The right load
The load limitation depends on whether the fracture was treated conservatively or surgically, and in the latter case on the type of surgery. In the majority of cases, a trimalleolar ankle fracture is surgically reduced and fixed with a plate and screws. In this case, the affected foot can usually be loaded immediately in 15-25 kg partial weight bearing and functionally treated in physiotherapy.
Usually, certain movement restrictions apply to the exercises for 4-6 weeks, such as avoiding pulling the foot more than 90° and avoiding rotational movements. In most cases, the foot can be fully loaded again after 6-8 weeks. Full weight bearing means normal walking and standing in everyday life and at work. Sports, especially sports with high stress on the ankle joint such as jogging or ball sports, should only be started again after 3-6 months.
How long unable to work
When the person affected by a trimalleolar ankle fracture is fully fit for work again depends on the severity of the injury, the healing process and also on the type of work performed. As a rule, sick leave is set to 4-6 weeks after the operation, after which time a job with, in the best case, predominantly sedentary work can be resumed.In special cases, for example after polytraumas, the affected person also starts working part-time for 4 hours a day and then increases the activity, depending on his or her resilience, up to full-time work. In the case of activities that require a high degree of physical resilience and flexibility, the sick leave can also be extended considerably longer than 6 weeks. Postoperative complications and consequential damage can also extend the period of incapacity to work.
Operation
A trimalleolar ankle fracture is treated surgically in most cases, especially if the ligamentous connection between the tibia and fibula, the syndesmosis, is also injured. Only in this way can the bones be reduced as precisely as possible in order to achieve the best possible result with regard to the mobility and resilience of the ankle joint. The operation is performed under general anesthesia and the patient is usually hospitalized for 3-5 days.
The parts of the joint are first reduced under the operation and then repositioned with screws and plates to achieve the most anatomically correct position possible. Debris zones can also be fixed with the help of a stable-angle plate. After the operation, a partial load of about 20 kg must be maintained for up to 6 weeks.
Therefore, physiotherapy begins in the hospital with gait training on supports and mobilizing exercises in the permitted directions. The in-patient physiotherapy is usually followed by an out-patient therapy for functional rehabilitation. The material used in the operation can be removed after one year at the earliest, in some cases it is left on the joint if it does not cause pain or restrict mobility.
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