Evaluation and treatment of ankle fractures

The ability to classify ankle fractures allows one to determine which fractures will probably do well with nonoperative treatment and which fractures will fare best with open reduction because of their inherent instability. An understanding of the Lauge-Hansen system also allows one to predict the degree of ligamentous injury on the basis of the osseous pattern of the injury. Operative management of ankle fractures requires a thorough understanding of ASIF technique. Open reduction is best performed with a fracture that is not anatomically reducible or with a fracture type that has been historically proven unstable with closed treatment. Restoration of anatomic alignment of articular surfaces should be the goal of treatment. When anatomic reduction has been achieved, ankle fractures generally do well whether they have been treated with operative or nonoperative techniques. Early motion is helpful if rigid fixation can be achieved, but one should not sacrifice stability in an attempt to begin early movement if rigid fixation has not been obtained. Decisions concerning length of immobilization and early movement should be based upon the principles of bone healing physiology.