Fibular fractures are usually associated with a complex injury; however, they can be an isolated fracture. Fibular fractures typically occur with a fracture of the tibia, part of an ankle fracture, a pilon fracture, or Maisonneuve fractures. Maisonneuve fractures involve a fracture of the proximal fibula associated with an occult injury of the ankle.
Isolated fibular fractures are rare and are usually the result of a direct trauma. The fibular carries approximately 15% of the axial load and is the site of muscle attachment for the peroneus muscles and the flexor hallucis longus muscle. If the physician has a patient with a fibular fracture and no other fracture involving the tibia, they will want to rule out a possible Maisonneuve fracture, especially if there is no history of direct trauma to the leg.
The physician should look for sign of a syndesmotic injury. These signs include
- Unexplained increase in medial clear space
- Tibiofibular clear space is widened (should be less than 5mm)
The x-ray will show the fracture to be rotational or oblique.
Maisonneuve fractures will require surgery to fix the syndesmosis. The fracture will need to be reduced and fixed. Syndesmotic screws are the screw of choice. It is important to determine if the injury is a Maisonneuve fracture or an isolated fibular fracture, as an isolated fibular fracture will not need surgery.