Talking LDT: What does a fractured fibula mean?

Editor’s note: Chiefs starting right guard Laurent-Duvernay Tardif is on the shelf for the foreseeable future with a fractured fibula. What does that mean, exactly? Let’s bring in our in-house injury expert Aaron Borgmann, to find out.

We unfortunately learned Sunday that Laurent Duvernay-Tardif suffered a fractured fibula on a play late in the game. Here, we will discuss the mechanism from the video provided and talk about possibilities for recovery based upon the information that has been released to the public.

For those unfamiliar with the fibula, it is a long thin bone on the lateral (outside) aspect of the lower leg. It runs from your knee to your ankle and supports approximately one-sixth of your body weight, unlike the larger tibia adjacent to it. Many structures, including muscles and ligaments, attach to it in the lower leg. It is also held to the tibia by the connective tissue known as syndesmosis. Fractures of this bone are relatively common and typically heal very well when managed correctly.

As you can see from the video above, the player has his left foot in the ground slightly pointed outward. The defensive player then falls on the lateral aspect of his lower leg and collapses LDT inward, pinning both his foot and knee, most likely in an externally rotated position.

As you can see from the picture below, there are many types of fractures that can occur in this bone:

Since we have no knowledge of type or even location of the fracture, we cannot assume which type the athlete sustained. Due to this, I will only speak to MY knowledge and experience with these injuries.

The most common fibular fracture injuries that I encountered in my NFL career were the following:

Simple non-displaced impact injuries:

These were from a direct blow to the lower leg and didn’t require surgery, only immobilization and bone healing time. Rehab here will be quick, as the bone needs no actual intervention, just time to heal. Since the fibula supports only minimal weight, ambulation in rehab can begin almost immediately and can progress quickly based upon athlete’s symptoms. Follow-up imaging over the course of weeks will determine bone healing status and the athlete will be worked back into tolerance watching for symptoms of pain over the fracture site.

Displaced isolated fibula only:

These injuries occur from the ankle being pinned and either twisted or hit directly on the lateral aspect of the lower leg. The exception in this injury is that in football players surgical intervention is needed to repair this in order to regain the structural integrity of the lower leg. A metal plate with screws will be inserted to the lateral aspect of the bone in order to facilitate proper alignment and fixation. Rehab is similar here as with the plate now acting as a support, the process can be accelerated with little time for weight-bearing restrictions.

Fibula fractures with ankle involvement:

Similar to above, only with more additional structures damaged. These typically come in the form of a fracture of the fibula and a dislocation of the ankle joint. As you can imagine, these are quite painful and while every attempt is made to relocate the ankle on the field, it can sometimes be difficult due to the level of pain the athlete is in. Surgical intervention again is required to repair the bone and, in this case, additional reconstruction will be needed to address any ligamentous structures at the ankle that may have been damaged such as the thicker Deltoid Ligament on the inside of the ankle.

Unique to this category is something called a Maisonneuve fracture. This is a spiral type fracture that occurs on the upper part of the fibula, but also involves the previously-discussed syndesmosis (structure that holds the fibula and tibia together). This is a surgical intervention that is typically more complex since you have to fixate the fracture but also address the injury to the thick connective tissue for structural stability. This is done by fixating the lower fibula to the tibia by a screw or piece of surgical wire known as a “TightRope.” This allows the normal relationship and stability of lower leg to be regained correctly.

In any case, with additional structures involved, the rehabilitation adds complexity, not necessarily time. With additional surgical fixation the structures that have been damaged are now secure and rehab can at times, depending upon the extent of damage and athlete demands, often proceed quicker here. A famous example of this is Terrell Owens return to the Super Bowl in a mere seven weeks post-injury. Early mobility is key and often much aquatic work is done in order to regain function quickly.

The bottom line

No matter the type that this athlete has suffered, the interventions lead to quality outcomes and the vast majority of players that I have encountered with these injuries make full and complete recoveries and go on to have little to no complications.

Aaron Borgmann is the owner of Borgmann Rehab Solutions and a former 12-year NFL Physical Therapist and Athletic Trainer.