Fibular fractures are usually associated with a complex
injury, however they can be an isolated fracture. Complex injuries where a
fibula fracture can occur include: fracture of the fibula and tibia, ankle
fracture, pilon fracture, and Maisonneuve fractures.
Maisonneuve fractures
involve a fracture of the proximal fibula associated with an occult injury of
the ankle. Isolated fibular fractures are rare and usually the result of direct
trauma. The fibula carries about 15% of the axial load and is the site of
muscle attachment for the peroneus muscles and the flexor hallucis longus
muscle. Check the patient who has a fibular fracture and no other fracture
involving the tibia to rule out a possible Maisonneuve fracture, especially if
there is no history of direct trauma to the leg. A high index of suspicion is
necessary to diagnose and treat this injury. For high fibular fractures, the
physician should look for signs of syndesmotic injury. Syndesmotic injury may
include an unexplained increase in the medial clear space or the tibiofibular
clear space is widened (should be less than 5mm). The x-ray will show the
fracture to be rotational or oblique. Maisonneuve fractures require surgery to
fix the syndesmosis. 
Treatment will consist of reduction and fixation. It is
important to determine if the injury is a Maisonneuve fracture or an isolated
fibular fracture. An isolated fibular fracture will not need surgery.
