depends on the hematoma filling the space between the fractured fragments.
○ Hematoma initiates the healing process leading to the soft callus to the hard rigid callus to remodeling.
● Rest
● Ice
○ Ice every 2-3 hours for 20 minutes
● Compress
● Elevate
● Stabilize the ankle and supports lower leg muscles
Recovery process
● Non-weight-bearing on the fractured leg is necessary because it allows for natural healing time to take effect.
○ Non-weight bearing means no weight on the healing leg.
○ 8-10 weeks (about 2 and a half months) for bone to heal
○ 12-16 weeks (about 3 and a half months) for complete healing
● Allowing patients to bear weight interferes with the natural healing process.
References
Hartford Healthcare. 2022. Fractured Fibula. https://hartfordhospital.org/services/bone-joint-institute/conditions/sports-injuries/fractured-fibula
Norvell, J.G (2019). Tibia and Fibula Fracture in the ED. https://emedicine.medscape.com/article/826304-overview
Puwadol Jaturawutthichai. (2022). [Xray]. Fracture fibula (leg bone). X-ray of leg (2 position: side and front view). https://www.shutterstock.com/image-photo/fracture-fibula-leg-bone-xray-2-248971054
Walters BB, Constant D, Anand P. Fibula Fractures. [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556139/