Fibula fractures are a common injury to the smaller of the two bones that comprise the lower leg. Fractures of the fibula can occur in conjunction with a tibia fracture or even a broken ankle. While many fractures occur because of a strong impact or force on the bone, fibula stress fractures are common, especially among athletes. If you’d like to learn more about fibula stress fracture and other common fibular fractures, read on to find out:
The fibula is one of four long bones in the body, which include the femur, humerus, and tibia. It is the smaller of the two leg bones extending between the knee and ankle and is sometimes referred to as the calf bone. It sits slightly behind and to the outside of the tibia and is vulnerable to breaks because of its size. The primary function of the fibula is as a point of attachment for many muscles in the lower leg and as a support to the larger tibia. Because of this, and the inherent forces placed on the bone by the muscles, stress fractures are common in the fibula. However, the fibula only has to support between 14 and 17 percent of the body’s weight, while the larger tibia supports much more.
While fibula fractures don’t receive the notoriety that breaks of the tibula or femur garner, breaks to the fibula have made front page news since Oakland Raiders quarterback, Derek Carr, suffered a devastating broken fibula during their game on Christmas Eve of 2016. The broken fibula required surgery and ended his hunt for both MVP and a Superbowl appearance.
Fibula fractures can either be complete, when the break goes through the whole bone, or incomplete, when the break does not go fully through the bone. The fracture may occur anywhere along the bone between the knee and ankle. Displaced fractures (when the bone becomes misaligned) are very rare in fibular fractures, as this bone doesn’t receive as much force as the weight bearing tibia bone.
The most common fibular fractures are:
Lateral malleolus fracture: This is a fracture to the fibula when the ankle joint is unaffected. This injury tends to occur when the ankle twists or bends awkwardly. The inner side of the ankle is unaffected.
Bimalleolar ankle fracture: In this type of fibular fracture, the injury to the fibula is associated with a corresponding injury to the inner side of the ankle. The ligaments connecting the ankle and fibula are injured and the resulting stress on the fibula causes a fracture.
Tibia-fibula fractures: These injuries result in fractures of both of the long bones in the lower leg. They are generally caused by severe injuries from car crashes, sports injuries, or falls.
Fibula stress fractures: The fibula becomes fractured as a result of repeated stress to the bone. Stress fractures can affect long distance runners and usually worsen with increasing levels of activity.
If you experience any of these symptoms, it is very important to see a medical professional immediately. Delayed treatment of a broken bone can result in worsening of the injury including damage to the surrounding ligaments and tissue.
If the doctor feels it is necessary, he/she may determine that additional tests are required to determine the severity of the injury and subsequent treatment.
X-rays are a commonly used imaging techniques that will show if the bone is broken or displaced, how many breaks occurred, and whether or not other bones were injured.
Computed tomography (CT) scans are a painless test that shows a cross-sectional image of the limb. The scan can provide very valuable information about the severity of the injury and can also help determine if the ankle or knee joints are involved in the injury.
The treatment of a fractured fibula depends on the severity of the injury and whether or not additional injuries have occurred in association with the fracture. Isolated fibula fractures usually heal quickly and do not require surgery, especially if the break occurs in the upper half of the bone. Non-surgical treatments may include the following:
R.I.C.E.: Rest, ice and elevate the affected leg to reduce pain and inflammation. Some minor fibula stress fractures can completely heal with this simple regiment. It may be recommended that you walk with crutches, use a knee scooter, or other crutch alternative such as iWALK2.0 that allows you move about while being non weight bearing on the affected leg.
Splint: Initially a doctor may suggest splinting the lower leg to provide comfort and support. A splint can be tightened or loosened, which is helpful with there is swelling in the leg. Once the swelling subsides, the doctor may consider additional treatments.
Brace or walking boot: One of these maybe recommended by your doctor to restrain the injured leg and allow for healing.
Non-weight bearing regimen: As with many injuries to the lower extremities, doctors will often recommend a period of non weight bearing activity where no weight can be put on the injured leg or foot. If this is a requirement for you, you’ll need a medical device such as crutches, a knee scooter, or other device such as the hands-free iWALK2.0 mobility device, to help you stay mobile throughout your recovery.
There are some instances when weight can be put on the ankle right away. However, most physicians will have patients wait 6 weeks before bearing weight on the leg.
If symptoms worsen or do not improve after a couple of weeks, surgery may be an appropriate course of action. Surgery may also be required if the injury is more complex and involves the tibia, ankle, and/or other muscles and ligaments.
While isolated fibula fractures most often do not require surgery, when the tibia is also fractured, the break has occurred near the ankle, or other muscles and ligaments are injured, more invasive treatment may be necessary.
During fibula surgery, the physician will use plates and screws or wires to fasten the fractured bone into place. During this procedure, bone fragments are re-positioned to their normal alignment and are then held together with special screws and metal plates that attach to the outer surface of the bone. There may be instances when the injury requires that a screw or nail be inserted into the middle of the bone to hold it in place.
Patients who suffer from a fractured fibula tend to make a full recovery provided they follow their doctor’s instructions. The severity of the injury will dictate the length of time to reach recovery. With minor fractures, return to most activities and even sports can take place in as little as 6 weeks. Those with severe fibular fractures where other bones, nerves or blood vessels, and soft tissue are also damaged will have a significantly longer recovery time.
As mentioned in the Treatment section of this article, it is very important to follow your doctor’s prescription. This will often include rest, ice, and elevation and a period of non-weight bearing on the leg, generally for at least 6 weeks. The amount of time you will be non-weight bearing will depend on how quickly you gain stability in the injured leg and ankle.
If surgery was necessary, immediately following you will most likely wear a splint on your injured leg. Once swelling has subsided, a cast or boot may be used to support the healing bone(s). Your doctor may encourage some leg motion in the early recovery period to avoid stiffness.
In addition, physical therapy may be prescribed while you are in your splint, cast or boot. Physical therapy will help to strengthen the surrounding muscles, prevent atrophy, and restore normal joint movement and flexibility.
While in the cast you may be expected to be non-weight bearing, which means that you will not be allowed to put any weight on the affected limb for several weeks to a few months, depending on the severity of the injury. A doctor may suggest putting some weight on the leg right away, but a different injury may require that no weight is put on the limb for some time. Following your doctor’s instructions carefully will help your recovery and will prevent further injury.
Unfortunately, a non-weight bearing recommendation can be very difficult to follow and requires the use of a walking aid such as crutches, a forearm crutches, knee scooter or other crutch alternatives such as iWALK2.0.
Traditional crutches allow you to move without putting weight on the injured foot. However, they can be cumbersome and require the use of your hands and arms. Fortunately, there are other alternatives on the market. A knee scooter requires less upper body strength than crutches but are not ideal for movement on stairs, in small areas or uneven terrain. New advances in hands-free crutch technology, such as iWALK2.0 allow a person to be non-weight bearing with the use of their arms and hands. This device, once strapped on properly, becomes an extension of your leg, and allows you hands-free mobility so you can continue a functional lifestyle during your non-weight bearing period. To learn more about the iWALK2.0, click here.
As with most injuries, fibular fractures can range from moderate to severe, depending on how the injury occurred, the individual’s overall health, and the patient’s willingness to follow the doctor’s recovery recommendations. Full recovery takes plenty of patience and rest, and without these, the risk for re-injury increases. It is very important to follow up with your physician regularly to be sure your injury is healing correctly. Fortunately, most people who suffer from fractures of the fibula heal completely and return to their normal levels of activity, including participation in athletics.
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ExitCare Patient Information. 2015 Baylor Scott & White Health. www.sw.org
Fields KB, et al “Fibular Fractures” UpToDate. January 2011
Physioadvisor.com.au. Fibula Fracture. Australian Physiotherapy Association
“A Stress Fracture Primer,” by Brian Fuller, D.P.M. www.runnersworld.com. “Runner’s World Magazine”