Return to Play After Distal Fibula Fracture in Hockey Players

Clinical Assessment for Return to Play

The American College of Radiology recommends that patients should be clinically followed until they are pain-free before increasing activity in a controlled manner, with return to play determined based on absence of pain with weight-bearing activities, full range of motion, restored strength and proprioception, and ability to perform sport-specific movements without discomfort 1, 2, 3, 4
Patients with distal fibula fractures should be assessed for full range of motion compared to the uninjured side, with restored strength and proprioception, and ability to perform sport-specific movements without discomfort 1, 2, 4

The American College of Radiology suggests that no additional imaging is typically required after the initial diagnosis of a stress fracture if the patient is healing well clinically, but MRI can provide prognostic information about return to play timeline if there are concerns about healing or persistent symptoms 1, 2, 3

The British Journal of Sports Medicine recommends a progressive, step-wise return to play protocol, beginning with light aerobic activities, progressing to sport-specific training without contact, advancing to non-contact team training, and finally returning to full contact practice and competitive play 4, 5, 6
Each step of the return to play protocol should be completed without pain or swelling before advancing, with the goal of returning to full competitive hockey between 12-16 weeks post-injury 1, 2, 5, 6

The American College of Radiology notes that trabecular bone injuries take longer to heal than cortical bone injuries, and decreased bone mineral density extends recovery time, with presence of persistent pain or swelling with activity indicating need for continued protection 1, 2
Inadequate rehabilitation of strength, balance, and proprioception increases re-injury risk, according to the British Journal of Sports Medicine 4

The Journal of the American Academy of Orthopaedic Surgeons suggests that use of a protective device or brace during initial return to play may be beneficial, with taping techniques providing additional support during the transition back to full competition 4, 6, 7

The British Journal of Sports Medicine warns that returning too early increases risk of re-injury or development of chronic instability, and inadequate rehabilitation of proprioception and balance can lead to functional instability even with good fracture healing 4, 7
Failure to address biomechanical issues that may have contributed to the initial injury, and neglecting to progressively increase training load during return to play, can also lead to poor outcomes 4, 5, 6, 7