Treatment of Fibula Styloid Fracture
Isolated distal fibular styloid fractures should be treated with open reduction and internal fixation (ORIF) using anatomically contoured locking plates, allowing immediate full weight-bearing and early mobilization. 1
Initial Assessment and Fracture Classification
When evaluating a fibular styloid fracture, determine the fracture pattern and mechanism of injury:
- Supination-external rotation (SE) fractures extend from the anterior edge in a posterosuperior direction 2
- Pronation-abduction (PA) fractures extend from the medial surface either transversely or obliquely in a laterosuperior direction and are often comminuted 2
- Assess for associated injuries, particularly medial malleolar involvement or syndesmotic disruption 3
Surgical Management
Operative Technique
The preferred fixation method is lateral anatomically contoured titanium locking plate fixation, which provides superior mechanical stability compared to traditional techniques 1:
- One-third tubular plates achieve a 99.5% union rate with low complication rates 4
- For complex or comminuted fractures, double plating with two one-third tubular plates provides enhanced fixation stability 5
- Locking plate technology allows for immediate full weight-bearing without increased risk of mechanical failure 1
Postoperative Protocol
Immediate full weight-bearing is safe and recommended following locking plate fixation 1:
- Begin active ankle and toe range of motion exercises immediately to prevent stiffness 6, 7, 8
- No casting or protected weight-bearing period is necessary with stable locking plate fixation 1
- This approach promotes earlier functional rehabilitation and faster return to work 1
Follow-Up and Monitoring
- Obtain radiographic follow-up at 3 weeks to confirm healing progression 6, 7, 8
- Bone healing rate is 100% at 3 months with locking plate fixation 1
- Monitor for complications including wound healing issues, hardware irritation, or infection 4
Complications and Hardware Removal
The overall complication rate with plate fixation is 19.3%, with most (79.5%) being minor complications 4:
- Minor complications include erythema, heterotopic ossification, neurapraxia, and delayed union 4
- Major complications (9.0%) include deep infection, nonunion/malunion, and osteomyelitis 4
- Hardware removal is needed in approximately 13.4% of cases for symptomatic hardware 4
- Septic complications requiring plate removal occur rarely but respond well to antibiotic treatment 1
Key Clinical Pitfall
Do not routinely obtain foot radiographs in the presence of isolated ankle fractures, as the yield is extremely low except for fifth metatarsal base fractures 3. Focus imaging on the ankle joint and distal tibiofibular syndesmosis.