From the Guidelines
The treatment for an undisplaced lateral malleolus fracture with a Salter-Harris type 1 component involves simple immobilization, as surgery is typically reserved for more complex cases with significant displacement or articular involvement 1. When managing such a fracture, the primary goal is to ensure proper healing while minimizing the risk of complications, particularly given the presence of a Salter-Harris type 1 component which involves the growth plate.
- Immobilization can be achieved with a short leg cast or a removable walking boot for a period of 4-6 weeks.
- Initially, it is recommended that the patient avoids weight-bearing for 1-2 weeks to reduce stress on the fracture site, followed by progressive weight-bearing as tolerated.
- Regular follow-up appointments with radiographic studies at 2-3 week intervals are crucial to monitor the healing process and to promptly identify any potential issues such as displacement or growth disturbances.
- For pain management, medications like acetaminophen or ibuprofen can be used as needed, with dosages adjusted according to the patient's age and weight, not exceeding the recommended daily limits.
- Additional measures to reduce swelling include elevating the affected extremity and applying ice for 20 minutes every 2-3 hours during the initial 48-72 hours. This conservative approach is favored for undisplaced fractures with an intact ankle mortise and no evidence of ligamentous injury, indicating stability of the ankle joint 1.
- The decision to proceed with surgical intervention would be reconsidered if there were signs of fracture displacement during the treatment period or if the fracture failed to heal properly, necessitating a more invasive approach to ensure optimal outcomes.
From the Research
Treatment for Undisplaced Lateral Malleolus Fracture with Salter-Harris Type 1 Component
- The treatment for an undisplaced lateral malleolus fracture with a Salter-Harris type 1 component is conservative management 2.
- Conservative treatment is recommended for patients with Salter-Harris type I and II distal tibial epiphyseal fractures 2.
- Below-knee cast immobilization can be an effective alternative in the treatment of both nondisplaced and displaced distal tibial physeal fractures, including those with intra-articular involvement 3.
- Closed reduction and internal fixation may be performed for patients with less than 2 mm of fracture displacement, while open reduction may be performed in patients with more than 2 mm of fracture displacement 2.
- The use of CT imaging may be necessary to accurately classify the fracture and assess the involvement of the articular surface, as conventional radiographs may have a low overall accuracy for these assessments 4.