How long should a cam (cam walker) boot be worn for a nondisplaced buckle fracture of the distal fibula?

Duration of CAM Boot Wear for Nondisplaced Buckle Fracture of Distal Fibula

A CAM (controlled ankle movement) boot should be worn for approximately 3 weeks for a nondisplaced buckle fracture of the distal fibula. 1, 2

Treatment Approach for Nondisplaced Buckle Fractures

• Nondisplaced buckle fractures of the distal fibula are stable injuries that can be successfully managed with conservative treatment 3
• A removable CAM boot is the preferred immobilization method over a cast for these injuries, as it provides:
  • Improved range of motion outcomes 4
  • Higher patient satisfaction scores 4
  • Significantly fewer complications (0.04/patient vs 0.54/patient with casts) 4
• The American Academy of Orthopaedic Surgeons (AAOS) recommends removable splints/boots as appropriate options for treating minimally displaced fractures 2

Duration of Immobilization

• Current evidence indicates that the optimal duration of immobilization for nondisplaced buckle fractures is 3 weeks 1, 2
• Radiographic follow-up is recommended at approximately 3 weeks to confirm adequate healing before discontinuing immobilization 2
• Prolonged immobilization beyond this period can lead to unnecessary complications such as:
  • Joint stiffness 2, 5
  • Muscle atrophy 5
  • Skin irritation (immobilization-related adverse events occur in approximately 14.7% of cases) 2, 5

Rehabilitation Considerations

• Active toe and ankle motion exercises should be initiated as soon as comfortable after diagnosis to prevent stiffness 2, 5
• Early controlled motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 2
• After boot removal at 3 weeks, gradual return to normal activities can begin if:
  • Radiographic healing is confirmed 2
  • Patient has minimal pain 5
  • Range of motion is improving 4

Special Considerations

• If there is any significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, a different treatment approach may be indicated 2
• For patients with poor compliance or those unable to follow instructions, a more rigid immobilization might be considered 2
• Monitor for potential complications during the immobilization period, including skin irritation and muscle atrophy 2, 5

Follow-up Protocol

• Initial radiographic evaluation to confirm diagnosis and fracture pattern 2
• Clinical and radiographic follow-up at approximately 3 weeks to assess healing and determine if immobilization can be discontinued 2
• No routine follow-up is typically needed after boot removal if healing is confirmed and symptoms have resolved 1