A trimalleolar ankle fracture is an injury to the upper ankle joint that affects both the tibia and the fibula. In addition, a trimalleolar ankle fracture also involves the fracture of the distal end of the tibia, called the Volkmann’s triangle. According to the Weber Classification, this fracture can be called a Weber C fracture in most cases. The criterion for a Weber C fracture is the destruction of the ligamentous connection between the tibia and fibula, the syndesmosis.
Treatment/Physiotherapy
- A trimalleolar ankle fracture is usually treated surgically, since the joint partners are usually shifted against each other and the syndesmosis injury massively affects the stability of the entire joint. During surgery, the ankle joint is usually refixed using a plate and several screws. The material can be removed once healing is complete, usually after at least 12 months.
After the operation, the ankle joint is normally stable immediately after the operation, or it can be exercised under partial weight-bearing.
- Functional post-treatment with physiotherapy starts already in the hospital to stimulate the metabolism and maintain mobility up to the permitted extent of movement. Both the load and the extent of movement are determined by the surgeon. Already in the hospital, walking with supports in partial load and the correct rolling is practiced.
- During the first 2 weeks after surgery, physiotherapy can be performed on an outpatient basis after discharge from hospital. In addition to gait training, the ankle joint is carefully and actively mobilized to avoid contractures and joint stiffening. In addition, the adjacent joints such as the knee and hip can be mobilized and the surrounding muscles are strengthened through exercises.
- Local physical therapy such as lymphatic drainage and short-term cold therapy can reduce the swelling of the ankle and relieve pain.
- From the 2nd week on, the treatment of the scar can already be started, in addition, standing and coordination exercises are added to the training.
- From the 7th week onwards, the full range of motion and full load can be practiced again in physiotherapy, depending on the pain.
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