What is the treatment for a lower fibula fracture?

Treatment of Lower Fibula Fractures

For isolated distal fibula fractures, non-operative management with cast immobilization is the recommended first-line treatment, with surgical fixation reserved for unstable or displaced fractures.

Assessment and Classification

When evaluating a lower fibula fracture, consider:

• Fracture location, displacement, and stability
• Associated injuries (ankle joint involvement, syndesmotic injury)
• Patient factors (age, activity level, comorbidities)

Treatment Algorithm

Non-operative Management

• Indicated for:
  • Stable, non-displaced isolated fibula fractures
  • Fractures with minimal displacement (<3mm)
  • No significant ankle mortise widening

Non-operative treatment consists of:

1. Cast immobilization or rigid immobilization for 6-8 weeks 1
2. Weight-bearing status:
   • Traditional approach: Non-weight bearing for 6 weeks
   • Emerging evidence: Early weight-bearing with appropriate immobilization may be possible 2

Surgical Management

• Indicated for:
  • Unstable fractures
  • Fractures with >3mm displacement 1
  • Fractures with ankle mortise widening
  • Fractures at the same level as tibial fractures in distal two-bone fractures 3

Surgical options include:

1. Open reduction and internal fixation (ORIF) with anatomically contoured locking plates

   • Provides strong, stable fixation
   • May allow earlier weight-bearing 2
   • Higher complication rates (up to 30.77%) 4

2. Intramedullary nail fixation

   • Lower complication rate (9.52%) compared to plate fixation 4
   • Equally effective for fracture healing and functional outcomes
   • May be preferred for supination external rotation type IV ankle injuries 4

Rehabilitation Protocol

1. Early phase (0-2 weeks):

   • Pain management
   • Elevation
   • Ice therapy
   • Protected weight-bearing as indicated

2. Intermediate phase (2-6 weeks):

   • Progressive weight-bearing based on fracture stability and fixation method
   • Range of motion exercises if permitted

3. Late phase (6-12 weeks):

   • Full weight-bearing
   • Strengthening exercises
   • Balance and proprioception training 1

Expected Outcomes

• Bone healing typically occurs by 3 months with proper treatment 2
• For stress fractures of the fibula, healing occurs on average by 7 weeks with non-operative management 5
• Return to activity/sport occurs on average by 9 weeks for stress fractures 5

Special Considerations

• For elderly patients with fragility fractures, a balanced approach between operative and non-operative treatment is required 1
• In distal two-bone fractures (tibia and fibula), fibular fixation is recommended when both fractures are at the same level and the tibial fracture is stabilized with a bridging plate 3
• Anatomically contoured locking plates provide stable fixation that may allow immediate full weight-bearing in selected cases 2

Potential Complications

• Non-union or delayed union (rare in fibular fractures)
• Malunion
• Hardware-related complications (with surgical fixation)
• Infection (2-3% risk with surgical intervention)

The treatment approach should prioritize restoration of function while minimizing complications. For most isolated distal fibula fractures, non-operative treatment with appropriate immobilization yields excellent outcomes, while surgical fixation should be reserved for unstable or significantly displaced fractures.