Fracture Fibula

Stress or fatigue fractures are very painful. Most often symptoms occur after athletic activity or physical exertion. Gradually pain worsens and becomes more constant. Stress fractures do not show up on standard x-rays. A bone scan maybe used to confirm the diagnosis. Stress fractures usually occur in the weight-bearing bones of the lower leg and foot. Stress fractures of the tibia account for half of all stress fractures, resulting mostly from athletic activity. These stress fractures are often mistaken for shin splints. In addition to the tibia, the fibula and other small bones of the foot are prone to stress fractures. 

Rupture of the superior peroneal retinaculum, which extends from the lateral aspect of the distal fibular to the calcaneus, may result in peroneal tendon subluxation. Sometimes there is an associated avulsion fracture of the lateral aspect of the distal fibula. Typically, the patient will complain of painful clicking of the ankle, particularly on dorsiflexion and eversion of the foot. The diagnosis is often obvious... 

In children common areas of appendicular stress fracture are the tibia, fibula or metatarsals and... 

Fig. 7.72. Unfused lateral epiphysis of the distal fibula simulating a fracture...

Fig. 8.4. Oblique fracture of the tibial shaft with transverse component. Plastic deformation of the fibula...

When the tibial fracture is an isolated injury, it will tend to drift into varus due to the pull of the long flexors attempting to shorten the fractured bone in the presence of an intact fibula (Fig. 9.9). 

Approximately 70% of tibial fractures are isolated whilst in the remainder, the fibula is also fractured (Rockwood 1991 Shannak 1988). The tibia shows... 

Fig. 9.8. Diaphyseal fracture of tibia and fibula. Despite wedging of the plaster cast, there is valgus alignment...

Fig. 9.9. Segmental fracture of tibia with intact fibula. Tibia remains in varus despite internal fixation. ESIN may not provide sufficient axial stability in unstable comminuted or segmental injuries...

Isolated fihula fractures are rare in children and usually result from direct blows. In adolescents however, one must be careful not to miss the Mai-soneuve fracture. This is a primary ankle injury where the tibio-fibular diastasis has been torn and the injury propagated proximally to exit often in the upper or middle third of the fibula. Radiographs of the ankle will demonstrate talar shift or fracture of the medial maleollus. Imaging of the entire fibula is required to identify the associated proximal fracture. 

Fig. 9.10. Congenital pseudarthrosis of the tibia. The leg has developed an anterolateral bow and the dysplastic segment has fractured. There is a similar lesion in the fibula...

Radiographs show a torus or greenstick fracture of the proximal tibial metaphysis. The fracture line may be poorly visible or even incomplete, running from the medial (tension) side. Occasionally, there may be valgus angulation and the fibula may also be fractured. 

Fractures of the head and neck of the fibula occur rarely in isolation and are more commonly associated with proximal tibial fractures, especially compression, bicondylar and subcondylar fractures. A spiral fracture of the proximal fibula is often associated with an ankle fracture, resulting from an external rotation force. These fractures are known as Maisonneuve fractures. Fibula head fractures can occur from direct impact, valgus stress (associated with a tibial condylar fracture), and varus injuries. Varus stresses can cause avulsion of the fibular styloid at the site of the biceps tendon and fibular (lateral) collateral ligament. Peroneal nerve injury is not uncommon with these injuries. Dislocation of the proximal fibula is often missed on the initial radiograph. 

Anterolateral dislocation is the commonest and is the result of a twisting fall. On an AP radiograph, the head of the fibula is seen almost in its entirety while on the lateral view, it is completely overlaid by the tibial condyle. In posteromedial dislocation, the fibular head is overlaid by the tibial condyle on the AP radiograph but is displaced posteriorly on the lateral view. In superior dislocation, the tibia is foreshortened as a result of a shaft fracture. 

Table 15.1. Risk of complications in 237 fractures of the distal tibia and fibula (Spiegel et al. 1978)...

Simanovsky N, Hiller N, Leibner E et al (2005) Sonographic detection of radiologically occult fractures in paediatric ankle injuries. Pediatr Radiol 35 1062-1065 Spiegel PC, Cooperman DR, Laros GS (1978) Epiphyseal fractures of the distal ends of the tibia and fibula. A retrospective study of 237 cases in children. J Bone Joint Surg 60A 1046-1050... 

Fig. 21.12. Ewing sarcoma. Pathological fracture through an aggressive lesion in the proximal fibula...

Hertz has investigated in great detail the effect of vitamin C deficiency on the regeneration of bone in the fractured fibula of a guinea pig. He found delayed absorption of the fracture hematoma, deficient production of osteoid trabeculae, and increased necrosis of the broken ends. Hertz also attempted to repeat Israel and Frankers refracture experiments, but with no success. Lexer obtained similar results, but he stressed the deficiency of blood supply as a cause of the failure of scorbutic tissues to heal. 

An x-ray was taken and reported as negative for fracture or dislocation. The prescribing of an MRl was postponed until the swelling had an opportunity to be reduced. There was no evidence of somatic dysfunctions at the knee joint or head of the fibula. 

R.P. was a 66-year-old woman who presented with a new symptom of lower extremity pain and discomfort for 6 months. She had been seen previously in the clinic for back and neck pain and had not received osteopathic manipulation for at least one year. She had breast cancer and had undergone lumpectomy, radiation treatment, and chemotherapy. The patient had been doing well and then fell and fractured her fibula and tibia of the right leg. The fracture was caused by the trauma and was not felt to be related to any metastatic processes. She underwent surgeiy for the fracture and had open reduction and in-... 

Musculoskeletal Clinical studies have shown an increased risk of fractures, especially in females with the use of thiazelidiones. In the PERISCOPE study, fractures occurred in 3% of patients treated with pioglitazone, compared with none in the glimepiride group. The majority of fractures observed in females were in the distal upper limb (forearm, hand, and wrist) or distal lower limb (foot, ankle, fibula, and tibia). [59 ]... 

Figure 3b y 3c show the TRR already described in section III The ABERDEEN IMPEDANCE IMAGING SYSTEM based on the measurements obtained from the pair of electrodes used. Figure 3b shows TRR various in very similar situations to 3 curves in healthy humerus, humerus 3 weeks post fracture -contralateral to the healthy arm in the same patient- and humerus 16 weeks post fracture - the same patient s arm now healthy after a fracture. Meanwhile Figure 3 c shows the values of a healthy right leg (tibia and fibula), a fracture leg - Vi weeks post trauma-, a successful bone reparation and a bone reconstruction with no union of the segments separated in the fracture. 

The measured values (specified in Figure 3) show, at a glance, that there is a variation in the values of bioimpedance in the different situations that can be present in a long bone structure innate integrity, fracture, integrity after the recuperation and no union after a long recuperation period. These values were measured in the upper limb (humerus) as well as in the lower limb (tibias and fibula). 

Z. B. Friedeoberg, J. D. Roberts. N. H. Didizian, and C T. Brighton. Stimulation of fracture healing by direct current in the rabbit fibula, J, Bone Joint Stag. 5JA 1400 (1971). 

Fractures caused by osteoporosis affect 50% of women and 20% of men over the age of 50 [1], Traditional treatment of bone fracture uses autograft, allograft, vascularized fibula and iliac crest grafts [2], and other bone transport techniques but limitations exist. 

The following examples show how imprecise classifications can affect the health and safety of workers. All three accidents were classified as a major injury in a mine. In the first accident, a 33-year-old development worker slipped in water and fractured his left fibula. In the second accident, a 33-year-old faceman fell while he was cleaning the top of the powered support. In the third, a 35-year-old faceworker fractured his left ankle when he lost his balance while changing his trousers at the end of a shift. 

The patient in this study developed a wear debris cyst in the fibula (confirmed by histology) with subsequent fi acture the UHMWPE component was replaced, and at 3 months post revision the patient s symptoms were improved [76]. Other clinical studies report UHMWPE fractures or revisions related to the UHMWPE component [31, 36, 77] although these studies did not report a biomechanics rationale for the UHMWPE failure, exaggerated varus/valgus deformity and/or ligamentous instability resulting in accelerated wear could participate in the mechanism for failure of these components as well. 

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