Treatment Recommendation for Non-Displaced Distal Fibula and Posterior Malleolus Fractures
Conservative management with immobilization is the appropriate treatment for this 33-year-old male with non-displaced distal fibula and non-displaced posterior malleolus fractures.
Initial Management
Immobilization is the primary treatment approach for minimally displaced fractures without instability 1. For this patient with non-displaced fractures, operative intervention is not indicated unless specific displacement criteria are met.
Key Stability Assessment Parameters
Before proceeding with conservative treatment, verify:
- Displacement is <3mm 1
- No dorsal tilt >10° 1
- Medial clear space <4mm (confirms ankle stability) 1
- No intra-articular involvement or step-off 1
If any of these thresholds are exceeded, surgical fixation becomes necessary 1.
Conservative Treatment Protocol
Immobilization Approach
- Apply removable splint or cast for stable, non-displaced fractures 1
- Immediate active toe motion exercises should be initiated to prevent stiffness, which does not adversely affect adequately stabilized fractures 1
- Apply ice at 3 and 5 days post-injury for symptomatic relief 1
Radiographic Follow-Up Schedule
- Obtain follow-up radiographs at approximately 3 weeks to confirm maintenance of alignment 1
- Repeat imaging at time of immobilization removal to confirm adequate healing 1
Posterior Malleolus Considerations
For the non-displaced posterior malleolus component specifically:
- Conservative treatment is recommended for Bartoníček type I, II, and undisplaced type III fractures without tibial plafond depression 2
- The clinical outcome depends heavily on syndesmotic integrity and absence of articular step-offs 2
- Surgical treatment is only indicated for displaced type III and type IV fractures 2
Monitoring for Complications
Watch for immobilization-related complications, which occur in approximately 14.7% of cases 1:
- Skin irritation
- Muscle atrophy
- Joint stiffness (most functionally disabling complication)
When Surgery Becomes Necessary
Surgical intervention is indicated if:
- Post-reduction displacement >3mm 1
- Dorsal tilt >10° 1
- Intra-articular involvement with step-off 1
- Syndesmotic instability develops 2
- Tibial plafond depression is present 2
For surgical cases, options include direct plating of the posterior malleolus or intramedullary fixation of the fibula, depending on fracture pattern 3, 4.