What is the treatment for a distal fibula fracture?

Treatment of Distal Fibula Fractures

For distal fibula fractures, surgical fixation is recommended for fractures with post-reduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement. 1

Assessment and Classification

• Evaluate for displacement, stability, and intra-articular involvement to guide treatment decisions 1
• Measure medial clear space - if ≤6 mm without proven instability, non-operative treatment can be considered 2
• Assess for concomitant ankle instability, which may need to be addressed during surgical treatment 3

Treatment Algorithm

Non-displaced/Stable Fractures

• Removable splints are appropriate for minimally displaced distal fibula fractures 4, 5
• Non-operative treatment shows good long-term outcomes in terms of pain and function for isolated stable fibula fractures 2
• Benefits of non-operative treatment include avoiding surgical risks and costs while maintaining good functional outcomes 2

Displaced/Unstable Fractures

• Surgical fixation is indicated for:

  • Radial shortening >3 mm 1
  • Dorsal tilt >10° 1
  • Intra-articular displacement 1
  • Proven ankle instability 3

• Surgical options include:

  • Open reduction internal fixation (ORIF) with anatomically contoured locking plates 6
  • Double plating technique for problematic fractures requiring enhanced fixation 7
  • Special considerations for osteoporotic fractures may include locked plate systems, anti-glide plate constructs, or dual plating 8

Post-Treatment Management

• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal 4
• Active finger motion exercises should be performed following diagnosis to prevent stiffness 4
• With anatomically contoured locking plates, immediate full weight-bearing may be possible, promoting earlier functional rehabilitation 6

Potential Complications

• Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 4, 9
• Surgical complications may include:
  • Need for hardware removal (33% in one study) due to persistent pain 2
  • Wound infections requiring antibiotic treatment (3% in one study) 2
  • Implant failure in osteoporotic bone if not properly addressed 8

Special Considerations

• For elderly patients with osteoporotic bone, early detection of osteoporosis is important to select appropriate fixation methods and avoid implant failure 8
• In cases of posttraumatic os subfibulare (avulsion fracture), surgical treatment generally results in substantial improvement with relatively low complication rates 3