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Operative Treatment of Ankle Fractures

- Discussion:
- main indication for operative Rx is failure of closed Rx:
- when closed reduction requires forced, abnormal positioning of foot (forced plantar flexion and inversion);
- when displaced or unstable fractures of either or both malleoli  result in displacement of talus or widening of mortise greater than 1 to 2 mm;
- Indications for Treatment:
- if in presence of medial tenderness, > 5 mm of space is seen either initially or on a stress radiograph, presumptive dx of substantial injury of the deltoid ligament can be made;
     - treat as bimalleolar frxs, w/ ORIF of lateral malleolus;
- exploration of medial side of ankle is not necessary unless there is evidence that the Deltoid Ligament has entered joint and is blocking reduction of talus;
- Post Op:
- if none are present, then partial wt bearing may be started by 4th to 6th week, and full wt bearing by the12th week, after which the patient may complete his rehabilitation program

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