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Proximal fibula fracture

AC separation Biceps tendon rupture Clavicle fracture Humerus proximal fracture Rotator cuff tear Scapular fractures Shoulder dislocations SLAP tear Sternoclavicular dislocation

Compartment syndrome (anterior, lateral, deep - superficial posterior)Coronoid process fracture Elbow dislocations Epicondylar fracture Humeral shaft fracture Intercondylar and condylar region fracture Olecranon fracture Radial head fracture (Mason I-IV)Supracondylar fracture (pediatric and adult)Triceps tendon rupture

Carpal bones fractures Carpal dislocations and ligament injuries Distal radius and ulna fracture Fight bite (human bite over MCP)Finger dislocations by joint Finger open fractures - amputations Forearm fractures Hand and finger tendon and ligament injuries Hand tendon injuries Metacarpal fractures Nail bed injuries Phalangeal fractures Tuft fracture

Cervical spine fracture (C1-C7)Cord syndromes Sacrum and coccyx fracture Thoracic and lumbar spine fracture

Acetabular fractures Hip dislocations Pelvis fractures Proximal femur fractures

Distal femur fractures Femoral shaft fractures Knee dislocation Knee ligament injuries Patellar dislocation Patellar fracture Patellar tendon rupture Pes anserine bursitis Prepatellar bursitis Quadriceps tendon rupture Tibial plateau fracture Tibial spine fracture Tibial tubercle fracture

Achilles tendon rupture Fibular shaft fracture Proximal fibula fracture Stress fracture (tibia-fibula)Tibial and Fibular shaft fracture Tibial shaft fracture Toddler's fracture

Ankle dislocation Ankle fractures Ankle sprain Maisonneuve fracture (proximal fibula and syndesmosis)Peroneal tendon dislocation or tear Peroneal tendon tear or dislocation Subtalar dislocation Syndesmotic injury (high ankle sprain)

Calcaneus fracture Cuboid fracture Cuneiform fractures Dancer's fracture (5th MT spiral shaft)Jones fracture (5th MT base - metadiaphyseal junction)Lisfranc injury (tarsometatarsal dislocation)March fracture (metatarsal stress fracture)Metatarsal fractures (1st-5th)Navicular fracture Plantar fascia rupture Talus fracture Tibialis posterior tendon dysfunction Toe dislocations

Proximal fibula fracture

Clinical Assessment Checklist

Browse categories and answer follow-up questions to refine your symptom profile.

Approach to the Critical Patient

Immediate priorities

Immediate priorities

Limb threat screen

Rapidly worsening pain

Pain out of proportion

Progressive paresthesia

Cold or pale foot

Pulseless limb

Neurovascular baseline before immobilization

Dorsalis pedis pulse

Posterior tibial pulse

Capillary refill

Motor

Ankle dorsiflexion strength

Great toe extension strength

Foot eversion strength

Sensation

Dorsum of foot sensation

First web space sensation

If pulseless limb, immediate reduction of gross deformity and emergent orthopedics and vascular surgery

If compartment syndrome concern, emergent orthopedics

Open fracture pathway

Open fracture pathway

Skin breach near fracture site

Active bleeding from wound

Visible bone

Deep puncture with contamination

If open suspected, antibiotics and tetanus pathway before definitive splinting when feasible

If gross contamination, irrigation and sterile dressing

Immediate orthopedics consultation

Key associated injury rule outs

Associated injury rule outs

Maisonneuve pattern exclusion

Ankle pain or swelling

Medial ankle tenderness

Proximal fibula tenderness with ankle mechanism

Widened ankle mortise on imaging

Knee ligament injury exclusion

Varus instability concern

Lateral joint line tenderness

Effusion and instability after twisting injury

Common peroneal nerve injury exclusion

Foot drop pattern weakness

Sensory loss over dorsum of foot

If polytrauma, ATLS primary survey sequence

History

Mechanism and timeline

Mechanism and timeline

External rotation with planted foot

Ankle syndesmosis injury concern

Maisonneuve injury concern

Direct lateral blow to proximal leg

Isolated proximal fibula injury pattern

Twisting knee injury

LCL and posterolateral corner injury concern

High-energy mechanism

Multi-ligament knee injury concern

Peroneal nerve injury risk

Time since injury

Ability to bear weight after injury

Symptom mapping

Symptom mapping

Lateral proximal leg pain

Ankle pain

Medial ankle pain

Knee pain

Numbness or tingling

Weakness with dorsiflexion or toe extension

Risk factors and modifiers

Risk factors and modifiers

Anticoagulant or antiplatelet use

Prior ipsilateral fracture or hardware

Osteoporosis risk

Chronic steroid use

Diabetes and wound healing risk

Smoking or nicotine exposure

Physical Exam

General and regional exam

General and regional exam

Inspection

Deformity

Swelling distribution

Ecchymosis tracking to ankle

Skin tenting or blanching

Open wound

Palpation

Fibular head and neck tenderness

Proximal tibiofibular joint tenderness

Lateral joint line tenderness

Medial ankle tenderness

Syndesmosis tenderness

Joint above and below screen

Knee range of motion tolerance

Ankle range of motion tolerance

Neurovascular and nerve-specific

Neurovascular and nerve-specific

Vascular

Dorsalis pedis pulse symmetry

Posterior tibial pulse symmetry

Capillary refill

Common peroneal nerve function

Ankle dorsiflexion weakness

Great toe extension weakness

Foot eversion weakness

Sensory change over dorsum of foot

Sensory change in first web space

Documentation before and after immobilization

Knee stability screen

Knee stability screen

LCL integrity screen

Varus laxity at 30 degrees concern

Posterolateral corner concern

Varus hyperextension mechanism

Instability complaint

Effusion

PITFALLS

PITFALLS

Proximal fibula fracture with normal ankle pain report still possible Maisonneuve

Missed peroneal nerve deficit without explicit foot dorsiflexion and toe extension testing

Incomplete imaging without ankle mortise views when mechanism suggests syndesmosis injury

Differential Diagnosis

Injury patterns and mimics

Injury patterns and mimics

Isolated proximal fibula fracture

Stable injury pattern when ankle and knee injuries excluded

Maisonneuve fracture

Proximal fibula fracture with unstable ankle injury

Proximal tibiofibular joint dislocation or sprain

Lateral knee pain with fibular head prominence

LCL sprain or rupture

Varus instability

Posterolateral corner injury

Rotational instability

Tibial plateau fracture

Lateral joint line tenderness with effusion

Peroneal neuropraxia without fracture

Compression at fibular neck

Time-critical diagnoses

Time-critical diagnoses

Acute compartment syndrome of leg

Pain out of proportion

Pain with passive stretch

Vascular injury

Diminished distal pulses

Cool foot

Open fracture

Wound communicating with fracture

Laboratory Tests

Minimal labs for isolated closed injury

Minimal labs for isolated closed injury

No routine labs for uncomplicated isolated closed fracture

If anticoagulant use with bleeding concern

Hemoglobin trend

INR if warfarin

Renal function for DOAC context

Open fracture and operative pathway

Open fracture and operative pathway

If open fracture suspected

Complete blood count for baseline

Creatinine for antibiotic dosing

Blood type and screen if operative pathway

If procedural sedation planned

Point-of-care glucose if altered mental status concern

Rhabdomyolysis and crush concern

Rhabdomyolysis and crush concern

If prolonged entrapment or crush

Creatine kinase

Creatinine and electrolytes

Urinalysis for heme positive without RBC

Diagnostic Tests

Scoring Systems

Scoring systems

Gustilo-Anderson open fracture classification

Type I

Wound <1 cm

Minimal contamination

Type II

Wound 1-10 cm

Moderate soft tissue injury

Type III

Wound >10 cm or high-energy

Extensive soft tissue damage

Segmental fracture or farm contamination

Salter-Harris physeal injury classification

Type I

Physis only

Type II

Physis plus metaphysis

Type III

Physis plus epiphysis

Type IV

Metaphysis plus physis plus epiphysis

Type V

Crush injury to physis

Radiographs

Radiographs

Tibia-fibula radiographs including joints above and below

Knee included

Ankle included

Ankle series when mechanism or symptoms suggest

AP view

Mortise view

Lateral view

Post-immobilization radiographs when reduction performed

Proximal fibula fracture plus ankle mortise widening

Maisonneuve diagnosis support

MRI

MRI

Occult knee ligament injury concern

LCL injury characterization

Posterolateral corner injury characterization

Persistent ankle instability concern with negative radiographs

Syndesmosis injury assessment

Persistent peroneal nerve deficit

Alternative compressive lesion evaluation when clinically indicated

CT

CT

Complex ankle injury concern

Syndesmosis alignment evaluation when radiographs equivocal

High-energy injury with suspected intra-articular extension elsewhere

Surgical planning support

Disposition

Discharge vs admission vs transfer

Disposition decisions

Discharge appropriate

Closed isolated proximal fibula fracture pattern

Normal distal pulses

No motor deficit

No ankle mortise instability on imaging when indicated

Pain controlled with oral regimen

Safe ambulation with aids

Urgent orthopedics consultation or admission

Open fracture

Neurovascular deficit

Compartment syndrome concern

Unstable ankle injury pattern

Suspected Maisonneuve fracture

Suspected multi-ligament knee injury

Transfer criteria

Vascular injury concern

Compartment syndrome concern

Open fracture requiring urgent OR without local capability

Follow-up and function

Follow-up and function

Ortho fracture clinic

7-10 day review for symptom and imaging reassessment if not no-follow-up pathway

Physiotherapy

Range of motion and gait progression when cleared

Weight bearing status

Weight bearing as tolerated if isolated injury and stable exam and imaging

Non-weight bearing if ankle syndesmosis injury concern

Treatment

Immediate life-saving interventions

Immediate life-saving interventions

If hemorrhagic shock physiology, resuscitation per trauma protocol

If pulseless limb, immediate reduction of gross deformity and emergent consultation

If open fracture suspected, antibiotics and tetanus pathway

Immobilization and Splinting

Immobilization and splinting

Lower extremity immobilization options

Knee immobilizer

Use for isolated proximal fibula fracture when associated injuries excluded

Posterior long leg splint

Use when pain severe or concern for associated injury

Immobilization principles

Avoid circumferential cast in swelling phase

Neurovascular re-check after immobilization

Joint above and below coverage for long bone injury

Practical conservative management option

Knee immobilizer or bulky dressing with weight bearing as tolerated when isolated injury confirmed

Reduction

Reduction

Indications for reduction

Fracture-dislocation pattern

Threatened skin

Neurovascular compromise

Contraindications or caution triggers

Suspected vascular injury requiring immediate specialist involvement

Suspected physeal injury requiring gentle technique

Open fracture requiring antibiotics and tetanus pathway first when feasible

Analgesia and anesthesia

Non-opioid analgesia

Acetaminophen PO 1000 mg every 6-8 hours

Maximum 3000 mg per 24 hours in older adults or liver disease risk

Ibuprofen PO 400 mg every 6-8 hours

Maximum 2400 mg per 24 hours

Opioid analgesia for severe pain

Morphine IV 0.05 mg/kg

Titration 0.02-0.03 mg/kg every 10-15 minutes to effect

Hydromorphone IV 0.01 mg/kg

Titration 0.005 mg/kg every 10-15 minutes to effect

Procedural sedation when required

ACEP procedural sedation capnography recommendation

Capnography adjunct for earlier hypoventilation detection

ACEP Level B recommendation

ACEP fasting recommendation

Do not delay procedural sedation based on fasting time

ACEP Level B recommendation

Medication options

Ketamine IV 1 mg/kg

Supplemental 0.25-0.5 mg/kg every 5-10 minutes

Propofol IV 0.5-1 mg/kg

Supplemental 0.25-0.5 mg/kg every 2-3 minutes

Post-reduction requirements

Immediate neurovascular re-check

Post-reduction imaging

Immobilization in position of stability

Failed reduction pathway

Persistent neurovascular deficit triggers immediate escalation

Irreducible deformity triggers urgent orthopedics

Open fracture medications and timing

Open fracture medications and timing

Antibiotics

Cefazolin IV 2 g

Repeat every 8 hours until definitive management per local protocol

If severe beta-lactam allergy

Clindamycin IV 900 mg

Repeat every 8 hours per local protocol

If farm or heavy contamination concern

Add gram-negative coverage per local protocol

Tetanus prophylaxis

Td or Tdap if immunization incomplete or unknown

Tetanus immune globulin if high-risk wound and unimmunized

Wound care

Sterile moist dressing

Gross debris removal without deep probing

DVT prophylaxis when relevant

DVT prophylaxis when relevant

Lower limb immobilisation VTE risk assessment

NICE Quality Standard recommendation for VTE risk assessment at discharge with lower limb immobilisation

Shared decision-making on pharmacologic prophylaxis when risk outweighs bleeding risk

Definition relevant to ED discharge

Immobilisation includes prevention of normal weight-bearing or normal limb use

If pharmacologic prophylaxis indicated by local protocol

Low molecular weight heparin dosing per local protocol

Renal dosing adjustment for reduced creatinine clearance

Special Populations

Pregnancy

Pregnancy

Imaging considerations

Shielding when feasible

Radiation minimization with clinically appropriate modalities

Analgesia considerations

Acetaminophen preferred first line

NSAID avoidance in later pregnancy per local obstetric guidance

VTE risk considerations

Increased baseline VTE risk

Lower threshold for risk assessment with immobilization

Geriatric

Geriatric

Fragility context

Low-energy mechanism possible

Osteoporosis evaluation pathway

Medication safety

Opioid delirium risk

NSAID renal and GI risk

Mobility and falls

Higher threshold for admission if unsafe ambulation

Pediatrics

Pediatrics

Growth plate injury risk

Salter-Harris consideration when pain near physis

Gentle immobilization and early ortho follow-up

Non-accidental trauma consideration

Inconsistent history

Additional injuries

Weight-based dosing

Analgesia dosing by kg

Sedation dosing by kg when required

Background

Epidemiology

Epidemiology

Typical healing time

Approximately 6 weeks for proximal fibula fracture healing in uncomplicated cases

Lower limb immobilisation and VTE risk context

Temporary lower limb immobilisation after injury associated with measurable DVT risk in published quality improvement literature

Pathophysiology

Pathophysiology

Fibula load-bearing contribution

Fibula bears a minority of body weight load

Injury pattern mapping

External rotation force transmission through interosseous membrane

Proximal fibula fracture as part of Maisonneuve injury

Nerve vulnerability

Common peroneal nerve proximity at fibular neck

Traumatic causes include proximal fibula fracture

Therapeutic Considerations

Therapeutic considerations

Conservative management rationale

Stable isolated proximal fibula fractures typically managed nonoperatively

Immobilization choice rationale

Hinged knee brace or knee immobilizer for comfort and protection when stable

Weight bearing rationale

Weight bearing as tolerated when isolated injury and associated injuries excluded

Critical miss prevention rationale

Mandatory ankle evaluation when mechanism suggests syndesmosis injury

Mandatory peroneal nerve exam documentation

Patient Discharge Instructions

copy discharge instructions

copy discharge instructions

Diagnosis

Proximal fibula fracture

Immobilization care

Keep splint or brace dry

Do not insert objects into splint

Loosen wrap if increasing tightness

Swelling control

Elevation above heart when resting

Ice 15-20 minutes at a time with skin protection

Activity

Weight bearing as tolerated only if instructed

Crutches if limping or pain with weight bearing

No running or jumping until cleared

Pain plan

Acetaminophen as directed

Ibuprofen as directed if safe for you

Opioid only if prescribed

Return to ED now

Increasing pain not controlled with medication

New numbness or tingling

New weakness lifting foot or toes

Toes becoming pale, blue, or cold

Increasing tightness in calf or severe pain with toe movement

Fever or wound drainage

Follow-up

Orthopedics or fracture clinic within 7-10 days unless given a no-follow-up pathway

Earlier follow-up if ankle pain develops

Blood clot warning symptoms

New calf swelling or pain

Chest pain

Shortness of breath

Immediate ED for these symptoms

References

Evidence-based sources

Evidence-based sources

ACI NSW Emergency Care Institute clinical tool for proximal fibula fractures

Isolated injuries managed with hinged knee brace and ortho follow-up

Orthopedics consultation for associated knee, ankle, or neurovascular injury

Orthopedic Teaching Northwestern ED management

Isolated proximal fibula fractures managed conservatively

Knee immobilizer or bulky dressing with weight bearing as tolerated when isolated injury confirmed

Radiopaedia Maisonneuve fracture reference

Proximal fibula fracture with unstable ankle injury pattern

CoreEM Maisonneuve fractures review

Proximal fibula fracture with distal tibiofibular syndesmosis injury and ankle mortise disruption

StatPearls Peroneal Nerve Injury

Proximal fibula fracture as cause of common peroneal nerve injury

NICE NG89 Venous thromboembolism risk reduction

VTE and bleeding risk assessment framework

NICE Quality Standard QS201 statement on lower limb immobilisation

VTE risk assessment for people discharged with lower limb immobilisation

Horner 2019 thromboprophylaxis in lower limb immobilisation review

Definition of lower limb immobilisation relevant to VTE risk assessment

ACEP Clinical Policy Procedural Sedation and Analgesia in the ED 2014

Capnography adjunct recommendation

ACEP Level B recommendation

Fasting time not a reason to delay sedation

ACEP Level B recommendation

ICD-10-CM S82.831A category for other fracture of upper and lower end of fibula

Laterality and encounter character requirements

SNOMED CT 59639009 Closed fracture of upper end of fibula

Disorder concept alignment for proximal fibula fracture coding

Medical Disclaimer

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Last Reviewed: March 6, 2026 by SymptomDX Medical Team

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

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