The fibula is a bone in the lower leg that runs in parallel with the tibia. The bone is located between the knee and the ankle joints and can be felt on the outside part of the lower leg. Fractures or breaking a bone can occur at any portion of the bone. Common sites of fracture include right below the knee, the shaft or at the part of the fibula located at the ankle joint. Fibula fractures often occur in conjunction with other bone, ligament and tendon injuries. After initial treatment of the fracture, patients will often undergo physical therapy to help regain function of the extremity and use crutches to be non-weight-bearing on the injured extremity. During the course of the post-operative care, patients can also be treated for known potential side effects such as deep venous thrombosis (DVT).
Casting
Casting is a technique for helping to immobilize a fracture. For fibula fractures the most common cast is a short leg cast for fibula fractures that occur near the ankle and long leg casts for fibular shaft fractures. Short leg casts will include the foot and go up to right below the knee. Long leg casts extend up to the thigh and include the foot. Casting may occur after a clinician manipulates the bone to help achieve a better alignment of the bones. A stockinette is placed on the skin of the leg where the edges of the cast will be. Cotton padding is wrapped in layers around the extremity first. Next using either fiberglass or plaster, a clinician will wrap over the cotton padding a few layers. The fiberglass and plaster harden as the clinician applies a mold to the cast to help to better immobilize the fracture site. This form of treatment can be either temporary or definitive management for the fracture.
Splinting
Splinting is a technique usually used in the setting of a recent fracture. It is ideal under these circumstances as fractures are associated with swelling. The splint allows the fracture site to swell and not constrict the leg. Splinting is often done as a temporary immobilization before surgery or performed after surgical fixation of the fibular fracture.
Common splints used for fibula fractures include the posterior slab and U-splint that are padded with a cotton roll. The posterior slab is a splint that is located in the back of the leg and over the sole of the foot. The length up the leg of the posterior slab depends upon where the fracture is. In general, the closer to the knee the fracture is, the higher up the posterior slab needs to go. A U-splint is often used in conjunction with the posterior slab to support the fibula on the inside and outside of the leg. This splint consists of a long piece of material that is shaped like a "U" that goes from the outside of the leg around the bottom of the foot and then goes up the inside of the leg. These pieces are over-wrapped with an elastic bandage.
Common splinting materials include plaster, fiberglass or prefabricated splints made of a variety of materials. Splinting is useful for all different types of fibula fractures as physicians can apply a splint to help hold the position of the fractured bones in conjunction with a manipulation of the bone fragments if necessary.
External Fixation
Fractures of the fibula and tibia that involve the ankle joint are often treated with the application of an external fixation device. This device is used to help keep the bones at length to allow for proper healing or to assist with a more definitive surgery at a later point. A surgeon places pins in the bones of the lower extremity and builds a construct with metal bars outside the body. This procedure can be done in the operating room or in the emergency department. An external fixation device is also useful for fractures where bone penetrates the skin, known as an "open fracture."
Open Reduction Internal Fixation
Open reduction internal fixation is the term for operative repair of a fracture with the placement of hardware under the skin. Fibula fractures can be repaired with screws and/or plates. Some fibula fractures are not treated, but the surgeon treats the tibia fracture and this allows the fibula to heal. Fractures of the tibia and fibula shafts are often treated with an intramedullary nailing of the tibia. This involves placing a long rod or nail inside the tibia bone through the fracture fragments.
Walking Boot
Minor fractures of the fibular component of the ankle or lateral malleolus can often be treated by placement of the injured extremity in a walking boot. This boot covers the foot and extends to just below the knee. It can allow for weight bearing early on in the fracture healing.
Open Fractures
When the bone penetrates the skin, the fracture is deemed to be "open" rather than "closed." The "Handbook of Fractures" states that antibiotics are necessary for open fractures. Common antibiotics given include cefazolin, gentamicin and penicillin depending upon the size of the wound and whether the wound is contaminated. Patients are often asked about their tetanus immunization status as well.
Pain Control
Pain control is a very important part of fibula fracture management. Patients often take non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or naproxen, acetaminophen and/or opioids. A clinician is responsible for informing a patient about what should be taken for pain following a fracture.
References
- "AAOS Comprehensive Orthopaedic Review"; Dr. Jay Lieberman (ed); 2008.
- "Handbook of Fractures"; Dr. Kenneth Koval and Dr. Joseph Zuckerman (eds); 2006.
