The fibula is part of the ankle joint with the tibia and talus. Fibula fractures are common injuries. They can damage the stability and mobility of the ankle. In recent years, more ankle fractures have been seen, especially in active and older people.
Fibula fractures are classified in several ways. There are classifications such as Pott, Ashurst and Bromer, and Danis-Weber. These methods consider the part of the fibula affected and how the injury occurs. Each type of fracture needs specific treatment.
Treatment can range from wearing a cast to surgery. It is decided depending on the stability of the fracture. In addition, physiotherapy is key to recovery. Helps improve ankle movement and strength.
In this article, we’ll take a close look at how fibula fractures are classified and treated. You’ll learn about the causes, treatments, and importance of a varied medical team. Knowing all of this will help you better choose your treatment and recovery plan.
Mechanisms of Injury in Fibula Fractures
Fibula fractures occur from different types of damage. The most common are external rotation, supination, abduction and pronation. According to Lauge-Hansen, these fibula injuries fall into four main types.
These are supination-adduction, supination-eversion (external rotation), pronation-eversion, and pronation-abduction.
External rotation and supination fractures
The most common are by supination-external rotation. They occur when the foot is supinated and the rotation is forced outwards. This event damages several parts in order.
- Anterior Peroneo-Atragalin Ligament
- Peroneal malleolus
- Posterior Ligaments
- Medial malleolus or deltoid ligament
Abduction and pronation fractures
Other fractures occur in pronation-abduction. Here, the foot is in pronation and receives an outward force. This scenario affects different areas.
- Fracture of the fibula at the diaphyseal level
- Injury to the medial malleolus or deltoid ligament
- Anterior tibiofibular ligament tear
- Possible involvement of the interosseous membrane
It is very important to know how the injury occurred. It helps to understand the fracture and plan treatment. Knowing how your fibula was fractured guides doctors in their ankle checkup. Thus, they can detect additional damage.
Classification of fibula fractures according to Danis-Weber
The Danis-Weber classification is widely used to categorize fibula fractures. It is based on how the fracture affects the tibiofibular syndesmosis. He divides fractures into three types: infrasyndesmal (A), transsyndesmal (B), and suprasyndesmal (C).
Type A Fractures: Infrasyndesmales
Type A fractures are below the syndesmosis. They account for 10% to 20% of ankle injuries. They can be stable and treated without surgery.
Type B Fractures: Transindesmales
Type B fractures occur in tibiofibular syndesmosis. They are the most common, up to 75% of fractures. They need to check the tibiofibular ligaments, as many are stable.
These fractures are usually spiroids and may be accompanied by other injuries, such as the medial malleolus.
Type C Fractures: Suprasyndesmal
Type C fractures are above the syndesmosis. They are from 7% to 19% of the total. The interosseous membrane is often affected as well.
Because they are unstable, C-fractures need surgery. It is crucial to remember Maisonneuve’s fracture, which requires rapid intervention.
Evaluation and diagnosis of fibula fractures
Diagnosing a fibula fracture requires an in-depth examination. This involves physical examination and imaging tests. These specific steps help us understand what type of fracture it is, and how to treat it.
Physical examination and assessment of ankle stability
If a fibula fracture is thought to be present, an ankle checkup is started. They look for painful areas, bump marks, and notice if there are abnormalities.
In addition, it is key to check the stability of the ankle with tests.
- Presence of localized painful spots
- Bruising or swelling
- Obvious deformity in the anatomy of the ankle
- Joint stability by varus and valg stress testing
These stress tests are essential. They help find out if the ligaments are unstable from the fracture.
Radiological and imaging studies
After the physical checkup, it is necessary to take pictures of the ankle. Thus, we use:
- Initial X-rays: These are crucial when suspecting a fibula fracture. They include views from the front and sides, but sometimes we need more specific photos.
- CT scan: Used for fractures that are more complicated or that damage the joint. It offers a clear view of the bones and makes surgery easier if needed.
Sometimes, an MRI helps see if there is damage to ligaments or cartilage. However, not all cases require this additional study.
To diagnose accurately, a thorough evaluation and the right photos are crucial. This allows us to indicate the best treatment for fibula fracture.
Treatment Options for Fibula Fractures
The treatment of these fractures can be of two types: conservative or surgical. This depends on the damage and stability of the ankle. If the fracture is mild and the ankle remains stable, treatment without surgery is often chosen.
This option does not require an operation. A plaster boot is placed to immobilize the area. This is done for 4 to 6 weeks, with the foot at a 90-degree angle. It will keep your ankle from getting stiff. However, between 14% and 43% of cases of this treatment have not so good results.
For more serious or displaced fractures, surgery is necessary. This type of surgery is done on complex fractures or those that affect more areas. It is called open reduction and internal fixation. Plates and screws are used to repair the bone. Sometimes, damaged ligaments are also fixed. After the operation, the area remains immobilized for 6 weeks.
Rehabilitation is very important to recover well. It begins two to three weeks after surgery. It focuses on regaining ankle movement and strengthening the leg. This improves balance. It is key to avoid future problems in the ankle.
Resuming sports activities varies, but often takes between 4 and 6 months. If there is persistent pain, it is sometimes necessary to remove the screws and plates after a year of the operation.
FAQ
What bones make up the ankle joint?
The fibula, tibia, and talus are in the ankle joint. A fracture in the fibula can make the ankle unstable.
What are the main classifications of fibula fractures?
There are several ways to classify these fractures. Some are based on the number of malleoli damaged. Others look at how the injury was caused. One more looks at exactly where the fracture is.
What treatment options are there for fibula fractures?
Treatment can be without surgery. It consists of keeping the area immobilized. Or surgery may be needed to put screws in and stabilize the bone.
What is the role of rehabilitation in the treatment of fibula fractures?
Physical therapy is vital for recovery. It helps to move the ankle well again. It also helps to regain strength in the leg muscles and stability.
What are the main mechanisms of injury in fibula fractures according to the Lauge-Hansen classification?
There are four ways to fracture the fibula. They are caused by twisting the foot inward and knocking down (supination-adduction). Or pulling it out while twisting it (supination-eversion). It can also be by pushing your foot down and out (pronation-eversion), or by twisting it inward while pushing your leg (pronation-abduction).
What structures are sequentially injured in supination-external rotation fractures?
When the fibula is fractured by twisting the foot outward, a ligament is first damaged. Then the peroneal malleolus is fractured. Then, the ligaments behind the ankle. And finally, the medial malleolus or the deltoid ligament.
What associated injuries can pronation-abduction fibula fractures have?
If the fibula is fractured by bending the foot down and inward, it can damage several parts. Including the medial malleolus, the deltoid ligament, and another ligament between the tibia and fibula. Sometimes, the membrane that covers them is also injured.
What is the Danis-Weber classification of fibula fractures based on?
Danis-Weber looks at whether the fracture is above, in the middle, or below the syndesmosis. It is an important point in deciding on treatment.
What are the characteristics of type A fibula fractures according to the Danis-Weber classification?
A-fractures are the lowest, below the syndesmosis. They can break the medial malleolus. But they usually don’t cause ligament damage.
What associated injuries do type B fibula fractures have according to Danis-Weber?
The B fractures are precisely in the syndesmosis. There is a particular type of spiral fracture in the fibula. And sometimes they affect the medial malleolus or tear the deltoid ligament. It is important to check if the ligaments in the fibula were injured as well.
Why are Danis-Weber type C fibula fractures considered unstable?
The C’s are above the syndesmosis. They involve damage to the ligaments and the interosseous membrane. They are difficult fractures and need surgery to heal well.
What aspects should the physical examination include in the event of a possible fibula fracture?
When examining an ankle for a possible broken bone, it is key to look at the pain, swelling, if it looks different and how it moves. Testing for instability is important.
What imaging studies are initially used to diagnose fibula fractures?
The first thing is X-rays in front and from the side. They help see the fracture. Sometimes more photos are needed to understand better, such as oblique or shrouds.
When is computed tomography (CT) scans indicated for fibula fractures?
A CT scan is used when it is necessary to see beyond what the X-rays show. Especially in complex fractures or with small fragments. It is essential to decide how to operate.
How are stable fibula fractures treated conservatively?
If a fracture is not aligned, but the bones touch, it can be treated without surgery. A special cast or booty is worn for about two months. It is important to place the ankle in the right position so as not to lose mobility.
When is surgical treatment of fibula fractures indicated?
If the fracture is very displaced or the bones are not well aligned, surgery may be needed. This is to put the bones back in place and hold them together. Sometimes you have to fix ligament injuries as well.
What aspects does postoperative rehabilitation include after fibula fracture surgery?
After surgery, the ankle must be immobilized so that it heals well. Then, it is vital to start physical therapy. This helps to regain mobility and strengthen the ankle. But, the sport can be resumed after several months.
