This article focuses on the shaft of the fibula, which can be located between the neck of the fibula, the narrowed portion just distal to the fibular head, and the lateral malleolus, which in concert with the posterior and medial malleoli, form the ankle joint. Fractures of the tibia and fibula are typically diagnosed through physical examination andX-rays of the lower extremities. The injury is common in athlete who is engaged in collision or contact sport . 2023 - TeachMe Orthopedics. Login. At Another Johns Hopkins Member Hospital: Tibia fractures are the most common lower extremity fractures in children. It is the main weight-bearing bone of the two. Fracture of the proximal fibula indicative of syndesmotic injury. If a medial malleolar fracture is present, it should be repaired with open fixation. 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 . There are different types of fractures, which can also affect treatment and recovery. B2 w/ medial lesion (malleolus or ligament) B3 w/ a medial lesion and fracture of posterolateral tibia. 2023 Lineage Medical, Inc. All rights reserved, Ohio Health Orthopedic Trauma and Reconstructive Surgery, 2. A CT scan may be required to further characterize the fracture pattern and for surgical planning. Vaccines & Boosters | Testing | Visitor Guidelines | Coronavirus. Both the posterior and medial malleolus arepart of the distal end of the tibia. Sproule JA, Khalid M, OSullivan M, et al. Fractures of the fibular shaft occurring without ankle injury nearly always are associated with tibial shaft fractures. Full healing usually is accomplished by 68 weeks. Accept We'll assume you're ok with this, but you can opt-out if you wish. The interosseus membrane is the stout connection between the tibia . Distal tibial metaphyseal fractures usually heal well after setting them without surgery and applying a cast. Tibia and fibula fracturesare characterized as either low-energy or high-energy. highest incidence in male is between 15-24 years of age, highest incidence in females is 75-84 years of age, modified hinge joint consisting of tibia, fibula, and talus, tibial plafond and talus are broader anteriorly and wider laterally, extends from medial malleolus to broad insertion onto navicular, sutentaculum tali, and talus, primary restraint to anterior displacement, IR, and inversion of talus, strongest ligament of lateral complex and least likely to be disrupted, anterior inferior tibiofibular ligament (AITFL), originates from anterolateral tubercle of distal tibia (Chaput), inserts anteriorly onto lateral malleolus (Wagstaffe), posterior inferior tibiofibular ligament (PITFL), broad origin from posterior tibia (Volkmann's fragment), inserts onto posterior aspect of lateral malleolus, distal continuation of intraosseous membrane, peroneus longus and brevis pass along posterior groove of lateral malleolus, at risk with posterolateral fibular plating, located posterior and inferior at the level of the medial malleolus, at risk with posterior placement of medial malleolus screws, course over anterior ankle between EDL and EHL, course posterior to medial malleolus between FDL and FHL, crosses anteriorly over fibula about distal 1/3, at risk with posterolateral and direct lateral approach to fibula proximally and with anterior/anterolateral approaches, at risk with posterolateral and direct lateral approach to fibula, primary restraint to anterolateral talar displacement, acts as buttress to prevent lateral displacement of talus, dorsiflexion results in fibula ER and lateral translation, accommodating anteriorly wider talus, plantarflexion results in narrower, posterior aspect of the talus leading to IR of talus, based on combination of foot position and direction of force applied at the time of injury, has been shown to predict the observed (via MRI) ligamentous injury in less than 50% of operatively treated fractures, 1. a combined posterior drawer and external rotation force is then applied to the knee to assess for an increase in posterolateral translation (lateral tibia externally rotates relative to lateral femoral condyle), knee positioned at 90 and external rotation and valgus force applied to tibia, as the knee is extended the tibia reduces with a palpable clunk, tibia reduces from a posterior subluxed position at ~20 of flexion to a reduced position in full extension (reduction force from IT band transitioning from a flexor to an extensor of the knee), altered sensation to dorsum of foot and weak ankle dorsiflexion, approximately 25% of patients have peroneal nerve dysfunction, may see avulsion fracture of the fibula (arcuate fracture ) or femoral condyle, side-to-side difference 2.7-4 mm = isolated LCL tear, primary varus = tibiofemoral malalignment, secondary varus = LCL deficiency with increased lateral opening, triple varus = remaining PLC deficient, overall varus recurvatum alignment, necessary to determine mechanical axis and if a, look for injury to the LCL, popliteus, and biceps tendon, coronal oblique thin-slice through the fibular head are best at visualizing the PLC structures, hinged knee brace locked in extension x4 weeks, followed by progressive functional rehabilitation, midsubstance repair have 40% failure rate following repair, repair of LCL, popliteus tendon and/or popliteofibular ligament should be performed if structures can be, anatomically reduced to their attachment site, avulsion fracture of fibular head can be treated with screws or suture anchors, avulsion injuries where repair is not possible or tissie is poor quality, goal is to reconstruct LCL and the popliteofibular ligament using a free tendon graft (semitendinosus or achilles), soft tissue graft passed through bone tunnel in fibular head, limbs are then crossed to create figure-of-eight and fixed to lateral femur to a single tunnel, trans-tibial double-bundle reconstruction, split achilles tendon is fixed to isometric point of the femoral epicondyle, one tibia-based limb and one fibula-based limb, fibula-limb is fixed to the fibular head with a bone tunnel and transosseous sutures to reconstruct the LCL, tibia-limb is brought through the posterior tibia to reconstruct the popliteofibular ligament, proximal attachment site at anatomic femoral LCL attachment, through the fibular head lateral to medial, docking into the tibial tunnel posterior to anterior with graft #2, graft #2 reconstructs the popliteus tendon, proximal attachment site at the anatomic popliteus tendon attachment, docking into the tibial tunnel posterior to anterior with graft #1, hinged knee brace, nonweightbearing for 6 weeks, range of motion protocols differ between surgeons, some advocate for passive ROM immediately 0-90, others immobilize for 2 weeks, then begin motion, at 6 weeks, begin weightbearing and closed-chain strenghtening, return to activities / sports ~ 6 to 9 months, operative treatment has improved outcomes compared to nonoperative treatment, repair has higher failure rate than reconstruction, particularly for midsubstance injuries, but also for soft tissue avulsions, anatomic reconstruction restores rotatory stability, but not all varus stability on stress testing, PLC reconstruction, +/- ACL reconstruction, +/-, acute and chronic combined ligament injuries, PLC reconstruction should be performed at same time or prior to (as staged procedure) ACL or PCL to prevent early cruciate failure, indicated in patients with varus mechanical alignment, failure to correct bony alignment jeopardizes ACL and PLC reconstruction success, ACL reconstruction + PLC repair 33% achieved IKDC grade A or B compared to 88% of patients who underwent ACL + PLC reconstruction, failure to identify a PLC injury will lead to failure of ACL or PCL reconstruction, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Proximal Tibiofibular Joint Ganglion Cysts, Pre-Participation Physical Exam in Athlete, Concussions (Mild Traumatic Brain Injury). Tibia and Fibula Fractures | Johns Hopkins Medicine It is caused by a pronation-external rotation mechanism. The fracture occurs from a direct blow to the outside of the leg, from twisting the lower leg awkwardly and, most common, from a severe ankle sprain. - frx above the syndesmotic result from external rotation or abduction forces that also disrupt. With an associated knee injury, patients have pain and swelling of the knee joint. Fibula Stress Fracture - Symptoms, Causes, Treatment & Rehabilitation Are you sure you want to trigger topic in your Anconeus AI algorithm? 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 ]. The repair of a ruptured deltoid ligament is not necessary in ankle fractures. 2023 Lineage Medical, Inc. All rights reserved. The tibia is a larger bone on the inside, and the fibula is a smaller bone on the outside. The proximal fibula is the insertion point for the biceps femoris posterolaterally, the soleus posteriorly, and the peroneus longus and extensor digitorum longus anteiorly. Tibial Shaft Fractures - Trauma - Orthobullets Stromsoe K, Hoqevold HE, Skjeldal S, et al. seen with SER-type fracture patterns, AITFL avulsion of anterior tibial margin (tibial This procedure involves placing a piece of foam in the wound and using a device to apply negative pressure to draw the edges of a wound together. The injury produces pain, tenderness, and swelling of the ankle making weight-bearing difficult or impossible. Wounds may be treated with vacuum-assisted closure. Are you sure you want to trigger topic in your Anconeus AI algorithm? Treatment is generally operative with intramedullary nailing. Or an external fixator may be used to surgically repair the wound. Medial malleolus transverse fracture or disruption of deltoid ligament . Copyright 2023 Lineage Medical, Inc. All rights reserved. At its most proximal part, it is at the knee just posterior to the proximal tibia, running distally on the lateral side of the leg where it . The triangular shape of the fibula is dictated by the insertion points of the muscles on the shaft. Pediatric Distal Tibial Fracture - Wheeless' Textbook of Orthopaedics This type of injury is known as a stress fracture. C3: proximal fracture of the fibula. The fibula is one of the two long bones in the leg, and, in contrast to the tibia, is a non-weight bearing bone in terms of the shaft. The fibula is a slender bone that lies posterolaterally to the tibia. The superficial peroneal nerve also gives sensation to the dorsum of the foot. Ankle Fractures are very common fractures in the pediatric population that are usually caused by direct trauma or a twisting injury. Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. One reason for this may be the treatment for the vast majority of isolated fibula shaft fractures is non-operative - this contrasts with the treatment of lateral malleolus fractures, which, although it is part of the fibula, technically, are categorized as ankle fractures and, therefore, have different treatment principles. Weber B: Lateral Malleolus Frx - Wheeless' Textbook of Orthopaedics Description. 2023 Lineage Medical, Inc. All rights reserved. Fibula Fractures - Post - Orthobullets Are you sure you want to trigger topic in your Anconeus AI algorithm? Posterolateral Corner Injury - Knee & Sports - Orthobullets leads to spiral fracture pattern with fibula fracture at a different level. For prognostic reasons, severely comminuted, contaminated barnyard injuries, close-range shotgun/high-velocity gunshot injuries, and open fractures presenting over 24 hours from injury have all been included in the grade III group. Medial malleolus transverse fracture or disruption of deltoid ligament, A - infrasyndesmotic (generally not associated with ankle instability), avulsion fracture of posterior tibia resulting from tripping, AITFL avulsion off anterior fibular tubercle usually A physical examination and X-rays are used to diagnose tibia and fibula fractures. Diagnosis is made with plain radiographs of the ankle. mechanism of injury. (0/3), Level 1 Anterior tibiofibular ligament disruption, 3. These fractures are usually transverse (across) or oblique (slanted) breaks in the bone. The superficial peroneal nerve innervates the musculature of the lateral compartment and is responsible for eversion and, to a much milder degree, plantarflexion of the foot. after fixing posterior malleolus move back to fibula fracture; place lag screw (2.7mm screw/2.0mm drill) followed with 1/3 tubular plate using antiglide technique on . open 1/3 tibial shaft fracture with placement of proximal 1/3 tibia and calcaneus/metatarsal pins to span fracture), construct stiffness increased with larger pin diameter, number of pins on each side of fracture, rods closer to bone, and a multiplanar construct, incision from inferior pole of patella to just above tibial tubercle, identify medial edge of patellar tendon, incise, insert guidewire as detailed below and ream, can lead to valgus malalignment in proximal 1/3 tibial fractures, helps maintain reduction when nailing proximal 1/3 fractures, can damage patellar tendon or lead to patella baja (minimal data to support this), semiextended medial or lateral parapatellar, used for proximal and distal tibial fractures, skin incision made along medial or lateral border of patella from superior pole of patella to upper 1/3 of patellar tendon, knee should be in 5-30 degrees of flexion, choice to go medial or lateral is based of mobility of patella in either direction, identify starting point and ream as detailed below, suprapatellar nailing (transquadriceps tendon), easier positioning if additional instrumentation needed, more advantageous for proximal or distal 1/3 tibia fractures, starting guidewire is placed in line with medial aspect of lateral tibial spine on AP radiograph, just below articular margin on lateral view, in proximal 1/3 tibia fractures starting point should cheat laterally to avoid classic valgus/procurvatum deformity, ensure guidewire is aligned with tibia in coronal and sagittal planes as you insert, opening reamer is placed over guidewire and ball-tipped guidewire can then be passed, spanning external fixation (ie. Etiology. Pediatric Distal Tibial Fracture. Posterolateral Corner Injury. Long-distance runners and hikers are at risk for stress fractures. Are you sure you want to trigger topic in your Anconeus AI algorithm? 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. Tornetta P, III, Spoo JE, Reynolds FA, et al. Most isolated lateral malleolus fractures are stable enough to allow you to put weight on the . 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.
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fibula fracture orthobullets