From the Research
The best course of treatment for an ununited avulsion fracture of the inferior tip of the lateral malleolus with minor avulsion fractures at the medial talus typically involves conservative management initially, with a focus on immobilization, pain management, and progressive physical therapy. This approach is based on the principle that avulsion fractures often respond well to conservative measures, and the lateral malleolus is not a primary weight-bearing structure 1. The presence of medial talar avulsion fractures suggests a more complex injury pattern involving the medial ankle structures, but these minor avulsions can typically heal with the same conservative protocol if stability is maintained.
Initial Management
- Immobilization using a walking boot or ankle brace for 4-6 weeks
- Non-weight bearing or partial weight bearing status for the first 2-3 weeks, gradually progressing to full weight bearing as tolerated
- Pain management with NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 1-2 weeks
Progressive Rehabilitation
- Physical therapy initiated after the immobilization period, focusing on:
- Range of motion exercises
- Progressive strengthening
- Proprioception training for 6-8 weeks
Surgical Intervention
If conservative treatment fails after 3 months with persistent pain and functional limitations, surgical intervention may be considered, typically involving internal fixation with screws or tension band wiring to secure the avulsed fragment 2, 3. However, the most recent and highest quality study suggests that conservative management is often sufficient, and surgical intervention should be reserved for cases with significant instability or persistent symptoms 1.