What are the treatment options for a non-displaced distal fibular fracture?

From the Guidelines

A non-displaced distal fibular fracture can be effectively treated with simple immobilization, as the fracture fragments are nonarticular or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as stated in a study published in the American Family Physician in 2002 1. The diagnosis of a non-displaced distal fibular fracture is typically based on a history of trauma, focal pain on palpation, and confirmation with radiographic studies.

Key aspects of treatment include:

• Immobilization with a short leg cast or walking boot for 4-6 weeks
• Initial management with the RICE protocol: rest, ice, compression, and elevation
• Pain management with acetaminophen or ibuprofen as needed
• Progressive weight-bearing status, depending on fracture stability
• Physical therapy after immobilization to restore strength and range of motion

It is essential to follow the treatment plan and attend physical therapy sessions to achieve full recovery within 6-12 weeks. If any concerns or complications arise, such as increased pain, numbness, or color changes in toes, it is crucial to contact a doctor immediately. The conservative approach is effective because the fibula bears only about 15% of body weight, and non-displaced fractures maintain proper bone alignment, as noted in the study 1.

From the Research

Non-Displaced Distal Fibular Fracture Management

• Non-displaced distal fibular fractures can be managed conservatively, especially in simple, minimally displaced fractures without ankle instability 2
• Conservative treatment is also considered in overaged unhealthy patients, even in unstable fractures 2
• Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described, including intramedullary fixation and open reduction internal fixation (ORIF) with plates and screws 3, 4, 2, 5, 6

Intramedullary Fixation Outcomes

• Intramedullary fixation of distal fibular fractures has shown excellent results, with a mean rate of union of 98.5% and good or excellent functional outcomes in up to 91.3% of patients 5
• The mean complication rate across studies was 10.3%, with issues such as implant-related problems requiring metalwork removal, fibular shortening, and metalwork failure predominating 5
• Intramedullary fixation has been compared to plate fixation, with some studies showing a lower complication rate with intramedullary fixation 6

Functional Outcomes

• Functional outcomes after intramedullary fixation of fibular fractures have been reported as good or excellent in 73%-100% of patients 6
• The mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores among all fixation types was 88.4 ± 3.40, and the mean Olerud and Molander Score among all fixation types was 76.7 ± 16.58 4

Treatment Considerations

• The choice of treatment for non-displaced distal fibular fractures depends on fracture type, displacement, and associated ankle instability 2
• Minimally invasive techniques, including intramedullary fixation, have been introduced to reduce wound complications and improve outcomes 3, 4, 5, 6