Non-surgical treatment
A non-operative or even conservative therapy of an external ankle fracture (ankle fracture) is a good alternative compared to a surgical intervention, which of course involves the general risks of surgery. A prerequisite for the non-operative therapy of an external ankle fracture is that the fracture is uncomplicated and stable. A bone fracture is considered stable if the fragments are not displaced against each other, the fracture line is as straight and smooth as possible, no bone fragments are chipped off and the bones involved do not measure too much distance from each other.
In the special case of an ankle fracture, such a stable fracture, which can usually be treated without further surgery, is called a Weber A type fracture: First, the ankle is cooled to reduce the bleeding and swelling. Once the swelling at the ankle joint has successfully subsided, a plaster cast is applied around the foot including the ankle and lower leg, which ensures immobilization in the joint for up to 6 weeks. In general, in the case of an uncomplicated Weber A fracture, it may be permitted by the physician to apply a plaster cast to the affected foot within the healing period.
Appearance and walking on or with the injured ankle can be quite advisable if the fracture is held in the correct position by a plaster cast from the outside, since the pressure on the fracture edges promotes the healing process. More complicated fractures of the outer ankle are mainly treated surgically, but this is not recommended in exceptional cases such as a known circulatory disorder, which makes surgery too risky. In such a case, a plaster cast is also used for immobilization for 6 weeks, but the affected person must gradually approach full weight bearing of the ankle for weeks under medical supervision. Regular x-ray checks are used to assess the healing process of the fracture and also to determine the appropriate time for taking the cast.
Complication
Complications can occur with conservative therapy as well as with surgery for an external ankle fracture. Complications in conservative therapy: Complications in surgical therapy:
- Slippage of the fracture (secondary dislocation)
- Pressure damage due to plaster
- False joint formation (pseudarthrosis)
- Sudeck’s disease
- Vascular, tendon and nerve injuries
- Infection
- (fracture slips off)
- Implant loosening
- False joint formation (pseudarthrosis)
- Sudeck’s disease
- Thrombosis / pulmonary embolism
Perspective / Forecast
The prognosis for regaining a permanently functional ankle joint is good regardless of the type of fracture. The prerequisite is an exact fracture alignment and the creation of natural (anatomical) ankle joint conditions. About eight weeks after the operation, a fluid gait pattern should be regained, cycling and swimming are possible.
Very stressful ankle sports such as football and tennis can be resumed after about 3-6 months. The healing time of an external ankle fracture is basically individual and depends on the type of fracture, its stability and condition, the age and activity level of the patient and of course on any accompanying injuries to the surrounding structures. If a non-operative treatment is carried out, the plaster cast is usually expected to remain in place for about six weeks.
This time is an average value, which in turn depends on the age and the corresponding healing rate of the bone. With increasing age, fractures heal more slowly and the bone substance is not always immediately fully loadable. Nevertheless, as with almost every fracture, longer immobilization does not necessarily produce better results.
With the help of physiotherapy and exercises, the foot should be gradually reloaded until, in the best case, it reaches its original functional level. In order to be able to correctly assess the healing process in individual cases, regular X-ray check-ups are usually carried out. Activities that place extraordinary stress on the ankle joint, such as certain sports, can be prohibited by the doctor even a few months after treatment.
After surgical therapy, the procedure is almost identical. In addition, materials used such as nails and screws are left in the bone for up to a year until they are removed. Further information on the healing time of an external ankle fracture can be found here.
