What to Know About Fibula Fractures

A fibula fracture is a partial or complete break of the fibula bone. The fibula is the smaller of two bones of the lower leg, situated between the knee and ankle that helps keep the ankle joint stable.

A fracture can be caused by a forceful impact, a traumatic sports injury, or any direct blow to the outside of the lower leg. It can also occur as result of an ankle injury.

For example, the energy involved in the severe twisting of an ankle can transfer up the leg and lead to a break at the upper part of the fibula. Fibula fractures can occur in sports, such as basketball, that require a rapid shift in direction or landing after a high jump.

Most fibula breaks also involve the rupture of supporting ligaments or the fracture of the adjacent tibia (shin bone).

This article describe three types of fibula fractures, including the symptoms and complications and how each are treated.

The Fibula

The fibula is a long, thin bone. It starts just below the knee joint on the outside of the leg and extends all the way down to the ankle joint.

The larger bone of the lower leg, the tibia, carries most of the body weight. The fibula helps keep the ankle joint stable.

The fibula does little to support the weight of the body. Still, it performs important functions. It's where ligaments attach to the knee and ankle joints.

Surgeons sometimes use some of the fibula if they need bone for surgery on another body part. This process is called a bone graft. People can still function well even after a bone graft has taken a large part of the fibula.

Types of Fibula Fractures

The three types of fibula fractures include:

• Fibula fractures from injury to the ankle joint
• Fibula fractures that occur with tibia fractures
• Stress fractures (small cracks from overuse)

Other fibular injuries are possible but are less common. The most common by far are ankle joint injuries. Typically, the ankle buckles or twists, and the fibula is damaged in the process.

Symptoms

Fibula fractures often occur with injuries to other bones, ligaments, and tendons around the knee and ankle.

Diagnosis

To diagnose a fibular fracture, your healthcare provider will examine the site of the injury, the knee joint, and the ankle joint. You'll probably need an X-ray image, too.

Other imaging studies such as magnetic resonance imaging (MRI) or a computerized tomography (CT) scan can be helpful if the fracture doesn't show up on an X-ray. Stress fractures, described below, are more likely to show up on an MRI or CT scan.

Ankle Injuries

Fibula fractures typically occur as part of an ankle injury. If the fibula is fractured, the ankle joint should also be checked for possible injury.

The most common type of fibula fracture is an injury to the end of the fibula bone near the ankle joint. These injuries can look and feel like a badly sprained ankle. Often, the injury can be treated similarly to a severe ankle sprain.

Ankle-Level Fibula Fracture Without Other Ankle Injury

Known as a lateral malleolus fracture, these injuries occur when the ankle twists or bends awkwardly. However, the inner (medial) side of the ankle is not affected. If the ankle isn't injured, the best treatment might be simple protection.

In these situations, a brace is often enough to support the ankle. Using crutches for a few days or weeks allows swelling and pain to subside. Once pain has eased, you can begin therapy. Therapy often includes mobility exercises, strengthening, and walking.

Fibula Fracture With Ankle Injury

If both the fibula and inner ankle are injured, the medial malleolus or deltoid ligament may be involved. More aggressive treatment might be necessary.

This situation is known as a bimalleolar ankle fracture. Often, surgery is needed to make the ankle joint stable. Without surgery, the ankle joint may heal without being properly aligned. Over time, that can lead to ankle arthritis.

A fibular fracture may also involve damage to the syndesmosis of the ankle. The syndesmosis is the group of ligaments that holds the two bones of the leg together, just above the ankle joint.

If the syndesmosis is damaged at the ankle, you might need surgery to re-align the bones.

Fibula and Tibial Shaft Fractures

Severe injuries from car crashes, sports injuries, or falls may involve both the tibia and the fibula above the ankle joint. These injuries are often referred to as "tib-fib" fractures. Realigning the leg bones in cases like these may mean surgery.

When the tibia is surgically repaired, the fibula does not normally need a separate surgery. In some tib-fib fractures, a long-leg cast (thigh to foot) will provide support without the surgery.

Stress Fractures of the Fibula

It's possible to fracture the fibula by placing too much pressure on it over and over again. This type of injury is known as a stress fracture. Long-distance runners and hikers are at risk for stress fractures. The pain may begin gradually. Usually, it gets worse with activity and better with rest.

Treatment

How a fibula fracture is treated depends on where the fracture is located and whether other bones or ligaments are also damaged.

Surgery may be recommended, but treatment usually starts with a splint or cast to help prevent movement and allow the bone to heal. This is called closed reduction and immobilization because the bone is set in place without surgery and the cast keeps it from moving. If possible, your healthcare provider can realign your broken bones without surgery.

While isolated fibula fractures usually heal quickly, some complex injuries may need further treatment. That's why it's critical for a medical professional familiar with fibula fractures to evaluate your injury and make sure you get the right treatment.

Surgery on the Fibula

In severe or complex cases, such as if the bone breaks through the skin or is broken in several pieces, a surgery to stabilize and heal a fibula fracture may be recommended.

Surgery may involve:

• Open reduction exposes the bone surgically to set it back in place. It is typically done on open fractures where the bone is visible. This procedure is usually accompanied by internal or external fixation.
• External fixation, a common way to repair a fractured fibula, refers to using materials, such as pins, clamps, and rods, to stabilize the fracture from the outside.
• Internal fixation refers to physically reconnecting the broken bones with materials such as screws, plates, rods and nails that will remain under the skin.
  
• Percutaneous pinning involves inserting wires to hold the bone pieces in place until they heal. The wires are later removed once the fibula fracture has healed.

Your surgeon will explain the repair method in a document called the operative report. The report may also explain the rest of your treatment plan. It often contain codes that indicate which side of the fibula was hurt.

Complications

Problems with the incision or the hardware can lead to complications after surgery. Because there is very little soft tissue between the skin and the bone, wounds may not heal as easily. Soft tissue refers to muscles, tendons, ligaments, and other types of tissue that surround and connect your bones.

After surgery, infections can happen. Wound healing can be more troublesome for people with health conditions such as diabetes. Smokers also have a higher risk of wound complications.

In some cases, arthritis and slow healing can complicate recovery. Lastly, pain associated with implanted hardware is not uncommon. Some people choose to have plates and screws removed after the fracture has healed.

Summary

A fibula fracture involves an injury to the smaller of two bones in your lower leg. Most of the time, fibula fractures happen near the ankle joint. Repetitive stress fractures are also common. In severe cases, the tibia or ligaments are also damaged.

Symptoms include pain on the outside of the leg, swelling, and bruising. To find out whether you have a fracture, an X-ray, MRI, or CT scan will be necessary.

The exact treatment will depend on where and how bad the injury is. A brace or cast can keep your leg stable while the fracture heals. But if the injury is severe or complex, you may need surgery to realign the bones.

A Word From Verywell

Talk with your healthcare provider about the best solution for your fracture. You may be nervous if more invasive treatments are needed. It's always okay to ask questions about surgery. It's also okay to ask about non-surgical options. Remember that ultimately, the procedure is meant to heal your injured fibula.

Make sure to ask your healthcare provider for tips to reduce your risk of further injury. It may be frustrating to wait until you're better to continue doing what you love, but it's well worth it.

You can reduce your risk of a fibula fracture by working to maintain your bone mass. Some factors such as age and gender are out of your control, but others such as quitting smoking and practicing sports safety can help.