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Closed Fracture of Tibula and Fibula

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My son broke his tibula and fibula playing football. The surgeon used a screw to hold the tibula in place. The X ray showed the fibula was still not aligned correctly. When I asked about it. The surgeon said "oh that's not important. the Tibula takes all the weight". Is this correct or should the fibula have been realigned as well?
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replied November 6th, 2011
Especially eHealthy
Damo57,

Yes, it is usual practice to not fix the fibula. The tibia is the main weight bearing bone in the leg. In fact, a piece of the fibula can be taken out and used as a vascularized bone graft, somewhere else in the body. Thus, in the midshaft it is considered an expendable bone.

The fibular almost invariably heals without intervention. Thus, it is left to its own devices. If, in the very rare case, there is a problem with the fibula, it can be addressed at a later date. But, again, it is very rare for the fibula to not heal.

And, if does not have to have a perfectly straight, end to end, alignment. As long as the ends are touching, it will heal and remodel, with time.


Hope your son is doing well. He has a long road of healing and rehabilitation ahead of him. Good luck.
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replied November 25th, 2011
Broken fibula - aligned but not healed, how long until it closes
Hi Gaelic, I have a similar question, although only my fibula is broken.

I broke the fibula and ruptured my deltoid ligament 9 weeks ago. I had ORIF surgery on my ankle 7 weeks ago, and all is going well - I am weight-bearing and getting around the house without crutches and boot-cast, although I am still using both outdoors since I don't feel confident enough on slippery ground.

I am re-assured by your response above, since an x-ray taken last week showed that my fibula had not healed, even though it was aligned. I was told that this didn't matter, for the same reasons as you already mentioned. The question I only thought of later is this: what happens if I get an impact right on the location of the break before it has healed? Will is knock the two parts of the fibula out of alignment?

Ultimately, I would like an idea of how long before my fibula is healed, although I expect this varies widely for different people.

Thanks in advance for any response,
James
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replied November 25th, 2011
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James,

Your injury is much different from the one that the original poster presented. In the original post, the patient had a midshaft tib-fib fracture, not involving the ankle joint.

Your injury sounds like a bimalleolar equivalent fracture. Instead of breaking the medial malleolus, you tore the deltoid ligament, which biomechanically is the same thing. You have disrupted both sides of the ankle joint, by tearing the deltoid ligament on the medial side and breaking the fibula on the lateral side.

So, your injury is different.

The distal fibula still usually heals without problems. I assume you had a plate placed on the fibula in the ORIF (open reduction and internal fixation). The deltoid is repaired if the joint remains unstable after fixing the fibula. So, some patients have the deltoid repaired and others do not.

When the fibula is plated, that can actually slow down abundant callus formation (the bone that heals fractures). So, the fracture line may stay apparent for some time. But, there is osteoid in the fracture, under the plate. Osteoid is the matrix that is laid down first in broken bones, to make them "sticky". Then later, the body puts calcium in the osteiod to make it callus. So, it does often take time for the callus to become apparent in plated fractures.


If you were to sustain a hard direct blow to the ankle or have a sufficient twisting mechanism, you could break the plate or pull the screws out of the bone. Then, of course, the bone ends would usually displace. The plate usually used on fibula fractures is a one third tubular plate, that can be bent using just your hands. So, it is only there to hold the bone ends together until the bone heals. It can take some stress, but not a great amount.

But, it sounds like you are doing okay. Otherwise, you would not be allowed to weight bear without your crutches or fracture brace.


At this time, the important thing is to be working on your ankle range of motion. Once ROM is obtained then strengthening exercises are started. One of the hardest things to regain after a significant ankle injury is proprioception (balance, agility). So, if you can, be sure to work on proprioception.


Good luck. Sounds like you are doing well.
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replied November 26th, 2011
Healing time for fractured fibula - aligned but not plated
Hi Gaelic, wow that was a thorough response, many thanks. I feel I am making pretty good progress with my ROM and mobility generally, thanks to my great physiotherapist.

The reason I posted on this thread was because your original response discussed the healing of the fibula.

I had a High Weber C fracture, plus ruptured deltoid ligament. The operation inserted 2 pins through the low part of the fibula into the tibia, plus the deltoid ligament was repaired. I hope you can see this x-ray http://tinyurl.com/d8ette5

The fracture of the fibula is out-of-shot above the top of x-ray, and I did NOT have a plate inserted over it - it was judged to be not necessary, nor justifying the increased trauma. Hence my question about the duration of the healing process.

My last x-ray a week ago showed that the fibula was aligned, but did not yet show signs of healing.

I will be able to ask my excellent physiotherapist next week about my concern about receiving an impact right on the location of the break. But in the meantime, I would value your opinion - as I am sure would other readers who stumble upon this excellent forum in future.

James
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replied October 3rd, 2012
I broke my tibia and fibula aug 2 2012. Surgery and a plate with 9 screws. I had cast on for 7 weeks and now im in a boot for 4 more weeks all non weigth bearing. I can take the boot off for 15 minutes each day to try to stretch my foot. I know im going to have to do P/T after im able to put weigth on my foot. How long will it take for my foot to have full motion? Im just hoping everything works out because i dont have a desk job and need my leg to be 100%.
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replied October 3rd, 2012
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BudsBreak,

Evey patient is different. The majority of the time it takes about 6-8 weeks to return to "regular" activity. Heavy manual labor and athletics usually takes a longer amount of time.

Also, the more dedicated and harder you work at therapy, usually the better the results. So, a lot of it is up to you.

Good luck.
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replied October 3rd, 2012
Thanks,
That gives me a time line. I know i have a lot of rehab to do, as long as my leg and foot have full motion it will be worth time and work. Rigth now that is hard to see.
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replied October 4th, 2012
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BudsBreak,

Remember, that is the time for rehab, the bone has to unite first. And, some patients take much longer than the couple of months after bone healing. It is not too uncommon for a few patients to take as long as a year to 18 months to achieve full recovery. It also depends upon the type of tib-fib fracture you had and how much soft tissues damage there was.

Again, if all the tissues have healed up okay, then you could do it in a couple a months with dedicated therapy after bony union.

Good luck.
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replied January 22nd, 2014
Broken Fibula healing times and advice
I broke my fibula on Oct 1st 2013, and was discharged on the 31-12-13.

I walked around for ten days not realising or perhaps hoping it wasn't broken. But after several shades of purple feet - and driving I decided to go to the minor injuries unit.

They x-rayed and put me in plaster, the bone was broken at the bottom, after I lept for a shot and came down on the outside of my left foot playing Badminton.

from the messages above it seems to me that I was VERY lucky as I suffered no known ligament damage.

I played badminton on the 14th of January (walking) and a week later played again with a little more of the odl self coming back - even a couple of jumps.

You guys are so right with recovery and nervousness, since I am actually so nervous of further damage that even tiny pain gets me to reduce pressure on that foot while trying to run, and that actually puts me at more risk of other damage, I am taking it steady but we are upto 14 weeks and really I need to start (with small amounts) Jogging to restore my natural running pattern.

I swear that foot is slightly longer than the other.

I still get pain, particularly with temperature change and this may go on for another 6 months says the doctor.

I do think I was lucky, it wasn't set, no screws put in, natural healing - maybe cos where it broke.

Tony
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