What is the diagnosis and treatment for a fracture of the lateral malleolus in a 19-year-old male?

From the Guidelines

A lateral malleolus fracture in a 19-year-old male typically requires treatment based on fracture stability and displacement, with the most recent and highest quality study recommending non-surgical management with a short leg cast or walking boot for 6-8 weeks for stable, non-displaced fractures 1. For stable, non-displaced fractures, non-surgical management with a short leg cast or walking boot for 6-8 weeks is recommended, along with non-weight bearing or partial weight bearing for the first 4-6 weeks as directed by the orthopedic surgeon. Pain management should include acetaminophen 650-1000mg every 6 hours and/or ibuprofen 400-600mg every 6-8 hours as needed, with elevation of the leg above heart level and ice application for 20 minutes every 2-3 hours during the first 48-72 hours to reduce swelling. Some key points to consider in the management of lateral malleolus fractures include:

• The use of radiography as the initial imaging study, with a sensitivity of 92-99% for detecting ankle fracture 1
• The importance of weight-bearing radiographs in assessing fracture stability, with a medial clear space of <4 mm confirming stability 1
• The need for surgical fixation with plates and screws for displaced or unstable fractures, followed by similar post-operative care
• The importance of physical therapy after the immobilization period to restore strength, range of motion, and function
• The need to monitor for complications such as nonunion, malunion, or post-traumatic arthritis For displaced or unstable fractures, surgical fixation with plates and screws is necessary, followed by similar post-operative care. The patient should be monitored for complications such as nonunion, malunion, or post-traumatic arthritis. This fracture occurs at the distal end of the fibula and is common in young adults due to sports injuries or ankle twisting mechanisms, with proper treatment generally leading to good outcomes given the patient's young age and good healing potential 1.

From the Research

Fracture of the Lateral Malleolus in a 19-Year-Old Male

• The management of isolated lateral malleolus fractures can be complex, and the decision to operate or not depends on various factors, including the stability of the ankle and the presence of other injuries 2, 3.
• Stable fractures of the ankle can be safely treated non-operatively, with studies showing excellent outcomes for patients with stable ankles 2, 4.
• The integrity of the medial column is essential for the stability of the fracture, and damage to the deltoid ligament or medial malleolus can indicate instability 2, 3.
• Weight-bearing radiographs can be used to assess the stability of the ankle and guide management, with advanced imaging not always necessary 2, 3.
• Surgical treatment options for unstable fractures include lateral or posterolateral plating, intramedullary fixation, and the use of locking plates and small or minifragment fixation 5, 3.
• The implementation of a structured treatment algorithm can reduce the number of surgical treatments for stable ankle fractures and standardize management 4.
• A study comparing the outcomes of surgical management of isolated displaced lateral malleolar fractures using antiglide plating and lateral plating found no significant difference in functional results or complication rates between the two techniques 5.