From the Research
Surgical intervention for distal fibula fractures is primarily indicated when the fracture is unstable or displaced, which compromises ankle joint stability and alignment, as evidenced by the most recent study 1. Surgery is typically recommended for Weber B and C fractures with greater than 2mm displacement or talar shift, as these indicate disruption of the syndesmosis and potential ankle mortise instability. Some key points to consider when deciding on surgical intervention include:
- Open fractures, fractures with significant soft tissue compromise, bi- or tri-malleolar fractures, and fractures with syndesmotic injury are all indications for surgery 2, 3.
- Patients with high functional demands or those who cannot comply with non-weight bearing restrictions may also benefit from surgical fixation 4.
- The standard surgical approach involves open reduction and internal fixation (ORIF) using plates and screws, with 3.5mm one-third tubular plates being commonly used, although minimally invasive techniques are gaining popularity 1, 5.
- Syndesmotic injuries often require temporary or permanent transsyndesmotic screws.
- Surgery aims to restore anatomic alignment of the ankle mortise, maintain fibular length, and ensure proper rotation, as even small degrees of malreduction can lead to post-traumatic arthritis and chronic ankle instability.
- Post-operatively, patients typically remain non-weight bearing for 6 weeks, followed by progressive weight bearing in a walking boot and physical therapy to restore range of motion and strength. However, a recent study 3 found that in adult patients with an isolated distal fibula and medial clear space ≤6 mm, without proven instability, these fractures can safely be treated non-operatively, while avoiding risks and costs of surgery and preserving good long-term outcome in terms of pain and function. It's also worth noting that minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared with traditional open reduction internal fixation 4.