What is the recommended treatment for a patient with a nondisplaced fibular head fracture?

Treatment of Nondisplaced Fibular Head Fracture

Nondisplaced fibular head fractures should be managed conservatively with immobilization, pain control, early mobilization with weight-bearing as tolerated, and close radiographic follow-up to monitor for secondary displacement.

Initial Management

• Conservative treatment is the standard of care for nondisplaced fibular head fractures, as these injuries rarely require surgical intervention unlike distal fibular fractures 1
• Immobilization options include:
  • Walking boot with crutches for mobility support 1
  • Custom 3D-printed bracing (carbon fiber nylon, 4mm thickness) secured with elastic bandage, providing lateral stability and pressure to the tibial head 1
  • Short-term immobilization followed by progressive weight-bearing 2

Pain Management and Activity Modification

• Analgesics are the cornerstone of conservative treatment, combined with activity modification to reduce mechanical stress on the fracture site 3
• Early mobilization with weight-bearing as tolerated should be initiated to prevent complications of prolonged bed rest 4

Critical Follow-Up Protocol

• Regular radiographic follow-up is mandatory to monitor for secondary displacement, which occurs in 30-50% of initially nondisplaced fractures 4
• Monitor specifically for:
  • Incomplete union or nonunion development 2
  • Persistent localized pain with reproducible tenderness at the fracture site 2
  • Development of antalgic gait pattern 2

Indications for Surgical Intervention

• Surgery is not indicated initially for isolated nondisplaced fibular head fractures 1
• Surgical intervention becomes necessary if:
  • Secondary displacement occurs during follow-up 4
  • Symptomatic nonunion develops despite adequate conservative management (persistent pain, difficulty with ambulation) 2
  • Associated posterolateral corner injuries or lateral collateral ligament avulsion are present 5

Common Pitfalls to Avoid

• Do not dismiss persistent lateral pain after appropriate conservative treatment—this may indicate fibular nonunion from micromotion strain at the incomplete fracture union site 2
• Smoking and premature weight-bearing significantly prolong healing time, even in conservatively managed fractures 6
• Initial radiographs may be inconclusive; advanced imaging (MRI) may be necessary to confirm the diagnosis when plain films are negative 1

Expected Outcomes

• Conservative management with appropriate bracing and mobilization typically results in full recovery without complications 1
• Healing rate with non-operative management is 90-95% 3
• If surgical stabilization becomes necessary for nonunion, complete pain resolution and return to normal gait occurs within an average of 2.3 months postoperatively 2