Fibula Fracture

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Anatomically, the fibula is a slender bone that is attached next to and below the tibia (shinbone). This bone bears very little bodyweight but provides lateral stability for the lower leg and acts as a tie rod to increase the range of motion for the ankle, especially lateral and medial rotation of the foot. The fibula is also the thinnest of all the long bones compared to its length.

There are several muscles of the leg, including some from the upper leg, that attach along the entire length of the fibula to include both ends and the shaft. The progression of the cross-section shapes of the shaft from triangular to irregular is driven by the insertion points of muscles and ligaments.

A fibula fracture is a broken bone located in the lower leg. A broken fibular can happen anywhere along the bone. However, it is a common ankle injury known as a distal fibula fracture. Like other broken bones, trauma is the main cause of a fibula fracture. Also, diseases affecting the bones can increase your risk of breaking your fibula. Furthermore, there are a total of four types of fibula fracture, including:

  • Displaced fracture – A displaced fracture is when the bone ends are out of place. Treatment usually begins with putting the bones back together so they can heal.
  • Stable fracture – A stable fracture means the bone ends are close together. A regular treatment process is only needed.
  • Comminuted fracture – Comminuted fractures of the fibula are generally high-energy injuries that break the bone into several pieces. Comminuted fibula fractures can be quite challenging to treat given the limited surface area by which a surgeon can reconstruct the bone fragments.
  • Open / compound fracture – Open or compound fracture means there is an opening in the skin near the fracture. This could be a deep wound, or it could involve the bone breaking through the skin. Because infection can set in rapidly, surgery is urgently necessary.

Fibula fractures can either be a simple fracture involving just the fibula bone itself. However, it can also become more complex, involving multiple bones and other joint structures, such as ligaments.

Causes & Symptoms of a Fibula Fracture

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A fibula can fracture in many places, and in numerous ways, including:

  • Lateral malleolus fracture – When the fibula breaks at the ankle, it is known as a lateral malleolus fracture. It normally occurs when the ankle twists or rolls violently until suddenly the lateral malleolus (part of the fibula on the lateral side of the ankle joint) snaps.
  • Stress fracture – This occurs when a repeated impact causes the bone to wear down and break. This is an overuse injury. It is the result of persistent, repetitive, and will worsen with activity.
  • Avulsion fracture – An avulsion fracture is when connective tissue attached to the bone pulls off a tiny chunk of the fractured bone.
  • Bimalleolar fracture – When the lateral malleolus of the fibula and the medial malleolus of the tibia break, it is called a bimalleolar fracture. With this type of break, the ligaments between the ankle and fibula are damaged as well.

Fibula fractures usually occur as part of an ankle injury. If the fibula is fractured, the ankle joint should also be checked for possible injury. The most common type of fibula fracture is an injury to the end of the fibula bone near the ankle joint.

These injuries may look and feel like a sprained ankle. If both the fibula and inner ankle are injured, the medial malleolus or deltoid ligament may be involved. Often, surgery is needed to make the ankle joint stable. Without surgery, the ankle joint may heal without being properly aligned.

Over time, that can lead to ankle arthritis. In some cases, a fibular fracture may also involve damage to the syndesmosis of the ankle. A syndesmosis is a group of ligaments that holds the two bones of the leg together, just above the ankle joint. Severe injuries from vehicle crashes, sports injuries, or falls may involve both the tibia and the fibula above the ankle joint (tibial-fibular fracture). Re-aligning the leg bones in cases like these may indicate the requirement of surgery.

Symptoms of a fractured fibula range from difficulty standing to a compound fracture that protrudes through the skin. Delayed treatment of a broken bone can result in a worsening injury that inflicts damage to the surrounding tissue and ligaments. Other symptoms linked to fibula fractures include:

  • Deformity – There may be a sign of deformity of the ankle or lower leg, such as having an abnormal lump or being bent.
  • Snapping sensation – Hearing a snapping, grinding, or popping during the injury.
  • Bruising / swelling – Bruising and swelling may be visible on the injured ankle.
  • Sharp pain – Pain can be present depending on the severity of the injury.
  • Limited range of motion – You may experience difficulty moving the ankle or leg.

Who gets a Fibula Fracture?

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Most conditions that are linked to fibula pain include overuse injuries, meaning they occur over time through repeated use. Therefore, fibula fractures can happen most often in:

  • Age – Older patients ages 50 and up are more prone to experiencing fibula fractures due to general wear and tear (degeneration).
  • Sports – Most athletes who play sporting activities that involve repetitive running and / or jumping are prone to fracturing their fibula bone. Some of these include skiing, soccer, and basketball. Additionally, motocross is a sport that includes a high risk of trauma, which can lead to fractures in a joint.
  • Vehicle trauma – Experiencing a vehicle accident can lead to several conditions, whether it is whiplash, fractures, and even death.
  • Unsupportive footwear – Running shoes that do not provide enough cushion and support proper foot mechanics may encourage the development of ankle pain, thus increasing the likelihood of a fracture.

How Does a Fibula Fracture Affect You? How Serious is it?

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If you experience a severe fibula fracture and choose to leave it untreated without any surgical procedure, it is possible for the bones to move out of place during healing. This is called malunion and can cause chronic instability of the bone or joint.

Surgery is necessary to re-align the broken bones, however, problems with the incision or the hardware can lead to complications after it. Because there is very little soft tissue between the skin and the bone, wounds may not heal as easily. Furthermore, after surgery, infections can occur. Wound healing can be more troublesome for people with health conditions such as diabetes.

Recommended Treatment & Rehabilitation for a Fibula Fracture

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During a diagnosis of a fibula fracture, your doctor will begin by examining your ankle to check for points of tenderness. The precise location of your pain can help determine its cause. Next, your doctor may move your foot into different positions to observe and check your range of motion. You may also be asked to walk for a short distance so that your doctor can examine your gait.

If your signs and symptoms suggest a break or fracture, your doctor may suggest one or a combination of the following imaging tests below:

 

X-rays

Most ankle fractures can be easily visualized on X-rays. A technician may need to take X-rays from several different angles so that the bone images won’t overlap too much. Stress fractures often do not appear on X-rays until the break actually starts healing.

Bone scan

A bone scan can help your doctor diagnose fractures that do not appear on X-rays. He or she will inject a small amount of radioactive material into a vein. The radioactive material is then attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas, including stress fractures, show up as bright spots on the resulting image.

Magnetic Resonance Imaging (MRI)

MRI uses radio waves and a strong magnetic field to create very detailed images of the ligaments that help hold your ankle together. This imaging helps to show ligaments and bones and can identify fractures not seen on X-rays.

Computed Tomography (CT) scans

CT takes X-rays from many different angles and combines them to make cross-sectional images of the internal structures of your body. CT scans can reveal more detail about the injured bone and the soft tissues that surround it. A CT scan may help your doctor determine the most recommended treatment for your fractured fibula.

After a diagnosis has been done, physiotherapy may be further advised. A physiotherapist can help treat a fractured fibula after it has been treated by a physician. After the bone is healed, your therapist will help you regain your strength, motion, balance, and sports skills.

After your leg is placed in a cast or cast boot, your physiotherapist will teach you how to walk without bearing weight on the injured ankle, using crutches or a walker. Some of these physiotherapy treatments may include:

  • Reducing swelling – Swelling is commonly the first sign after an ankle fracture. Treatment may include gentle massage, the use of a compression wrap, ice, or heat, and elevating the affected ankle when at rest.
  • Walking instruction – Your physiotherapist will help you begin to put some of your weight on the injured leg, gradually progressing to full weight.
  • Gait training – Your physiotherapist will offer specific instruction and exercises to restore a normal walking pattern. The focus will be on how your foot and ankle move, and the timing of your steps.
  • Restoring your ankle mobility – Your physiotherapist may use manual therapy to gently move your foot and ankle joints and surrounding tissues to reduce stiffness, and increase the ankle’s bending range of motion.
  • Returning to your regular activities – As you regain strength and flexibility, your physiotherapist will provide further training specific to your daily activities.

During your physiotherapy session, your therapist will design a specific exercise plan for you to begin after the cast has been removed to help you strengthen and regain motion in your fractured fibula. The following exercises include:

 

Calf stretch

Sit with your affected leg straight and supported on the floor. Your other leg should be bent, with the foot flat on the floor. Next, place a towel around your affected foot just under the toes. Hold one end of the towel in each hand, with your hands above your knees. Pull back gently with the towel so that your foot stretches toward you. Hold the position for 15-30 seconds, then repeat 2-4 times a day.

 

Ankle dorsiflexion

Sit with your affected leg straight and supported on the floor. Your other leg should be bent, with the foot flat on the floor. Keeping your affected leg straight, gently flex your foot back toward your body so your toes point upward. Then slowly relax your foot to the starting position. Repeat this method 8-12 times a day.

 

Resisted ankle inversion

Sit on the floor with your good leg crossed over your other leg. Hold both ends of an exercise band and loop the band around the inside of your affected foot. Then press your good foot against the band. Keeping your legs crossed, slowly push your affected foot against the band so that the foot moves away from your good foot. Slowly relax, then repeat 8-12 times a day.

 

Resisted ankle eversion

Sit on the floor with your legs straight. Then, hold both ends of an exercise band and loop the band around the outside of your affected foot. Next, press your good foot against the band. Keeping your leg straight, slowly push your affected foot outward against the band and away from your good foot without letting your leg. Repeat this exercise 8-12 times a day.

Alternative & Homeopathic Treatment for a Fibula Fracture

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Most homeopathic treatments include the use of Epsom salt or simply resting your injured ankle. Therefore, here are some home remedies for you to try:

  • Rest – It is recommended to not carry heavy items or play sports for a few days or weeks after you have dislocated your ankle in order to reduce further pain.
  • Eat healthy – Nutrients and vitamin D contained in meals can both help support your ankle recovery. You can also take vitamin D supplements as well.
  • Epsom salt – You can soak your ankle in a warm bath with Epsom salt after a few days of injury. Epsom salt may help soothe sore muscles and connective tissues, and it may help with joint stiffness.
  • Ice application – Apply ice to the ankle several times a day to help reduce pain and swelling. 
  • Compression – Apply an elastic compression bandage to help limit swelling.

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