The leg is then immobilised with a splint until the patient arrives in hospital.

All ankle fractures without bony displacement and injury to the fibrous connection between the tibia and fibia (syndesmosis) can be treated without surgery. Prompt surgery cannot usually be considered in patients suffering from severe diseases who can only be operated upon at great risk, or those with significant circulatory disorders of the legs, or with venous ulcers of the calf or infections of the forefoot.

Once the ankle swelling has subsided with immobilisation with a plaster splint or a split plaster dressing, a closed plaster cast is applied. After the plaster has been removed and X-rays show satisfactory results, weight-bearing on the ankle can be gradually increased. In the case of simple fractures of the outer ankle bone (lateral malleolus), once a plaster cast has been applied the patient can walk again straightaway.

Surgical treatment

If an ankle fracture involves displacement of the bone ends, then an operation is necessary. Surgery is also required after damage to the syndesmosis – the fibrous connection between the tibia and fibula – but only if both ligaments are torn. Prompt surgery – within a few hours – is essential in the case of severe injuries such as open fractures, damage to blood vessels and nerves as well as breaks with severe soft tissue damage. If the ankle swelling is too far advanced, surgery must be delayed until this has subsided as otherwise the risk of infection is considerably increased. Until swelling has subsided, the calf is immobilised with a plaster splint or in a split cast. During this period, the leg must be elevated and cooled.

In order to prevent muscle wasting and thrombosis, isometric exercises should be started even when the leg is still in plaster. So-called thrombosis prophylaxis must be given until the ankle is capable of full load-bearing. This is achieved through physiotherapy and daily pain-free injections of a heparin derivative into the fatty tissue of the abdominal wall or thigh. After the plaster cast is removed, intensive physiotherapy exercises are needed to restore mobility of the ankle joint.