From the Guidelines
The treatment for an acute puncture avulsion fracture of the lateral malleolus typically involves a combination of immobilization, pain management, and progressive rehabilitation, with a focus on maintaining ankle stability and preventing long-term complications.
Key Considerations
- Immobilization using a short leg cast or a removable walking boot for 4-6 weeks, depending on fracture severity and displacement, is a common approach 1.
- Pain management includes acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for the first 1-2 weeks.
- Elevation of the affected limb above heart level for 20-30 minutes several times daily and application of ice packs for 15-20 minutes every 2-3 hours during the first 48-72 hours will help reduce swelling.
- Weight-bearing status should be determined by the orthopedic specialist but typically progresses from non-weight-bearing to partial and then full weight-bearing over 4-6 weeks.
- Physical therapy should begin after immobilization to restore range of motion, strength, and proprioception, usually lasting 6-12 weeks.
Surgical Intervention
Surgical intervention with internal fixation may be necessary if the fracture is significantly displaced (>2mm) or if the ankle joint is unstable, as evidenced by a study published in the Journal of the American College of Radiology 1.
Recent Guidelines
Recent guidelines published in the British Journal of Sports Medicine suggest that a short period (<10 days) of immobilization with a plaster cast or rigid support can be of added value in the treatment of acute lateral ligament injury, as it decreases pain and edema and improves functional outcome 1.
Imaging Studies
Imaging studies, such as radiographs, are essential in diagnosing and evaluating the severity of the fracture, with a sensitivity of 92-99% for detecting ankle fractures using the Ottawa Ankle Rules (OAR) criteria 1.
From the Research
Treatment Options for Acute Puncture Avulsion Fracture of the Lateral Malleolus
- The treatment for an acute puncture avulsion fracture of the lateral malleolus depends on the stability of the ankle joint 2.
- If the ankle is stable, nonsurgical management can produce excellent outcomes 2.
- In cases where clinical or radiographic findings indicate ankle instability, surgical fixation options are considered 2.
Surgical Fixation Options
- Lateral or posterolateral plating are possible surgical fixation options for unstable ankle fractures 2.
- Intramedullary fixation is also a viable option for managing unstable ankle fractures 2.
- The use of locking plates and small or minifragment fixation can be important adjuncts in surgical management, depending on individual patient needs 2.