Elderly females often have osteoporosis leading to weakening of the bone whereas young males often have very strong ligaments. The highest prevalence of fibular avulsion fractures occurs in elderly females and young adult males. Typically, the avulsed fragment of bone is small and does not enter the ankle joint as it is still attached to the ligament that pulled it off the bone. As a result, the ligaments tear or in some instances a section of the ligament may stay intake and pull off (avulse) a small piece of bone from the end of the fibula. The sudden inward rolling (inversion) of the ankle places excessive strain on the outer ankle ligaments attaching the fibula to various bones in the ankle (talus and calcaneus). The injury is essentially a moderate-severe ankle sprain except that instead of only tearing the outer (lateral) ankle ligaments a small fragment of the prominent outer ankle bone (fibula) is pulled off (avulsed) by the attached ligament. Clinical Presentationįibular avulsion fractures are usually the result of an acute inversion injury to the ankle. Although a fibular avulsion fracture is technically an “ankle fracture” the injury is essentially the equivalent of a moderate-severe ankle sprain and should not be mistaken for a more severe ankle fracture which often does require surgery. The fracture is treated by immobilizing the ankle with a boot or ankle brace with gradual reintroduction of weight bearing over a period of weeks. The diagnosis is made by x-raying the ankle. The injury produces pain, tenderness, and swelling of the ankle making weight-bearing difficult or impossible. Fibular avulsion fractures most commonly occur from an inversion of the ankle that causes the ankle ligaments to pull a small piece of bone off of the end of the fibula.
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