Fibula fracture: symptoms, treatment and recovery

fibular

and the tibia are the long bones of the lower leg. The fibula is small and located on the outside of the lower leg. The tibia is a bone located on the inside of the lower leg.

The fibula and tibia meet at the knee and ankle joints. Two bones help stabilize and support the ankle and foot.

A fracture of the fibula occurs when a fall from a height or any blow to the outer surface of the lower leg. Even a sprained ankle can lead to a fracture of the fibula. A fracture of the fibula can occur at any point.

Photo: Medscape Reference

Types of Fibula Fracture

Types of fibula fracture include:

• Lateral malleolar fibular fracture - occurs when the fibula breaks at the ankle joint;
• Fracture of the proximal head of the fibula - localized at the upper end of the fibula in the area of ​​the knee joint;
• Avulsion fracture - a fracture in which the tendon tears off part of the bone from the side of its attachment;
• Stress fractures occur as a result of repetitive trauma while running or walking;
• Fibula fractures are common in athletes, especially those who participate in running, jumping, soccer, and basketball.

Morpho-topographic aspect of spiral fractures of long tubular bones

ANNOTATION

A total of 360 spiral fractures were studied using chicken long bone models. The location and direction of the spiral fracture line were determined for different types of rotation - clockwise and counterclockwise. It has been established that in the case of rotation of any free epiphysis in both directions while the other is fixed, the indicated line is equally often located on both the anterior and posterior surfaces of the bone and always runs from left to right. When the free upper epiphysis rotates clockwise, this spiral line goes from bottom to top; when rotated in the opposite direction, it goes from top to bottom. When the lower end of the bone rotates with a fixed upper direction, the direction of the spiral fracture line, depending on the type of rotation, is exactly the opposite.

ABSTRACT

360 spiral fractures have been studied on models of chicken long tubular bones. The localization and direction of the spiral fracture line are determined for different types of rotation - clockwise and counterclockwise. It has been established that in the case of rotation of any free pineal gland in both directions with a fixed other one, the indicated line is equally often located both on the front and on the back surface of the bone and always runs from left to right . When the free upper pineal gland rotates clockwise, this spiral line goes from bottom to top, while rotating in the opposite direction, from top to bottom. When the lower end of the bone rotates with a fixed upper direction of the spiral fracture line, the opposite is the case depending on the type of rotation.

Key words: long tubular bones, spiral fracture, type of rotation, direction of the spiral fracture line.

Keywords: long tubular bones; spiral fracture; rotation type; the direction of the spiral line of the fracture.

Introduction

Spiral (helix-shaped) fractures of long tubular bones (SPTC) ( Fig. 1 ) occur due to rotation of one end of the bone while the other is fixed [1–5]. In this case, a tension is formed in the bone, passing along a helical line along which the bone first breaks. Due to the bending of the bone cylinder, compression occurs on the side opposite the helical line and a straight line of fracture of the bone tissue is formed, connecting the ends of the spiral part of the fracture ( Fig. 2 ) [1, 3, 5].

Figure 1. Spiral fracture of the middle third of the femoral shaft [6]

Figure 2. Deformation of the tubular bone during torsion: P – direction of external influence; a – stress forming a helical fracture line; b – stress forming a straight fracture line [1]

SPTK are not particularly uncommon. For example, according to S. Salminen (2005) [6], among all hip fractures, 36.7% are helical in nature, and according to a study by F. Madadi et al. (2011) [7], spiral fractures of the tibia accounted for 13.4% of bone fractures. injuries of this localization.

SPT is a fairly common injury in athletes, in particular skiers, speed skaters, snowboarders, football players (including American football players), and participants in combat sports [2, 8–10]. Less commonly, these types of fractures can occur in car and motorcycle accidents [9, 11], in particular, fractures of the lower leg of a pedestrian’s supporting leg when a vehicle hits him tangentially, which imparts a rotational moment to the body [12–14]; when falling on an inclined surface with obstacles that can fix a limb while the body continues to move [9], during physical violence or industrial injuries [9, 15].

In the aspect of forensic fractology, the question of the topography features of the spiral line of the primary bone rupture depending on the direction of rotation of its free epiphysis is of great practical interest. The correct answer to the question posed is often extremely important for determining the mechanism of injury, clarifying the circumstances of the incident and issuing a well-founded expert opinion [5].

However, there is very little research in this direction. No such information was found in the Medline database; only one publication dating back to 1983 was found in the Google Scholar database [16]. Its author, Finnish specialist O. Böstman, found that in 78% of cases the spiral component of the fracture line was located in the anterolateral quadrant of the circumference of the tibia, and the vertical element of the fracture was in the posteromedial one.

In the Russian-language literature, almost only the works of scientists from the Altai Medical Institute V.E. are devoted to this topic. Yankovsky and V.N. Kryukova.

The research of the first author [4,5] was carried out more than 40 years ago, published in relatively little-known publications and now represents, to a certain extent, a bibliographic rarity. According to the data summarized in the doctoral dissertation of V.E. Yankovsky (1974) [5], with external rotation of the diaphysis of the femur or tibia, the helical fracture line goes in the direction from top to bottom and inward. With internal rotation, this line has the opposite direction.

This conclusion raises a number of questions. Firstly, it is not entirely clear on which surface of the bone this helical line of bone tissue rupture is located.

Secondly, the rotation of the diaphysis of the mentioned bones, both external and internal, will have a different direction relative to the clockwise direction of the right and left leg. Therefore, the presented conclusion is not complete and generalizing.

The author also proposes a method for determining the direction of bone rotation by restoring a perpendicular to the helical fracture line, which corresponds to the direction of tensile forces and, therefore, the direction of rotation of this part of the bone ( Fig. 3 ). In certain cases this method may be useful. However, it is not always convenient for practical use.

Figure 3. Rotation fracture of the tibia; determining the direction of rotation [1, 5]

Two later monographs by V.N. Kryukova (1986, 1995) [1, 8] also do not bring much clarity to the issue under consideration. In modern publications on forensic medicine, for example, in the textbook by N.N. Tagaev (2003) [3], literally a few lines are devoted to this issue without any specifics. Even the National Manual of Forensic Medicine (2014) [17] completely lacks any information of this kind.

Thus, the issue under consideration is not sufficiently developed. There are practically no specific and sufficiently clear criteria that make it possible to accurately assess the direction of rotation of the free end of a long tubular bone by the type and location of the line of spiral rupture of bone tissue. Therefore, the purpose of this study was an attempt to fill, at least partially, the existing gap.

Material and methods

Long tubular chicken bones were used as a model for the experiment: radius – 100, ulna – 120, humerus – 120, tibia – 20 ( Table 1 ).

From a purely technical point of view, this is a very convenient object for studying the morphology of SPDTC. In addition, which is important, it is not a problem to obtain any required amount of experimental material.

So, in total, 360 SPDTCs were studied, obtained with a fixed lower epiphysis and rotation of the upper one clockwise and in the opposite direction - 180 observations in each case. (The direction of rotation of the free end of the bone, be it upper or lower, relative to the movement of the hour hand is determined by mentally looking at the bone from above, that is, the way we usually look at a watch with its dial facing up).

The obtained quantitative results were assessed using generally accepted descriptive statistical tests. The accepted level of significance for differences in indicators is 95% or more (p≤0.05).

results

The results of the study are presented in table. 1 .

Table 1.

Quantitative characteristics of the studied material and the results of the study

Discussion

Analysis of the data obtained reveals certain patterns.

Firstly, in the case of rotation, all types of long bones used in the experiment are damaged equally. In other words, the morphology of a spiral fracture does not depend on the anatomical identity of the bone, that is, its place in the skeleton.

Secondly, when the free upper end of the bone rotates with a fixed lower epiphysis, both in a clockwise and counter-clockwise direction, two types of SPDTC can occur, differing from each other in the localization of the helical line of the primary rupture of the bone tissue.

In one type of fracture this line is located on the front surface of the bone, in another - on the back. The frequency of one and the other type is approximately the same - about half of all fractures have the same mechanism of injury. The observed noticeable differences in the frequency of one or another localization of the spiral part of a fracture of some bones (for example, radius, humerus, tibia during counterclockwise rotation) are associated not so much with the design features of the latter, but with a relatively small number of observations. In general, in the entire sample, the indicated differences in the corresponding percentage indicators are statistically insignificant.

The described phenomenon serves as a significant clarification of the very brief and insufficiently defined information in this regard existing in the literature.

Thirdly, the spiral line of the fracture in the horizontal direction always goes from one lateral edge of the bone to the other (say, from left to right), which is quite natural.

Fourth, the difference between the studied SPDTs, determined by the type of rotation of the free end of the bone, lies in the orientation of the helical part in the vertical direction ( Fig. 4 ).

Figure 4. Localization and direction of the spiral fracture line depending on the type of rotation: I, II, III – radius, ulna, humerus, respectively; Clockwise rotation – front (A) and back ( B) views; counterclockwise rotation – front ( C) and back ( D)

Thus, if you look at the spiral fracture line directly from the side of its localization, then the direction of this line when rotating the upper epiphysis clockwise will always be oriented from bottom to top. On the contrary, in the case of rotation in the opposite direction, the break line runs from top to bottom.

Based on the data of the study, it is theoretically possible to imagine the morphology of the SPDTC in the opposite situation, that is, when the lower end of the bone rotates while the upper end is fixed.

In this case, the conclusion remains that the line of the primary rupture of bone tissue always runs from left to right along the anterior or posterior surfaces of the bone. At the same time, the movement of this line in the vertical direction, determined by the nature of rotation (clockwise or counterclockwise), will be exactly the opposite of what is described, namely: when the free lower epiphysis rotates clockwise, the line goes from top to bottom, counterclockwise – from bottom to top ( Table 2 ).

Table 2.

Localization and direction of the spiral fracture line depending on the type of rotation

Conclusion

The study of the morphology of the SPDTC depending on the direction of rotation of the free epiphysis revealed clear patterns.

The revealed patterns of localization and direction of the helical part of the SPDTC generally confirm the correctness of the method for determining the course of rotation of the free end of the bone, proposed by V.E. Yankovsky (1974) [5]. However, in my opinion, the new approach to this issue is very convenient in practical terms and allows us to quite accurately resolve expert questions regarding the mechanism of injury and clarify the circumstances of the incident.

References: 1. Kryukov V.N. Mechanics and morphology of fractures. – M., Medicine, 1986. – 160 p. 2. Pigolkin Yu.I., Dubrovin I.A., Leonov S.V. Blunt object trauma // Forensic medicine and forensic medical examination: national guidance / ed. Yu.I. Pigolkina. – M.: “GEOTAR-Media”, 2014. – Ch. 4. – pp. 70–99. 3. Tagaev N.N. Forensic medicine: textbook / edited by. ed. A.M. Bandurkas. – Kharkov: Fakt, 2003. – 1267 p. 4. Yankovsky V.E. Topography of stresses and the mechanism of fractures of the tibia bones in some types of deformations // Questions of morphology and pathology of supporting tissues: scientific materials. conf. Altai State honey. Institute. – Barnaul, 1972. – pp. 37–38. 5. Yankovsky V.E. Materials on the biomechanical features of long tubular bones of the lower extremities (substantiation of forensic medical criteria for the examination of injuries): dis. ...Dr. med. Sci. – M., 1974. – 367 p. 6. Salminen S. Femoral shaft fractures in adults: epidemiology, fracture patterns, nonunions, and fatigue fractures. A clinical study: acad. dis. – Helsinki: University of Helsinki, 2005. – 145 p. 7. Adult tibial shaft fractures – different patterns, various treatments and complications / F. Madadi, A. Eajazi, F. Madadi [et al.] // Med. Sci. Monit. – 2011. – Vol. 17, N 11. – P. CR640–CR645. doi: 10.12659/MSM.882049 8. Kryukov V.N. Fundamentals of mechano- and morphogenesis of fractures. – M.: Folium, 1995. – 232 p. 9. Huizen J. What is a spiral fracture? Causes and treatment. – Last reviewed: 30 Aug. 2021. – Available: https://www.medicalnewstoday.com/articles/319174.php (date of circulation: 06/10/2018). 10. Tibial fractures in alpine skiing and snowboarding in Finland: a retrospective study on fracture types and mechanisms of injury in 363 patients / A. Stenroos, H. Pakarinen, J. Jalkanen // Scand. J. Surg. – 2021. – Vol. 105, N 3. – P. 191–196. doi: 10.1177/1457496915607410 11. Yakunin S.A., Leonov S.V. Automotive injury // Forensic medicine and forensic medical examination: national guidance / ed. Yu.I. Pigolkina. – M.: “GEOTAR-Media”, 2014. – Ch. 7. – pp. 148–185. 12. Deryagin G.B., Agafonov V.V. Ground transport injury: educational method. allowance. – M.: MosU Ministry of Internal Affairs of Russia, 2008. – 91 p. 13. Solokhin A.A. Forensic medical examination in cases of motor vehicle injury. – M.: Medicine, 1968. – 236 p. 14. Yankovsky V.E. Some features of the formation of fractures // Mater. VI All-Russian congress court. doctors – M. – Tyumen, 2005. – P. 312–313. 15. Damage caused by unarmed people and animals / S.V. Leonov, I.A. Dubrovin, I.A. Tolmachev [and others]. – Forensic medicine and forensic medical examination: national guidance / ed. Yu.I. Pigolkina. – M.: “GEOTAR-Media”, 2014. – Chapter 5. – P. 100–128. 16. Böstman O. Morphological observations of torsional fractures of the adult tibial shaft // Acta Orthop. Scand. – 1983. – Vol. 54, N 4. – P. 627–633. doi: 10.3109/17453678308992901 17. Forensic medicine and forensic medical examination: national guide / ed. Yu.I. Pigolkina. – M.: “GEOTAR-Media”, 2014. – 728 p.

Diagnosis of fibula fracture

People with a leg injury should see a doctor for a diagnosis. During the diagnostic process the following is carried out:

1. Physical examination
   - the doctor will look for any noticeable deformities;
2. X-ray
   - used to detect a fracture or displacement of a bone;
3. Magnetic resonance imaging
   (
   MRI
   ) - provides a more detailed scan and can produce detailed pictures of internal bones and soft tissues;
4. Computed tomography
   (
   CT
   ) and other tests may be performed to make an accurate diagnosis and assess the severity of a fibular fracture.

Ilizarov apparatus

The Ilizarov apparatus on the arm is often used. Usually it is set for a fairly long period, the duration of which is determined by the doctor. The device is attached using knitting needles that are passed through holes in the bone. The patient is under anesthesia. The knitting needles are crossed at an angle of 90 degrees and fixed on the ring. The required length is marked with nuts. Subsequently, the doctor adjusts the desired length. With the help of the Ilizarov apparatus, the parts of the bone fit tightly to each other. This device does not allow them to diverge, since it fixes the fragments.

Open fracture of the fibula (compound fracture)

In an open fracture, part of the bone passes through the skin and comes out. Open fractures are often the result of severe trauma or a direct blow, such as a fall or auto accident. This type of fracture is often accompanied by additional injuries. Some injuries can be potentially life-threatening.

Open fibula fractures should be treated immediately. Patients are given antibiotics to prevent infection. The wound is thoroughly cleaned and internal fixation with a plate and screws is used to stabilize the fracture. A bone graft is used to speed up healing.

Symptoms and classification of helical fractures

Conventionally, all helical fractures are divided into several types.

According to the etiology of damage, there are:

• Traumatic. These are damages that occur as a result of exposure to external factors.
• Pathological. These are damages that occur due to the influence of other pathological factors. This could be the development of tuberculosis or oncology. Also, these damages appear due to the influence of external factors.

Depending on the severity of the bone damage, the injuries are:

1. Incomplete. This is the appearance of a crack or break at the site of damage.
2. Full.

Moreover, such damage occurs:

• Damage without displacement of bone fragments. They usually appear in children. It is their bone tissue that is not yet sufficiently developed.
• Damage with displacement of bone fragments. In this case, the bone fragments move far away from each other. They also change the axis of the bone.

According to the type of shape and direction of damage there are:

• Transverse.
• Oblique.
• Longitudinal.
• Helical.
• Ringed.
• Wedge-shaped.

Damages can also be compression or impacted.

With a compression fracture, the bone fragments become very small. Therefore, there is no clear fracture line. With an impacted fracture, one part of the bone slowly penetrates into the other.

There are also damages:

• Open. This is damage in which the integrity of the skin and communication with the external environment are disrupted. Moreover, it can be firearm or non-firearm.
• Closed. This is an injury in which the skin is not broken.

There are also damages:

• Combined. In this case, the victim not only develops a fracture, but also the integrity of the internal organs and the skull is compromised.
• Combined. With such a fracture, the integrity of the bone tissue in one area is disrupted.

Closed fracture (simple fracture)

With a closed fracture, the skin remains intact. The goal of treating closed fractures is to realign the bone fragments, control pain, allow time for the fracture to heal, prevent complications, and restore normal function of the leg. Ice is used to relieve pain and reduce swelling. The leg should be in an elevated position.

If surgery is not required, a brace or cast is used, and crutches are recommended when walking. After fusion, it is necessary to strengthen the weakened joints with the help of physical therapy.

First aid for a helical fracture

Before the ambulance arrives or the victim is transported to the emergency room, relatives can help him.

Initially, they should give the victim a medicine with an analgesic effect.

They must then immobilize the damaged area. This can be done using a splint or other available means.

Remember: all actions must be performed carefully. The victim must not be harmed.

And if a person has received an open fracture, then it is important to first remove the damaged parts of the bone, clean the wound, and apply a bandage. In case of severe bleeding, apply a tourniquet.

Remember: if the patient is in shock, he is given anti-shock therapy. It will help bring the patient to his senses.

Do not forget that only specialists can make an accurate diagnosis.

Prevention of recurrent fibula fracture

To prevent future fibula fractures, athletes should wear appropriate safety equipment.

To reduce the risk of fracture, you must:

• Wear suitable shoes;
• Follow a diet rich in calcium products, such as milk, yogurt, cheese;
• Do exercises to strengthen your bones;
• A fibula fracture usually resolves without further problems, but complications may occur:
• Degenerative or traumatic arthritis;
• Abnormal deformities or dysfunction of the ankle joint;
• Constant pain;
• Damage to the nerve and blood vessels around the ankle joint;
• Chronic swelling of the limb.

Most fibular fractures do not have any serious complications. Within a few weeks to several months, most patients recover completely and can continue their normal activities.

Rehabilitation

It takes approximately four months to fully recover from a helical leg fracture. In case of comminuted fractures, complications or combined injuries, the rehabilitation period can take even longer - up to six months. In order for a person to regain all the abilities of the bones after damage, certain procedures are used in medicine, which include:

• rubbing and therapeutic massage;
• resumption of limb movements in the early stages of the rehabilitation period;
• physiotherapy;
• physiotherapy necessary for the prevention of the degenerative process and liberation of movements;
• limiting physical activity;
• dieting.

This type of injury is quite difficult to treat, which is why the rehabilitation period after it is longer than after simpler limb injuries.

We have given a detailed description of a helical fracture.

How is shock wave therapy performed to treat delayed fracture consolidation?

In case of delayed consolidation of the fracture (non-union of the bone), the procedure is performed once every 7-10 days. At the Avatage Medical Center, doctors use special attachments that stimulate the formation of callus (stimulate osteogenesis). The impact is applied to the fracture area. Doctors at the Avatage Medical Center use their own patented methods for treating and preventing delayed fracture consolidation, based on the use of Storz Medical equipment. As the famous scientist Professor G. Ilizarov said: “Tensile tension is a powerful factor that activates tissue growth. According to this pattern, it is possible to stimulate the formation of new structural units of fibrous tissue, blood vessels, skin, and bones.” Taking this into account, we force muscles to contract and stretch using biomechanical stimulation (directed local vibration therapy), which trains the muscles and makes them work without making movements. This effect complements shock wave therapy and accelerates the process of bone healing.