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Abstract: Direct violence is a relatively common cause of fibula fracture, which mainly occurs during traffic accidents or strenuous sports, and can be divided into superior fibula fracture, distal fibula fracture and middle fibula fracture. In this case, the patient suffered a fracture of the fibula due to an impact during sports, and the fracture of the middle and lower fibula was confirmed by an outpatient X-ray.
Basic information】Male, 45 years old
Type of disease】Fracture of the fibula
Hospital】Harbin First Hospital
Date of consultation】May 2021
Treatment plan]: Incisional internal fixation surgery + elevation of the affected limb + ankle pump exercises + ice packs
Treatment Period】7 days of hospitalization and 1 month of outpatient follow-up
Results】Fracture repositioning and fixation, pain relief
I. Initial consultation
The patient, Mr. Cui, came to our hospital because he felt pain in his calf after a serious violent injury caused by direct impact with another person while playing soccer. After inquiring about the patient’s activity status before the pain, as well as X-ray and CT examinations, it was initially determined that the patient had a fracture of the middle and lower fibula due to excessive stress on the fibula, and had a misalignment of the fracture end and a spiral fracture of the distal tibiofibular joint, which was less stable. Due to the poor stability of the patient, the patient and his family were informed that if conservative treatment, such as plaster fixation or splinting, was used, it would be difficult to ensure the stability of the fracture end and the fracture would be prone to delayed healing, non-healing, or even deformed healing. In order to ensure the smooth healing of the fracture, and at the same time to restore the ankle joint movement as soon as possible and avoid the stiffness of the ankle joint, surgical treatment is recommended to restore the stability of the fracture end by internal fixation with incision and repositioning titanium plate screws. In addition, the distal tibiofibular joint should be repositioned and fixed at the same time to ensure normal clearance and stability of the ankle cavity during the surgery. The patient and his family readily agreed, so the patient was admitted to the hospital and prepared for surgery.
II. Treatment process
After further examination, the patient was diagnosed to have a spiral fracture of the middle and lower fibula with poor stability of the fracture end, and the fracture end would soon be re-displaced after manipulation. During surgery, a fracture repositioning forceps was used for temporary fixation to maintain the relative stability of the fracture end, and a titanium plate screw was placed on the lateral side of the fibula for final fixation, while the distal tibiofibular joint was confirmed to be separated and fixed with screws at the same time. After fluoroscopy, the fracture end repositioning, screw length and ankle cavity clearance were confirmed to be as expected, the surgical incision was closed and drainage strips were placed to drain the fracture. After surgery, the patient was instructed to use a brace for temporary immobilization and to keep the affected limb elevated to eliminate swelling and relieve pain symptoms.
III. Treatment effect
The patient was discharged from the hospital after 7 days of hospitalization and was instructed to continue to keep the affected limb elevated and to perform ankle pump exercises in daily life to accelerate the repair of the fracture. One month after the operation, the patient came to the hospital for a follow-up X-ray examination and found that the fracture line was gradually blurred and the fracture end did not become dislocated again. The patient reported that he was able to turn in bed without restriction and could walk with the aid of a double crutch without weight-bearing on the affected limb.
IV. Notes
After a series of surgical treatment and postoperative recuperation, the patient’s swelling and pain were significantly relieved and the recovery of the fibula fracture was good. However, since the fibula fracture is not completely healed in a short period of time, the patient needs to pay attention to the protection of the soft tissues around the fracture in daily life to avoid local swelling that causes excessive tension and leads to osteofascial compartment syndrome, which in turn leads to adverse consequences, and the following conditions still need to be noted after discharge Situation.
1. patients need to apply cold packs with ice packs and continuously elevate the affected limb to eliminate swelling by using gravity.
2. Before complete healing, the fracture site should not be weight-bearing, otherwise the internal fixation may break and may even affect the normal healing of the fracture. Generally, after 6-8 weeks, the fibula fracture will gradually heal completely, and normal weight-bearing can be resumed after the review of X-ray film.
3. Before the internal fixation is removed, do not participate in strenuous exercise to prevent re-fracture.
V. Personal insight
In clinical practice, when a fibula fracture occurs, if the stability of the fracture end is good, it can be fixed with a cast or splint, but if it is less stable, surgery is usually considered to obtain better recovery results. Direct violent injury is a common risk factor for fibula fracture. In this case, the patient suffered a fibula fracture due to violent impact while playing soccer with another person, and the fracture end was too unstable to be treated conservatively, so the patient had to be treated by incision and internal fixation.
Thus, during daily strenuous sports, attention should be paid to protecting the fibula from direct violent impact with others, using calf pads for protection if necessary, and wearing good protective gear can effectively prevent physical injury. Once a fibula fracture occurs, patients should seek medical attention as soon as possible and apply cold compresses immediately to ensure that local swelling is controlled in a timely manner, which is beneficial to both the patient’s recovery and the later stages of treatment.