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#FIBULA FRACTURE MANUAL#

↑ 3.0 3.1 Gougoulias N, Khanna A, Sakellariou A, Maffulli N: Supination-external rotation ankle fractures: Stability a key issue.

'Population-based epidemiology of 9767 ankle fractures.' Foot and Ankle Surgery 24.1 (2018): 34-39. Acta Chir Orthop Traumatol Cech 2002 69:243-247. Part I: Epidemiologic evaluation of patients during a 1-year period.

↑ Jehlicka D, Bartonicek J, Svatos F, Dobias J: Fracture-dislocations of the ankle joint in adults.

'Minimally invasive plate osteosynthesis for treatment of ankle fractures in high-risk patients.' The Journal of Foot and Ankle Surgery 57.3 (2018): 494-500./ref>

Complications range from 5-60%Bazarov, Irina, et al.

Minimally invasive plate osteosynthesis (MIPO).

Many physicians will repeat more frequently.

Repeat weight bearing xrays at about 6 weeks.

Transition to walking boot from cast/splint.

Decision driven by degree of pain, stability.

Stable standard radiographs, instability on stress radiographs.

Absence of talar subluxation or lateral translation.

Absence of widening of medial clearspace.

Soft tissue injury at the time of the fracture.

Risk factors that predict Surgical Complication.

Managed nonsurgically had good or excellent clinical results (AOFAS scores).

In patients with widening of joint space on stress radiographs without evidence of deltoid ligament injury.

Yde et al: follow-up of 3-10 years nonanatomic reduction managed surgically had a good functional result (83%), compared nonsurgical management (55%).

Increased risk of post-traumatic Ankle Osteoarthritis.

Greater risk of displacement, nonunion, delayed union compared to surgical management.

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Unstable fractures managed non-surgically.Stability: most often unstable injuries.Location: occur above the level of the syndesmosis.Fracture: originate at the level of the syndesmosis.Correspond to the SER pattern described Lauge-Hansen classification.Fracture: occur below the level of the syndesmosis.Describes the radiographic position of the distal fibula fracture in relation to the syndesmosis.Illustration of weber classification for distal fibula fractures. Due to marked variability seen in measurement of similar MRI findings.

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Not recommended in clinical decision making.Talar tilting on standard non–weight-bearing radiographs (suggests deltoid disruption).However, specificity was between 13% and 39% with a very high false negative rate.Maximum width of the fracture line on the lateral radiograph of Factors associated with stability from Nortunen et al.May be influenced by amount of weight patient is willing to put on affected limb.Holmes et al had similar excellent outcomes using a MCS cutoff of 7 mm.Hoshino found patients with stable weight bearing films at 7 day follow up had excellent outcomes.

#FIBULA FRACTURE MANUAL#

Two studies have demonstrated gravity stress views as effective as manual stress views, less painful to patients.

Position of ankle does not affect the examination.

Force of gravity is constant, predictable.

This allows the foot to fall into external rotation because of gravity.

Distal half of the leg is then placed over the end of the table.

Patient is in lateral decubitus position, injured side down.

Neither sensitive (57%), nor specific (59%) ĭemonstration of gravity ankle stress view.

Medial-sided tenderness, swelling, and ecchymosis can suggest deltoid ligament injury.

Tenderness along distal fibula, possibly crepitus.

Swelling, bruising will often be observed.

Patients will describe an acute mechanism.

Calcaneal Apophysitis (Sever's Disease).

Fifth Metatarsal Apophysitis (Iselin's Disease).

Formed by articulation formed by the distal Fibula, distal Tibia and Talus.

Stabilized laterally by ATFL, CFL, PTFL.

Distal component of Fibula that helps form the ankle joint.

Considered unstable, require surgical fixation.

Lateral malleolus fractures that have an incongruent ankle mortise.

Isolated lateral malleolus fractures without lateral subluxation of the talus.

Management is generally dependent on the stability of the ankle mortise.

Represent 56% to 65% of all ankle fractures.

Isolated lateral malleolus fractures are the most common ankle fracture pattern.

Likely most common fracture pattern in the lower extremity.

This page refers to fractures of the distal Fibula.

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Fibula fracture