From the Guidelines
A fibular fracture with slight displacement can be effectively managed with simple immobilization, as surgery is not typically required for minimally displaced fractures. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician journal 1, the diagnosis of a fibular fracture is based on a history of trauma, focal pain on palpation, and confirmation with radiographic studies.
Key Considerations
- The treatment approach for a fibular fracture with slight displacement prioritizes conservative management, focusing on immobilization to allow for proper healing.
- Immobilization is particularly suitable when fracture fragments are small, nonarticular, or minimally displaced, as stated in the study 1.
- This approach aligns with the goal of minimizing morbidity, mortality, and improving quality of life by avoiding unnecessary surgical interventions.
Management Strategy
- Initial management may include rest, ice, compression, and elevation (RICE) to reduce pain and swelling, although this is not explicitly mentioned in the provided study 1, it is a common practice in orthopedic care.
- Weight-bearing restrictions may be necessary, but the study 1 does not specify the details of weight-bearing status, which would typically depend on the fracture's location and severity.
- The use of a removable walking boot or ankle brace can provide stability while allowing for some movement, but the study 1 emphasizes simple immobilization as appropriate for minimally displaced fractures.
- Regular follow-up with orthopedic evaluation and X-rays is crucial to monitor healing progress, although the specific timeline (e.g., 2,6, and 12 weeks) is not detailed in the study 1.
From the Research
Treatment Options for Fibular Fracture with Slight Displacement
- Intramedullary fixation is a minimally invasive technique that can be used to treat unstable distal fibular fractures, with a mean rate of union of 98.5% and good or excellent functional outcomes in up to 91.3% of patients 2.
- Minimally invasive techniques, including intramedullary nailing, can provide excellent functional results with low complication rates compared to traditional open reduction internal fixation 3.
- Intramedullary fixation of fibula fractures has a mean union rate of 99.1% and good and excellent results in 73%-100% of patients, although current data is limited and suffers from inconsistency in outcome reporting 4.
Comparison of Intramedullary Fixation and Plate Fixation
- Intramedullary fixation is associated with significantly fewer wound-related complications, implant removals, and nonunions compared to plate fixation, although no differences were found regarding malunion and long-term functional outcome 5.
- Intramedullary nailing of the fibula with syndesmotic intranail fixation is a viable treatment option for patients at high risk for complications, offering a minimally invasive and quick procedure with adequate fixation strength 6.
Clinical Outcomes and Complications
- The mean complication rate for intramedullary fixation of distal fibular fractures is 10.3%, with issues such as implant-related problems, fibular shortening, and metalwork failure predominating 2.
- Minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates, with a mean American Orthopedic Foot and Ankle Society hindfoot-ankle score of 88.4 ± 3.40 and a mean Olerud and Molander Score of 76.7 ± 16.58 3.