Have You Been Diagnosed
With A Fibula Fracture?

Fibula fractures are a common type of ankle fracture. If you have fractured your fibula, is surgery a must? How long will it take to heal? Is there anything you can do to help minimize your ankle joint pain and get you back to normal activity more quickly?




Ankle Anatomy

The ankle is made up of three main bones: the tibia, the fibula and the talus. The tibia is the weight bearing bone, or the bone on which we literally stand. It is located on the medial or inside aspect of the lower leg. The fibula, located on the lateral or outside of the leg, functions as an attachment point for ligaments and tendons of the lower leg. The talus completes the ankle joint and is the bone that helps to allow for ankle mobility.


ankle anatomy



How is the Fibula Fractured?

The most common means of sustaining a fibula fracture is via an inversion ankle sprain. As the ankle rolls inward, stress is placed on the laterally located fibula. The fracture itself can occur from the talus running into the bottom aspect of the fibula. Another type of ankle fracture, called an avulsion fracture, occurs when the stretched lateral ligaments literally pull a piece of the fibula off the distal end.

Of course there are other ways of fracturing the fibula including trauma that allows the bones to twist, or be compressed. This type of injury generally results in fracture of both the tibia and fibula with the fracture sites being higher up from the ankle joint itself. Spiral fractures are common with this twisting mechanism with the fracture site being longer and more vertical.


Will I Need Surgery?

Not all fibula fractures will require surgery. The size of the fracture, location, and most importantly the stability of the fracture will determine if surgery is necessary. A small hairline fracture or a small avulsion fracture will generally not require surgery. Spiral fractures, fractures that demonstrate a gap, and combination tibia and fibula fractures generally will require surgery.

If surgery is required, it is generally performed immediately. Pins, plates, and screws are utilized in order to achieve solid fixation of the bony ends. The goal of this hardware is to keep the ends of the bone aligned while healing occurs.


Fibula Fracture





Both for post-operative injuries and those fractures that do not require surgery, the use of an immobilizer boot will be required. Depending on the nature of the fracture you may or may not have to keep all weight off the leg as it heals. Fractures in general take six to eight weeks to completely heal. Follow up x-rays will monitor your progress and be used to help determine how long immobilization will be required and when you will be allowed to put weight on your ankle.

One potential complication following fracture fixation surgery relates to the pins and screws themselves. With time and movement of the ankle, these small pins or screws can start to move out of the bone. Because the soft tissue around the ankle is quite thin, these pins and screws can be aggravating. Do not be alarmed. If they become painful, removal of the screw is quite easy and generally done during a typical doctor’s office visit.


Physical Therapy

Once healing of the fracture has occurred, physical therapy will be greatly helpful in returning you to normal function. The goals of physical therapy will include reducing your ankle joint pain, returning you to normal walking, reducing swelling, restoring normal range of motion, and improving strength. Utilizing ice therapy and elevation of the ankle is a simple thing you can do to minimize swelling. Being consistent with following home exercise recommendations will also speed your recovery.

Restoring normal ankle mobility and range of motion often requires manual joint mobilizations by the physical therapist. The length of immobilization following a fracture will reduce the ability of the bones of the ankle to glide and slide as they should. The physical therapist will assist in restoring this normal ankle motion.


physical therapist working on ankle


Depending on your level of activity, incorporating balance and agility activities will also be helpful in returning you to function. If your fracture was associated with ligament involvement, the use of a brace for sports may be necessary, at least initially.


Summary

• The fibula is the non-weight bearing bone of the ankle, located on the lateral side of the leg.

• Fibula fractures occur generally with trauma or are associated with lateral ankle sprains.

• Fractures of the fibula do not always require surgery. Size, location, and stability of the fracture will determine if you are a surgical candidate.

• Fractures will require immobilization and six to eight weeks to heal.

• Physical therapy will play an important role in reducing your ankle joint pain and returning you back to normal function.


Isolated fibula fractures generally have positive outcomes both following surgery and after immobilization for healing. Follow the recommendations of the medical professionals and you will be back on your feet in no time.





References

Clin Podiatr Med Surg. 2012 Apr;29(2):155-86, vii. Epub 2012 Feb 24. Ankle fractures. Mandi DM.

J Am Acad Orthop Surg. 2009 Apr;17(4):220-30. Distal fibula malunions. Chu A, Weiner L.

Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005595. Rehabilitation for ankle fractures in adults. Lin CW, Moseley AM, Refshauge KM


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