Initial evaluation includes a medical history, physical examination, and x-rays.
Physical examination is done to ensure pulses, nerve function, swelling and skin
integrity. If there is any bleeding around the fracture site this may be concerning
for a skin puncture and this has an increased urgency as this can lead to increased
risk of infection. Occasionally a CT scan is needed to evaluate more complex fractures.
Initial treatment initially includes reduction if needed and immobilization in a
splint. Nonsurgical treatment reserved for those fractures where the fragments are
not out of place or the ankle is not unstable. Occasionally a stress x-ray may be
done to ensure ankle stability.
Surgical treatment is indicated if the fragments are not aligned or the ankle appears
unstable. Surgical treatment is done plates and screws to hold the fragments in
the correct position. Without fixation of displacement fragments, fractures may
not heal or heal in a suboptimal position resulting in pain or the early development
of arthritis. Typical treatment involves no weight bearing on the ankle for 6 weeks
and possibly 12 weeks with unstable injuries. Return to driving is variable but
averages 9 to 12 weeks from the time of injury.