What is the treatment?
This depends upon the type and severity of the injury and is decided by a consultant and their team.
Non surgical treatment
If the fracture is stable (this means the two ends of the broken bone do not move) and is in a good position it can be treated with a plaster cast below the knee or removable brace. Weight bearing is permitted for stable fractures but not for unstable fractures.
If the fracture is very unstable (Weber B/C) or displaced, surgery may be required to reset or "fix" the bones in the correct position. This may involv:
- Immediate surgery. When the fracture is uncomplicated plates and screws may be used to fix the fracture.
- Staged surgery. When there has been significant damage to the soft tissues around the joint, the ankle must be rested for a short period of time before surgery can be performed. This allows the swelling and inflammation in the tissues to go down. In the intervening period, the ankle is positioned then held in place by external fixation. While this may be inconvenient and occasionally uncomfortable, the open cage allows the skin and soft tissues to heal. It also allows the medical staff to monitor changes and quickly treat any developing complications, like large bruises or infections. Once the soft tissues are considered safe, surgery will go ahead to fix the joint permanently.
There are variety of different options in the particular operation used, however if surgery is performed you will be non-weight-bearing for at least 2 weeks while the wounds and bones heal.
For many, non-weight-bearing is a frustrating experience. Using crutches or hopping greatly reduces your activities and sometimes ability to return to work. However, it is essential the newly set bones are not over-strained. An in-hospital physiotherapist will assess you for a mobility aid and teach you how to move around, as well as assessing your ability to get up and down stairs.
For more information on the operation, rehabilitation and recovery for ankle fractures see Surgery for Ankle Fractures.
What about pain?
Whilst you are in hospital you will be monitored and the medical staff will give you pain medication as required and prescribed. You will be given instructions on management of the pain by nursing staff before you leave hospital.
Whether you have surgery or not, swelling is quite common. In order to reduce swelling, your foot should be elevated (above the level of your waist) for 50 minutes of every hour for the first two weeks following surgery.