Sunday, December 25, 2016
Fractured fibula for Marcus Mariota.
Broken fibula for Derek Carr.
Words matter when it comes to medicine. Patients and their families potentially can get confused when different terms are used to describe the same situation. This is especially true when reporters, people who write for a living, use interchangeable words and readers might presume one injury is worse than another. With the above tweet, ESPN’s Mr. Schefter sows those seeds of confusion.
Fracture, broken and cracked all mean the same thing…the integrity of a bone has been disrupted. One term does not imply a more serious injury. You can’t be a little bit broken, fractured or cracked. However, fractures may be more or less serious than others. Some need surgery while some, with time can heal on their own.
It is important to know that the fibula is a strut bone in the shin that runs from the knee to the ankle. While it is an important structure, it is not part of the bones that make up the knee joint (femur and tibia) or the two that make up the ankle joint (tibia and talus).Fibula fractrues are often associated with tibia fractures but isolated injuries to the fibula do occur. When they do, the fractures are not all treated the same. For the isolated fibula injury, it’s like real estate; it’s all about location.
Fibular head fractures usually occur because of a direct blow or a twisting injury and non-displaced fractures are often treated with supportive care: weight bearing as tolerated, ice and pain medications. Fractures that are displaced, meaning that the two ends don’t align well, may need an orthopedic specialist to consider surgery. The big deal with this injury is the peroneal nerve. It wraps around the fibular head and if it is damaged, the muscles it controls can stop working, leading to foot drop.
Mid-shaft fibular fractures are relatively uncommon, but are usually due to a direct blow. Unless the bone is shattered or significantly displaced (not aligned), the treatment is time.
The distal fibula has a bony protuberance or bulge that is called the lateral malleolus. Ligaments that attach to it help stabilize the ankle. Fractures of the lateral malleolus or the distal part of the fibula may need surgery to maintain ankle stability.
The big thing to remember about fibula fractures has to do with anatomy. The tibia, fibula, knee and ankle form a ring. If there is a twisting injury, there are usually two injuries to be found because it’s hard to twist a ring and break it in only one place. Think of twisting a pretzel and snapping only one curve. For the certified athletic trainer on the field or the doctor in the ER or office, finding an isolated fibula fracture leads to looking for another injury before accepting “just” one injury. And that second injury may be torn a ligament in the knee or ankle that may be more important than the obvious broken bone.
Based on news releases, Derek Carr’s broken fibula may be distal and it required surgery. The location of Marcus Mariota’s fracture hasn’t been released just yet. It’s a reminder that the word broken did not determine injury severity or the need for surgery. It was just a word.This entry was tagged Adam Schefter, broken, Derek Carr, fibula, fibular head, fracture, lateral maleolus, location, Marcus Mariota, midshaft, proximal