Treatment for Non-Displaced Distal Fibula Fracture
A non-displaced distal fibula fracture should be managed with a posterior splint extending from below the knee to the toes with the ankle in neutral position for approximately 3 weeks, followed by radiographic confirmation of healing. 1
Initial Immobilization Protocol
- Apply a posterior splint with the ankle maintained at 90 degrees to prevent equinus contracture and accommodate anticipated swelling in the first 48-72 hours 1
- The splint should extend from below the knee to the toes 1
- This conservative approach is appropriate for isolated, minimally displaced distal fibular fractures with stable ankle mortise (medial clear space <4mm on weight-bearing radiographs) 1
Immediate Active Motion
- Initiate active toe motion exercises immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling complications 1
- Active toe motion does not adversely affect adequately stabilized fractures 1
Duration and Follow-Up
- Maintain initial splinting for approximately 3 weeks 1
- Obtain radiographic follow-up at 3 weeks to confirm adequate healing 1
- Weight-bearing radiographs at follow-up provide critical information about fracture stability, particularly the medial clear space 1
Critical Assessment for Stability
Before committing to conservative management, you must rule out instability indicators:
- Examine for medial tenderness, bruising, or swelling—these suggest deltoid ligament injury and potential instability requiring surgical consideration 1
- Assess whether the fibular fracture is above the syndesmosis, which indicates higher risk of syndesmotic injury 1
- Rule out bi- or trimalleolar fractures, which are inherently unstable and typically require surgical fixation 1
- Exclude open fractures or high-energy mechanisms that warrant immediate orthopedic consultation 1
Common Pitfalls to Avoid
- Do not miss associated injuries such as medial ankle tenderness, syndesmotic injury, or Maisonneuve fracture pattern—always examine for these conditions 1
- Monitor for complications including skin irritation and muscle atrophy, which occur in approximately 14.7% of immobilization cases 1
- Avoid prolonged immobilization beyond what is necessary, as this increases risk of stiffness without improving outcomes 2