Distal fibula fractures in Nnational Football KLeague athletes

Werner, Brian C.; Mack, Christina; Franke, Kristina; Barnes, Ronnie P.; Warren, Russell F.; Rodeo, Scott A.

Affiliations

¹Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA

²Real World Insights, QuintilesIMS, Durham, North Carolina, USA

³New York Giants, East Rutherford, New Jersey, USA

⁴Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, USA

Abstract and keywords

Background: Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes’ season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition.

Purpose: To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture rates in NFL athletes by position, type of play, and contact type; (3) determine the rates of distal fibula fracture surgery in NFL athletes; and (4) report the days missed due to distal fibula fractures in NFL athletes.

Study Design: Descriptive epidemiology study.

Methods: A retrospective review of distal fibula fractures reported to the NFL from 2000 to 2014 was performed using the NFL Injury Surveillance System. All distal fibula fractures were included, along with isolated and combined fracture patterns. Stress fractures and proximal fibula fractures were excluded. Epidemiological data and rates of surgery were determined. Return to sport was calculated and stratified by injury pattern and management.

Results: Overall, 237 distal fibula fractures in NFL athletes from 2000 to 2014 were included; 197 (83%) were isolated distal fibula fractures. A mean of 16 distal fibula fractures occurred each year (median, 16 per year). Fractures occurred most frequently on running (38%) and passing (24%) plays, but the frequency was next highest on kickoffs (16%), despite the relative infrequency of kickoffs during the average game compared with other play types. Surgery was reported for more than half of all distal fibula fractures (n = 128, 54%). Overall, patients who underwent surgery missed significantly more days (mean, 123.8 days) than players who did not undergo surgery (mean, 75.3 days) (P < .001). Players with isolated distal fibula fractures had significantly fewer days missed (mean, 93.6 days) compared with those with combined patterns (mean, 132.3 days) (P = .0004).

Conclusion: Fibula fractures affect a number of NFL athletes and result in significant time missed from competition. Further research is required to determine the optimal management of fibula fractures in NFL athletes. In this study, time to return to play depended on both the fracture pattern and whether surgery was required and ranged from 72 to 145 days.

Keywords: National Football League; fibula fracture; return to sport; ankle fracture; surgery; kickoff; American football

Links

DOI: 10.1177/2325967117726515

PubMed: 28959699

PubMedCentral: PMC5593228

WoS: 000410920900001

Cited Works (3)

Year	Entry
2015	Lievers WB, Adamic PF. Incidence and severity of foot and ankle injuries in men’s collegiate American football. Orthop J Sports Med. 2015;3(5):2325967115581593.
2010	Anderson RB, Hunt KJ, McCormick JJ. Management of common sports-related injuries about the foot and ankle. J Am Acad Orthop Surg. September 2010;18(9):546-556.
2007	Brophy R, Barnes R, Rodeo S, Warren R. Prevalence of musculoskeletal disorders at the NFL Combine: trends from 1987 to 2000. Med Sci Sports Exer. January 2007;39(1):22-27.

Cited By (1)

Year	Entry
2019	Kluczynski MA, Kelly WH, Lashomb WM, Bisson LJ. A systematic review of the orthopaedic literature involving National Football League players. Orthop J Sports Med. August 2019;7(8):2325967119864356.