Fibular Fracture

What is a Fibular Fracture?

A fibular fracture is a break in the bone (the fibular) that lies adjacent to the tibia in the lower leg. A fibula fracture can vary in severity, from minor stress fractures to complete breaks, and may occur due to trauma, overuse, or underlying medical conditions. Depending on the location and extent of the fracture, it can affect mobility, stability, and daily activities, often requiring treatment ranging from rest and immobilisation to surgery.

Guide to Understanding the Anatomy of the Lower Leg and How a Fibular Fracture Affects Your Mobility and Function.

Anatomy of the Lower Leg

The lower leg consists of two bones:

• Tibia (shinbone): The larger, weight-bearing bone.
• Fibula: The smaller (thinner) bone that runs parallel to the tibia, providing structural support. It also serves as an attachment point for muscles and ligaments.

The fibula plays a crucial role in ankle stability and lower limb function, even though it bears less weight than the tibia.

How a Fibular Fracture Affects Mobility and Function

A fracture in the fibula can impact:

• Weight-bearing ability: While the fibula itself is not a primary weight-bearing bone, its injury can still affect walking and stability.
• Ankle and knee stability: Depending on the fracture site, the injury may disrupt ligament attachments, leading to instability.
• Pain and swelling: Common symptoms that can limit movement and daily activities.
• Muscle function: The fibula provides attachment points for several muscles, so a fracture can interfere with normal movement.

Types of Fibular Fractures

Fibular fractures are classified based on their location and severity:

1. Lateral Malleolus Fractures
   1. Occur at the lower end of the fibula near the ankle.
   2. Often associated with ankle sprains or ligament injuries.
   3. These injuries range from minor to severe, sometimes requiring surgery if unstable.
2. Proximal Fibula Fractures
   1. Located near the top of the fibula, close to the knee.
   2. Proximal Fibula Fractures may be caused by direct trauma or excessive rotational forces.
   3. Sometimes linked to injuries of the knee ligaments, such as in a Maisonneuve fracture.
3. Shaft Fractures
   1. Occur along the middle section of the fibula.
   2. Can result from direct impact or twisting injuries.
   3. Severity varies from minor cracks to complete breaks that may affect leg stability.
4. Stress Fractures
   1. Small cracks in the fibula caused by repetitive stress are common in athletes and runners.
   2. Often develop gradually due to overuse rather than a single traumatic event.
   3. Symptoms include persistent pain that worsens with activity.

Prevalence and Demographics

Fibular fractures are relatively common and can occur in people of all ages, often as a result of trauma, sports injuries, or overuse. Their prevalence varies depending on factors such as age, activity level, and underlying health conditions.

Prevalence

• Fibular fractures account for a significant proportion of lower limb fractures, with lateral malleolus fractures being one of the most frequent ankle injuries.
• Studies suggest that ankle fractures, including those involving the fibula, comprise approximately 9% of all fractures in adults.
• Stress fractures of the fibula are more common in individuals engaged in high-impact activities, such as running or military training.

Demographics

The likelihood of sustaining a fibular fracture varies across different age groups and activity levels:

1. Children and Adolescents
   1. Often occur due to falls, sporting injuries, or playground accidents.
   2. Growth plate (physis) fractures near the fibula’s lower end are more common in younger children.
   3. Adolescents in high-impact sports like football, basketball, and gymnastics are at higher risk.
2. Young Adults (18–40 years)
   1. Typically result from sports-related trauma, including contact sports (e.g., soccer, rugby) or high-energy activities like skiing and skateboarding.
   2. Stress fractures are frequently seen in runners and military personnel due to repetitive impact.
3. Middle-Aged Adults (40–60 years)
   1. More likely to suffer fibular fractures from twisting injuries or falls, especially during recreational sports or activities.
   2. Ankle fractures, including lateral malleolus fractures, become more common in this group due to bone density and joint stability changes.
4. Older Adults (60+ years)
   1. Higher risk due to osteoporosis, which weakens bones and increases susceptibility to fractures from low-impact falls.
   2. Simple missteps or minor falls can lead to significant injuries, often requiring longer recovery times.

Activity-Related Risk Factors

• Sports & Athletics: Football, basketball, skiing, and running increase the risk of fibular fractures.
• High-Impact Occupations: Construction workers and military personnel are more prone to fibular fractures due to repetitive stress or trauma.
• Sedentary Lifestyles & Ageing: Reduced bone density and weak muscles may increase the risk of fractures from minor falls.

Understanding the prevalence and demographics of fibular fractures helps recognise risk factors and implement prevention strategies, particularly for high-risk groups.

Symptoms and Causes of Fibular Fractures

Common Symptoms of a Fibular Fracture

The severity of symptoms will depend on where the fracture is and type of fracture, but common signs include:

• Pain: Sharp or aching pain along the outer lower leg, worsening with movement or weight-bearing.
• Swelling and Bruising: Often around the ankle or shin, indicating soft tissue damage.
• Deformity: In severe fractures, the leg or ankle may appear misshapen.
• Difficulty Walking: Depending on the fracture type, bearing weight may be painful or impossible.
• Tenderness and Sensitivity: The fractured area may feel painful to touch.
• Numbness or Tingling: If nerves are affected, sensation changes may occur.

Common Causes of Fibular Fractures

Fibular fractures can result from various injuries, ranging from high-impact trauma to repetitive stress.

1. Sports Injuries

• High-impact sports: Football, rugby, basketball, and skiing often involve sudden twists, direct blows, or falls that can fracture the fibula.
• Ankle sprains: A severe ankle sprain can sometimes cause an associated fibular fracture, particularly in lateral malleolus fractures.
• Contact injuries: Tackles or collisions in sports can lead to fibular fractures due to forceful impact.

2. Direct Trauma

• Car accidents: A strong impact, such as a dashboard injury, can cause a break in the fibula.
• Blunt force injuries: A direct hit to the lower leg from an object (e.g., a heavy fall on the leg or being kicked) can fracture the fibula.
• Crush injuries: Getting the lower leg trapped under heavy objects or machinery can result in severe fractures.

3. Falls

• Slips and trips: Landing awkwardly on the foot or twisting the leg can cause a fibular fracture.
• Falls from height: Falling from ladders, stairs, or unstable surfaces increases the risk of a fibular break.
• Elderly falls: Older adults with osteoporosis are particularly vulnerable to fibular fractures from even minor falls.

4. Stress Injuries

• Overuse and repetitive strain: Common in long-distance runners, dancers, and military personnel due to repeated impact.
• Gradual onset: Unlike traumatic fractures, stress fractures develop over time and may initially cause mild discomfort that worsens with activity.
• Common sites: Typically occur along the shaft of the fibula due to continuous strain.

Understanding the causes of fibular fractures can help recognise risk factors and take preventive measures, especially for those involved in high-impact activities or at risk due to age or lifestyle.

Risk Factors for Fibular Fractures

The following are factors that can increase the likelihood of sustaining a fibular fracture, including:

• Sports and High-Impact Activities: Contact sports (e.g., football, rugby) and high-impact activities (e.g., running, skiing) raise the risk of trauma or stress fractures.
• Repetitive Stress and Overuse: Long-distance running, military training, and physically demanding jobs can lead to stress fractures.
• Osteoporosis and Bone Weakness: Conditions that reduce bone density, such as osteoporosis, increase fracture risk, especially in older adults.
• Age-Related Risks: Children and adolescents are prone to fractures due to active lifestyles, while older adults are at higher risk due to falls and bone fragility.
• Poor Footwear and Biomechanics: Improper footwear, flat feet, or misalignment in gait can contribute to stress fractures.
• Previous Injuries: A history of ankle sprains, fractures, or lower leg injuries can weaken the fibula and make it more vulnerable.

Recognising these risk factors can help with prevention strategies, such as strengthening exercises, proper footwear, and fall prevention measures.

Complications of Fibular Fractures

While many fibular fractures heal well with proper treatment, some cases may lead to complications that impact long-term mobility and function. These include:

1. Chronic Pain

• Persistent pain may occur due to nerve irritation, improper healing, or soft tissue damage.
• It may worsen with activity, weather changes, or prolonged standing.
• It can sometimes be managed with physiotherapy, pain relief strategies, or lifestyle modifications.

2. Joint Instability

• If the fracture affects the ankle (lateral malleolus) or knee (proximal fibula), ligament damage can lead to instability.
• Weakness in the ankle or knee may increase the risk of future sprains or injuries.
• Severe instability may require bracing or surgical intervention.

3. Post-Traumatic Arthritis

• A fracture involving the ankle or knee joint can lead to cartilage wear over time, causing arthritis.
• Symptoms include pain, stiffness, and decreased movement.
• Early physiotherapy and proper rehabilitation can help delay or reduce symptoms.

4. Non-Union or Delayed Healing

• Some fractures may heal slowly or fail to heal (non-union), particularly in cases of poor blood supply, smoking, or inadequate immobilisation.
• Non-union may require additional treatments such as bone grafting or surgical fixation.
• Delayed healing can prolong recovery time and impact mobility.

Seeking specialist orthopaedic care helps prevent complications. Access Ortho offers rapid access to urgent orthopaedic care. 

Diagnosis and Assessment of Fibular Fractures

Diagnostic Process

Healthcare providers follow a structured approach to accurately diagnose a fibular fracture, which includes:

1. Medical History
   1. Discussion of how the injury occurred (e.g., trauma, fall, overuse).
   2. Review of symptoms, including pain, swelling, and mobility limitations.
   3. Assessment of previous injuries or conditions affecting bone health (e.g., osteoporosis).
2. Physical Examination
   1. Inspection for swelling, bruising, deformity, or tenderness along the fibula.
   2. Gentle palpation to locate the pain and assess for potential ligament damage.
   3. Mobility tests to evaluate ankle, knee, and overall lower limb function.
   4. Assessment of circulation and nerve function in the foot and lower leg.

Diagnostic Tests

Various imaging techniques are used to confirm the presence, severity, and location of the fracture:

1. X-rays (First-line imaging)
   1. Provides a clear view of bone breaks and alignment.
   2. Used to classify fractures (e.g., lateral malleolus, shaft, or proximal fibula fractures).
   3. It may involve different angles to detect subtle fractures.
2. CT Scans (Detailed bone imaging)
   1. Used for complex or unclear fractures, particularly around joints.
   2. Provides a three-dimensional view to assess bone displacement or fragmentation.
3. MRI (Soft tissue and stress fracture detection)
   1. Helps identify stress fractures not visible on X-rays.
   2. Assesses ligament, tendon, or muscle injuries associated with the fracture.
4. Ultrasound (Less common)
   1. Occasionally used to assess soft tissue damage or guide fracture diagnosis in children.

A combination of these methods ensures an accurate diagnosis, guiding appropriate treatment and rehabilitation for optimal recovery. The medical team at Access Ortho will provide a thorough examination and arrange the required radiology to help guide your treatment plan. 

Special Considerations for Fibular Fractures

The following special considerations need to be taken into account when treating fibular fractures. The medical team at Access Ortho will consider all aspects of a patient’s health, lifestyle and recovery when formulating a treatment plan. 

Athletes

• Higher risk due to high-impact activities and repetitive stress.
• Requires careful rehabilitation to restore strength and prevent re-injury.
• Stress fractures are common, often needing modified training and rest.

Elderly Patients

• Increased risk due to falls and osteoporosis-related bone fragility.
• Healing may be slower, requiring extended immobilisation or physiotherapy.
• Fall prevention strategies are crucial for long-term mobility.

Children

• Growth plate fractures (physical injuries) are a concern.
• Healing is generally faster, but improper treatment can affect bone development.
• It may require different treatment approaches, such as splinting instead of surgery.

Patients with Osteoporosis

• There is a higher risk of fractures from minor trauma due to reduced bone density.
• Treatment may involve bone-strengthening medications and calcium/vitamin D supplementation.
• Longer healing times and higher risk of non-union.

Tailored treatment plans and preventive measures are essential for these groups. Access Ortho offers tailored treatment plans guided by the advice of a specialist orthopaedic surgeon. 

Management and Treatment of Fibular Fractures

Treatment Options

1. Conservative Management (For stable fractures)
   1. Immobilisation with a cast, brace, or walking boot.
   2. Rest, ice, compression, and elevation (known as RICE) to reduce swelling.
   3. Gradual weight-bearing as healing progresses.
2. Surgical Intervention (For severe or unstable fractures)
   1. Internal fixation with plates, screws, or rods.
   2. Used for displaced fractures, joint involvement, or non-union cases.
   3. Post-surgical physiotherapy to restore strength and mobility.
3. Rehabilitation Protocols
   1. Early mobilisation exercises to prevent stiffness.
   2. Strength and balance training to restore function.
   3. Gradual return to activities guided by healthcare providers.
4. Pain Management Strategies
   1. NSAIDs or prescribed pain relievers for inflammation.
   2. Ice therapy and elevation to reduce discomfort.
   3. Physiotherapy techniques such as massage or electrical stimulation.

A personalised treatment plan ensures optimal recovery and long-term function. Access Ortho offers rapid appointments for patients with acute orthopaedic injuries and will discuss treatment options for all patients. Follow-up care will ensure that patients are monitored for complications to ensure a successful outcome.

Prevention of Fibular Fractures

• Proper Footwear: Supportive shoes to reduce strain.
• Exercise Programs: Strengthening and balance exercises to prevent falls.
• Safety Measures: Fall prevention strategies and protective gear in sports.
• Bone Health Maintenance: Adequate calcium, vitamin D, and weight-bearing exercises.

Recovery and Prognosis for Fibular Fractures

Expected Recovery Timeline

• Initial healing (0-6 weeks):
  • Immobilisation and rest, with minimal weight-bearing.
  • Swelling and pain management.
• Rehabilitation (6-12 weeks):
  • Gradual weight-bearing and physiotherapy are needed to restore range of motion.
  • Exercises to increase strength in the ankle and lower leg muscles.
• Full recovery (3-6 months):
  • Complete healing and return to normal activities, depending on fracture severity.
  • Long-term rehabilitation may continue to rebuild strength and flexibility.

Return to Activities

• Daily Activities: Can often resume within 6-8 weeks, depending on the fracture type.
• Work: Office or non-physical jobs may allow earlier return, but physically demanding work may take longer.
• Sports: Typically after 3-6 months, once strength and function are restored, with clearance from a healthcare provider.

Recovery varies depending on the fracture, the individual’s age, overall health, and adherence to rehabilitation. The orthopaedic medical team at Access Ortho will guide your return to activity during your recovery. 

Fracture Clinic Information

When Should I Go to a Fracture Clinic?

If you’ve suffered a fracture, sprain, or dislocation and need immediate attention, visit Access Ortho (a private fracture clinic) for quick, specialised care. If you suspect a bone is broken, experience severe pain, or are unable to move the affected area, Access Ortho is your go-to destination. You can attend without a referral and get faster access to orthopaedic specialists compared to emergency rooms.

Access Ortho offers follow-up care and second opinions to ensure you get the best recovery plan even if you’ve already been to an emergency department or seen your GP. Their affordable services provide rapid access to expert orthopaedic care.

What is a Fracture Clinic?

A fracture clinic is a specialised facility that focuses on treating musculoskeletal injuries, including fractures and dislocations. At Access Ortho, you’ll receive comprehensive care, including:

• Full assessment and diagnosis of upper and lower limb injuries
• Referrals for imaging (X-rays, scans)
• Non-invasive treatments like casting
• Surgical options and rehabilitation advice
• Follow-up care to monitor your progress

Access Ortho offers expert care by medical staff highly trained in orthopaedics, ensuring you’re on the path to a speedy recovery.

FREQUENTLY ASKED QUESTIONS

How long does it take for a fibular fracture to heal?

Healing time will vary depending on how severe the fracture is. Typically, the bone can take 6 to 12 weeks to heal, with full recovery taking up to 3 to 6 months.

Can I walk with a broken fibula?

It depends on the type and severity of the fracture. Walking may be possible with support, such as crutches or a boot for stable, non-displaced fractures. Always follow your doctor’s advice.

Do all fibular fractures require surgery?

No, many fibular fractures can be treated conservatively with casting or bracing. Surgery is typically only needed for displaced or severe fractures or if there are complications like joint involvement.

What is the difference between a broken ankle and a broken fibula?

A broken ankle refers to fractures in the bones around the ankle joint, often involving the fibula, tibia, and possibly the talus. A broken fibula specifically refers to the injury of the fibula bone, which may or may not involve the ankle joint.

How soon can I return to sports after a fibular fracture?

Before returning to high-impact sports, you should wait at least 3-6 months for a full recovery. This timeframe can vary based on the fracture’s severity and your progress in rehabilitation.

Will I need physiotherapy after a fibular fracture?

Yes, physiotherapy is often recommended to restore strength, range of motion, and function. It can help prevent stiffness and improve recovery.

What are the signs of a stress fracture in the fibula?

Signs include persistent pain along the outer lower leg that worsens with activity, swelling, tenderness, and sometimes bruising. Stress fractures develop gradually and may initially be mistaken for muscle soreness.

Can I drive with a broken fibula?

It depends on the fracture’s location and which leg is injured. If it’s your driving leg (usually the right leg), you will need to avoid driving until you regain full control and mobility, which can take several weeks.

How can I tell if my fibular fracture is healing properly?

Signs of proper healing include gradually decreasing pain, reduced swelling, and the ability to bear weight on the leg. X-rays may be taken to confirm bone healing.

What exercises can I do during recovery?

Initially, gentle range-of-motion exercises for the ankle and knee are recommended. As healing progresses, strengthening exercises and weight-bearing activities can help rebuild strength. Always follow your healthcare provider’s recommendations based on your recovery stage.