From the Guidelines
Management of a distal fibula fracture in the right ankle should prioritize simple immobilization when fracture fragments are small, nonarticular, or minimally displaced, as this approach is supported by the American College of Foot and Ankle Surgeons 1. When managing a distal fibula fracture, it's essential to consider the severity of the fracture and the patient's overall condition.
- Immobilization using a cast, walking boot, or splint for 4-6 weeks is a common approach, depending on the fracture severity.
- Weight-bearing restrictions are crucial, with non-weight bearing or partial weight bearing for the first few weeks as directed by the orthopedic surgeon.
- Pain management options include acetaminophen and NSAIDs like ibuprofen, unless contraindicated, to reduce pain and inflammation.
- Elevation of the ankle above heart level and ice application for 15-20 minutes several times daily can help reduce swelling and pain.
- After the immobilization period, physical therapy focusing on range of motion exercises, strengthening, and proprioception training is vital for optimal recovery.
- Surgery may be necessary for displaced fractures, typically involving internal fixation with plates and screws, as determined by the orthopedic surgeon based on fracture displacement, stability, and patient factors 1. Key considerations in management include:
- Fracture severity and displacement
- Patient's overall health and medical history
- Need for surgical intervention versus non-surgical management
- Regular follow-up with orthopedics to monitor healing progress and adjust the treatment plan accordingly.
From the Research
Management of Distal Fibula Fractures
- The management of distal fibula fractures depends on the type, displacement, and associated ankle instability of the fracture 2.
- For simple, minimally displaced fractures without ankle instability, conservative treatment leads to excellent results 2.
- Surgical treatment is indicated when fracture or ankle instability are present, with several techniques described, including open reduction internal fixation, minimally invasive plate osteosynthesis, intramedullary nailing, and intramedullary screw fixation 3, 4, 2.
Treatment Outcomes
- The outcomes of minimally invasive techniques for fixation of distal fibular fractures are excellent, with low complication rates compared to traditional open reduction internal fixation 3.
- Intramedullary fixation of unstable distal fibular fractures can give excellent results, comparable to modern plating techniques, with a mean rate of union of 98.5% and good or excellent functional outcomes in up to 91.3% of patients 4.
- Non-operative treatment of isolated type B fibula fractures can result in similar long-term outcomes in terms of function and pain compared to operative treatment, while avoiding the risks and costs of surgery 5.
Complications
- Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon 2.
- Implant-related problems, fibular shortening, and metalwork failure are common complications associated with intramedullary nailing 4.
- Revision surgery for implant removal due to persistent pain complaints is a common complication in surgically treated patients 5.