Management of Distal Fibular Fractures

Initial Immobilization Approach

The American College of Radiology recommends that isolated, minimally displaced distal fibular fractures can be managed with a posterior splint that extends from below the knee to the toes, maintaining the ankle in neutral position 1
Stable ankle fractures, indicated by a medial clear space of less than 4mm on weight-bearing radiographs, can be managed conservatively with splinting 1
The posterior splint should be applied with the ankle at 90 degrees to prevent equinus contracture and allow for anticipated swelling in the first 48-72 hours 1

Medial tenderness, bruising, or swelling suggests deltoid ligament injury and potential instability, requiring closer follow-up or surgical consideration 1
Fibular fracture above the syndesmosis indicates a higher risk of syndesmotic injury 1
Bi- or trimalleolar fractures are inherently unstable and typically require surgical fixation rather than splinting alone 1
Open fractures or high-energy mechanisms warrant immediate orthopedic consultation 1

Initial splinting should be maintained for approximately 3 weeks with radiographic follow-up to confirm adequate healing 2, 3
Weight-bearing radiographs at follow-up provide critical information about fracture stability, particularly assessing the medial clear space 1

Immediate active toe motion exercises should be initiated to prevent stiffness, which is one of the most functionally disabling complications 2, 3
Finger and toe motion does not adversely affect adequately stabilized fractures 2

Do not miss associated injuries, such as medial ankle tenderness, syndesmotic injury, or Maisonneuve fracture pattern, and always examine for these conditions 1
Monitor for complications, including skin irritation and muscle atrophy, which occur in approximately 14.7% of immobilization cases 2, 3