- Physical complaints
- Bone fracture
- Broken fibula
Broken fibula
Fibula fracture},{
A broken fibula is a fracture of the lower leg. The lower leg consists of the tibia and the fibula.
In most cases, a fibular fracture is at the lower end, near the ankle. A fracture in this part of the fibula is classified according to the 'Weber classification'. A fracture at the upper end of the fibula is much less common.
Weber classification for fibular fractures
Dr. Bernhard Georg Weber, a Swiss surgeon, was the first to categorize fibular fractures based on the location of the break. The classification is used to determine which treatment is needed to allow the fracture to heal. The syndesmosis plays an important role in this classification.
The syndesmosis is the joint with the ligaments between the fibula and the tibia, just above the ankle. With a fibular fracture, there is a risk of injury to the syndesmosis. If this joint is damaged, the fibula and tibia can separate too far. This results in an unstable ankle mortise. In this context, unstable means there is an increased risk of osteoarthritis of the ankle joint or persistent ankle pain.
The Weber classification includes three types of fractures:
| Weber | Meaning |
|---|---|
| A | The fibula is broken below the syndesmosis and there is no additional damage to other ankle bones or ligaments. |
| B | The fracture is at the level of the syndesmosis. This increases the risk of damage to the syndesmosis and ankle ligaments. |
| C | The fracture is above the syndesmosis and it is usually damaged. This is the most troublesome of the three. This type of fracture is also often accompanied by injury to the ankle ligaments and a fracture or dislocation of the distal end of the tibia. |
How does a fibular fracture occur?
A fracture of the fibula most often results from a trauma (accident). For example, a lateral blow to the bone during a collision or in contact sports such as soccer and hockey. This is a high-energy trauma, in which the impact on the bone is strong enough to break it.
This is not the case with a Weber A fracture. This type of fracture does not always require high-energy trauma. It can also be an avulsion fracture, in which the tip of the fibula is pulled off by an ankle ligament. This usually happens when spraining the ankle.
Another possible cause of a fibular fracture is bone loss (osteoporosis). This makes the bone more likely to break.
Signs and symptoms of a broken fibula
Almost immediately after the fracture, it is no longer possible to bear weight on the leg. There is severe (tender-to-pressure) pain and the lower leg may appear crooked. This is usually not visible with a Weber A fracture, but can occur with a Weber B or C fracture.
With a fracture at the lower end of the fibula, there is pain with ankle movements, and the ankle swells and bruises. This is different with a fracture at the upper end of the fibula. In that case, ankle movements are usually not painful and the fracture is not always visible. If swelling and discoloration do occur, this is usually on the outside of the lower leg, just below the knee.
How is a broken fibula diagnosed?
The patient's history, followed by a physical exam, often provides sufficient clues. To further assess a possible fracture, specific questions are asked and assignments are given according to the so-called 'Ottawa Ankle Rules'. These rules help distinguish between a broken fibula and an ankle sprain.
If a broken fibula is suspected, imaging is always performed. This usually starts with X-rays taken from the front, side and oblique angles. These images provide information about the type of fracture. With a Weber B or C fracture, a CT scan or MRI scan may also be performed. This better visualizes any injury to the syndesmosis and provides more information about possible injury to ligaments, muscles or nearby nerves.
Treatment of a broken fibula
Many medical specialists use the Weber classification to determine whether surgery is necessary. With a Weber A fracture, this is usually not the case, and the broken bone is treated with a rest period of about 6 weeks. During this period, no weight may be placed on the leg. Non-weight-bearing ankle movements within the pain limit are allowed. Sometimes the lower leg is placed in a protective cast.
With a Weber B, and especially with a Weber C fracture, there is a lower chance of natural healing. This is considered an unstable fracture, and surgery is then necessary. During surgery, the broken bone and the syndesmosis are repaired using fixation material . This material consists of plates, screws, wires and/or pins.
During rehabilitation, guidance from a physical therapist is strongly recommended. It is important to restore mobility, muscle strength and load tolerance. The physical therapist may use treatments such as mobilization techniques, massage, medical taping and exercise therapy.