From the Guidelines
Surgical intervention is the recommended treatment for a fibular fracture with displacement, as it provides better outcomes in terms of functional recovery and reduced risk of complications such as malunion and nonunion. However, the provided evidence primarily focuses on clavicle fractures, not fibular fractures. Despite this, the general principle of treating displaced fractures to prevent malunion and nonunion can be applied.
When considering the treatment of a fibular fracture with displacement, several factors come into play, including the severity of the displacement, the stability of the ankle, and the patient's overall health and activity level. Treatment options may include:
- Immobilization with a cast or walking boot for 6-8 weeks, with weight-bearing restrictions determined by the severity of displacement 1.
- Pain management with acetaminophen or NSAIDs, if not contraindicated.
- Elevation of the affected limb and ice application to reduce swelling.
- Physical therapy after immobilization to restore strength and range of motion.
- Surgical intervention with plates, screws, or rods may be necessary to realign the bone fragments properly, especially in cases with significant displacement or when the fracture affects ankle stability.
It's essential to note that the provided evidence does not directly address fibular fractures, but the principles of treating displaced fractures can be applied. The most recent and highest quality study on clavicle fractures 1 suggests that surgical treatment can provide better outcomes in terms of functional recovery and reduced risk of complications, which can be extrapolated to other types of fractures, including fibular fractures.
In real-life clinical practice, the treatment of a fibular fracture with displacement would depend on various factors, including the patient's overall health, activity level, and the severity of the fracture. A thorough evaluation and consultation with an orthopedic specialist are necessary to determine the best course of treatment.
From the Research
Fibular Fracture with Displacement
- A fibular fracture with displacement can be treated with various methods, including open reduction internal fixation, minimally invasive plate osteosynthesis, intramedullary (IM) nailing, and IM screw fixation 2.
- The choice of treatment depends on the severity of the fracture, the patient's overall health, and the surgeon's preference.
- A study published in 2014 found that fibular fixation is recommended in all 42 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilized 3.
- Another study published in 2018 found that an immediate weight-bearing protocol can be an effective method for determining functional ankle stability in patients with isolated distal fibular fractures 4.
- Minimally invasive fixation of distal fibular fractures with intramedullary nailing has been shown to be a viable option, with a low rate of wound complications and excellent functional results 5, 6.
- A systematic review published in 2021 found that minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared with traditional open reduction internal fixation 2.
Treatment Options
- Open reduction internal fixation: This is the current gold standard in treating unstable distal fibular fractures, but it carries a risk of wound complications 2.
- Minimally invasive plate osteosynthesis: This technique has been shown to provide excellent functional results with low complication rates 2.
- Intramedullary (IM) nailing: This technique has been shown to be a viable option, with a low rate of wound complications and excellent functional results 5, 6.
- IM screw fixation: This technique has been shown to provide excellent functional results with low complication rates 2.
Outcomes
- The outcomes of treatment for fibular fractures with displacement depend on the severity of the fracture, the patient's overall health, and the surgeon's preference.
- A study published in 2021 found that the mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores among all fixation types was 88.4 ± 3.40, and the mean Olerud and Molander Score among all fixation types was 76.7 ± 16.58 2.
- Another study published in 2023 found that the average time to union was 10.3 weeks, and the average time to weight-bearing was 6.8 weeks with a walking boot and 11.2 weeks without a walking boot 5.