From the Guidelines
For a mildly angulated mid-shaft fibula fracture, simple immobilization is the appropriate treatment, as indicated by the American College of Foot and Ankle Surgeons 1. This approach is suitable when fracture fragments are small, nonarticular, or minimally displaced. The treatment involves:
- Immobilization to allow the fracture to heal
- Pain management with medications such as acetaminophen or ibuprofen
- Elevation of the leg to reduce swelling
- Application of ice to reduce pain and inflammation
- Physical therapy after immobilization to restore range of motion and strength The conservative approach is preferred because the fibula is not a primary weight-bearing bone, and mild angulation typically heals well without surgical intervention, as supported by the study published in the American Family Physician 1. Key considerations in the treatment plan include:
- Monitoring healing through regular X-rays
- Adjusting treatment as needed based on follow-up assessments
- Allowing partial weight-bearing with crutches initially, progressing to full weight-bearing as pain allows
- Starting physical therapy after immobilization to promote recovery and prevent long-term complications.
From the Research
Treatment Options for Mildly Angulated Mid Shaft Fibula Fracture
- The treatment for a mildly angulated mid shaft fibula fracture can vary depending on the severity of the fracture and the patient's overall health 2.
- Non-operative management, such as the use of a splint or cast, can be effective for stable fractures, allowing for early weight-bearing when the ankle is stable 2, 3.
- Functional bracing with a removable brace has been shown to be a safe and more comfortable alternative to casting, with significant differences in comfort and range of motion at 6 weeks 3.
- Manual physical therapy following immobilization can also be effective in improving function and reducing pain, with statistically significant and clinically meaningful improvements observed at 4 and 12 weeks 4.
- Immediate weight-bearing in a walking boot has been demonstrated to be effective in promoting healing in Jones fractures, with similar outcomes to cast immobilization with weight-bearing restrictions 5.
Considerations for Treatment
- The patient's ability to comply with the use of a removable type of immobilization to enable controlled exercise is essential, as it can increase the risk of adverse events 6.
- The type of support or immobilization used can affect the outcome, with some studies showing that the use of a backslab or air-stirrup can improve ankle dorsiflexion range of motion 6, 3.
- The use of electrotherapy modalities, such as neurostimulation, may be beneficial in the short-term, but more research is needed to confirm this 6.