What is the treatment for a distal fibula fracture?

From the Guidelines

Treatment for a distal fibula fracture typically depends on whether the fracture is stable or unstable, with stable, non-displaced fractures often managed conservatively and unstable or displaced fractures requiring surgical fixation. The most recent and highest quality study 1 provides moderate evidence to support the use of conservative management for stable, non-displaced fractures, with a walking boot or cast for 4-6 weeks, weight-bearing as tolerated, elevation of the affected limb, ice application for 15-20 minutes several times daily, and pain control with acetaminophen or NSAIDs like ibuprofen (400-800mg every 6-8 hours).

Key Considerations

• Unstable or displaced fractures generally require surgical fixation with plates and screws, followed by similar post-operative care including a period of protected weight-bearing 1.
• Physical therapy should begin after the initial immobilization period, focusing on range of motion exercises, strengthening, and balance training.
• Most patients can expect full recovery within 3-4 months, though some may experience mild residual symptoms.
• The fibula plays a crucial role in ankle stability, so proper treatment is essential to prevent long-term complications like chronic pain, instability, or post-traumatic arthritis.

Treatment Approach

• Conservative management is recommended for stable, non-displaced fractures, with a focus on pain control, immobilization, and gradual return to weight-bearing activities.
• Surgical fixation is recommended for unstable or displaced fractures, with a focus on restoring anatomical alignment and promoting healing.
• Post-operative care should include a period of protected weight-bearing, followed by gradual progression to full weight-bearing activities.
• Regular follow-up appointments with orthopedic specialists are important to monitor healing progress through X-rays and adjust the treatment plan as needed 1.

From the Research

Treatment Options for Distal Fibula Fracture

• Nonoperative treatment can be successful for stable ankle fractures, with more than 90% of isolated nondisplaced fractures of the distal fibula managed nonoperatively with excellent results 2.
• Unstable fractures should be treated surgically, as operative management consistently leads to better outcomes 2.
• For minimally or nondisplaced, closed, distal fibula fractures, short-term immobilization and progressive weightbearing is the standard of care, with most patients expected to heal with excellent functional outcome 3.
• However, a subpopulation of patients may develop symptomatic incomplete union or nonunion despite appropriate management, and may require operative intervention to eliminate pain 3.

Surgical Treatment

• Intramedullary fixation of distal fibular fractures can give excellent results, with a mean rate of union of 98.5% and good or excellent functional outcomes in up to 91.3% of patients 4.
• Minimally invasive techniques, including minimally invasive plate osteosynthesis, intramedullary nailing, and intramedullary screw fixation, can provide excellent functional results with low complication rates compared to traditional open reduction internal fixation 5.
• Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described, and outcome is excellent in most cases 6.

Complications

• Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon 6.
• Implant-related problems requiring metalwork removal, fibular shortening, and metalwork failure are common complications of intramedullary fixation 4.
• Distal fibula nonunion appears to be a relatively common cause of persistent lateral ankle symptoms in patients who do not enjoy a satisfactory recovery after appropriate conservative treatment 3.