Non-weight bearing short leg cast until fx is healed (6-8wks). There is no statistically significant difference in outcomes between NWB casting for 6 weeks (96% successful with average return to activity of 4.9months) compared to surgery (82% successful with average return to activity of 5.2 months). (Torg S, AAOS Now Jan 2010).
Continued weight bearing without treatment can lead to fragmentation, dislocation and collapse of the medial column.
Surgery indicated if fracture line extends across two cortices, or across one cortice with displacement or cystic changes.
High-level athlete: consider ORIF due to high risk of nonunion / prolonged symptoms.