From the Research
The best course of treatment for an ununited avulsion fracture of the lateral malleolus typically begins with conservative management, including rest, ice, compression, and elevation (RICE protocol) for 4-6 weeks, as recommended by the most recent and highest quality study 1.
Initial Management
- Patients should use a walking boot or ankle brace for stability and take NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for pain and inflammation.
- Physical therapy focusing on ankle strengthening and proprioception exercises should be initiated after the acute pain subsides.
Indications for Surgical Intervention
- If conservative treatment fails after 3-6 months, surgical intervention may be necessary, typically involving open reduction and internal fixation (ORIF) with screws or tension band wiring to secure the avulsed fragment.
- Surgery is particularly indicated for larger fragments (>25% of the articular surface), displacement greater than 2mm, or in active patients with persistent symptoms.
Decision-Making Factors
- The decision between conservative and surgical management depends on the size of the fragment, degree of displacement, patient activity level, and presence of ankle instability.
- Ununited avulsion fractures often result from inadequate immobilization during initial healing or disruption of blood supply to the fragment, making proper treatment essential to prevent chronic ankle instability and post-traumatic arthritis, as noted in a study on the management of isolated lateral malleolus fractures 1.
Recent Study Findings
- A recent study on the management of isolated lateral malleolus fractures found that ankle stability is maintained by ligamentous and bony anatomy, and that identifying injury to the deep deltoid ligament and associated ankle instability influences management 1.
- Another study on the reduction and fixation of avulsion fractures of the tibial eminence using a mini-open technique found that this approach can achieve satisfactory results, with improved Lysholm and Tegner scores, and negative Lachman and anterior drawer tests 2.