A Fracture That’s Rarely Alone

​"The guy with the ankle pain was brought back from x-ray. What is going on there?""A fibular fracture," my colleague said.I am always looking for radiographic images of orthopedic injuries. It is a passion. I believe that plain x-rays of bony injuries must be in the wheelhouse of an emergency physician. We tend to see them first, and we need to know what to look for and what to tell the patient to look for.With those words—a fibular fracture—time stopped. She had my full attention. I went to see the screen. "What do you mean a fibular fracture? Where?"My mind raced. It could just be a regular distal fibular fracture—a Weber A or B. Before I got to the computer, she said, "Midshaft."My eyes stopped on the oblique fracture at the distal third of the fibular, and then darted up and down searching for the other injury. Isolated fibular fractures rarely happen. The fibula is just not subjected to the same mechanism as the upper extremity's ulna. The leg does not ward off nightstick-type blows like the forearm. Torsion of the ankle is much, much more common.Midshaft, the tibia and fibula abide by the rule of the ring. If you try to break a ring by twisting, it will break at two places. If you see a break at one location, then another fracture location must be sought. I first looked at the proximal fibula to check for a Maisonneuve fracture. It is uncommon for the two breaks to occur on the fibula but not impossible. It was OK."D...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs