What type of splint is recommended for an isolated distal fibular fracture?

Management of Isolated Distal Fibular Fractures: Splinting Options

For isolated distal fibular fractures that are simple and minimally displaced without ankle instability, a short-arm radial gutter splint is recommended as the optimal initial immobilization choice. 1

Diagnostic Assessment

• Confirm diagnosis with radiographs to evaluate:
  • Fracture displacement
  • Associated injuries
  • Evidence of joint instability
• Consider stress X-rays to detect associated mortise instability 2
• CT without IV contrast may be used for complex cases to better visualize fracture morphology 3

Splinting Selection Algorithm

For Stable, Minimally Displaced Distal Fibular Fractures:

1. Short-arm radial gutter splint is the preferred option because:
   • It provides comparable stability to long-arm splints 1
   • Patients report significantly better functional outcomes (higher DASH scores) 1
   • Better patient tolerance and comfort 1

For Unstable or Significantly Displaced Fractures:

1. Consider surgical intervention if:

   • Fracture is unstable or significantly displaced 2
   • Ankle mortise instability is present 2

2. If surgery is not indicated or must be delayed:

   • Sugar tong splint can be used (though patient satisfaction may be lower) 1
   • Rigid immobilization with casts for displaced fractures 3

Important Clinical Considerations

Immediate Management

• Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 4, 3
• Ice application during the first 3-5 days can provide symptomatic relief 3
• NSAIDs for pain and inflammation control 3

Follow-up Care

• Initial follow-up examination should occur approximately 8 days after splint application 1
• Monitor for loss of fracture reduction at follow-up visits 1
• Average immobilization duration is approximately 3-4 weeks 3

Potential Complications

• Loss of reduction (occurs in approximately 39% of cases with either splint type) 1
• Excessive immobilization risks include chronic pain, joint stiffness, muscle atrophy, and complex regional pain syndrome 3
• Wound healing complications are frequent with surgical management, especially with plate fixation 2

Special Populations

• In elderly patients with osteoporotic bone:
  • Conservative treatment should be considered even for some unstable fractures 2
  • Evaluate for osteoporosis risk 3
  • Consider calcium and vitamin D supplementation 3

Clinical Pearl

Research shows that both sugar tong splints and short-arm radial gutter splints have comparable performance in maintaining initial reduction of distal fractures. However, the short-arm splint is better tolerated by patients, making it the preferred choice for initial immobilization of isolated distal fibular fractures that don't require surgical intervention 1.