From the Guidelines
Non-displaced distal fibular fractures should be treated with simple immobilization, as this approach is appropriate when fracture fragments are small, nonarticular, or minimally displaced. This recommendation is based on the study by the American College of Foot and Ankle Surgeons 1. The treatment plan should include:
- Immobilization using a short leg cast or a removable walking boot for 4-6 weeks
- Initial treatment with rest, ice, compression, and elevation (RICE protocol) to reduce swelling and pain
- Weight-bearing status depends on the stability of the fracture, but most patients can begin partial weight-bearing with crutches immediately, progressing to full weight-bearing as tolerated within 1-2 weeks
- Pain management with acetaminophen (500-1000mg every 6 hours as needed) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) for the first 1-2 weeks
- Physical therapy after immobilization to restore ankle range of motion, strength, and proprioception, usually lasting 4-6 weeks The conservative approach is effective due to the fibula bearing only about 15% of body weight and the intact tibia providing stability during healing, as well as the rich blood supply in the distal fibula region promoting good healing potential 1. Regular follow-up with radiographs at 2 and 6 weeks is recommended to ensure proper bone alignment and healing progression. Surgery is rarely needed for non-displaced fractures unless they become displaced during the healing process or fail to heal with conservative treatment.
From the Research
Non-Displaced Distal Fibular Fracture Treatment
- Non-displaced distal fibular fractures can be treated conservatively, leading to excellent results 2, 3
- Conservative treatment is recommended for simple, minimally displaced fractures without ankle instability 2
- Conservative treatment can also be considered in older, unhealthy patients, even in unstable fractures 2
- Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described 2, 4
Stability Assessment
- Stability in ankle fractures is a controversial issue, but better understanding of the mechanism of injury and ankle biomechanics can help define stability after isolated fractures of the distal fibula 3
- Stress tests and weight-bearing radiographs can be used to assess ankle stability after isolated fractures of the lateral malleolus 3
Treatment Outcomes
- Nonoperative treatment of isolated fractures of the distal fibula can lead to excellent results in more than 90% of cases 3
- Minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared to traditional open reduction internal fixation 4
- The mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores and Olerud and Molander Score among all fixation types were 88.4 ± 3.40 and 76.7 ± 16.58, respectively 4