Functional treatment
1. Indication
Functional treatment is indicated only for stable fractures.
Functional treatment can also be indicated following ORIF of unstable fractures.
With functional treatment, movement of the ankle joint is possible.
2. Functional treatment
Implementation
Usually, functional treatment should continue for about 6 weeks after injury.
Elastic bandages, functional braces, and compression stockings support the soft tissues. Remove the brace if the patient feels pain, and check the soft tissues for pressure sores.
Mobilize the patient as soon as possible. Physiotherapy can be helpful (joint movements, lymphatic drainage, manual therapy). Weight bearing is allowed within the limits of any pain and / or swelling.
Check x-rays are taken after 3 and 6 weeks.
Without immobilization, pharmaceutical thromboembolic prophylaxis is only indicated in high risk patients.
Non-steroidal anti-inflammatory medication helps to relieve pain and swelling.
Additional swelling may occur after removal of the brace. This can be treated with an elastic bandage, or a compression stocking.
At 3 months, if there are symptoms of lateral instability, either inversion stress x-rays, or MRI, are used to investigate lateral ligament integrity.
3. Postoperative treatment of ankle fractures treated with a cast/brace
If the patient complains of severe or increasing pain, the possibility of compartment syndrome or other circulatory disorders should be considered. The cast should be split or the brace loosened. If this does not result in a rapid improvement, the cast or brace should be removed.
Mobilize the patient as soon as possible. Weight bearing is allowed in stable fractures.
Remove the plaster if the patient feels pain, and check the soft tissues for pressure sores.
If the cast loosens, it should be changed and renewed. The cast is removed after 6 to 8 weeks.
Physiotherapy is then usually necessary for 2-4 weeks.
In some patients, additional swelling occurs after removal of the cast. This can be treated with an elastic bandage, or a compression stocking.
At 3 months, if there are symptoms of lateral instability, either inversion stress x-rays or MRI can be used to investigate lateral ligament integrity.
