When to initiate weight-bearing activities in a patient with a non-displaced distal fibula fracture?

From the Guidelines

Weight bearing on a non-displaced distal fibula fracture can typically begin immediately, as the most recent evidence suggests that early weight bearing does not increase the risk of fracture displacement or compromise healing. According to the study by Smith et al 1, weight-bearing radiographs provide important information, particularly with fractures of uncertain stability, and a medial clear space of <4 mm should confirm stability.

Key Considerations

• The fibula is not a primary weight-bearing bone, which allows for earlier mobilization compared to tibial fractures.
• Most patients can start with touch-down weight bearing immediately after injury while wearing a protective boot or cast.
• Partial weight bearing (25-50% of body weight) can be advanced within the first two weeks, gradually progressing to full weight bearing over 4-6 weeks as pain and swelling decrease.
• Physical therapy should begin once adequate healing has occurred, usually around 4-6 weeks post-injury, focusing on ankle range of motion, strengthening, and balance exercises.

Rehabilitation Progression

• Early controlled weight bearing promotes better blood flow to the fracture site, enhances bone healing, prevents muscle atrophy, and reduces joint stiffness.
• Patients should monitor for increased pain, swelling, or displacement during the progression to full weight bearing, as these may indicate the need to slow down the rehabilitation process.
• The study by Smith et al 1 highlights the importance of individualized treatment plans, taking into account the patient's pain tolerance, fracture stability, and overall health status.

From the Research

Non-Displaced Distal Fibula Fracture Management

• The management of non-displaced distal fibula fractures can vary depending on the stability of the fracture and the presence of ankle instability 2, 3.
• Studies have shown that immediate weight-bearing can be allowed in patients with stable, non-displaced distal fibula fractures, with favorable outcomes and accelerated recovery 4, 5.
• The use of locking screw plates and anatomically contoured locking plates can provide strong and stable fixation, allowing for immediate full weight-bearing 4, 5.

Weight-Bearing Protocols

• A study published in the Journal of Orthopaedic Trauma found that an immediate weight-bearing protocol can be used to determine ankle stability in patients with isolated distal fibular fractures, with a medial clear space (MCS) of less than 4 mm on non-stressed initial radiographs 6.
• Another study published in the Musculoskeletal Surgery journal found that immediate weight-bearing yielded positive outcomes, with a significant increase in the AOFAS score and complete bone healing in all cases 4.
• The use of weight-bearing radiographs can help to assess ankle stability and guide treatment decisions 6, 2.

Treatment Outcomes

• Studies have shown that nonoperative treatment of isolated, non-displaced fractures of the distal fibula can lead to excellent results, with over 90% of patients achieving successful outcomes without surgery 2.
• Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described, including open reduction and internal fixation with locking plates 4, 5, 3.
• The outcome is generally excellent in most cases, with complications regarding wound healing being frequent, especially with plate fixation 3.