UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

腓骨骨折

Author
Karl B Fields, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
卢新昌, 主治医师

引言

腓骨骨折，特别是累及踝关节和骨干近端的腓骨骨折很常见，通常由轻微创伤引起。腓骨骨折的初步处理多由初级保健医师及急诊临床医师完成，因此这些人员必须熟悉腓骨骨折。

本专题将讨论腓骨骨折的诊断和处理。踝关节骨折及扭伤、腓骨应力性骨折，以及儿童腓骨骨折见其他专题。 (参见“成人踝关节骨折概述”和“踝关节扭伤”和“胫骨和腓骨应力性骨折”和“儿童的胫腓骨干骨折”和“Ankle fractures in children”)

流行病学及危险因素

成人腓骨骨折多由创伤引起。年龄较大女性踝骨折中大多数为孤立性腓骨骨折，每年发病率大约为1-2/1000白人女性[1]。腓骨骨折也可能由反复负重引起，称为应力性骨折。

对于年长成人，腓骨干或胫骨干骨折的关键危险因素似乎是骨量。降低骨量的因素比总体健康状况或其他跌倒危险因素产生的影响更大。大部分研究表明，在较年长成人中，女性发生腓骨骨折的数量最多[2]。然而，一项前瞻性研究发现在踝关节附近发生腓骨骨折的患者中并无性别差异[3]。吸烟是腓骨骨折的另一重要危险因素[4]。

运动涉及跑步过程中突然改变方向(cutting) (特别是接触或碰撞相关运动)的运动员腓骨骨折发病率更高[5]。典型的例子包括美式橄榄球、英式足球和英式橄榄球。下坡的冬季运动参与者具有相对较高的腓骨骨折发生率。腓骨骨折在单板滑雪中比在滑雪(双脚踏较细的雪橇)中更常见，并且两种情况的骨折类型也不同。滑雪者多发生胫骨近端1/3骨折和腓骨骨折，而单板滑雪者发生孤立性腓骨远端1/3骨折的可能性更大[6]。

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-06-06.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Hasselman CT, Vogt MT, Stone KL, et al. Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Joint Surg Am 2003; 85-A:820.
  2. Makwana NK, Bhowal B, Harper WM, Hui AW. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br 2001; 83:525.
  3. Asloum Y, Bedin B, Roger T, et al. Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing. Orthop Traumatol Surg Res 2014; 100:S255.
  4. Kelsey JL, Keegan TH, Prill MM, et al. Risk factors for fracture of the shafts of the tibia and fibula in older individuals. Osteoporos Int 2006; 17:143.
  5. Slauterbeck JR, Shapiro MS, Liu S, Finerman GA. Traumatic fibular shaft fractures in athletes. Am J Sports Med 1995; 23:751.
  6. Patton A, Bourne J, Theis JC. Patterns of lower limb fractures sustained during snowsports in Otago, New Zealand. N Z Med J 2010; 123:20.
  7. Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br 2003; 85:1134.
  8. Duchesneau S, Fallat LM. The Maisonneuve fracture. J Foot Ankle Surg 1995; 34:422.
  9. Kwaadu KY, Fleming JJ, Lin D. Management of complex fibular fractures: double plating of fibular fractures. J Foot Ankle Surg 2015; 54:288.
  10. McConnell T, Creevy W, Tornetta P 3rd. Stress examination of supination external rotation-type fibular fractures. J Bone Joint Surg Am 2004; 86-A:2171.
  11. Egol KA, Amirtharajah M, Tejwani NC, et al. Ankle stress test for predicting the need for surgical fixation of isolated fibular fractures. J Bone Joint Surg Am 2004; 86-A:2393.
  12. Michelson JD, Magid D, McHale K. Clinical utility of a stability-based ankle fracture classification system. J Orthop Trauma 2007; 21:307.
  13. Kardouni JR. Distal fibula fracture diagnosed with ultrasound imaging. J Orthop Sports Phys Ther 2012; 42:887.
  14. Ekinci S, Polat O, Günalp M, et al. The accuracy of ultrasound evaluation in foot and ankle trauma. Am J Emerg Med 2013; 31:1551.
  15. Takao M, Uchio Y, Naito K, et al. Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures. J Trauma 2004; 57:1303.
  16. Constantinou M, Brown M. Non-union distal fibula avulsion fracture in a 16 year old male: A clinical case report. J Sci Med Sport 2012; 15:S135.
  17. Boden BP, Lohnes JH, Nunley JA, Garrett WE Jr. Tibia and fibula fractures in soccer players. Knee Surg Sports Traumatol Arthrosc 1999; 7:262.