Management of Pediatric Non-Displaced Proximal Fibular Head Fractures
For pediatric non-displaced proximal fibular head fractures, immobilize with a posterior splint or back-slab for approximately 3 weeks with radiographic follow-up during the first 3 weeks and at cessation of immobilization to confirm the fracture remains non-displaced.
Immobilization Method
- Posterior splinting is the preferred immobilization technique over collar and cuff methods, as it provides superior pain relief during the first 2 weeks after injury 1, 2.
- The posterior splint should be applied to maintain the knee in slight flexion (approximately 20-30 degrees) to reduce tension on the fibular head and associated lateral collateral ligament structures 1.
Duration of Immobilization
- Immobilization should be maintained for approximately 3 weeks, which represents standard practice supported by clinical outcomes data for non-displaced pediatric fractures of the upper extremity that can be extrapolated to fibular head fractures 1.
- This 3-week protocol balances adequate healing time against the risk of joint stiffness and muscle atrophy in the pediatric population 1.
Radiographic Monitoring
- Obtain radiographic follow-up during the first 3 weeks of treatment to detect any displacement that may occur during the healing process 1, 2.
- Repeat radiographs at the cessation of immobilization (around 3 weeks) to confirm the fracture remains non-displaced before allowing return to activities 1, 2.
Weight-Bearing Status
- Non-weight-bearing or protected weight-bearing with crutches should be maintained during the immobilization period to prevent displacement and reduce pain 1.
- Progressive weight-bearing can be initiated after radiographic confirmation of maintained alignment at 3 weeks 1.
Critical Caveats
- While the evidence base specifically for proximal fibular head fractures in children is limited, the principles of immobilization for non-displaced pediatric fractures are well-established and applicable 1.
- Any signs of displacement on follow-up radiographs warrant immediate orthopedic consultation, as displaced fibular head fractures may require surgical intervention with techniques ranging from tension band fixation to lag screw stabilization 3.
- Associated injuries to the lateral collateral ligament or posterolateral corner structures must be evaluated clinically, as these may alter management even in the setting of a non-displaced fracture 3.