What is the treatment for an undisplaced fracture of the lateral malleolus (fibular bone) with a Salter-Harris type 1 component?

From the Guidelines

The treatment for an undisplaced fracture of the lateral malleolus with a Salter-Harris type 1 component involves simple immobilization, as the fracture fragments are nonarticular and minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as stated in a study published in the American Family Physician in 2002 1. The immobilization can be achieved with a short leg cast or a removable walking boot for 4-6 weeks.

• Key considerations for the treatment include:
  • Avoiding weight-bearing for 1-2 weeks initially, followed by progressive weight-bearing as tolerated
  • Regular follow-up with orthopedics at 1-2 week intervals to monitor healing and ensure the fracture remains properly aligned
  • Pain management with acetaminophen (650mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) as needed
  • Ice application for 20 minutes several times daily and elevation of the extremity above heart level to reduce swelling
• The Salter-Harris type 1 component requires careful monitoring to prevent growth disturbances, but surgical intervention is typically unnecessary unless displacement occurs during the healing process.
• After immobilization, physical therapy should begin to restore range of motion and strength, promoting a full recovery and minimizing the risk of long-term morbidity and impact on quality of life.

From the Research

Treatment for Undisplaced Fracture of the Lateral Malleolus

The treatment for an undisplaced fracture of the lateral malleolus (fibular bone) with a Salter-Harris type 1 component can be conservative or surgical, depending on the specific circumstances of the fracture and the patient's overall health.

• Conservative treatment may be considered for:
  • Undisplaced or minimally displaced fractures without ankle instability 2
  • Patients who are older or have underlying health conditions that make surgery risky 3, 2
• Surgical treatment may be indicated for:
  • Fractures with significant displacement or ankle instability 4, 3, 5
  • Cases where conservative treatment is not effective or feasible 3, 2
• The decision between conservative and surgical treatment should be based on a thorough evaluation of the patient's condition, including the severity of the fracture, the presence of any associated injuries, and the patient's overall health and functional status 4, 3, 2

Key Considerations

• The presence of a Salter-Harris type 1 component may affect the treatment approach, as these fractures involve the growth plate and require careful management to avoid long-term complications 6, 4
• The stability of the ankle joint and the presence of any associated ligamentous injuries should be carefully assessed to determine the best treatment approach 4, 5
• The patient's age, overall health, and functional status should be taken into account when deciding between conservative and surgical treatment 3, 2