Management of unstable ankle fractures and syndesmosis injuries in athletes

Athletes with unstable ankle injuries treated with rigid and anatomic internal fixation with concomitant repair of indicated ligaments followed by an accelerated rehabilitation program consisting of early weight bearing and near-immediate range of motion (ROM) can obtain excellent outcomes. Early ROM and weight bearing, if indicated depending on the specific injury pattern, can be effective with low morbidity. Return to sports can be expected as early as 4 weeks after rigid fixation of an isolated fibula fracture and up to 8 to 10 weeks after stabilization of a bimalleolar equivalent fracture with deltoid repair. Syndesmosis fixation can take up to 4 to 6 months before successful return to sport.