What is the initial treatment for a mid shaft non-displaced fibula fracture?

Initial Treatment for Mid Shaft Non-Displaced Fibula Fracture

The initial treatment for a mid shaft non-displaced fibula fracture should be conservative management with a simple arm sling or functional brace for immobilization rather than a figure-of-eight bandage.

Assessment and Diagnosis

• Obtain upright radiographs (posteroanterior, lateral, and oblique views) to accurately assess fracture displacement 1
• Evaluate for associated injuries, particularly to ensure there is no tibial involvement or syndesmotic disruption
• Confirm the fracture is truly non-displaced (less than 3mm displacement and less than 10 degrees angulation)

Conservative Management Protocol

1. Immobilization:

   • Use a simple arm sling or functional brace rather than figure-of-eight bandage 1
   • Immobilization period typically 4-6 weeks depending on clinical and radiographic healing

2. Pain Management:

   • NSAIDs for pain and inflammation control 1
   • Multimodal analgesia strategy as needed, with consideration of patient's volume status and muscle damage 2

3. Weight-bearing Status:

   • Progressive weight bearing as tolerated
   • Isolated fibula fractures without displacement can typically tolerate early weight bearing

Monitoring and Follow-up

• Follow-up radiographs at 2-3 weeks to ensure maintained alignment
• Clinical assessment for:
  • Localized tenderness at fracture site
  • Gait pattern
  • Range of motion of ankle and knee

Rehabilitation

• Early range of motion exercises after initial pain subsides
• Directed home exercise program to prevent stiffness 1
• Progressive strengthening exercises as healing progresses

Potential Complications to Monitor

• Nonunion (though rare in non-displaced fibula fractures)
• Persistent pain at fracture site suggesting incomplete healing
• Development of antalgic gait

When to Consider Surgical Intervention

Surgical intervention is rarely needed for isolated, non-displaced midshaft fibula fractures but may be considered if:

• Patient develops symptomatic nonunion despite appropriate conservative management 3
• Secondary displacement occurs during follow-up
• Patient has persistent, localized pain at the fracture site after adequate trial of conservative treatment 3

Special Considerations

• Advise smoking cessation as it increases nonunion rates 2, 1
• For diabetic patients, close monitoring of skin to prevent pressure points 1
• In elderly patients, consider evaluation for osteoporosis 1

The evidence strongly supports conservative management for isolated non-displaced midshaft fibula fractures, with excellent functional outcomes and avoidance of surgical risks 4. Long-term studies show no significant difference in pain and function between operative and non-operative treatment for isolated fibula fractures, with non-operative treatment avoiding the risks and costs of surgery 4.