Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Stress Fracture of Fibula

SYMPTOMS

Gradual onset of localised exercise induced pain on fibula. This injury is common in young athletes but less common than tibia stress fractures. It typically occurs as a result of sudden changes in training habits, such as increase in intensity or amount of impact.

AETIOLOGY

This stress fracture is caused by excessive jumping or running exercises where rotation pivoting landings are involved.

CLINICAL FINDINGS

There is localised tenderness on palpation and swelling over the fracture site. Pain can be provoked by repetitive jumping on the forefoot on hard ground.

INVESTIGATIONS

X-ray is normal until callus formation has started or fracture displaces. MRI will show sub-cortical oedema at the fracture site but can often not identify the line of the stress fracture. CT scans usually show the fracture line better.

TREATMENT

This injury most often responds to conservative treatment including modification of training over three months when the fracture is healed. There is seldom an indication for immobilisation or surgery. An ankle brace, reducing the rotation of the ankle, will reduce the symptoms.

REFERRALS

Refer to physiotherapist for planning of a three months’ return programme back to sport. Note the errors in training that could have caused the injury and do not repeat.

EXERCISE PRESCRIPTION

Cycling and swimming are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Bone tumour (X-ray will differentiate).

PROGNOSIS

Excellent.

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