Most fractures often occur in conjunction with fractures of the upper tibia or tibial shaft. However, direct force can cause fractures of the fibular head or cervical vertebrae. The fracture line may be oblique or transverse. Displacement of the fracture ends is relatively uncommon.

bubble_chart Clinical Manifestations

There is a history of direct external force injury to the lateral side of the lower leg, with pain, swelling, and tenderness. Although the patient can walk without crutches, pain occurs when bearing weight. Tenderness is present at the soft tissue contusion fracture site. However, if compression of the tibia and fibula at the mid-calf or fixed rotation of the foot in a flexed knee position causes pain at the injury site, a proximal fibular fracture may be present. Additionally, pain may be elicited when the affected limb resists knee flexion due to the attachment of the biceps femoris muscle to the fibular head.

bubble_chart Treatment Measures

Due to minimal displacement, reduction is often unnecessary. Many patients require no specific treatment. Even when walking with crutches without bearing weight on the affected limb, pain is not induced. For patients with more severe pain, a long-leg Gypsum cast can be applied with the knee in full extension for 4 weeks. The Gypsum should extend from the mid-thigh to the big toe and be well-molded around the knee. After 4 weeks, the Gypsum is removed, and the patient is allowed to walk after 6 weeks.

In cases of proximal fibular fracture, attention should be paid to potential injury of the common peroneal nerve. In some patients, the nerve may suffer from contusion or compression, while in others, it may become trapped within the callus, leading to gradually developing paralysis weeks after the injury. The affected foot should be positioned in dorsiflexion to relax the peroneal muscles, tibialis anterior, and extensor muscles. If no recovery is observed after 2 months, surgical exploration of the nerve should be performed, with suturing or decompression as needed. In rare cases of fibular head fracture where the proximal fragment attached to the biceps femoris is displaced upward and backward, the knee should be flexed to reposition the fragment. If X-ray confirms persistent displacement, surgical fixation of the fragment to its normal position is required. Postoperatively, the knee should be immobilized in a Gypsum cast at grade II flexion.