FIBULA FRACTURE

QUESTIONS AND ANSWERS

Understanding Fibular Fractures

While the fibula contributes to weight-bearing, it handles only a small fraction—about 5-17% of your body weight. This means fibular fractures, though significant, are generally less severe than fractures in bones with greater weight-bearing responsibility. Such fractures often accompany severe ankle sprains and can occur anywhere along the fibula.

Who’s at Risk?

Athletes and Active Individuals:

• Fractures of this type are common in athletes, especially those involved in sports with sudden direction changes, like soccer and rugby.
• Participants in downhill winter sports, notably snowboarders, are also prone to fibular fractures, with distinct fracture patterns differing from those in skiing.

Lifestyle Factors:

• Cigarette smoking has been identified as a risk factor, impacting bone health and increasing fracture risk.
• Sudden increases in activity levels can also contribute to these injuries.

Older Adults:

• Bone mass is a critical risk factor, with lower bone density leading to higher susceptibility. Factors that reduce bone mass, like certain diseases, play a more significant role than general health status.

Immediate Care

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Understanding the nature and risks of fibular fractures can better prepare you for preventive measures and appropriate responses if such an injury occurs.

Epidemiology and Aetiology of Distal Fibular Fractures

Distal fibular fractures, commonly known as ankle fractures, are the most frequent type of injury in this category. These fractures are particularly prevalent among different age groups but manifest differently depending on the individual’s age and activity level.

Epidemiology

In the younger population, these fractures usually result from traumatic incidents such as sports injuries or accidents. Conversely, in the elderly, particularly older women, distal fibular fractures tend to arise from low-energy events, like simple falls, resulting in similar tissue damage levels as seen in younger adults. Statistically, about 1 to 2 out of every 1,000 white women experience these fractures annually.

Aetiology

The cause of distal fibular fractures can be broadly divided into two categories. In younger adults, high-impact activities often lead to these fractures. Meanwhile, in older populations, the cause can usually be attributed to lower energy impacts. Another contributing factor across age groups is repetitive stress on the bone, which can lead to what is known as stress fractures. These occur gradually due to persistent, minor impacts that collectively surpass the bone’s ability to repair itself.

Understanding these distinctions in epidemiology and aetiology is crucial for healthcare professionals when diagnosing and formulating treatment plans for distal fibular fractures, catering to the specific needs of different age groups.

How to Prevent Stress Fractures Through Risk Factor Modification

Preventing stress fractures is crucial for anyone beginning a new exercise routine or maintaining an active lifestyle. Here’s how you can modify risk factors effectively:

Choose the Right Footwear

• Appropriate Shoes: Invest in shoes that match the specific demands of your activity. Whether you’re running, walking, or participating in another sport, the right footwear can provide the necessary support and cushioning to minimize impact stress.

Gradual Progression

• Slow and Steady: Avoid doing too much too soon. Gradually increase the intensity and duration of your physical activities. This allows your body to adapt and strengthens your bones over time.

Warm Up and Cool Down

• Pre-Exercise Preparation: Always start with a warm-up to increase blood flow and prepare your muscles for the workout.
• Cooling Down: End each session with a proper cool down and stretching routine to reduce muscle stiffness and prevent injury.

Strengthening and Flexibility

• Muscle Conditioning: Incorporate exercises that focus on strengthening and stretching the muscles used in your preferred activities. This not only supports your joints but also helps distribute load more evenly across your body.

Listening to Your Body

• Recognize Warning Signs: Pay attention to any signs of fatigue or discomfort. Pain should never be ignored, as it can be an early indicator of potential stress fractures.

By considering these factors, you can significantly reduce the risk of developing stress fractures and maintain a healthy, active lifestyle.

Symptoms of a Fibula Fracture:

Some of the most prevalent warning signs and symptoms of a broken fibula are pain, edema, and discomfort. Other indications and symptoms are:

• Weight-bearing on the damaged leg is impossible
• A bruised and bleeding leg
• Visible deviation
• Cold and numbness in the foot
• To the touch delicate

Types of Treatment for a Fibula Fracture

Treatment is based on the kind, location, and severity of the fracture. Open (skin is broken) or closed fractures are common categories for fractures. Furthermore, our doctor will straighten the bones and then put your child’s leg in a cast or splint, whether closed or open. This keeps the fracture from moving, allowing it to heal. If deemed necessary, the doctor will prescribe crutches. Also, your child can learn to walk without bearing weight on the fractured leg with a physical therapist.

Closed Fracture Treatment

Depending on the severity, a closed fracture does not usually require surgery. Unless other portions of the leg are damaged, a splint or cast that restricts mobility will typically suffice.

Closed Reduction

If you do need further treatment to straighten your bones, your doctor could suggest a closed reduction. This procedure is conducted when a doctor realigns the ends of a fractured bone without making a skin incision.

Open Reduction

When a bone may have shattered in more than two locations, your doctor normally performs reduction surgery.

Rehabilitation and Physical Therapy

After being immobilized for several weeks, the leg may become weak, and joints could stiffen. Physical therapy is crucial and typically begins with an individual assessment, focusing on:

• Pain and swelling
• Range of motion (ROM)
• Muscle strength
• Healing of surgical scars
• Ability to walk and bear weight

Physical therapy starts with ankle strengthening and mobility exercises. Once the patient can bear weight, walking and stepping exercises are introduced. Balance exercises, such as wobble board activities, are essential for regaining unassisted mobility.

Phases of Rehabilitation

The rehabilitation process can be broken down into four phases:

1: Maximum Protection (Weeks 0 to 6)

• Immobilization with a cast or boot
• Elevating the ankle to reduce swelling
• Non-weight bearing
• Core and hip strengthening exercises

2: Range of Motion and Early Strengthening (Weeks 6 to 8)

• Emphasis on restoring full, pain-free ROM
• Initial weight-bearing exercises
• Proprioception and gait training

3: Progressive Strengthening (Weeks 8 to 12)

• Full ROM restoration
• Pool running and gradual return to more dynamic activities
• Introduction of plyometric exercises

4: Advanced Strengthening (Weeks 12 to 16)

• Impact and sport-specific training
• Functional drills with support braces

Long-term Care

To minimize future fracture risks, consider:

• Wearing suitable footwear
• Consuming calcium-rich foods like milk, yogurt, and cheese
• Engaging in weight-bearing exercises to strengthen bones

This integrated approach ensures a comprehensive recovery, addressing both immediate treatment and long-term health.

Nonunion

Nonunion occurs when the ends of a broken bone don’t mend together. Your doctor will often utilize bone grafting and electrical and magnetic stimulation devices in the absence of surgery.

Open Fracture Treatment

If your child has an open fracture, your child will need emergency medical help. While you are waiting for assistance, remember to rest, ice, compress, and elevate (RICE). Surgery is necessary for open fractures as serious secondary medical conditions exist, such as skin loss and artery damage. Your surgeon will concentrate on:

• Preventing contamination and infection by cleaning the wound.
• Preserving the bone’s position before surgery by stabilizing the wound.
• Imaging studies to determine the sort of operation required.
• Evaluating if using antibiotics to prevent infection is necessary.

Our surgeon may treat your fracture using internal or exterior techniques during surgery. Also, our doctor will insert metal implants to hold the fractured bone together while it heals if it requires an internal fixing. The metal screws or pins that hold the bones in place for severe open fractures often protrude outside the skin.

What is a Fibula Stress Fracture?

A fibula stress fracture is a hairline crack in the bone of the fibula. Numerous lower leg muscles link to the fibula bone. In comparison to the fibula, which has a large portion of its surface used for muscle attachment, the tibia is the bigger, heavier bone. Because of the traction and twisting pressures generated by the surrounding muscles, the fibula bone can develop a stress fracture.

Understanding Stress Fractures

Stress fractures occur when there is a mismatch between bone strength and the mechanical stress placed upon it. These injuries range from mild inflammation, known as periostitis, to severe fractures involving a complete cortical break. They are common in athletes due to repetitive submaximal loading over time, often seen in running and jumping sports. The lower extremities, including the fibula, are particularly susceptible.

Healthy bones constantly balance microcrack creation and repair. However, when stress exceeds the bone’s capacity for repair, cracks begin. With continued loading, these cracks can coalesce, leading to a clinically symptomatic stress fracture. If not addressed, this can progress to a complete fracture.

What Causes a Fibula Stress Fracture?

The main cause is an overuse injury. However, there are a few things that might make it more likely to sustain one:

• Because the peroneal muscles must exert more force for a longer period of time during toe-off in the running gait cycle, athletes who overpronate (roll their feet in) during running are more vulnerable.
• The ankle rolls inward as the arch of the foot flattens, twisting the lower leg and knee. The lower leg muscles, many of which link to the fibula bone, are under higher pressure because the bones in the foot cannot bear the strains as well as they should.
• Using orthotic inserts, which are worn in the patient’s shoes, can treat overpronation and other biomechanical foot dysfunctions. They regulate how the heel sits, enabling typical foot biomechanics.

Preventing Stress Fractures

To mitigate the risk of stress fractures, it’s crucial to manage training intensity and volume carefully. Incorporating rest periods and gradually increasing workload helps maintain bone health. Addressing biomechanical issues, like overpronation, with appropriate interventions such as orthotics, can further reduce the likelihood of injury.

Understanding the stages of bone fatigue—crack initiation, propagation, and complete fracture—can also guide athletes and trainers in recognizing early symptoms and taking preventive measures. With proper care and attention, stress fractures can be minimized, ensuring athletes remain strong and injury-free.

Symptoms of a Fibula Stress Fracture

• The calf region is painful, and there is localized discomfort at a fibula point.
• Instead of an identifiable moment in time when the damage happened, the pain normally develops gradually over time.
• Although this is not as severe as a stress fracture of the tibia, discomfort will exist in the lower leg when bearing weight.
• After some time of rest, the discomfort could go away, but exercise makes it increasingly worse.

What Causes a Fibula Stress Fracture?

The main cause is an overuse injury. However, there are a few things that might make it more likely to sustain one:

• Because the peroneal muscles must exert more force for a longer period of time during toe-off in the running gait cycle, athletes who overpronate (roll their feet in) during running are more vulnerable.
• The ankle rolls inward as the arch of the foot flattens, twisting the lower leg and knee. The lower leg muscles, many of which link to the fibula bone, are under higher pressure because the bones in the foot cannot bear the strains as well as they should.
• Using orthotic inserts, which are worn in the patient’s shoes, can treat overpronation and other biomechanical foot dysfunctions. They regulate how the heel sits, enabling typical foot biomechanics.

Treatment for a Fibula Stress Fracture

Comprehensive Management Strategies for Stress Fractures

Stress fractures require tailored management strategies depending on their location and severity. Below is a detailed guide on managing various types of stress fractures while maintaining the focus on fibula stress fractures in children.

Fibula Stress Fracture in Children

For at least six weeks, or until the bone soreness has subsided, children should refrain from sports. Anything that exercises the calf muscles is not helpful in healing. Your doctor will do another X-ray after the recovery time, and it’s possible that this could reveal a stress fracture. New bone tissue has developed as a result. Children should replace running with swimming.

Calf Supports

To safeguard the lower leg muscles, put on a heat retainer calf support. This lessens the strain on the fibula bone.

Exercises

A comprehensive rehabilitation program should include lower leg stretches and strengthening exercises. By doing this, you can make sure that your child’s muscles are in good shape and are strong and flexible enough to handle the demands of your sport.

Foot Biomechanics

Overpronation is excessive rolling or flattening of the foot. This puts additional strain on the lower leg. Corrective shoe inserts can correct any biomechanical impairment.

Training Errors

Examine your child’s sports training methods to determine if overtraining, increasing the workload too quickly, or poor shoe choice are factors. Your child’s running shoes should last about 400 miles or 6 months. After that, the quality of the midsole is reduced. This results in less cushioning and support.

Massage

Upon the doctor’s approval, the lower leg muscles may get massage treatments from a qualified practitioner. This improves the muscles’ health and restores their flexibility and suppleness.

Fibula Stress Fracture Exercises

Exercises that stretch as opposed to those that strengthen are more crucial for healing a stress fracture in the fibula. Since overuse is the main cause of the injury, it is not advisable to exercise your calf muscles, especially during the recovery period. The bigger gastrocnemius muscle and the soleus muscle, which is situated deeper and lower down the leg, make up the calf muscles. Also, physical therapy technicians state that bending and straightening the knee to properly stretch leg muscles helps to get the leg back to functioning at 100%.

Management of Other Stress Fractures

Leg and Foot Stress Fractures

• Femoral Shaft: Most injuries are managed conservatively with rest and activity modification. For severe cases, surgical intervention may be necessary.
• Patella: Typically managed with immobilization and a gradual return to activity.
• Tibia: Conservative management is common, but surgery may be needed for complex fractures.

Tarsal Bones

• Calcaneal Stress Injuries: Respond well to conservative management.
• Navicular Stress Injuries: Require close monitoring and may need surgical intervention if conservative measures fail.

General Preventive Measures

• Proper Footwear: Wear shoes suitable for specific exercises to avoid undue stress on the bones.
• Gradual Progression: When starting a new exercise regimen, gradually increase intensity and duration.
• Warm-Up and Cool-Down: Always include proper warm-up before and cool-down after exercises to maintain muscle health.

Conclusion

Managing stress fractures involves a combination of rest, rehabilitation, and sometimes surgical intervention, depending on the fracture’s location and severity. By understanding and implementing these strategies, you can ensure a safe and effective recovery, minimizing the risk of re-injury.

Request An Appointment For Your Child’s Broken Leg

The Medical City Children’s Orthopedics and Spine Specialists have been providing excellent broken arm fractures for many years. We focus on improving the long-term health of your child’s bones. If your child is in pain as a result of a broken leg, call one of our compassionate experts at 214-556-0590 to schedule an appointment with us. Finally, we offer personalized treatment and urgent pediatric care services at all of our four locations — Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX.  If you notice any symptoms of a broken arm in your child, don’t hesitate to contact us to avoid complications.

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Footnote:

National Library of Medicine: Fibula Fracture