Presentation and options in management of avulsion fracture fibular head: A prospective study of rare entity

Abstract

Introduction: Avulsion fracture of the fibular head is a rare entity. Significance of this entity is lies in association with injuries to the ligaments and neurovascular structures attached to it. Presentation of these injuries is quite variable. Management of this injury is still controversial in spite of various available fixation methods. We report various different presentation and options in management of this rarely reported injury. Material and method: A prospective, single centre study of six patients of fracture fibular head was presented with injury to knee joint. All were male with average age 31 years (range 19-44 years). Left knee joint was involved in the four and right was in the two patients. All cases were of sports injury. Final diagnosis was proved by X-ray, 3D CT and magnetic resonance imaging. Three cases among them had complete avulsion of fibular head, 3 cases had undisplaced fracture fibular head; among one case was complicated by fracture shaft tibia. Patients with complete avulsion were treated by open reduction and fixation by using various methods. Complications and outcome were recorded in follow-up for 6 to 24 months (mean 21 months). Results were evaluated using Lysholm knee scores. Results: The average Lysholm knee score was 91.33 points. Excellent result (score 95-100) was seen in 1 case, good results (score 84-94) were seen in 3 cases and fair result (score 65-83) was seen in 1 case. The excellent and good result was 83%. Conclusions: Our study shows that avulsion of fibular head can present from undisplaced fragment to complete avulsion with grade I to III ligamentous injury or/and with peroneal nerve injury. These injuries can manage with various treatment options from conservative to fixation of avulsed fragment by various devices, depending on severity and combined injury.

Single-Stage Arthroscopy-Assisted Reduction and Internal Fixation (ARIF) of Tibial Rim Fracture With Posterior Cruciate Ligament Reconstruction and Repair of Posterolateral Complex and Meniscal Injury

“… 17 We used a lateral incision with sufficient skin bridge from the anteromedial incision to fix the arcuate fragment of the fibular head to avoid skin necrosis. Although numerous fixation options exist, 18 a cannulated screw with a static tension band wiring at 90° flexion provides a robust fixation for this avulsion fracture .…”