Evolution of Technology

Anatomic Distal Fibula Plate

There are many ways to surgically repair a fracture of the distal fibula. One such technique is to utilize an anatomic distal fibula plate to hold the correct aligned or reduced fracture fragments in place. These plates are anatomically contoured to specifically fit to the natural or native alignment of the distal fibula.

The plates are most commonly applied to the outer surface of the fibula bone and are fixed to the bone using screws. This commonly used construct allows for anatomic reduction of the fracture portion of the fibula as well as allowing for a variety of options with regard to type and size of screw, plate length, and fracture location.

Evolution of Procedure

Open Reduction Internal Fixation of the Distal Fibula

The procedure that is most commonly performed for unstable fractures of the lateral malleolus, also known as the distal fibula, is open reduction and internal fixation of the distal fibula. The surgery is performed through either a direct lateral incision which is on the outside of the ankle directly overlying the bone, or through a posterior lateral incision which is slightly behind the fibula bone on the outside of the ankle. The fracture site, or broken portion of the bone, is then identified and any damaged portion of it or the surrounding tissue that cannot be repaired is removed. The ends of the bone are then aligned and held in place with either clamps or removable wires and intra-operative X-ray or fluoroscopy is utilized to make sure that the bone is appropriately aligned. The fracture reduction and alignment is then permanently held in place using plates and screws which are left in place permanently unless they cause symptoms. Following surgery patients will often be left in a splint to the foot and ankle for 2-4 weeks to allow for the bone to heal and the soft tissue to rest. Patients will most commonly follow-up with their surgeon at 2 weeks following surgery to have their sutures of staples removed and then again at 6 weeks for X-rays to assess for fracture healing. The patient will not be allowed to walk on the ankle until post-operative X-rays demonstrate full bone healing which commonly occurs at 6-8 weeks following surgery.

Evolution of Diagnosis

Distal Fibula Fracture

Fracture of the distal fibula (lateral malleolus) occur commonly due to inversion or twisting in jury to the ankle. The fibula is the small bone on the outside or lateral aspect of the lower leg and spans from the knee joint to the ankle. The distal portion (part closest to the ankle) comprises the lateral malleolus which is the lateral buttress or restraint to the ankle joint. The lateral malleolus can be felt as the bony prominence at the outside of the ankle and along with the medial malleolus (bony prominence at the inside of the ankle) provides bony support and stability to the ankle joint. Fracture of the lateral malleolus are common ankle fracture which can often be treated without surgery in either a splint or a cast following closed reduction. If the injury appears unstable on x-ray imaging, then the fracture requires surgery to re-establish ankle stability.