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From the Research
Management of Distal Fibula Tip Avulsion Fracture
The management of a distal fibula tip avulsion fracture can be approached in several ways, depending on the severity and displacement of the fracture.
- For minimally or nondisplaced, closed, distal fibula fractures, the standard of care has been short-term immobilization and progressive weightbearing 1.
- In cases where the fracture is unstable or displaced, open reduction internal fixation (ORIF) with plates and screws may be necessary to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis 2.
- Minimally invasive techniques, such as intramedullary fixation, have also been introduced as an alternative to traditional ORIF, with excellent clinical and functional outcomes reported in up to 91.3% of patients 3.
- A systematic review of minimally invasive techniques, including minimally invasive plate osteosynthesis, intramedullary nailing, and intramedullary screw fixation, found that these methods can provide excellent functional results with low complication rates compared to traditional ORIF 4.
- In cases of avulsion-type fracture of the distal fibula, recognition of the fracture and subsequent proper management of the underlying peroneal tendon pathology by immobilization or surgery may prevent future tendon dysfunction 5.
Treatment Options
Treatment options for distal fibula tip avulsion fracture include:
- Short-term immobilization and progressive weightbearing for minimally or nondisplaced fractures
- ORIF with plates and screws for unstable or displaced fractures
- Minimally invasive techniques, such as intramedullary fixation, for unstable or displaced fractures
- Immobilization or surgery to manage underlying peroneal tendon pathology in cases of avulsion-type fracture
Clinical Outcomes
Clinical outcomes for distal fibula tip avulsion fracture treatment include:
- Excellent functional outcomes reported in up to 91.3% of patients with intramedullary fixation 3
- Good or excellent functional outcomes reported in up to 92% of patients with unlocked intramedullary nailing 3
- Mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores of 88.4 ± 3.40 and mean Olerud and Molander Score of 76.7 ± 16.58 among all fixation types 4