Proximal Fibular Fractures

What is a Proximal Fibular Fracture?

A proximal fibular fracture occurs in the upper portion of the fibula bone near the knee joint. This specific type of fracture can affect knee stability and lower leg function.

Types of Proximal Fibular Fractures

The proximal fibula is located at the top (proximal end) of the fibula bone, which is the smaller of the two bones located in the lower leg, the other being the tibia. The fibula runs parallel to the tibia, with the proximal fibula situated just below the knee joint. The anatomy of the proximal fibula plays a significant role in knee stability and lower leg function.

Anatomy of the Proximal Fibula:

• Head of the Fibula: The top part of the fibula, called the fibular head, articulates with the tibia at the proximal tibiofibular joint. This joint is not a weight-bearing joint, but it does allow slight movement and plays a role in the overall stability of the lower leg.
• Lateral Collateral Ligament (LCL): The LCL of the knee attaches to the fibular head. This ligament helps stabilise the knee joint laterally (on the outside) and controls excessive side-to-side motion.
• Fibular Muscles: Several muscles, including the peroneus longus and peroneus brevis, originate from or insert near the fibula and contribute to foot eversion and ankle stability.
• Tendon and Ligament Attachments: Other important structures like the biceps femoris tendon attach to the fibula, aiding in knee flexion and stabilising the joint.

Role in Knee Stability and Lower Leg Function:

• Knee Stability: The proximal fibula contributes to lateral knee stability through the attachment of the LCL. It also indirectly supports the knee by providing a base for muscle attachments, such as the biceps femoris tendon.
• Ankle and Foot Function: Though the fibula doesn’t directly bear weight, its role in muscle attachment helps with ankle and foot movement. The peroneal muscles, connected to the fibula, allow for dorsiflexion and eversion of the foot, which are essential for balance and walking.
• Weight Distribution: While the tibia is primarily responsible for weight-bearing, the fibula provides a structural scaffold and helps in distributing stresses during movement.

Types of Proximal Fibular Fractures:

Proximal fibular fractures are relatively uncommon but can occur due to direct trauma or twisting injuries. These fractures may vary in severity and may involve the fibular head or the shaft near the knee.

1. Avulsion Fracture:
   1. Avulsion fractures occur when a small bone fragment is pulled off by a ligament or tendon. For the proximal fibula, an avulsion fracture often involves the attachment of the LCL or biceps femoris tendon.
   2. Symptoms include swelling, pain at the lateral knee, and difficulty with lateral movement.
2. Spiral or Oblique Fractures:
   1. These occur when a twisting force is applied to the leg. The break may be angled diagonally, and the fibula may fracture in a spiral shape.
   2. Symptoms include pain, bruising, and difficulty with movement.
3. Transverse Fracture:
   1. A straight break across the fibula. This is typically caused by direct impact or a fall. It can disrupt the integrity of the knee and ankle if not appropriately managed.
4. Comminuted Fracture:
   1. Involves the fibula being broken into multiple pieces, often resulting from high-impact trauma such as a car accident or sports injury.
   2. Treatment usually requires surgical intervention due to the complexity of the break.
5. Stress Fracture:
   1. Often seen in athletes or individuals with repetitive stress on the leg, a stress fracture of the proximal fibula can develop over time, causing gradual pain and swelling, particularly around the knee.
6. Fibula Shaft Fracture with Proximal Involvement:
   1. In more severe injuries, the fracture may extend down the shaft of the fibula, but the proximal portion, especially near the knee, may also be involved. This can affect the function of both the knee and ankle.

Classification of different fracture patterns affecting the proximal fibula.

The classification of fractures affecting the proximal fibula can be broadly divided into several patterns, each with distinct mechanisms and treatment approaches:

1. Avulsion Fractures:

Common in the proximal fibula, this type is typically associated with the Lateral Collateral Ligament (LCL) or the biceps femoris tendon. When they are stretched, they pull a small piece of bone off the fibular. It often results from sudden, forceful movements, such as a twist or a direct blow. Pain, swelling, and instability are common symptoms.

2. Direct Trauma Fractures:

These fractures are caused by direct blows or impacts, such as falls or collisions. The force applied to the fibula can cause a transverse, spiral, or comminuted fracture. Symptoms may include pain, swelling, and bruising at the site of injury, with possible damage to the surrounding muscles and ligaments.

3. Stress Fractures:

Stress fractures are small bone cracks that develop due to repetitive stress or overuse. They are common in athletes or individuals with high physical activity and typically cause gradual pain and discomfort around the fibula, especially with activity.

4. Associated Ligamentous Injuries:

Proximal fibular fractures often involve damage to the surrounding ligaments, such as the LCL, which can compromise knee stability. Injuries to the biceps femoris tendon or other soft tissues are also common. These ligamentous injuries can lead to instability or decreased movement in the knee and ankle.

Each fracture pattern requires tailored management to address both the bone injury and any associated ligamentous damage for optimal recovery. Access Ortho specialises in treating all arm and leg fractures, including fibular fractures. 

Prevalence and Demographics of Proximal Fibular Fractures

Proximal fibular fractures are relatively uncommon, but they do occur in certain age groups and activity settings. Here’s an overview of the statistical information surrounding the occurrence of these fractures:

Age Distribution:

• Young Adults (18-40 years): This age group tends to experience proximal fibular fractures most commonly due to sports injuries, such as high-impact activities and accidents. Activities like football, basketball, or skiing increase the likelihood of injury in this demographic.
• Older Adults (40-70 years): In this group, fractures are often the result of direct trauma (e.g., falls) or low-energy injuries. Osteoporosis, which is more prevalent in older adults, may increase the risk of fractures in the fibula.
• Elderly (70+ years): Proximal fibular fractures in older adults are typically caused by falls, with the bone becoming more fragile due to age-related bone density loss. These fractures may also be associated with other comorbidities, including decreased muscle strength and balance.

Common Activities Leading to Injury:

• Sports-Related Injuries: High-impact and contact sports are the leading cause of proximal fibular fractures. Common activities include:
  • Football: Frequent tackles, twists, and blows to the lateral leg can lead to fractures.
  • Basketball: Jumping, pivoting, and landing on an unstable surface can result in both fractures and associated ligament injuries.
  • Skiing and Snowboarding: Ski-related trauma, particularly from falls or collisions with objects, can cause direct injury to the proximal fibula.
  • Rugby and Martial Arts: These high-contact sports put athletes at greater risk for direct trauma to the lower leg, leading to fibular fractures.
• Motor Vehicle Accidents (MVAs): Proximal fibular fractures can also occur in MVA victims, often from lateral impacts or collisions where the lower leg is forced against a solid object.
• Falls: As people age, the risk of falls increases, particularly among older adults. A fall onto the side of the leg or from a height can lead to direct trauma to the fibula.

Sports-Related Incidence:

• Football: The most common sport linked to proximal fibular fractures, often occurring due to sudden twists, tackles, or lateral impacts during play.
• Basketball: Also high on the list, particularly because of the rapid changes in direction, jumping, and landing.
• Running Sports: Long-distance running or activities like trail running can sometimes, though less frequently, contribute to stress fractures in the fibula.
• Due to the high-impact nature of competitive athletes, especially those in contact sports, fractures can occur in combination with ligamentous injuries, like LCL tears or meniscus damage.

Associated Injury Patterns:

• Ligament Injuries: Proximal fibular fractures frequently occur with injuries to surrounding ligaments, especially the LCL, which is crucial for knee stability. Damage to the biceps femoris tendon is also common, leading to weakness and instability.
• Knee Injuries: The fibula’s connection to the knee joint through the LCL means that fractures at the proximal end often occur in conjunction with knee injuries, for example, sprains or tears of the ligaments.
• Ankle Injuries: Given the fibula’s involvement in the ankle joint, fractures can sometimes be associated with syndesmotic injuries or damage to the joint that connects the tibia and fibula, leading to instability in the lower leg.
• Tibial Fractures: In more severe cases, a proximal fibular fracture may be associated with fractures of the tibia, either in the same event or as a result of the injury mechanism (e.g., direct trauma or high-impact collision).

Summary:

Proximal fibular fractures occur across a wide age range but are most common in young adults involved in high-contact or high-impact sports. They are often associated with ligament and knee injuries, especially in sports-related cases. Older adults often suffer from these fractures due to falls or low-energy trauma, with bone fragility increasing the risk. Sports-related incidents, especially in football, basketball, and skiing, are the primary causes of these fractures, although MVAs and falls also contribute significantly.

Symptoms and Causes of Proximal Fibular Fractures

Proximal fibular fractures can present with a variety of symptoms, depending on the injury and the associated damage to surrounding structures.

Common Symptoms:

1. Pain:

Intense pain at the site of injury, typically on the lateral (outer) side of the knee or lower leg. The pain may increase with movement or weight-bearing.

2. Swelling and Bruising:

Swelling around the knee or fibular head, along with visible bruising, especially after direct trauma or sports injuries.

3. Tenderness:

Tenderness over the fibula, especially around the fibular head, is common. Touching the area may exacerbate the pain.

4. Limited Range of Motion:

Difficulty moving the knee or ankle due to pain or damage to the surrounding ligaments and muscles.

5. Instability:

If the fracture involves ligamentous damage (such as the LCL or biceps femoris tendon), there may be knee instability or difficulty with lateral movement.

6. Deformity:

In more severe fractures, a visible deformity may be present due to displacement of the bone or damage to adjacent structures.

7. Numbness or Tingling:

This can occur if there is associated nerve damage, though it is rare.

Causes of Proximal Fibular Fractures

Sports Injuries:

• Injury Mechanism:
  • Proximal fibular fractures commonly occur in high-impact and contact sports. A sudden twisting or lateral force to the knee or lower leg, such as during football, basketball, or rugby, can cause fractures. The fibula can break due to the rotational forces or direct hits, often in conjunction with ligament injuries like LCL tears.
  • In skiing or snowboarding, falls or collisions can also cause direct trauma to the fibula, particularly when the leg is bent awkwardly under the body.
• Symptoms: Intense pain, swelling, and difficulty bearing weight or moving the leg.

Direct Trauma:

• Injury Mechanism:
  • Proximal fibular fractures may occur due to a direct blow to the fibula from an external force. This type of trauma can happen during contact sports, falls, or accidents (e.g., being struck by an object or falling onto the lateral side of the leg).
  • A direct hit to the fibula, such as in an automobile collision or a fall from a height, can cause a transverse or comminuted fracture.
• Symptoms: Pain at the site of impact, swelling, and bruising.

Falls:

• Injury Mechanism:
  • Falls, particularly in older adults, are a common cause of proximal fibular fractures. Falling onto the side of the leg, such as in a sideways fall, can exert enough force to break the fibula. The fibula often fractures when the knee is bent at an unnatural angle or impacted directly.
  • In older adults with weaker bones due to osteoporosis, a simple fall can often result in a more severe fracture.
• Symptoms: Immediate pain, swelling, and bruising, often accompanied by an inability to bear weight.

Motor Vehicle Accidents (MVAs):

• Injury Mechanism:
  • In MVAs, proximal fibular fractures often occur due to direct impacts on the leg from a collision. Lateral force on the lower leg, especially in side-impact crashes, can lead to fractures of the fibula. In severe cases, this can occur alongside tibial fractures or other injuries to the knee and leg.
  • Fractures in these scenarios can be more complex, involving both the bone and the surrounding ligaments.
• Symptoms: Severe pain, swelling, and possible deformity, with the added complexity of other injuries in a high-impact scenario.

Twisting Injuries:

• Injury Mechanism:
  • A twist or rotation of the lower leg can cause the fibula to fracture, especially if the knee or ankle is fixed while the body turns or moves. This mechanism is common in both sports and non-sport situations.
  • In activities like running, dancing, or walking on uneven ground, a sudden rotation or misstep can put enough strain on the fibula to cause a fracture, particularly in the context of an already weakened bone.
• Symptoms: Sudden onset of sharp pain, possible swelling, and difficulty moving the leg due to pain or instability.

Risk Factors Increasing the Likelihood of Proximal Fibular Fractures

Several factors may increase the risk of sustaining a proximal fibular fracture. These risk factors include both environmental influences and individual characteristics.

Athletic Participation:

• Risk: Athletes, particularly those involved in contact or impact sports, have a higher risk of proximal fibular fractures due to the physical nature of the activities. Sudden twists, lateral movements, and tackles put strain on the lower leg.
• Examples: Football, rugby, skiing, and basketball.

Contact Sports:

• Risk: Sports that involve tackling, blocking, or any form of direct contact significantly increase the risk of fractures, especially in the fibula. The Lateral Collateral Ligament (LCL) and surrounding soft tissues often get involved in these injuries.
• Examples: American football, rugby, and martial arts.

Osteoporosis:

• Risk: Individuals with osteoporosis or similar conditions that weaken bone density are at greater risk of fractures, including proximal fibular fractures. The fibula, while non-weight bearing, can still break under stress if the bone is brittle.
• Associated with: Older adults, particularly women post-menopause, who experience a decrease in bone mineral density.

Previous Injury History:

• Risk: If a person has previously suffered a fracture in the fibula or surrounding structures, they may be at a higher risk of re-injury. Scar tissue, changes in gait, or muscle weakness can alter the way the leg bears weight, leading to an increased likelihood of future fractures.
• Examples: A history of previous fibular fractures or sprains.

Age-Related Risks:

• Risk: As people age, bone density decreases, and the risk of falls increases. Older adults are more prone to fragility fractures, and a simple fall can cause a fibular fracture due to the bone’s reduced strength.
• Associated with: Elderly individuals, particularly those with osteoporosis, balance problems, or muscle weakness.

Summary:

Proximal fibular fractures are caused by a variety of factors, including sports injuries, direct trauma, falls, motor vehicle accidents, and twisting injuries. Risk factors such as athletic participation, osteoporosis, previous injury history, and age-related changes can increase the likelihood of these fractures. People involved in high-contact sports or those with weakened bones due to aging or medical conditions are at particular risk.

Complications of Proximal Fibular Fractures

Proximal fibular fractures, while often treated successfully, can sometimes lead to various complications that affect both the healing process and long-term functionality. Below are potential complications specific to these types of fractures:

1. Common Peroneal Nerve Injury:

• Mechanism: The common peroneal nerve runs near the proximal fibula, making it vulnerable to injury with fractures in this region. If the fracture site is displaced or there is swelling around the fibula, it can lead to compression or direct trauma to the nerve.
• Symptoms:
  • Foot drop (difficulty lifting the foot).
  • Numbness or tingling felt in the foot or lower leg.
  • Weakness in foot dorsiflexion (lifting the foot upward).
• Management: Nerve injuries may require specific treatments such as physiotherapy and, in severe cases, surgical decompression or nerve repair. Recovery can vary, with mild cases improving over time and more severe cases requiring longer intervention.

2. Knee Instability:

• Mechanism: The fibula’s proximal portion plays a critical role in stabilising the knee, particularly through the attachment of the Lateral Collateral Ligament (LCL). Fractures in this area, especially when combined with ligament damage, can lead to knee instability.
• Symptoms:
  • Instability or a feeling of the knee “giving out”.
  • Difficulty with lateral movement or bearing weight on the knee.
• Management: Knee instability may be addressed with rehabilitation, but severe cases might require surgical reconstruction of the LCL or other stabilising ligaments to restore full knee function.

3. Chronic Pain:

• Mechanism: Some individuals with proximal fibular fractures may experience persistent or chronic pain even after the bone has healed. This could be due to improper alignment during healing, nerve involvement, or the formation of scar tissue around the fracture site.
• Symptoms:
  • Ongoing pain or tenderness around the fibula or knee, especially during movement.
  • Discomfort during activity or when pressure is applied to the leg.
• Management: Treatment may involve physical therapy, pain management strategies (such as medications), and in some cases, corticosteroid injections or surgery if the pain is severe or persistent.

4. Delayed Union:

• Mechanism: A delayed union refers to the slow or incomplete healing of the fractured fibula. This can occur for a number of reasons, including poor blood supply to the area, inadequate immobilisation, or underlying health conditions (e.g., osteoporosis).
• Symptoms:
  • Continued pain or discomfort at the fracture site after the expected healing time.
  • Swelling and tenderness that persists longer than usual.
• Management: In cases of delayed union, additional interventions may be necessary. This can include bone stimulation, revisiting the fracture site for surgical intervention or bone grafting to encourage healing.

5. Post-Traumatic Arthritis:

• Mechanism: If the fibular fracture is associated with injury to the knee joint, in particular to the Lateral Collateral Ligament (LCL) or other structures that help stabilise the joint, it can lead to the development of post-traumatic arthritis. This occurs when the joint surfaces are damaged and wear down over time due to altered mechanics or incomplete healing.
• Symptoms:
  • Pain and stiffness in the knee, especially with movement.
  • Swelling and a decrease in the range of movement of the knee.
  • Difficulty with activities that involve bending or bearing weight on the knee.
• Management: Early intervention may include anti-inflammatory medications, joint protection strategies, and physiotherapy. In severe cases, knee arthroplasty (joint replacement) may be considered if arthritis significantly affects function.

Summary:

Proximal fibular fractures, while often treatable, come with several potential complications that can impact long-term function and quality of life. These include common peroneal nerve injury, leading to sensory or motor deficits; knee instability, which can affect mobility; chronic pain, which may persist even after healing; delayed union, where the bone heals slowly or incompletely; and the development of post-traumatic arthritis, particularly if associated knee joint structures are damaged. These complications can often be managed with a combination of medical treatment, physiotherapy, and, in more severe cases, surgical intervention. Getting specialist orthopaedic advice for fibular fractures is important to help avoid complications. Access Ortho offers rapid appointments for urgent orthopaedic injuries. 

Diagnosis and Assessment

Diagnostic Process

The following steps are taken to Accurately Diagnose Proximal Fibular Fractures

1. Physical Examination
   1. Inspect for swelling, bruising, or deformity around the lateral knee and proximal fibula.
   2. Palpate the fibula to localise tenderness and assess for crepitus.
   3. Assess weight-bearing ability and gait disturbances.
2. Neurological Assessment
   1. Evaluate the common peroneal nerve, which wraps around the fibular neck.
   2. Test for foot drop (weak dorsiflexion) and sensory changes over the dorsum of the foot and lateral leg.
3. Vascular Examination
   1. Check distal pulses (dorsalis pedis, posterior tibial) to assess blood flow.
   2. Evaluate capillary refill and skin temperature for signs of vascular compromise.
4. Joint Stability Testing
   1. Assess the knee for lateral ligament injuries, as proximal fibular fractures may be associated with lateral collateral ligament (LCL) damage.
   2. Perform the proximal tibiofibular joint stress test to identify instability.
   3. Evaluate the ankle, as fibular fractures can be part of Maisonneuve injuries, indicating syndesmotic disruption.

Diagnostic Imaging

The following imaging techniques may be used to assist in the diagnosis of a proximal fibular fracture

1. X-rays (First-line imaging)
   1. AP and lateral knee views to identify fractures and assess displacement.
   2. Full-length tibia-fibula views to check for concomitant fractures.
   3. Ankle X-rays if a Maisonneuve fracture is suspected.
2. CT Scans (For complex fractures)
   1. Provides detailed bony anatomy for comminuted or intra-articular fractures.
   2. Helps plan surgical fixation in unstable fractures.
3. MRI (Soft tissue and ligament assessment)
   1. Detects ligamentous injuries (LCL, ACL, syndesmosis).
   2. Identifies bone marrow oedema and occult fractures.
4. Stress Views (If instability is suspected)
   1. Used to assess syndesmotic or proximal tibiofibular joint instability.
5. Vascular Studies (When Indicated)
   1. Doppler ultrasound for suspected vascular compromise.
   2. CT angiography if arterial injury is a concern, particularly with high-energy trauma.

Special Considerations

The patient’s age, lifestyle, pre-existing conditions, and ability to participate in rehabilitation must be considered when diagnosing and treating fractures. The medical team at Access Ortho is skilled in caring for orthopaedic injuries and considers all these aspects. The following are some special considerations that need to be factored into patient care. 

1. Athletes and Return to Sport
   1. High risk of associated ligament injuries, particularly to the LCL and ACL.
   2. Rehabilitation focuses on strength, stability, and proprioception.
   3. Return to sport depends on fracture healing, soft tissue recovery, and functional strength.
2. Elderly Patients
   1. Increased risk of osteoporotic fractures and delayed healing.
   2. Higher likelihood of fall-related injuries with concurrent knee or hip involvement.
   3. Management often emphasises early mobilisation to prevent deconditioning.
3. Growing Adolescents
   1. Consider growth plate involvement (proximal fibular physis), which may affect leg length or joint alignment.
   2. Risk of Salter-Harris fractures, requiring close monitoring for growth disturbances.
4. Associated Knee Injuries
   1. Commonly linked to LCL, ACL, or posterolateral corner injuries.
   2. Requires comprehensive knee assessment to prevent instability and chronic pain.
5. Vascular Compromise
   1. Rare but serious complication, particularly with high-energy trauma.
   2. Popliteal artery injury should be suspected in cases with severe deformity or absent pulses.
   3. Immediate vascular assessment and imaging are critical to prevent limb-threatening complications.

Management and Treatment

Treatment Options

Conservative Management Protocols

• Indications:
  • Non-displaced or minimally displaced fractures.
  • No associated ligamentous or neurovascular injuries.
  • Stable proximal tibiofibular joint.
• Approach:
  • Immobilisation with a brace or cast for 2–6 weeks, depending on pain and stability.
  • Weight-bearing as tolerated with crutches initially, progressing as pain allows.
  • Physiotherapy for range of motion (ROM), strength, and proprioception.

Surgical Indications and Techniques

• Indications for Surgery:
  • Displaced fractures with joint instability.
  • Comminuted fractures affecting function.
  • Ligamentous injuries requiring repair (e.g., LCL, ACL).
  • Proximal tibiofibular dislocation.
  • Neurovascular compromise.
• Surgical Techniques:
  • ORIF – (Short for Open Reduction and Internal Fixation) with screws or plates.
  • Fibular head resection in cases of chronic instability.
  • Ligament reconstruction if associated knee instability is present.

Rehabilitation Guidelines

• Early phase (0–6 weeks):
  • Immobilisation as required.
  • Gentle ROM exercises to prevent stiffness.
  • Isometric strengthening exercises.
• Mid-phase (6–12 weeks):
  • Gradual weight-bearing progression.
  • Functional strengthening, balance training.
  • Low-impact activities (cycling, swimming).
• Late phase (3+ months):
  • Sport-specific training for athletes.
  • Full strength and proprioception recovery.
  • Gradual return to high-impact activities.

Pain Management Strategies

• Medications:
  • NSAIDs or paracetamol for pain and inflammation.
  • Opioids for severe pain in the acute phase (short-term use).
• Non-Pharmacological Approaches:
  • Ice therapy for swelling.
  • Elevation and compression.
  • Physiotherapy techniques such as manual therapy and TENS.

Return to Activity Progression

• Daily activities: Within a few weeks if pain allows.
• Low-impact sports: After 6–8 weeks if strength and stability permit.
• Contact sports or high-impact activities: Typically after 3–6 months, depending on fracture healing and associated injuries.
• Clearance criteria: Full strength, ROM, and neuromuscular control with no pain.

The management and treatment of proximal fibular fractures depends on the type of injury and the patient. The medical team at Access Ortho are highly skilled in caring for fractures and will guide you on an optimal treatment plan for your injury. 

Prevention

To reduce the risk of proximal fibular fractures, individuals should focus on proper training techniques to avoid excessive stress on the knee and lower leg. Protective equipment, such as braces or padding, can help prevent impact injuries, especially in contact sports. Conditioning programs that enhance strength, flexibility, and balance improve joint stability and reduce injury risk. Fall prevention strategies, particularly for older adults, include balance training and environmental modifications. Lastly, bone health maintenance through adequate calcium, vitamin D, and weight-bearing exercises helps improve bone strength and resilience.

Recovery and Prognosis

Recovery and prognosis following a proximal fibular fracture varies greatly. It is important to seek specialist Orthopaedic care to ensure your best outcome. The team at Access Ortho, led by orthopaedic surgeons, will be able to advise you on your expected timeline. However, it is important to note that variations in recovery do occur. The following is a guide only. 

Recovery Timeline

1. Acute Phase (0–6 weeks)
   1. Pain and swelling management with ice, elevation, and medications.
   2. Immobilisation, if required, with limited weight-bearing initially.
   3. Gentle range of motion (ROM) exercises to prevent stiffness.
2. Rehabilitation Phase (6–12 weeks)
   1. Gradual weight-bearing progression, depending on fracture stability.
   2. Strength training focusing on quadriceps, hamstrings, and ankle stability.
   3. Balance and proprioception exercises to restore joint control.
3. Return to Activities (3–6 months)
   1. Low-impact activities (cycling, swimming) after 8–12 weeks.
   2. Return to full weight-bearing and functional movements.
   3. Sport-specific drills introduced based on strength and stability.
4. Long-Term Outcomes (6+ months)
   1. Most fractures heal without long-term issues, but ligament injuries may extend recovery.
   2. Some individuals may experience mild residual stiffness or weakness.
   3. Chronic instability or nerve irritation (e.g., peroneal nerve involvement) may require ongoing management.

Rehabilitation Milestones

1. Weight-Bearing Progression
   1. Partial weight-bearing (if needed) with crutches in the early phase.
   2. Full weight-bearing by 6–8 weeks, depending on fracture healing.
2. Range of Motion Goals
   1. Knee flexion and extension restored within 8–12 weeks.
   2. Full ankle and hip mobility maintained to prevent compensatory issues.
3. Strength Benchmarks
   1. Quadriceps and hamstring strength reaching 70–80% of the uninjured leg by 12–16 weeks.
   2. Single-leg balance and control restored before progressing to dynamic activities.
4. Return to Sport Criteria
   1. Full pain-free ROM and strength in the affected leg.
   2. Ability to perform high-impact and agility drills without instability.
   3. Cleared for contact sports after 4–6 months, depending on associated injuries.

Fracture Clinic Information

What is a Fracture Clinic?

Access Ortho’s fracture clinics provide specialised care for musculoskeletal injuries, offering a comprehensive approach from initial assessment to rehabilitation coordination.

Specialised Care Available at Fracture Clinics:

1. Initial Assessment:
   1. Prompt evaluation by orthopaedic specialists to diagnose fractures and related injuries.
   2. Referral for imaging services, including X-rays, to facilitate immediate diagnosis.
2. Treatment Planning:
   1. Development of individual treatment plans tailored to the specific injury and patient needs.
   2. Options may include immobilisation with casts or splints and advice regarding surgical interventions if necessary.
3. Ongoing Monitoring:
   1. Regular follow-up appointments in the clinic to monitor healing progress and adjust treatment plans as required.
   2. Management of potential complications to ensure optimal recovery.
4. Rehabilitation Coordination:
   1. Collaboration with physiotherapists to design and implement rehabilitation programs.
   2. Focus on restoring function, strength, and mobility to the affected area.

When to Attend a Fracture Clinic:

You should attend a fracture clinic if you have a suspected upper or lower limb injury, such as a fracture, sprain, or strain, and need expert orthopaedic care. This can be after you have been seen in the ED or by your GP for follow-up treatment, or you can go directly to a fracture clinic like Access Ortho as your first point of call. No referral is required, meaning you can get an immediate assessment, radiology, and a tailored treatment plan without delay. Since Access Ortho specialises in orthopaedic injuries, you will receive specialist-led care focused solely on musculoskeletal conditions, ensuring the best possible recovery.

Access Ortho’s fracture clinics are designed to provide efficient, specialist-led care, ensuring patients receive timely and appropriate treatment for their musculoskeletal injuries.

Frequently Asked Questions

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

Most proximal fibular fractures heal within 6–12 weeks, depending on how severe the fracture is and any associated injuries. Full recovery, including regaining strength and function, may take 3–6 months, particularly if there is ligament involvement.

Will I need surgery for my proximal fibular fracture?

Surgery is typically required if the fracture is displaced, unstable, or associated with ligament damage (e.g., LCL or ACL injuries). Non-displaced fractures usually heal with conservative management, such as immobilisation and physiotherapy.

Can I walk with a proximal fibular fracture?

It depends on the fracture type. Many non-displaced fractures allow for weight-bearing as tolerated with crutches. However, unstable fractures or those with associated ligament injuries may require restricted weight-bearing for several weeks.

What is the difference between a proximal fibular fracture and other knee injuries?

A proximal fibular fracture affects the upper part of the fibula near the knee and may be associated with ligament damage (e.g., LCL, ACL, or posterolateral corner injuries). Other knee injuries, for example meniscus tears or patellar fractures, primarily involve the knee joint itself rather than the fibula.

When can I return to sports after a proximal fibular fracture?

Return to sport depends on healing and rehabilitation progress but generally occurs within 3–6 months. Athletes must regain full strength, range of motion, and joint stability before returning to high-impact activities.

What are the signs of nerve damage with a proximal fibular fracture?

The common peroneal nerve, which runs around the fibula, can be affected. Signs of nerve damage include:

• Foot drop (difficulty lifting the foot).
• Numbness or tingling along the outer leg and top of the foot.
• Weakness in ankle dorsiflexion and eversion.

How is knee stability affected by a proximal fibular fracture?

If the lateral collateral ligament (LCL) or posterolateral corner structures are involved, knee stability may be compromised, leading to instability, difficulty pivoting, and chronic pain. Proper rehabilitation is essential to restore stability.

What exercises are safe during recovery?

Safe exercises include:

• Early phase: Gentle range of motion (ROM) exercises for the knee and ankle.
• Mid-phase: Isometric strengthening (quadriceps, hamstrings), stationary cycling.
• Late phase: Balance, proprioception, and resistance training to restore function.

Always check with your medical team regarding exercises you should and should not be doing. 

Do I need a knee brace after a proximal fibular fracture?

A knee brace may be needed if there is ligament involvement or joint instability. Otherwise, bracing is not always necessary for isolated fractures. Your orthopaedic specialist will determine if a brace is required.

How can I prevent long-term complications?

• Follow rehabilitation guidelines to restore strength and stability.
• Address any ligamentous injuries early to prevent chronic instability.
• Monitor for nerve symptoms, such as foot drop, and seek medical advice if they occur.
• Maintain bone health with proper nutrition and weight-bearing exercises to prevent future fractures.