The external ankle fracture (fibula fracture) can be treated surgically or conservatively. Which treatment is appropriate in individual cases depends on the exact location of the fracture and which structures are affected. In this context, it is particularly important whether the syndesmosis (“ligament adhesion”) between the inner and outer ankle is also affected and whether there are accompanying injuries.
Which external ankle fracture can be treated conservatively?
A visibly malpositioned fracture of the outer ankle (dislocated fracture) should be set up (reduced) by the emergency physician at the scene of the accident in order to avoid pressure damage to the soft tissues (skin, nerves, vessels) caused by bone fragments. In principle, two different procedures are available for the treatment of an external ankle fracture: On the one hand there is a surgical reconstruction and fixation of the bone, on the other hand there is the so-called conservative treatment without surgical intervention. The decision to treat an external ankle fracture conservatively depends on the extent of the injury.
Open fractures or fractures in which the fracture ends of the bones have slipped too far apart (dislocated fractures) are classified as so-called Weber B or C fractures and require surgery. On the other hand, uncomplicated fractures that are below the syndesmosis (“ligament adhesion”) (classification type Weber A), as well as fractures in which the ends of the bones have not shifted against each other (undisplaced fractures) can be treated without surgery (conservatively). Conservative treatment is also often chosen in cases of so-called contraindications, i.e. findings that speak against surgery.
These contraindications are, for example, considerable circulatory disorders in the area of the operation, which would lead to significantly poorer wound healing. Such circulatory disturbances can be the result of a pronounced peripheral arterial occlusive disease (PAD), diabetes mellitus or smoking. Unfortunately, there is often a combination of all these factors that speak against surgery.
Even if there is an increased risk of infection due to leg ulcers (“open legs”) or already existing forefoot infection, surgery is often not necessary for safety reasons. Even in patients at a very high age, the risk of an operation must be carefully weighed up against a possible benefit; here too, the therapy often proceeds rather conservatively. The conservative therapy of an external ankle fracture initially consists of the correction of both ends of the fracture.
This means that the ankle is straightened for the time being. Then the foot or outer ankle is splinted with a so-called airwalker. The affected outer ankle is then immobilised and protected for about six weeks so that the ends of the fracture can grow together again in the correct position.