Abstract

This case report describes a rare inferomedially displaced proximal fibular fracture associated with acute common peroneal nerve injury in a 73-year-old man after an industrial crush injury. The patient presented with severe knee pain and a subjective sensory deficit on the dorsum of the right foot. Given the marked inferomedial displacement of the fracture fragment and the associated neurological symptoms, surgical intervention was selected to achieve anatomical reduction and permit direct nerve assessment. After four days of soft-tissue management, open reduction and internal fixation were performed via a posterior approach with the patient in the prone position. The fragment was securely fixed with 4.5-mm cannulated screws, and nerve exploration confirmed mild nerve sheath injury without complete disruption; therefore, neurorrhaphy was not required. This case illustrates that operative intervention may be considered in selected patients with markedly inferomedially displaced proximal fibular fractures, particularly when acute neurological deficits are present. In this specific displacement pattern, a posterior approach in the prone position may provide a useful surgical option for achieving anatomical reduction while allowing direct neurovascular protection. Level of evidence: V.

• Keywords: Fibula; Bone fractures; Peroneal neuropathies; Internal fracture fixation; Case reports