What is the treatment for a proximal fibula fracture, specifically regarding the use of a knee immobilizer?

Treatment for Proximal Fibula Fracture

For proximal fibula fractures, knee immobilization is recommended for 1 week, followed by progressive weight bearing over 4 weeks to allow proper healing and prevent complications. 1

Initial Management

• Proximal fibula fractures should be evaluated for associated injuries, particularly to the common peroneal nerve, which can be secondarily injured due to the fracture 2
• Pain management is essential and should include appropriate analgesia while avoiding NSAIDs in patients with renal dysfunction 3
• Immobilization with a knee immobilizer is indicated to stabilize the fracture site and reduce pain during the initial healing phase 1

Treatment Protocol

• Initial immobilization with a knee immobilizer for the first week to stabilize the fracture and minimize movement at the fracture site 1
• Partial weight bearing should be allowed for 2 weeks following the initial immobilization period 1
• Progressive advancement to full weight bearing over the next 2 weeks (total of 4 weeks from injury) 1
• A gradual and progressive physical therapy program should be initiated, including:
  • Range of motion exercises
  • Muscle strengthening
  • Gait training 1

Special Considerations

• Isolated proximal fibula fractures without displacement or associated injuries generally have good outcomes with conservative management 2
• For proximal fibula fractures with associated tibiofibular joint dislocation, surgical intervention may be necessary to restore joint stability 4, 1
• In cases of Maisonneuve fracture (proximal fibula fracture associated with ankle injury or deltoid ligament tear), treatment depends on the stability of the syndesmosis:
  • Partial syndesmotic disruption can be managed non-operatively with immobilization 5
  • Complete syndesmotic disruption may require surgical fixation 5

Monitoring and Follow-up

• Regular radiographic assessment should be performed to ensure proper bone healing 3
• Full knee range of motion can typically be achieved after approximately 4 weeks with appropriate rehabilitation 1
• Return to daily activities and sports can generally be expected after 6 months with proper treatment 1

Potential Complications

• Common peroneal nerve injury may occur as a secondary complication of proximal fibula fractures, resulting in weakness or foot drop 2
• If not properly treated, chronic instability of the proximal fibula with symptoms such as snapping, pain, and potential nerve palsy can develop 4
• Excessive flexion and internal rotation during positioning should be avoided to minimize the risk of complications 6