From the Research
The initial treatment for a nondisplaced fracture of the distal fibula typically involves conservative management with a short leg cast or a removable walking boot for 4-6 weeks, with immediate weight-bearing as tolerated in a functional walking boot, as supported by the study published in the Journal of Orthopaedic Trauma in 2018 1.
Key Considerations
- Weight-bearing status depends on the fracture stability, with most patients starting with partial weight-bearing and progressing to full weight-bearing as tolerated.
- Pain management includes acetaminophen (500-1000mg every 6 hours) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for the first 1-2 weeks.
- Elevation of the affected limb above heart level and application of ice for 15-20 minutes every 2-3 hours during the first 48-72 hours helps reduce swelling.
- Regular follow-up with orthopedics at 1-2 weeks initially and then at 6 weeks is necessary to monitor healing through X-rays.
- Physical therapy typically begins after cast removal to restore range of motion, strength, and function.
Rationale
The conservative approach is effective because nondisplaced fibular fractures generally have good blood supply and healing potential, and the fibula bears only about 15% of the body's weight, allowing for earlier mobilization compared to other lower extremity fractures. A study published in the World Journal of Orthopedics in 2021 2 also supports the use of conservative treatment for simple, minimally displaced fractures without ankle instability.
Additional Considerations
- The study published in the Journal of Orthopaedic Trauma in 2018 1 suggests that an immediate weight-bearing protocol may be an effective method for determining functional ankle stability in patients with isolated distal fibula fractures.
- However, it is essential to carefully evaluate weight-bearing radiographs for joint asymmetry and/or medial clear space widening to avoid poor outcomes.