From the Research
The initial treatment for a distal fibular chip fracture typically involves conservative management with rest, ice, compression, and elevation (RICE protocol) for 24-48 hours, along with pain management using NSAIDs. This approach is supported by the most recent and highest quality study, which suggests that stable ankle fractures can be successfully managed nonoperatively 1. The key aspects of treatment include:
- Weight-bearing status depends on fracture stability, but most patients can bear weight as tolerated with a supportive walking boot or ankle brace for 4-6 weeks
- A short period of immobilization with a removable walking boot or ankle brace helps protect the fracture while allowing early range of motion exercises to prevent stiffness
- Physical therapy should begin within 1-2 weeks to restore strength and mobility
- Surgery is rarely needed unless the fracture involves a large fragment with displacement or ankle joint instability, as indicated by studies such as 2 and 3 Regular follow-up with orthopedics at 2 weeks and 6 weeks is recommended to ensure proper healing and to guide progression of activities. It's worth noting that while some studies suggest the potential benefits of minimally invasive techniques, such as intramedullary fixation, for unstable distal fibular fractures, the current evidence does not conclusively support its superiority over standard techniques 2, 3. Therefore, conservative management remains the preferred initial approach for distal fibular chip fractures, with surgery reserved for cases with specific indications, such as large fragment displacement or ankle joint instability.