bypass fracture, likely adjacent joint (i.e. It is caused by a pronation-external rotation mechanism. - C3 proximal fracture of the fibula. Isolated fibular fractures comprise the majority of ankle fractures in older women, occurring in approximately 1 to 2 of every 1000 White women each year [ 1 ]. Long-distance runners and hikers are at risk for stress fractures. Diagnosis is made with plain radiographs of the ankle. Pearls/pitfalls. The fibula supports the tibia and helps stabilize the ankle and lower leg muscles. Obtain 3 views of the ankle (AP, lateral, and mortise) to look for ankle fracture or syndesmotic disruption. "use strict";var wprRemoveCPCSS=function wprRemoveCPCSS(){var elem;document.querySelector('link[data-rocket-async="style"][rel="preload"]')?setTimeout(wprRemoveCPCSS,200):(elem=document.getElementById("rocket-critical-css"))&&"remove"in elem&&elem.remove()};window.addEventListener?window.addEventListener("load",wprRemoveCPCSS):window.attachEvent&&window.attachEvent("onload",wprRemoveCPCSS); BONE DYSPLASIAS, METABOLIC BONE DISEASES, AND GENERALIZED SYNDROMES, THE ORTHOPAEDIC MANAGEMENT OF MYELODYSPLASIA AND SPINA BIFIDA, The Diagnosis and Management of Musculoskeletal Trauma, Surgical Reconstruction of the Lateral Collateral Ligament, Staying Out of Trouble with the Hip: Make linear longitudinal incision along the posterior border of the fibula (length depends on desired exposure) may extend proximally to a point 5cm proximal to the fibular head Weightbearing on the involved leg may be allowed as tolerated by the patient. Generally, fibula fractures do well, and most patients have normal function at long-term follow-up (. The injury is common in athlete who is engaged in collision or contact sport . The deep peroneal nerve innervates the musculature of the anterior compartment and is responsible for the dorsiflexion of the foot and toes. Vaccines & Boosters | Testing | Visitor Guidelines | Coronavirus. The tibia is much thicker than the fibula. Additionally, lateral collateral ligament of the knee originates from the lateral epicondlye of the femur to insert on the superior portion of the fibular head and is the . Wang Q, Whittle M, Cunningham J, et al. The following article will focus on fractures of the fibula that are proximal to the ankle joint and the treatment of such fractures. Fractures of the fibula can be described by anatomic position as proximal, midshaft, or distal. Pathophysiology. Patients with fibular shaft or head fractures generally present with tenderness and swelling in the area of injury. Medial malleolus transverse fracture or disruption of deltoid ligament, 3. (1/3), Level 3 Description. The repair of a ruptured deltoid ligament is not necessary in ankle fractures. Medial malleolus transverse fracture or disruption of deltoid ligament . Repair of the deltoid ligament tear is not believed to be necessary (. Ulnar gutter splint/cast. There will be a pain in the lower leg on weight-bearing although . If a fibula fracture is associated with a. if skin cannot be closed, vac-assisted closure should be considered in short-term. 12/11/2019. Damage to this nerve may result in deficits in those movements. ; Patients may report a history of direct (motor vehicle crash or axial loading) or indirect . We'll assume you're ok with this, but you can opt-out if you wish. If patient is unable to participate in examination and concern is high clinically, intracompartmental compartment measurements should be performed, floating knee is an indication for antegrade tibial nailing and retrograde femoral nailing, distal 1/3 and spiral tibial shaft fractures, tibial shaft is triangular in cross-section, proximal medullary canal is centered laterally, important for start point with IM nailing, anteromedial tibial crest is composed of dense, cortical bone and rests in a subcutaneous position, making it useful as a landmark, tibial tubercle sits anterolaterally, approximately 3 cm distal to joint line, gerdy's tubercle lies laterally on proximal tibia, pes anserinus lies medially on proximal tibia, attachment of sartorius, semitendinosus, and gracilis, superficial medial collateral ligament (MCL) attaches approximately 5-7 cm distal to joint line deep to the pes anserinus, adjacent fibula supports attachments for the lateral collateral ligament complex and long head of biceps femoris, tibia is responsible for about 80-85% of lower extremity weight-bearing, fibrous structure interconnecting tibia/fibula which provides axial stability, fibula rests in distal tibial incisura and is stabilized by syndesmotic ligaments, anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), inferior transverse tibiofibular ligament (ITL), interosseous ligament (IOL) - continuation of interosseus membrane, syndesmotic stability can be affected by distal, spiral tibial shaft fractures, Fracture classification is primarily descriptive based on pattern and location, Oestern and Tscherne Classification of Closed Fracture Soft Tissue Injury, Injuries from indirect forces with negligible soft-tissue damage, Superficial contusion/abrasion, simple fractures, Deep abrasions, muscle/skin contusion, direct trauma, impending compartment syndrome, Excessive skin contusion, crushed skin or destruction of muscle, subcutaneous degloving, acute compartment syndrome, and rupture of major blood vessel or nerve, Gustilo-Anderson Classification of Open Tibia Fractures, Limited periosteal stripping, clean wound < 1 cm, Minimal periosteal stripping, wound >1 cm in length without extensive soft-tissue injury damage. Lauge Hansen classification: - classification: - C: fibula fracture above syndesmosis. Posterolateral corner (PLC) injuries are traumatic knee injuries that are associated with lateral knee instability and usually present with a concomitant cruciate ligament injury (PCL > ACL). This is a fracture in the metaphysis, the part of tibia before it reaches its widest point. Maisonneuve fractures with syndesmotic injury imply injury to the medial side of the ankle joint. Weber C fractures can be further subclassified as 6. Position. Patients are followed at 1-month intervals with plain radiographs until the fractures are healed. The deep peroneal nerve is responsible for sensation over the first dorsal webspace. Located posterolaterally to the tibia, it is much smaller and thinner. Figure 3 Normal syndesmotic relationships include a tibiofibular clear space (open arrows) <6 . Fibula and its ligaments in load transmission and ankle joint stability. Fourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures. Are you sure you want to trigger topic in your Anconeus AI algorithm? This type of injury is known as a stress fracture. Pain will usually have developed gradually over time, rather than at a specific point in time that the athlete can recognise as when the injury occurred. Fractures of the proximal head and neck of the fibula are associated with substantial damage to the knee (. performed with the hip flexed 45, knee flexed 80, and foot is ER 15. Fractures that involve syndesmotic injury or ankle or knee fracture often require surgical treatment. Sometimes they may also involve the fracture of the growth plate (physis) located at each end of the tibia. Stress Fractures of the Fibula . (0/3). Ankle Fractures are very common fractures in the pediatric population that are usually caused by direct trauma or a twisting injury. Although tibia and fibula shaft fractures are amongst the most common long bone fractures, there is little literature citing the incidence of isolated fibula shaft fractures. Transverse comminuted fracture of the fibula above the level of the syndesmosis, 2. lawnmower) or iatrogenic during surgical dissection, (patterned off adult Lauge-Hansen classification), Adduction or inversion force avulses the distal fibular epiphysis (SH I or II), Rarely occurs with failure of lateral ligaments, Further inversion leads to distal tibial fracture (usually SH III or IV, but can be SH I or II), Occasionally can cause fracture through medial malleolus below the physis, Plantarflexion force displaces the tibial epiphysis posteriorly (SH I or II), Thurston-Holland fragment is composed of the posterior tibial metaphysis and displaces posteriorly, External rotation force leads to distal tibial fracture (SH II), Thurston-Holland fragment displaces posteromedially, Easily visible on AP radiograph (fracture line extends proximally and medially), Further external rotation leads to low spiral fracture of fibula (anteroinferior to posterosuperior), External rotation force leads to distal tibial fracture (SH I or II) and transverse fibula fracture, Occasionally can be transepiphyseal medial malleolus fracture (SH II), Distal tibial fragment displaces laterally, Thurston-Holland fragment is lateral or posterolateral distal tibal metaphysis, Can be associated with diastasis of ankle joint, Leads to SH V injury of distal tibial physis, Can be difficult to identify on initial presentation (diagnosis typically made when growth arrest is seen on follow-up radiographs), distal fibula physeal tenderness may represent non-displaced SHI, full-length tibia (or proximal tibia) to rule out Maisonneuve-type fracture, assess fracture displacement (best obtained post-reduction), non-displaced (< 2mm) isolated distal fibular fracture, displaced (> 2mm) SH I or II fracture with, acceptable closed reduction (no varus, < 10 valgus, < 10 recurvatum/procurvatum, < 3mm physeal widening), or II fracture with unacceptable closed reduction (varus, > 10 valgus, > 10 recurvatum/procurvatum, > 3mm physeal widening) and > 2 years of growth remaining, displaced SH I or II fracture with unacceptable closed reduction (varus, > 10 valgus, > 10 recurvatum/procurvatum, > 3mm physeal widening) and < 2 years of growth remaining, requires adequate sedation and muscle relaxation, only attempt reduction two times to prevent further physeal injury, NWB short-leg cast if isolated distal fibula fracture, NWB long-leg cast if distal tibia fracture, interposed periosteum, tendons, or neurovascular structures, percutaneous manipulation with K wires may aid reduction, open reduction may be required if interposed tissue present, transepiphyseal fixation best if at all possible, high rate associated with articular step-off > 2mm, medial malleolus SH IV fractures have the highest rate of growth disturbance, 15% increased risk of physeal injury for every 1mm of displacement, can represent periosteum entrapped in the fracture site, partial arrests can lead to angular deformity, distal fibular arrest results in ankle valgus defomity, medial distal tibia arrest results in varus deformity, complete arrests can result in leg-length discrepancy, if < 20 degrees of angulation with < 50% physeal involvement and > 2 years of growth remaining, bar of >50% physeal involvement in a patient with at least 2 years of growth, fibular epiphysiodesis helps prevent varus deformity, if < 50% physeal involvement and > 2 years of growth remaining, contralateral epiphysiodesis if near skeletal maturity with significant expected leg-length discrepancy, typically seen in posteriorly displaced fractures, can occur after triplane fractures, SH I or II fractures, usually leads to an increased external foot rotation angle, anterior angulation or plantarflexion deformity, occurs after supination-plantarflexion SH II fractures, occurs after external rotation SH II fractures, treatment options include physical therapy, psychological counseling, drug therapy, sympathetic blockade, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). They account for 10 to 15 percent of all pediatric fractures. Patients with tibia fractures, syndesmosis injuries, or ankle fractures should be referred to an orthopaedic surgeon. The pain may begin gradually. Wounds may be treated with vacuum-assisted closure. usually associated with an injury to the medial side Proper . These fractures occur in the knee end of the tibia and are also called tibial plateau fractures. There are several distinct portions of the fibula in terms of structure, including the head, neck, shaft, and the distal end termed the lateral malleolus.