From the Guidelines
For an undisplaced fracture of the lateral malleolus, non-surgical management with functional treatment in the form of exercise and functional support is preferred over immobilisation, as it allows for the maintenance of ankle mortise stability and promotes bone healing without surgical intervention. This approach is supported by the British Journal of Sports Medicine study from 2018 1, which emphasizes the importance of functional treatment and exercise in the management of ankle injuries, including fractures. The treatment plan should include:
- A short period of immobilization to reduce pain and swelling, if necessary
- Functional support with a brace or tape to provide stability and promote healing
- Exercise therapy to maintain ankle range of motion and strength
- Elevation of the affected limb and application of ice to reduce swelling
- Regular follow-up with orthopedics to monitor healing and adjust the treatment plan as needed It is essential to note that surgery should be reserved for cases where the fracture displaces or the patient develops complications, as it carries the risk of unnecessary invasive treatment and potential complications, as highlighted in the study 1. By prioritizing functional treatment and exercise, patients with undisplaced fractures of the lateral malleolus can achieve optimal outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Treatment of Undisplaced Fracture of Lateral Malleolus
- The treatment of undisplaced fractures of the lateral malleolus can be conservative or operative, depending on the stability of the fracture and the presence of other injuries 2.
- For isolated lateral malleolar fractures, the Weber classification is frequently used, and conservative treatment is indicated for most Weber A fractures and 80% of Weber B fractures 2.
- The stability of the fracture should be assessed by a gravity stress and a weightbearing radiograph, and if the fracture is stable, it can be treated nonoperatively 2, 3.
- However, if the fracture is unstable, surgical treatment is recommended, especially for Weber B supination-external rotation (SER) injuries, Weber B pronation-abduction (PA) injuries, and Weber C fractures 2.
Non-Surgical Treatment
- Non-surgical treatment of lateral malleolar fractures is safe, and a structured treatment algorithm can reduce the number of unnecessary surgical procedures 4.
- A long-term follow-up study found that non-surgical treatment of stable ankle fractures does not lead to an increase in reoperations caused by non-union, and a treatment algorithm that reduces the need for primary surgical procedures has resulted in a significant decrease in reoperation rates 4.
Operative Treatment
- Operative treatment of displaced lateral malleolar fractures can be effective, and techniques such as Knowles pin fixation and antiglide plating have been used with good results 5, 6.
- However, the choice of operative technique may not significantly affect the outcome, and both techniques have been found to have comparable results in terms of ankle score, function, and complication rates 6.