Treatment Course for Non-Displaced Proximal Fibula Fracture
Non-displaced proximal fibula fractures are typically managed conservatively with immobilization and close radiographic monitoring, as these injuries are generally stable and heal well without surgical intervention.
Initial Assessment and Imaging
- Obtain plain radiographs as the initial imaging modality to confirm the fracture is truly non-displaced and to rule out associated injuries 1
- Carefully evaluate for associated ankle injuries, particularly syndesmotic disruption or deltoid ligament tears, as proximal fibula fractures can occur as part of a Maisonneuve injury pattern 2
- Assess for concomitant tibial shaft fractures or proximal tibiofibular joint (PTFJ) dislocation, which would significantly alter management 3
Conservative Management (Standard Approach)
- Immobilize the fracture with a cast or walking boot for 4-6 weeks, as most isolated non-displaced proximal fibula fractures are stable and respond well to non-operative treatment 2
- The Maisonneuve fracture pattern, when associated with only partial syndesmotic disruption, demonstrates that proximal fibula fractures are often more stable than traditionally assumed and can be successfully managed conservatively 2
Radiographic Follow-Up Protocol
- Obtain follow-up radiographs at 10-14 days after initial injury to monitor for any displacement that may have occurred during early healing 1
- Repeat radiographic assessment at 4-6 weeks to confirm appropriate healing progression and callus formation 1
- Continue monitoring until radiographic union is confirmed, which typically occurs within 8-12 weeks for most fibular fractures 4
Weight-Bearing Progression
- Allow weight-bearing as tolerated based on patient comfort, as the fibula is not a primary weight-bearing bone 5
- Progress mobilization gradually to prevent complications associated with prolonged immobilization 6
Common Pitfalls to Avoid
- Failure to identify associated injuries is the most critical error—always carefully examine the ankle joint and syndesmosis, as isolated proximal fibula fractures can be part of more complex injury patterns 2, 3
- Missing a PTFJ dislocation can lead to chronic instability, persistent pain, and even peroneal nerve palsy if left untreated 3
- Inadequate follow-up imaging may miss delayed displacement, though this risk is lower with truly non-displaced fractures compared to metatarsal fractures 1
Indications for Surgical Consideration
- Surgical fixation is indicated if the fracture is associated with tibial shaft fracture, requiring anatomical reduction and transfixation to restore proper length and rotation 3
- PTFJ dislocation requires open reduction and screw fixation to prevent chronic instability 3
- Displacement occurring during conservative treatment would necessitate surgical intervention 1