Ankle Fractures
Non-Operative Management of Ankle Fractures
Ankle fractures are common injuries that can often be managed non-operatively when appropriately selected. The decision for non-operative management depends on fracture stability, displacement, associated ankle ligament injuries and patient factors.
Weber Classification and Weight-bearing:
- Weber A fractures (fracture below syndesmosis ligament): Generally stable and most are suitable for non-surgical management
- Weber B fractures (at level of syndesmosis): Selected stable fractures can be treated non-operatively but many require surgery
- Weber C fractures (above syndesmosis): Usually require surgery due to inherent instability
Initial Management:
- Immediate immobilisation with appropriate splinting
- Ice, compression, and elevation to control swelling
- Pain management as clinically indicated
- Assessment of circulation and nerve symptoms (particularly in high energy injuries)
- X-ray evaluation and sometimes CT scans or MRI scans
Non-operative Treatment (where appropriate):
1. Initial Phase (0-2 weeks):
- Below-knee plaster cast or removable boot
- Non-weight-bearing or touch weight-bearing for Weber B and full weight bearing for
- many Weber A fractures although other factors can come into play
- Regular neurovascular observations (circulation and nerve symptoms)
- Early toe movements encouraged (to prevent swelling and stiffness)
- Follow-up X-rays or scans to ensure position maintained
2. Intermediate Phase (2-6 weeks):
- Conversion to walking cast if fracture stable
- Progressive weight-bearing as tolerated for stable Weber A and B fractures
- Regular x-ray assessment to check healing and position
- Monitoring for loss of reduction (and surgery if position becomes unacceptable)
3. Late Phase (6-12 weeks):
- Cast removal typically at 6-8 weeks
- Initiation of physiotherapy (particularly in adults)
- Range of motion exercises
- Proprioception training
- Graduated strengthening program
Rehabilitation Focus:
- Active ankle movements after cast removal
- Progressive resistance exercises
- Balance and proprioception training
- Gait re-education
- Return to activities based on individual progress
Expected Recovery Timeline:
- Initial healing: 6-8 weeks
- Return to normal walking: 3-4 months
- Full recovery: 6-9 months but can take longer in adults
- Sport-specific rehabilitation may extend beyond this period
Common Complications of Non-operative Management:
- Early Complications:
- Loss of reduction
- Skin pressure areas
- Complex regional pain syndrome
- Deep vein thrombosis
- Late Complications:
- Post-traumatic arthritis
- Chronic ankle stiffness
- Persistent swelling
- Residual pain with activities
Indications for Converting to Operative Management:
- Loss of reduction
- Progressive displacement
- Development of skin compromise
- Failure to progress as expected
- Unstable fracture patterns or associated unstable ligament injuries
Patient Education Points:
- Importance of compliance with weight-bearing restrictions
- Regular elevation to control swelling
- Early movement of unaffected joints
- Recognition of warning signs requiring review
- Realistic expectations regarding recovery timeline (it takes many months to fully recover even after the bone has healed)
Monitoring and Follow-up:
- Regular clinical review at 1-2 week intervals initially
- Serial X-rays to ensure maintenance of reduction
- Assessment of cast integrity and skin integrity
- Monitoring for complications
- Graduated return to activities
Physiotherapy Focus Areas:
- Range of motion exercises
- Muscle strengthening
- Balance and proprioception
- Gait training
- Sport-specific rehabilitation when appropriate
Long-term Outcomes:
- Most patients achieve good functional outcomes
- Some residual stiffness common initially
- Return to pre-injury activity level typically possible
- May have occasional weather-related symptoms
- Regular exercise program beneficial for maintaining function
- Ankle fractures that heal in unacceptable positions tend to do poorly as it is a major weight bearing joint.
Success Factors:
- Patient attitude to injury treatment and recovery
- Compliance with treatment and rehabilitation
- Early recognition of complications
- Structured rehabilitation program
- Regular monitoring and follow-up
How can I book an appointment at the Fracture Clinic?
You can call their phone number or make an appointment online via their website. The clinic is open from 8 a.m. to 4 p.m., Monday through Friday.
Do you accept insurance?
We work with multiple health insurance providers. We offer Medicare rebates where applicable and can assist you in understanding your potential coverage. We recommend:
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Checking your specific insurance policy for physiotherapy, or orthopaedic specialist coverage
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Bringing your Medicare card and private health insurance details to your consultation
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Consulting with our team for precise rebate information, especially if you have DVA or WorkCover coverage
We are committed to transparent pricing and we will provide a comprehensive breakdown of potential costs and rebates during your initial consultation. For patients with eligible Medicare, DVA, WorkCover and/or private health insurance, out-of-pocket expenses can be significantly reduced.
