Treatment Protocol for Distal Fibula Fractures
The optimal treatment protocol for distal fibula fractures includes surgical fixation with anatomically contoured locking plates for displaced fractures, allowing immediate full weight-bearing, while non-displaced fractures can be managed with removable splints. 1
Initial Assessment and Classification
- Fractures should be classified based on displacement (significant displacement defined as >3mm), dorsal tilt (>10°), and presence of intra-articular involvement 2, 3
- Radiographic evaluation is essential for confirming diagnosis and fracture pattern 3
Treatment Algorithm
For Non-displaced/Minimally Displaced Fractures:
- Removable splinting is appropriate with a typical immobilization period of 3-4 weeks 2, 3
- Active finger motion exercises should be performed immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects 4, 2
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 2, 3
For Displaced Fractures (>3mm displacement, >10° dorsal tilt, or intra-articular involvement):
- Open reduction and internal fixation (ORIF) is indicated 2, 3
- Fixation options include:
- Anatomically contoured locking plates, which provide strong and stable fixation allowing immediate full weight-bearing with 100% bone healing rate at 3 months 1
- Double plating technique for complex fractures, which has shown good clinical outcomes with high healing rates 5
- Intramedullary fixation as an alternative to plate fixation, especially in elderly patients, those with chronic comorbidities, or compromised soft tissue, resulting in fewer wound-related complications, implant removals, and nonunions 6
- Posterior or posterolateral plating, which achieves good clinical and high functional outcomes with potentially lower hardware removal rates 7
Post-Operative Management
- Following stable fracture fixation, early wrist motion is not routinely necessary 4, 2
- When external fixation is used, limiting the duration of fixation is recommended to reduce complications 4
- For patients with internal fixation using volar locked plates, shorter immobilization periods (1-3 weeks) produce superior short-term outcomes compared to 6 weeks of immobilization, though long-term outcomes are similar 8
- A home exercise program should be prescribed for rehabilitation 4
Prevention of Complications
- Active finger motion exercises are crucial to prevent stiffness, which can be very difficult to treat after fracture healing 4, 2
- Monitor for potential complications such as:
- Skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 2, 3
- Hardware-related pain, which may necessitate removal in some cases (reported in 13.6-18.6% of patients) 7
- Infection risk, which can be minimized with appropriate surgical technique and postoperative care 1