Treatment of Fibula Fractures
The treatment of fibula fractures should be based on fracture stability, with non-displaced fractures managed conservatively with rigid immobilization and unstable fractures requiring surgical fixation. 1
Assessment and Classification
- Radiographic parameters indicating instability and need for surgical intervention include radial shortening >3 mm, dorsal tilt >10°, and intra-articular displacement 2, 1
- Fracture types at the level of the syndesmosis include supination-external rotation (SE) and pronation-abduction (PA), reflecting the mechanism of injury 3
Treatment Algorithm
Non-operative Management
- Rigid immobilization (cast or boot) is recommended for non-displaced and stable fibula fractures 1
- Cast immobilization for 6 weeks is appropriate for initial stages of fracture healing 3
- Conservative treatment shows good outcomes in children with transverse fractures of the distal tibia and fibula 4
- Removable splints are appropriate for minimally displaced fractures, particularly in the distal radius/fibula region 5
Surgical Management
Surgical fixation is indicated for:
Plate osteosynthesis is the most common method of surgical stabilization for fibula fractures, with a high union rate of 99.5% 6
Surgical Techniques and Outcomes
- Open reduction and internal fixation (ORIF) is the standard surgical approach for unstable fibula fractures 7
- Plate fixation techniques include:
- The overall complication rate with plate fixation is approximately 19.3%, with most complications (79.5%) being minor 6
- Major complications requiring subsequent surgery occur in only 1.7% of cases 6
Special Considerations
Elderly Patients
- The evidence does not demonstrate any significant difference between casting and surgical fixation in patients aged >55 years with distal radius fractures, which may have implications for fibula fracture management in older adults 2
Associated Tibial Fractures
- In tibial pilon fractures with associated fibula fractures, fibula fixation is not routinely necessary and does not result in decreased mechanical complications 8
- Fibula fracture fixation should be reserved for cases where it may aid reduction or provide additional stability 8
Post-Treatment Care
- Active finger motion exercises should be performed following diagnosis to prevent stiffness 5
- Physical therapy for range of motion and strengthening exercises is recommended after the immobilization period 1
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 5
Potential Complications
- Hardware-related symptoms may develop in some patients, with approximately 13.4% requiring hardware removal 6
- Syndesmosis screw removal may be necessary in about 5.7% of cases 6
- Monitor for potential complications such as skin irritation or muscle atrophy during immobilization 5
Pitfalls and Caveats
- Failure to identify associated syndesmotic injuries can lead to poor outcomes and may require additional surgical intervention 1
- Inadequate reduction of unstable fractures can lead to malunion, post-traumatic arthritis, and poor functional outcomes 2, 1
- In children, perfect axial reposition should be aimed at, but some degree of malposition (varus up to 6 degrees, valgus up to 10 degrees) may be acceptable as it often corrects with growth 4