From the Guidelines
The treatment of a nondisplaced lateral malleolus fracture typically involves conservative management with a short leg cast or a removable walking boot for 4-6 weeks. Initially, the RICE protocol (Rest, Ice, Compression, Elevation) is recommended to reduce swelling and pain 1. Weight-bearing status depends on fracture stability, with most patients progressing from non-weight-bearing to partial weight-bearing within 1-2 weeks as tolerated. Pain management includes acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for 5-7 days.
Key Considerations
- Physical therapy should begin after immobilization to restore range of motion, strength, and proprioception, typically lasting 4-6 weeks.
- Regular follow-up with orthopedics at 2,4, and 6 weeks with X-rays ensures proper healing.
- This conservative approach is effective because nondisplaced lateral malleolus fractures maintain the ankle mortise's stability, allowing bone healing without surgical intervention 1.
- Surgery is only considered if the fracture displaces during treatment or fails to heal properly.
Imaging and Diagnosis
- The Ottawa Ankle Rules (OAR) are useful in determining the need for imaging in patients with acute ankle trauma, with a sensitivity of 92% to 100% and specificity of 16% to 51% for excluding fractures 1.
- CT ankle without IV contrast or MRI ankle without IV contrast may be used for further evaluation in patients with persistent pain or suspected osteochondral injury 1.
From the Research
Treatment Options for Nondisplaced Fracture of the Lateral Malleolus
- For nondisplaced fractures of the lateral malleolus, treatment may involve conservative methods, as seen in a study from 2 which compared two conservative methods of treating isolated fractures of the lateral malleolus and found that immediate weight-bearing and mobilization resulted in earlier rehabilitation.
- The study from 2 also found that there was no significant difference in the amount of pain experienced or in the requirement for analgesics, and early mobilization was not associated with any complications.
Surgical Intervention
- In some cases, surgical intervention may be necessary, and a study from 3 investigated the prognostic difference between immediate and delayed weight-bearing on lateral malleolus fractures after surgery, finding that immediate weight-bearing was associated with a shortened length of hospital stay and time to return to work.
- Another study from 4 evaluated the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures, finding that this method was safe and effective with advantages over plate osteosynthesis, including less soft tissue dissection and less prominent hardware.
- A technical note from 5 described a short single-incision approach for antiglide plate fixation of oblique fractures of the lateral malleolus, which presents the advantage of less risk of damaging the soft tissues and disturbance of the fracture hematoma.
- A study from 6 described a technique for percutaneous cannulated screw stabilisation for painful non-union of lateral malleolus ankle fractures, finding that this method was safe and effective with a low risk of soft tissue complications.