From the Guidelines
Simple immobilization is the most appropriate management for small fractures at the tip of the fibula and the anterior process of the calcaneum, as these fractures are typically nonarticular and minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as stated in their 2002 guidelines 1. The management of these fractures involves:
- Limiting weight-bearing activities for a short period
- Using immobilization techniques to allow for proper healing
- Monitoring for any signs of complications or displacement
- Gradually returning to normal activities once the fracture has healed
The use of surgery is typically reserved for cases where the fracture fragments are significantly displaced or involve the joint, which is not the case for small, nonarticular fractures at the tip of the fibula and the anterior process of the calcaneum. By prioritizing simple immobilization, patients can expect a full recovery with minimal risk of complications, as the blood supply to these areas is generally good, promoting healthy healing 1.
In terms of specific treatment protocols, the focus should be on:
- Immobilizing the affected area to prevent further injury
- Managing pain with appropriate medications, such as acetaminophen or NSAIDs, for a short period
- Gradually increasing mobility and weight-bearing activities under the guidance of a healthcare professional
- Considering physical therapy to restore full range of motion, strength, and proprioception once the fracture has healed.
From the Research
Management of Small Fracture at Tip of Fibula and Anterior Process of Calcaneum
- The management of small fractures at the tip of the fibula and the anterior process of the calcaneum can be conservative or surgical, depending on the severity and displacement of the fracture 2, 3.
- For small, non-displaced fractures, cast immobilization or functional treatment with full weight-bearing can be effective, with most patients achieving good to excellent results and a fast return to work 3.
- However, if the fracture is large or displaced, early excision of the fragment may be necessary to prevent non-union and persistent symptoms 2.
- The use of impulse compression therapy has also been shown to be beneficial in reducing pain and improving subtalar movement in patients with intra-articular calcaneal fractures 4.
- In general, the management of fractures in or about the ankle should be conservative, with immobilization without repositioning, to avoid traumatizing adjacent nerves, veins, and arteries 5.
- A program of management aimed at restoring a painless and mobile foot, including reduction of deformity and early movement, can also be effective in treating intra-articular fractures of the calcaneum 6.
Treatment Options
- Cast immobilization
- Functional treatment with full weight-bearing
- Surgical excision of the fracture fragment
- Impulse compression therapy
- Conservative immobilization without repositioning