From the Guidelines
A posterior ankle splint is the recommended initial management for a non-displaced distal fibular fracture. This recommendation is based on the principle of simple immobilization for small, nonarticular, or minimally displaced fractures, as suggested by the American College of Foot and Ankle Surgeons 1. The splint should be applied with the ankle in a neutral position at 90 degrees, extending from below the knee to the toes, with padding between bony prominences to prevent pressure sores.
The splint should be secured with an elastic bandage wrapped in a spiral fashion from distal to proximal, not too tight to avoid compromising circulation. This type of splint provides adequate immobilization while allowing for swelling that typically occurs in the first 48-72 hours after injury. Key considerations for the initial management include:
- Immobilization to prevent further injury and promote healing
- Accommodation for swelling to reduce the risk of compartment syndrome
- Elevation of the extremity above heart level to minimize edema
- Application of ice for 20 minutes every 2-3 hours while awake to reduce pain and inflammation
- Appropriate pain medication as needed to ensure patient comfort
Weight-bearing status should typically be non-weight bearing or touch-down weight bearing with crutches until follow-up with an orthopedic specialist, usually within 5-7 days, when the splint may be converted to a walking boot or cast depending on healing progress and stability of the fracture. The choice of a posterior ankle splint over other types of immobilization is preferred initially because it best meets the needs for immobilization, swelling accommodation, and reduction of compartment syndrome risk, aligning with the principles outlined for the management of such fractures 1.
From the Research
Initial Management of Non-Displaced Distal Fibula Fracture
The recommended approach for managing non-displaced distal fibula fractures is nonoperative treatment, as stated in 2 and 3.
- Nonoperative treatment includes the use of a splint or cast to immobilize the ankle and allow the fracture to heal.
- The specific type of splint recommended for initial management is not specified in the provided studies.
- However, it is implied that a stable and immobilizing splint is necessary to allow the fracture to heal properly, as unstable fractures may require surgical intervention 2, 3.
- The studies suggest that nonoperative treatment can lead to excellent results in over 90% of cases for non-displaced fractures 2, and that conservative treatment can be considered even in unstable fractures for certain patients, such as the elderly or those with health issues 3.
Considerations for Splint Selection
When selecting a splint for initial management, considerations should include:
- The stability and immobilization provided by the splint
- The comfort and fit of the splint for the patient
- The ability to monitor and assess the fracture during the healing process
- The potential for complications, such as wound healing issues or hardware removal, although these are more relevant to surgical interventions 4, 5.