Treatment for Non-Displaced Fracture at Tip of Lateral Malleolus in the Ankle
Non-displaced fractures at the tip of the lateral malleolus should be treated conservatively with immobilization in a removable walking boot or cast for 4-6 weeks, with early mobilization as tolerated to prevent stiffness and promote healing.
Initial Management
The treatment approach for non-displaced lateral malleolar tip fractures follows a step-wise algorithm:
Initial immobilization options:
- Removable walking boot (preferable for most patients)
- Short-leg cast (if compliance is a concern)
- Knee-high device for more complex cases or in patients with diabetes 1
Weight-bearing status:
- Protected weight-bearing as tolerated with assistive device initially
- Progress to full weight-bearing as pain allows
- Early mobilization is recommended to prevent stiffness 2
Pain management:
- Topical NSAIDs with or without menthol gel as first-line treatment
- Oral NSAIDs or acetaminophen as needed for breakthrough pain
- Ice application for 20 minutes at a time during the first 48-72 hours
- Heat therapy may be beneficial after the initial inflammatory phase 2
Monitoring and Follow-up
- Clinical and radiographic follow-up at 2 weeks to ensure maintained alignment
- Second follow-up at 4-6 weeks to assess healing
- Monitor for complications such as:
- Delayed union or non-union
- Post-traumatic arthritis
- Persistent pain or instability
Evidence-Based Rationale
Conservative management is highly effective for isolated non-displaced fractures of the malleoli. Studies have demonstrated high rates of union and good functional outcomes with non-operative treatment 3. In a study of 57 patients with isolated medial malleolar fractures treated conservatively, 55 healed without further intervention, with good functional scores and no evidence of instability or post-traumatic arthritis 3.
The principles of management for lateral malleolar tip fractures are similar, with conservative treatment being the standard of care for non-displaced fractures. This approach minimizes the risks associated with surgery while achieving excellent outcomes.
Special Considerations
- Diabetes: Patients with diabetes may require more aggressive immobilization with a non-removable knee-high device to ensure compliance and prevent complications 1
- Elderly patients: May benefit from earlier mobilization to prevent deconditioning
- Athletes: May require more structured rehabilitation protocol for return to sport
When to Consider Surgery
Surgical intervention should be reserved for:
- Displaced fractures
- Bi- or trimalleolar fractures
- Open fractures
- Injuries compromising the skin
- Fractures involving the ankle joint surface (plafond)
- Development of painful non-union 3
If surgical intervention becomes necessary, minimally invasive techniques such as lag screw fixation may be considered for suitable fracture patterns, as this approach has shown fewer complications compared to plate fixation 4.
Rehabilitation Protocol
After the immobilization period:
- Begin with gentle range of motion exercises
- Progress to strengthening exercises
- Balance and proprioception training
- Gradual return to normal activities over 6-12 weeks
By following this treatment algorithm, patients with non-displaced lateral malleolar tip fractures can expect excellent outcomes with minimal risk of complications.