Alternative Fixation of a Comminuted Fibular Head Avulsion in a Patient With an Ipsilateral Tibial Intramedullary Nail: A Hybrid Construct Case Report.

Authors

Kannan Murthy, Tiffany T Nguyen, Akshay Som, Youssef Messiha, Najib Ussef

Published in

Cureus. Volume 18. Issue 9. Pages e117027. Epub Sep 27, 2026.

Abstract

Fibular head avulsion fractures are uncommon injuries that disrupt the posterolateral corner of the knee and are frequently accompanied by injury to the adjacent common peroneal nerve. Current fixation options, cannulated screw fixation, locking compression hook plates, and suture anchor or transosseous repair, generally require either a fragment large enough to accept a screw or an intact, unobstructed proximal fibula for tunnel placement. We report a 33-year-old male pedestrian struck by a motor vehicle. He had an open proximal tibial fracture treated with intramedullary nailing and, approximately one week later, was found to have a comminuted fibular head avulsion. He also sustained posterolateral corner disruption, common peroneal nerve palsy, and a positive Lachman exam. The retained tibial intramedullary nail constrained conventional screw trajectories and bone-tunnel placement, while comminution of the avulsion fragment hindered reliable single-implant fixation. The fragment was stabilized with a hybrid construct combining transosseous Krackow sutures of FiberWire through the biceps femoris tendon, passed via Beath pins and tied over the anteromedial tibia. Additionally, a three-hole 3.5 mm locking compression plate (LCP) hook plate was applied to buttress the proximal fibula, along with primary repair of a mid-substance LCL tear, and formal common peroneal neurolysis. Examination under anesthesia after fixation demonstrated reduction of varus stress gapping from +3 to neutral. At nine weeks, the patient had knee range of motion of 0° to 115°, had advanced to weight-bearing as tolerated, and demonstrated maintained reduction with intact hardware and interval healing on radiographs. The common peroneal nerve palsy subsequently resolved completely; given full clinical recovery, electromyography was not indicated. This case describes a reproducible alternative technique for fibular head avulsion complicated by comminution and retained intramedullary hardware.

PMID:
42952478
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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