From the Research
The treatment of isolated malleolar fractures should be based on the stability and displacement of the fracture, with conservative management recommended for stable, non-displaced fractures and surgical intervention for unstable or displaced fractures. For stable, non-displaced fractures (less than 2mm displacement), conservative management is typically recommended, consisting of a short leg cast or removable boot for 4-6 weeks, non-weight bearing or partial weight bearing for the first 2-3 weeks, followed by progressive weight bearing as tolerated 1. Pain management includes acetaminophen or NSAIDs like ibuprofen (400-600mg every 6-8 hours) as needed. For unstable or displaced fractures (greater than 2mm displacement), surgical intervention is necessary, usually involving open reduction and internal fixation (ORIF) with screws, plates, or tension band wiring depending on the fracture pattern 2. Post-operative care includes a short leg cast or boot for 2-6 weeks, with weight bearing restrictions for 6-8 weeks. Physical therapy should begin after immobilization to restore range of motion, strength, and proprioception. Some studies suggest that conservative treatment of isolated medial malleolar fractures displaced ≤2 mm is safe, with comparable functional outcomes to surgical treatment 1. However, for fractures displaced >2 mm, the choice of treatment may depend on the patient's characteristics and demands, and further research is needed to determine the best approach 1. It is also important to consider the potential for associated injuries, such as syndesmotic instability, and to carefully evaluate the fracture pattern and patient's condition to determine the best course of treatment 3, 4. In cases where the fracture is not clearly visible on initial radiographs, further imaging such as MRI or CT scans may be necessary to confirm the diagnosis and guide treatment 5.
Some key points to consider in the treatment of isolated malleolar fractures include:
- The importance of accurate diagnosis and evaluation of the fracture pattern and patient's condition
- The need for careful consideration of the potential for associated injuries, such as syndesmotic instability
- The use of conservative management for stable, non-displaced fractures and surgical intervention for unstable or displaced fractures
- The importance of post-operative care and physical therapy to restore range of motion, strength, and proprioception
- The need for further research to determine the best approach for fractures displaced >2 mm.
Overall, the treatment of isolated malleolar fractures requires a careful and individualized approach, taking into account the specific characteristics of the fracture and the patient's condition.