A Rare Case of Traumatic Bilateral Fibular Head Fractures

Abstract

Avulsion fibular head fractures are rare. There is only one reference of bilateral fibular fractures after epileptic seizure. We aim to present the mechanism and the treatment of this rare injury. We present the case of a 30-year-old woman who was hit by a car on the anteromedial side of both knees. Clinical and radiographic control showed bilateral fibular head fractures. Knee instability was not found at both knees and MRI did not show any concomitant ligament ruptures. Bone bruises of both medial condyles found in MRI explain the mechanism of this injury. The patient was treated conservatively with functional knee braces for 6 weeks allowing full range of motion, but otherwise mobilised as normal without any support. Six weeks after the trauma, there were no symptoms while the fractures sites had united completely after 6 months. One year postinjury the patient was free from symptoms.

Bilateral Avulsion Fracture of the Fibula Head of the Knee Associated with Avulsion Fracture of the Iliotibial Band: A Rare Case of Fracture Segond Associated with Arcuate Fracture

“…In our case, the injury mechanism was similar with an anterior to posterior force on the anteromedial face of the knees, creating varus forces and internal rotation bilaterally associated with hyperextension caused by being run over by a car. This trauma was similar to a case report of bilateral avulsion fracture of the fibular head, but without a Segond fracture [1]. The other case reported in the literature with the same fracture pattern was due to seizure [22].…”

“…In a retrospective study of 2318 knee injuries, only 13 had suffered this injury (0.6%) [21]. Bilateral traumatic fractures of the fibular head have only been described in two cases: a young woman victim of being hit by a car [1]. The second case was a patient who suffered a seizure which led to an avulsion fracture of both fibular heads due to forced contraction of the femoral biceps [22].…”

“…The ALL is another important structure and has received more attention due to the redefinition of the knee's anterolateral anatomy. According to Huang, the "arcuate" sign is used to describe an avulsed bone fragment with a close relation to the insertion of the arcuate complex, which consists of the fabellofibular, popliteofibular, and arcuate ligaments, usually in the styloid process of the fibular head [1,21]. In that same study, no rupture of the tendon of the biceps femoris muscle was found as well as no evidence of avulsed bone fragment included the origin of the lateral collateral ligament (LCL) nor the biceps femoris tendon.…”

“…The first case described in the literature of bilateral avulsion fracture of the fibular head was treated nonsurgically without immobilization and with early range of motion allowed, with good results [21]. The other case described, on the other hand, was treated nonsurgically with immobilization by a functional brace, allowing a range of motion, progressing to weight-bearing after the disappearance of pain symptoms and bone bruises [1]. In their report, Harhaji et al described an isolated case of avulsion fracture of the fibular head with a comminuted fracture pattern which was fixed with a metal wire [2].…”

Isolated avulsion fracture of the fibular head

“…According to the literature, avulsion of the head of the fibula is described as a possible indicator of posterolateral instability of the knee mostly associated with other knee structure injuries 14 . These injuries can occur when anteromedial region of the tibia sustains direct hit while the knee is fully extended 15 .…”