Surgical management of arcuate (proximal fibular head) avulsion fractures: a scoping review of techniques and outcomes

PURPOSE: This scoping review aims to map and describe the range of surgical techniques used in the management of arcuate fractures (proximal fibular head avulsion fractures) and to summarize their reported outcomes and complications. METHODS: A scoping review was conducted using a literature search across Embase, Scopus, Cochrane Library, PubMed, and Web of Science, up to 8 December 2025, following PRISMA-ScR reporting guidelines. All eligible studies were case reports or small case series. Eligibility criteria included English-language articles reporting the surgical management of arcuate fractures and postoperative outcomes. RESULTS: Twelve studies involving 90 patients were included. Three fixation strategies were recorded: suture anchor fixation in 29 patients (32.2%), tension-based techniques in 23 patients (25.6%), and screw-and-washer fixation in 38 patients (42.2%). Radiographic union was explicitly reported in 25 of 29 anchor-treated patients, 18 of 24 fractures treated with tension-based constructs, and all screw-and-washer cases; however, reporting was incomplete and nonuniform. Complications and reoperations were most frequently described in tension-based reports, which also included severe and heterogeneous injury patterns. Standardized patient-reported outcomes were sparse, and rehabilitation protocols varied. Methodological appraisal identified recurrent limitations in case selection, completeness of reporting, and outcome assessment. CONCLUSION: Evidence for operative FHAF management remains limited to heterogeneous case reports and small case series. Radiographic healing was frequently reported across fixation constructs, but inconsistent reporting and variation in injury severity, associated procedures, and rehabilitation preclude reliable comparison between techniques. Fixation should be individualized according to fragment size and morphology, fragment quality, soft-tissue repairability, and associated ligamentous injuries. Standardized multicentre studies are needed. LEVEL OF EVIDENCE: IV.