Conservative therapy for external ankle fracture
In principle, conservative therapy of the external ankle fracture is possible for non-displaced fractures and fractures without syndesmosis injury. This includes simple external ankle fractures or internal ankle fractures below the syndesmosis as well as non-displaced external ankle fractures at the level of the syndesmosis, provided that the syndesmosis is not injured. In a conservative treatment approach, the therapy consists of immobilising the external ankle fracture with a plaster cast, for example, after any displaced bone parts have been brought back into their correct position.
During this so-called reduction, a doctor will align palpable bone fragments correctly by hand. The result is checked with an X-ray examination to obtain an exact result. A split lower leg cast is used to immobilize the fracture.
With appropriate pain therapy and so-called thrombosis prophylaxis (prevention of a blood clot), we first wait until the affected lower leg is sufficiently swollen and healed. This usually takes about 3 weeks. After that the patient is allowed to put light weight on the affected leg again.
Initially, however, only a so-called partial load should be applied, i.e. standing with the entire body weight on the broken leg should be avoided. With the help of adapted crutches and regular physiotherapy, the load can be continuously increased within the second 3 weeks, depending on the patient’s pain. After a total of 6 weeks, the fracture of the outer ankle has usually healed sufficiently under conservative treatment so that the cast can be removed.
Until then and also afterwards, regular x-ray checks of the fracture are still necessary to assess the position of the fragments on each other. In the event of subsequent slippage or displacement or sudden instability, an operation may still be necessary in the second step. Overall, conservative treatment of the external ankle fracture is a relatively low-risk procedure.
Possible risks and complications can include pressure points caused by the plaster on the skin and in underlying tissue. Unfortunately, stiffening of the joint can also be observed from time to time, but in most cases it can be remedied by appropriate physiotherapeutic measures. In some patients, thrombosis (a clot that closes a vessel) can occur due to the long period of lying down, which is why one usually carries out a drug-based thrombosis prophylaxis from the beginning.
Shortly after removal of the plaster cast, movement of the affected leg may also be restricted, as both the bones and the muscles become less able to bear weight due to very long periods of protection in the plaster cast. About 10% of patients also develop arthrosis (wear and tear) of the affected ankle earlier in the long-term than people who have never suffered an external ankle fracture. Only very few of them have a lifelong foot malposition.
An airwalker is a boot that is used for various foot injuries and also for the therapy of an outer ankle fracture. The Airwalker is therefore considered an alternative to a plaster cast. It consists of a plastic shell.
Inside the boot there is a vacuum cushion that adapts well to the shape of the patient’s leg. Therefore the outer ankle fracture can be stabilized well. A movement of the leg is possible because the Airwalker is very light.
Furthermore, it is well ventilated, which makes it easier to reduce swellings. Since the Airwalker can also be removed at any time, the attending physician can assess the progress of the therapy of the external ankle fracture better than with a rigid cast. The disadvantage is that the boot must fit correctly and if used incorrectly, there is no healing therapy but pain and a worsening of the external ankle fracture.
Furthermore, even though the Airwalker offers the possibility of easy and immediate loading, the outer ankle should not be overloaded too early. In some cases, the Airwalker cannot be used as an alternative to a plaster cast for certain reasons. Whether the Airwalker is suitable for the treatment of an external ankle fracture is decided by the attending physician.