Fibula fractures management

Abstract

Isolated distal fibula fractures represent the majority of ankle fractures. These fractures are often the result of a low-energy trauma with external rotation and supination mechanism. Diagnosis is based on clinical signs and radiographic exam. Stress X-rays have a role in detecting associated mortise instability. Management depends on fracture type, displacement and associated ankle instability. For simple, minimally displaced fractures without ankle instability, conservative treatment leads to excellent results. Conservative treatment must also be considered in overaged unhealthy patients, even in unstable fractures. Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described. Outcome is excellent in most cases. Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon.

Keywords: Ankle; Distal fibula; Fibula fracture; Lateral malleolus; Management; Treatment.

Figure 1

Danis-Weber classification of distal fibula isolated fractures. A: Type A; B: Type B; C: Type C.

Figure 2

Lateral, mortise and antero-posterior radiographic views of a Danis-Weber type B left distal fibula fracture. Conservative treatment is the correct choice for this case because minimal displacement of the fracture and absence of associated ankle instability are demonstrated.

Figure 3

Radiographic and clinical results at 3 mo from a one-third tubular plate fixation of a Danis-Weber type B left distal fibula fracture.

Figure 4

Clinical and radiographic results at 3 mo from surgical treatment of a Danis-Weber type B right distal fibula fracture with an anatomic angular stable plate.

Figure 5

Clinical case of a Danis-Weber Type B left distal fibula fracture treated with locked nailing. A: Intraoperative image demonstrating fibula nail insertion with guided instrumentation; B: Detail of the clinical result of minimally invasive approach for fibular nail insertion; C: Antero-posterior X-rays demonstrating fracture fixation with fibular nail completed with two guided intersyndesmotic screws.

Figure 6

Lateral and antero-posterior view X-rays taken 4 mo after conservative treatment of a Danis-Weber type A distal fibula fracture. Despite the radiographic evidence of nonunion the patient is completely asymptomatic, and no further treatment is indicated.

Figure 7

Clinical case of a Danis-Weber type C left distal fibula fracture treated with a one-third tubular plate. At post-op X-rays, malreduction with residual medial displacement is demonstrated. A dedicated adjustable tibio-fibular suture button fixation was added to obtain anatomic reduction and correction of associated ankle instability.