A 41 y.o. woman fell while playing in the snow and injured her ankle
how would you treat her minimally displaced , non articular fibular fracture?
Our patient had a “bimalleolar equivalent” fracture of the ankle. Because of the spiral nature of the fracture shown on the lateral below, a stress view of the ankle must be done.
spiral fibular fx seen on lateral view
In this case the stress view showed widening of the ankle mortice and required a surgical repair.
widening of the ankle mortice on stress view
Injuries to the fibula when there is an isolated fracture of the distal tip can often be treated like an ankle sprain. This is the most common injury to the ankle. Bimalleolar fractures on the other hand, involve the fibula and medial malleolus and almost always require a surgical repair. The third type of ankle fracture involves the syndesmosis between the tibia and fibula. Referred to as a Maisonneuve fracture, it is a spiral fracture of the proximal third of the fibula near the head with tearing of the interosseous membrane and tibiofibular syndesmosis often with a deltoid ligament tear or medial malleolus fracture. There will be a widening in the ankle mortice.
A fourth type of fibular fracture is common in long distance runners. This is a stress fracture of the mid fibula which comes on gradually and can be seen on ultrasound.
A similar disruption of the interosseous membrane occurs in the forearm with the Galeazzi fracture, a fracture of the distal radius with dislocation of the distal radioulnar joint. Because of the tear in the interosseous membranes both the Maisonneuve and Galeazzi fractures may cause compartment syndrome.
Hoglund L, Sibernagel K, Taweel N. Distal fibular stress fracture in a female recreational runner: a case report with musculoskeletal ultrasound imaging findings. Int J Sports Phys Ther. 2015 10(7):1050-58.
Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg Am 1976. Apr;58(3):337-42.
Wilson FC. Fractures of the ankle: pathogenesis and treatment. South Orthop Assoc. Summer 9(2):105-15.