Fibular Injury (Proximal)

Abstract

Injuries to the proximal fibula are uncommon; as such, the proximal fibula is often overlooked in patients presenting with knee injuries. The proximal fibula serves a critical role in knee stability and function by providing attachment sites for multiple knee-stabilizing ligaments, muscles, and tendons. Injury to the proximal fibula may consist of proximal tibiofibular joint (PTFJ) chronic recurrent subluxation, acute PTFJ dislocation, acute fracture, or bone stress injury. The common fibular nerve, due to its proximity to the fibular neck, may be compromised in association with these injuries. Proximal fibula fractures are also seen in the setting of unstable ankle injuries, known as Maisonneuve fractures. Evaluation of proximal fibular injuries should include assessing the mechanism of injury, symptoms of instability, the strength and range of motion at the knee and ankle, and sensory function throughout the lower leg, ankle, and foot. Imaging should begin with plain films of the knee or tibia–fibula and proceed with advanced imaging, when needed to guide management and plain films are inconclusive. Nondisplaced proximal fibular fractures generally heal uneventfully following a 3- to 4-week period of immobilization with early return to weight bearing, while more complicated (comminuted, both bones, or with an unstable ankle injury) fractures or dislocations require referral to orthopedic surgery.