Classic history and presentation: Presentation of proximal fibula fractures varies based on the severity of the trauma and presence of associated ligament and neurovascular injuries. Typically, proximal fibula fracture presents with local edema and tenderness on palpation of the lateral leg over the proximal fibula and can sometimes result in antalgic gait and discoloration and deformity of the lateral leg.
Depending on the associated injuries, these fractures may also present with:
- Knee instability due to ligament damage
- Avulsion of the lateral collateral ligament (LCL)
- Weakness (eg, foot drop) and sensory issues distal to the injury due to peroneal nerve damage
- Pain over the medial malleolus suggestive of a Maisonneuve fracture
- Age – This is usually seen in athletes younger than 25 years and individuals with decreased bone density who are older than 50 years.
- Sex / gender – This most commonly affects young male athletes and postmenopausal women.
Pathophysiology: This is typically a direct injury to the proximal fibula. There can alternatively be a twisting injury to the ankle that transmits through the interosseus membrane where the force exits through the proximal fibula. There can also be an association with a multiligamentous knee injury in which there is a high amount of energy transmitted to the knee through a motor vehicle accident, direct trauma, or a twisting injury.