The Diagnosis, Treatment, and Aftercare of Ankle Fractures

Ankle fractures are among the most common types of fracture among adults in Germany, with an incidence of 74 ± 32 cases per 100 000 persons per year. Treatment strategies have changed considerably over the past decade. In this review, we present the current treatment strategies for ankle fractures, aftercare, and long-term results.

Current treatment strategies for ankle fractures were summarized in the framework of a narrative review and expert consensus of the German Orthopaedic Foot and Ankle Society (Deutsche Assoziation für Fuß und Sprunggelenk, D.A.F.). The current mode of postoperative aftercare for ankle fractures and the long-term results were retrieved from structured literature reviews.

Stable, non- or minimally displaced unimalleolar fractures (AO 44A and 44B) can be treated non-operatively with an early return to function. Stability should be verified by bilateral, weight-bearing radiography. Fractures that are unstable or displaced should be treated surgically. Active individuals seem to benefit from anatomic reduction and the stabilization of all fractures and unstable syndesmotic injuries (360° treatment). Minimally invasive techniques are recommended in case of critical soft-tissue conditions or major comorbidity. The benefit of the currently prevailing restrictive postoperative regimens (six weeks of immobilization and reduced or no weight-bearing) has been called into question by the findings of a large number of randomized controlled trials. Early weight-bearing and mobilization improve early functional outcomes without increasing complication rates. Long-term studies have shown that a moderate to poor functional outcome can be expected in up to 20% of cases ≥ 10 years after the operative treatment of an ankle fracture.

Treatment strategies and aftercare regimens have evolved over the past decade. Future studies will need to determine whether these new strategies yield better long-term clinical outcomes.