Treatment of Acute Avulsion Fracture of the Lateral Malleolus Tip

Initial Assessment

The American College of Radiology recommends standard three-view ankle radiographs (anteroposterior, lateral, and mortise views) to evaluate the fracture fragment and overall ankle alignment 2
The American College of Radiology suggests applying Ottawa Ankle Rules to determine the need for radiographs in patients with acute ankle trauma 2
An anterior talofibular ligament view radiograph may be useful for diagnosis of distal fibular avulsion fractures if not seen on traditional three-view radiographs, as recommended by the American College of Radiology 2

Functional treatment with early mobilization is superior to immobilization for acute ankle injuries including avulsion fractures, with benefits including faster return to work, better patient satisfaction, and faster return to sports, according to the British Journal of Sports Medicine 1
A lace-up ankle brace is preferred over an elastic bandage or tape for better reduction of swelling, fewer complications, and faster return to work, as reported by the British Journal of Sports Medicine 1
Exercise therapy should be incorporated into the treatment plan to prevent recurrence of lateral ankle injuries and improve long-term outcomes, as recommended by the British Journal of Sports Medicine 1

Regular radiographic follow-up is essential to ensure proper healing and alignment, with weight-bearing radiographs helping to assess stability, according to the American College of Radiology 2

5-33% of patients with lateral ankle injuries still have pain and complaints of instability after 1 year, and 3-34% experience recurrent ankle sprains, as reported by the British Journal of Sports Medicine 1
Failure to recognize associated ligamentous injuries can compromise outcomes, and overly aggressive rehabilitation before adequate healing can lead to displacement or nonunion, as noted by the American College of Radiology 2