- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. They often result from minor trauma. Initial management is often provided by primary care and emergency clinicians, who must therefore be familiar with these injuries.
The diagnosis and management of fibular fractures is discussed here. Ankle fractures and sprains, stress fractures of the fibula, and fibula fractures in children are reviewed separately. (See "Overview of ankle fractures in adults" and "Ankle sprain" and "Stress fractures of the tibia and fibula" and "Tibial and fibular shaft fractures in children" and "Ankle fractures in children".)
EPIDEMIOLOGY AND RISK FACTORS
Fibular fractures in adults are typically due to trauma. 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 . Fibular fractures may also occur as the result of repetitive loading and in this case they are referred to as stress fractures.
In older adults, the key risk factor for fractures of the fibular or tibial shaft appears to be bone mass. Factors that reduce bone mass had greater impact than overall health status or other risk factors for falling. Most studies show that women experience the greatest number of fibular fractures among older adults . However, one prospective study found no gender difference among patients with fibular fractures near the ankle . Cigarette smoking is another important risk factor for fibular fractures .
Athletes engaged in sports that involve cutting, particularly those associated with contact or collision, have a higher incidence of fibular fractures . Typical examples include American football, soccer, and rugby. Participants in downhill winter sports have relatively high rates of fibular fractures. These are more common in snowboarding than skiing, and fracture patterns are different for each. Skiers often fracture the proximal third of the tibia and also the fibula, whereas snowboarders are more likely to sustain isolated fractures of the distal third of the fibula .
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- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- Skin integrity
- DIAGNOSTIC IMAGING
- Plain radiographs and initial approach to imaging
- - Classification schemes
- Musculoskeletal ultrasound
- Advanced imaging
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR ORTHOPEDIC REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- RETURN TO WORK OR SPORT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS