{
  "schemaVersion": 2,
  "eyebrow": "Orthopedic trauma",
  "title": "Ankle Fracture",
  "summary": "Assess neurovascular status and reduction urgency first, then determine mortise stability with appropriate radiographs and stress testing. Stable fractures can usually progress nonoperatively; talar shift, syndesmotic instability, or fracture-dislocation generally requires reduction and operative stabilization.",
  "seoDescription": "Point-of-care evaluation and management of ankle fractures, including imaging, instability assessment, reduction, fixation, and postoperative weight-bearing.",
  "clinicalQuestion": "How should physicians identify instability, prioritize reduction, and select operative versus nonoperative management for acute ankle fractures?",
  "specialty": "Orthopedic Surgery",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "ankle fracture",
    "ankle fracture-dislocation",
    "Ottawa Ankle Rules",
    "syndesmotic injury",
    "ankle mortise instability",
    "ORIF",
    "weight bearing"
  ],
  "keyTakeaways": [
    "Obtain ankle radiographs for malleolar pain plus posterior-edge/tip tenderness of either malleolus or inability to bear weight for four steps immediately and in clinical evaluation; the Ottawa Ankle Rules have high sensitivity for fracture detection. [9][10][11]",
    "Document dorsalis pedis and posterior tibial perfusion, sensation, skin compromise, and deformity before and after reduction; urgent open reduction is indicated when closed reduction fails or neurovascular deficit is present. [17]",
    "Medial clear-space widening greater than 4 mm or tibiofibular clear space greater than 6 mm on stress imaging supports syndesmotic instability and generally warrants stabilization. [9]",
    "A posterior malleolar or medial malleolar fracture with syndesmotic or medial clear-space widening should prompt tibia-fibula radiographs to exclude a proximal fibular Maisonneuve fracture. [16]",
    "After stable operative fixation, early protected weight bearing may be feasible, including in selected patients with trans-syndesmotic screws; postoperative loading should remain individualized to fixation stability, soft tissues, and surgeon protocol. [4][20][22]"
  ],
  "sections": [
    {
      "id": "immediate-triage-and-reduction",
      "eyebrow": "Emergency priorities",
      "heading": "Identify fracture-dislocation and threats to the soft-tissue envelope",
      "intro": "Reduction urgency is determined by alignment, skin, and neurovascular findings rather than fracture classification alone.",
      "paragraphs": [
        "For visible deformity or suspected fracture-dislocation, examine and document dorsalis pedis and posterior tibial perfusion, capillary refill, motor function, sensory status, open wounds, and focal skin tenting before splinting or reduction. A dislocated ankle with threatened skin, vascular compromise, or neurologic deficit requires urgent reduction; urgent open reduction is necessary when closed reduction fails or neurovascular deficit is present. [17]",
        "After reduction, repeat the neurovascular examination and obtain post-reduction ankle radiographs. Temporize an unstable fracture-dislocation with immobilization; when soft-tissue swelling makes immediate internal fixation unsafe, staged external fixation followed by definitive ORIF after soft-tissue recovery is an accepted pathway. Pin placement should avoid anticipated definitive surgical incisions. [17]",
        "Do not localize the examination to the malleoli. Palpate the proximal fibula and assess for syndesmotic pain or mechanism suggestive of external rotation injury. A proximal fibular fracture may be clinically occult in patients presenting chiefly with ankle pain. [16]"
      ],
      "bullets": [
        "Treat as an open fracture pathway when a wound communicates with the fracture or joint; do not delay orthopedic assessment for definitive imaging.",
        "Escalate urgently for irreducible dislocation, absent or deteriorating distal perfusion, progressive neurologic deficit, or skin blanching/tenting over displaced bone. [17]"
      ],
      "subsections": [],
      "table": {
        "caption": "Immediate management triggers for acute ankle fracture presentations. [17]",
        "columns": [
          "Finding",
          "Interpretation",
          "Next action"
        ],
        "rows": [
          [
            "Fracture-dislocation with skin tenting or threatened soft tissues",
            "Risk of skin necrosis and conversion to an open injury",
            "Urgent reduction, post-reduction neurovascular examination, immobilization, and orthopedic management. [17]"
          ],
          [
            "Neurovascular deficit",
            "Limb-threatening complication or persistent displacement",
            "Urgent reduction; urgent open reduction if closed reduction fails. [17]"
          ],
          [
            "Marked swelling with unsuitable operative soft tissues",
            "Increased wound complication risk with immediate definitive fixation",
            "Temporize, including staged external fixation when needed, then perform definitive ORIF after soft-tissue recovery. [17]"
          ]
        ]
      }
    },
    {
      "id": "radiographic-workup",
      "eyebrow": "Diagnostic pathway",
      "heading": "Use radiographs to determine fracture pattern and mortise stability",
      "intro": "The central imaging question is whether the talus remains concentrically reduced within a stable mortise.",
      "paragraphs": [
        "Obtain ankle radiographs when malleolar pain is accompanied by bony tenderness along the posterior edge or tip of either malleolus, or inability to bear weight for four steps both immediately after injury and at assessment. For midfoot pain, obtain foot radiographs when there is navicular tenderness, fifth-metatarsal-base tenderness, or inability to bear weight for four steps. The Ottawa Ankle Rules are highly sensitive and can reduce unnecessary radiography. [9][10][11]",
        "Order anteroposterior, mortise, and lateral ankle views. The mortise view best evaluates the tibiotalar joint space and talar alignment; in adults, the clear spaces should be symmetric and no greater than 4 mm. Weight-bearing radiographs are preferred when tolerated because they can reveal subtle alignment abnormalities or joint-space widening not apparent on non-weight-bearing images. [9][16]",
        "If initial films show a posterior malleolar fracture or displaced medial malleolar fracture without a distal fibular fracture, scrutinize the syndesmosis and medial clear space. Associated widening implies possible force transmission to the proximal fibula; obtain anteroposterior and lateral radiographs of the tibia and fibula to identify a Maisonneuve injury. [16]"
      ],
      "bullets": [
        "Use external-rotation or gravity stress radiographs when syndesmotic disruption is suspected and routine views do not establish instability. [9]",
        "MRI is most useful when persistent symptoms or clinical concern suggests ligamentous injury, syndesmotic injury, osteochondral injury, or tendon involvement despite nondiagnostic radiographs. [9]"
      ],
      "subsections": [
        {
          "heading": "Radiographic instability markers",
          "paragraphs": [
            "On stress imaging, medial clear space greater than 4 mm or tibiofibular clear space greater than 6 mm indicates syndesmotic instability. Significant widening generally supports surgical stabilization rather than isolated immobilization. [9]"
          ],
          "bullets": [
            "A widened medial clear space or syndesmotic gapping after fibular fixation should prompt intraoperative syndesmotic assessment. [14][18]",
            "External-rotation and lateral stress tests are used intraoperatively; the lateral stress test has been reported as more reliable for detecting syndesmotic injury. [14]"
          ]
        }
      ],
      "table": {
        "caption": "Imaging findings that alter ankle-fracture management. [9][16]",
        "columns": [
          "Study or finding",
          "Threshold or pattern",
          "Management implication"
        ],
        "rows": [
          [
            "Ottawa Ankle Rules",
            "Malleolar pain plus malleolar bony tenderness or inability to take four steps",
            "Obtain ankle radiographs. [9][11]"
          ],
          [
            "Mortise radiograph",
            "Asymmetric clear spaces or clear space greater than 4 mm",
            "Evaluate for talar displacement and ligamentous/mortise instability. [16]"
          ],
          [
            "Stress radiograph",
            "Medial clear space >4 mm or tibiofibular clear space >6 mm",
            "Syndesmotic instability; surgical stabilization is generally indicated. [9]"
          ],
          [
            "Ankle radiograph with posterior or medial malleolar fracture but no distal fibular fracture",
            "Medial clear-space or syndesmotic widening",
            "Image the full tibia and fibula for Maisonneuve fracture. [16]"
          ]
        ]
      }
    },
    {
      "id": "stability-and-treatment-selection",
      "eyebrow": "Definitive management",
      "heading": "Separate stable fractures from an unstable ankle mortise",
      "intro": "Treatment selection follows stability and soft-tissue status, not the presence of a fracture line alone.",
      "paragraphs": [
        "A stable, concentrically reduced ankle mortise can be managed nonoperatively with immobilization and progressive weight bearing as tolerated. Stable nonsurgical fractures commonly return toward baseline function in approximately 6 to 8 weeks. [17]",
        "ORIF is generally indicated for an unstable ankle mortise in patients fit for surgery when soft-tissue conditions permit. Fracture-dislocation, talar shift, unstable bimalleolar or trimalleolar patterns, and demonstrated syndesmotic instability are operative patterns because restoration and maintenance of a congruent mortise is the therapeutic objective. [17][21]",
        "Timing should balance reduction and skin protection against wound risk. Definitive fixation is often performed within 24 hours, but can be delayed for several days when swelling requires soft-tissue recovery; a staged approach is appropriate when immediate definitive fixation would compromise wound healing. [17]"
      ],
      "bullets": [
        "Intraoperatively, assess syndesmotic stability after malleolar reduction and fixation; persistent gapping or medial clear-space widening on stress imaging warrants syndesmotic fixation. [14][18]",
        "Syndesmotic injuries occur in approximately 10% to 13% of ankle fractures. [14]",
        "Medial malleolar fixation may be selectively omitted after fibular stabilization in some unstable bimalleolar or trimalleolar injuries, but nonfixation has been associated with more radiographic nonunion despite similar reported ankle function; make this decision only after confirming stable reduction. [3]"
      ],
      "subsections": [],
      "table": {
        "caption": "Stability-based management framework for ankle fractures. [9][17][21]",
        "columns": [
          "Clinical-radiographic branch",
          "Key discriminator",
          "Usual next step"
        ],
        "rows": [
          [
            "Stable fracture",
            "Concentric mortise without demonstrated stress instability",
            "Immobilization with progressive weight bearing as tolerated and interval clinical-radiographic follow-up. [17]"
          ],
          [
            "Unstable mortise",
            "Talar shift, unstable bimalleolar/trimalleolar pattern, or syndesmotic instability",
            "Orthopedic operative planning for ORIF when soft tissues permit. [17][21]"
          ],
          [
            "Syndesmotic instability",
            "Stress medial clear space >4 mm or tibiofibular clear space >6 mm",
            "Syndesmotic stabilization during operative treatment. [9]"
          ],
          [
            "Fracture-dislocation with unacceptable soft tissues",
            "Persistent instability plus swelling or skin risk",
            "Reduction and temporizing stabilization; definitive fixation after soft-tissue recovery. [17]"
          ]
        ]
      }
    },
    {
      "id": "postoperative-rehabilitation",
      "eyebrow": "Recovery",
      "heading": "Advance loading after fixation according to construct stability and soft tissues",
      "intro": "Routine prolonged non-weight-bearing after every fixation is increasingly difficult to justify, but not every construct has been studied equivalently.",
      "paragraphs": [
        "Traditional care after ORIF of unstable ankle fractures with syndesmotic screw stabilization has often used 6 to 8 weeks of non-weight-bearing. A case series reported full weight bearing within 15 days after ORIF with trans-syndesmotic screws without loss of reduction, hardware failure, or increased complications, supporting early protected weight bearing in selected patients. [4]",
        "Randomized and observational evidence summarized in recent reports supports earlier mobilization after stable operative fixation. A multicenter randomized trial comparing immediate protected weight bearing with casted non-weight-bearing reported better 6-week Olerud-Molander scores (43 versus 35) and better early ankle range of motion in the immediate-weight-bearing group. [20] A 2025 retrospective cohort found no statistically significant difference in complications across early, intermediate, and delayed weight-bearing groups after ankle ORIF. [6][22]",
        "Prescribe loading only after the treating surgeon confirms acceptable reduction, construct stability, and wound status. Delay or restrict weight bearing when the fixation construct, postoperative radiographs, soft tissues, or patient-specific capacity to comply makes early loading unsafe; the literature and postoperative protocols remain variable. [5][22]"
      ],
      "bullets": [
        "At follow-up, reassess wound integrity, alignment, pain trajectory, ankle motion, and interval radiographs before advancing activity.",
        "Counsel that even anatomically reduced and stabilized ankle fractures can lead to post-traumatic ankle arthritis; one estimate is approximately 14%, attributed in part to chondral injury sustained at fracture. [17]"
      ],
      "subsections": [],
      "table": {
        "caption": "Postoperative loading evidence after operative ankle-fracture fixation. [4][6][20][22]",
        "columns": [
          "Scenario",
          "Evidence signal",
          "Practical decision"
        ],
        "rows": [
          [
            "Stable ORIF construct",
            "Immediate protected weight bearing improved early functional scores and range of motion in a multicenter randomized trial. [20]",
            "Consider early protected loading when reduction, fixation, and wound status are satisfactory."
          ],
          [
            "ORIF with trans-syndesmotic screws",
            "A case series reported full weight bearing within 15 days without reduction loss, hardware failure, or increased complications. [4]",
            "Early protected weight bearing can be considered selectively rather than assuming mandatory 6- to 8-week non-weight-bearing."
          ],
          [
            "Variable fracture complexity or surgeon concern about fixation/soft tissues",
            "Postoperative protocols remain variable despite studies not showing a significant short-term complication difference by weight-bearing timing. [5][6][22]",
            "Individualize restrictions and obtain interval radiographs before progression."
          ]
        ]
      }
    },
    {
      "id": "follow-up-and-complications",
      "eyebrow": "Surveillance",
      "heading": "Detect loss of reduction, wound failure, and late joint consequences",
      "intro": "Follow-up should test whether the ankle remains congruent and whether rehabilitation progression is outpacing tissue recovery.",
      "paragraphs": [
        "After nonoperative treatment or ORIF, compare serial radiographs for maintenance of mortise congruity and fixation position, and examine the incision or fracture blisters for wound dehiscence or infection. Escalate new deformity, worsening pain, neurovascular change, or radiographic displacement to the operating surgeon because these findings may represent loss of reduction or fixation failure.",
        "Persistent pain, instability, or limited recovery after apparently healed fracture should trigger a focused reassessment for syndesmotic injury, osteochondral injury, tendon injury, or post-traumatic arthritis. MRI is the most sensitive modality for ligamentous tears, syndesmotic injuries, osteochondral defects, and tendon involvement when those diagnoses remain clinically plausible. [9]",
        "Functional recovery is not synonymous with radiographic union. Stable nonoperative fractures may approach baseline function by 6 to 8 weeks, whereas unstable injuries requiring ORIF may recover more slowly because of greater tissue injury and immobilization; monitor return to walking, range of motion, and work-related function alongside imaging. [17]"
      ],
      "bullets": [
        "Use new medial clear-space widening or syndesmotic gapping as a signal to reassess ankle stability rather than treating persistent symptoms as uncomplicated postoperative pain. [9][14]",
        "Discuss post-traumatic arthritis risk during longitudinal follow-up, particularly after injuries with substantial articular or chondral trauma. [17]"
      ],
      "subsections": [],
      "table": {
        "caption": "Findings during follow-up that warrant a change in management. [9][14][17]",
        "columns": [
          "Follow-up finding",
          "Concern",
          "Next step"
        ],
        "rows": [
          [
            "New deformity, worsening pain, or radiographic displacement",
            "Loss of reduction or fixation failure",
            "Urgent orthopedic reassessment and repeat radiographs."
          ],
          [
            "Wound dehiscence, increasing drainage, or infection concern",
            "Postoperative wound complication",
            "Prompt surgical wound assessment and management."
          ],
          [
            "Persistent pain or instability with nondiagnostic radiographs",
            "Syndesmotic, ligamentous, osteochondral, or tendon injury",
            "Obtain MRI when the result will clarify the suspected soft-tissue or osteochondral diagnosis. [9]"
          ]
        ]
      }
    }
  ],
  "faq": [],
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    {
      "number": 5,
      "title": "Weight-bearing timing after the operative management of ankle fractures: Single center audit and critical appraisal of literature - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1067251624002424",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Weight-bearing timing after the operative management of ankle fractures: Single center audit and critical appraisal of literature - ScienceDirect\nThe postoperative weight-bearing policy following internal fixation of unstable ankle fractures varies greatly and is largely surgeon-dependent. In",
      "score": 0.84918517
    },
    {
      "number": 6,
      "title": "Early weight bearing is not associated with short-term complications in ankle fractures - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1067251625000134",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Early weight bearing is not associated with short-term complications in ankle fractures - ScienceDirect\n# Early weight bearing is not associated with short-term complications in ankle fractures. We aim to compare postoperative complications between early weight bearing (EWB), intermediate wei",
      "score": 0.8380581
    },
    {
      "number": 7,
      "title": "Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0949265822000689",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study - ScienceDirect\n# Original Article Early weight bearing and mobilization decrease perioperative complications in patients after ankle f",
      "score": 0.8259413
    },
    {
      "number": 8,
      "title": "JBJS Search",
      "detail": "www.jbjs.org",
      "url": "https://www.jbjs.org/sso.php?state=o%3Dlogout%26r%3Dhttps%253A%252F%252Fwww.jbjs.org%252Fsearch.php%253Ftype%253Dimagegroup%2526a_title%253Dankle%252Bfracture",
      "authors": "www.jbjs.org",
      "host": "www.jbjs.org",
      "snippet": "... Ankle Fracture Management · A Contemporary Surgical Approach. Blitz, Benjamin; Joseph, Jennifer Mary; Bhuta, Jay N.; Mittal, Rahul. JBJS JOPA, 13(4):e25.00015",
      "score": 0.19110149
    },
    {
      "number": 9,
      "title": "Acute Ankle Sprain - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK459212",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "The use of the Ottawa ankle rules yields a near 100% sensitivity for detecting clinically significant fractures, reducing the need for unnecessary radiographs by approximately 30% (see Image. Acute Ankle Sprain, Radiograph). When obtained, plain radiographs should include anteroposterior, lateral, a",
      "score": 0.69199765
    },
    {
      "number": 10,
      "title": "Ottawa Ankle Rules and Subjective Surgeon Perception to Evaluate Radiograph Necessity Following Foot and Ankle Sprain - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4071746",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Orthopedic surgeon subjective analysis concerning fracture occurrence showed 55.6% sensitivity, 90.1% specificity, 46.5% positive predictive value and 92.9% negative predictive value. The general orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% ",
      "score": 0.64880073
    },
    {
      "number": 11,
      "title": "IMPLEMENTATION OF OTTAWA ANKLE RULES IN UNIVERSITY HOSPITAL EMERGENCY ROOM: PILOT STUDY",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10592341",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "in order to avoid unnecessary radiographs, the Ottawa Ankle Rules (OAR) were developed. The rules consider radiographic examination necessary only when there is pain in specific bone points or Inability to weight-bear at least four steps.7), (10 The OAR are active, validated, and accepted in numerou",
      "score": 0.59457535
    },
    {
      "number": 12,
      "title": "MRI Evaluation of Ligamentous Injury in Weightbearing-Stable ...",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12534871",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "by O Saatvedt · 2025 · Cited by 4 — Patients with a suprasyndesmotic ankle fracture that show no medial clear space widening on weightbearing radiographs demonstrate low rates",
      "score": 0.59089786
    },
    {
      "number": 13,
      "title": "Clinical Value of the Ottawa Ankle Rules for Diagnosis of Fractures in Acute Ankle Injuries",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3640009",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Of the 183 ankle injuries seen, the emergency orthopedic specialists predicted based on the OAR that there were 126 patients with malleolar fractures. These patients, classified as positive by the OAR, are considered to require a series of standard ankle radiographs to confirm the diagnosis. Sixty-o",
      "score": 0.5515985
    },
    {
      "number": 14,
      "title": "Ankle Dislocation - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK554610",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "After the malleoli have been addressed, the last structure to evaluate is the tibiofibular syndesmosis. Precise diagnosis of syndesmosis injury intra-operatively is difficult, and surgical indications for fixation remain controversial. Syndesmosis injuries occur in 10% to 13% of all ankle fractures.",
      "score": 0.52334785
    },
    {
      "number": 15,
      "title": "Clinical value of the Ottawa ankle rules for diagnosis ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/23646202",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "by X Wang · 2013 · Cited by 56 — The Ottawa ankle rules (OAR) are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography.",
      "score": 0.5195463
    },
    {
      "number": 16,
      "title": "Ankle Radiographic Evaluation - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK557462",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "The standard radiographic analysis of the ankle includes 3 views: the anteroposterior (also referred to as dorsoplantar), the internal oblique (or mortise), and the direct lateral. The anteroposterior view is used to evaluate the ankle mortise, though the lateral portions of the talus and tibiotalar",
      "score": 0.45638612
    },
    {
      "number": 17,
      "title": "Ankle Fracture - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK542324",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Operative Treatment\n\nOpen reduction and internal fixation\n\nUrgent open reduction of an ankle fracture-dislocation may be necessary if attempts at closed reduction have failed or if there is a neurovascular deficit. Ankle fracture open reduction and internal fixation (ORIF)  is typically indicated fo",
      "score": 0.7244226
    },
    {
      "number": 18,
      "title": "Open Reduction Internal Fixation of a Bimalleolar Ankle ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/27441940",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "by RF Ostrum · 2016 · Cited by 11 — After open reduction of an ankle fracture, the treating surgeon must always evaluate syndesmotic stability. ideal reduction clamp positioning, diameter and",
      "score": 0.47943115
    },
    {
      "number": 19,
      "title": "Immediate Improvement in Physical Function After ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/32433196",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "by JM Kohring · 2020 · Cited by 12 — Conclusions: Patients experienced an immediate and significant improvement in PF outcomes and ankle ROM after symptomatic SSR for ankle fracture ORIF with",
      "score": 0.38207284
    },
    {
      "number": 20,
      "title": "Fracture Care Is at the Heart of Orthopaedic Surgery - OrthoBuzz",
      "detail": "orthobuzz.jbjs.org",
      "url": "https://orthobuzz.jbjs.org/2025/07/17/fracture-care-is-at-the-heart-of-orthopaedic-surgery",
      "authors": "orthobuzz.jbjs.org",
      "host": "orthobuzz.jbjs.org",
      "snippet": "Looking at another study, many of us who care for ankle fractures have routinely kept our patients non-weight-bearing for a period of 6 weeks after surgery. In the July 2, 2025 issue of The Journal, Khojaly et al. from Ireland investigated the effects of immediate protected weight-bearing (IWB) vers",
      "score": 0.7811474
    },
    {
      "number": 21,
      "title": "Study Details | NCT03362229 | Medial Malleolus: Operative Or Non-operative | ClinicalTrials.gov",
      "detail": "clinicaltrials.gov",
      "url": "https://clinicaltrials.gov/study/NCT03362229",
      "authors": "clinicaltrials.gov",
      "host": "clinicaltrials.gov",
      "snippet": "Statistical analysis for the trial will be performed by an independent statistician employed through the local University statistics department/Edinburgh Clinical Research Facility. Primary and secondary outcome measures are displayed in the relevant section below.\n\nOfficial Title\n\nMedial Malleolus:",
      "score": 0.7653308
    },
    {
      "number": 22,
      "title": "Early Weight Bearing Is Not Associated with Short-Term Complications in ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S1067251625000134",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Early weight bearing is not associated with short-term complications in ankle fractures - ScienceDirect Skip to main contentSkip to article The Journal of Foot and Ankle Surgery Available online 18 January 2025 In Press, Corrected ProofWhat’s this? Early weight bearing is not associated with short-t",
      "score": 0.8091708
    },
    {
      "number": 23,
      "title": "The effect of time to post-operative weightbearing on functional and clinical outcomes in adults with a displaced intra-articular calcaneal fracture; A systematic review and pooled analysis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0020138318300809",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: The effect of time to post-operative weightbearing on functional and clinical outcomes in adults with a displaced intra-articular calcaneal fracture; A systematic review and pooled analysis - ScienceDirect\n# The effect of time to post-operative weightbearing on functional and clinical outcome",
      "score": 0.7931224
    },
    {
      "number": 24,
      "title": "Operative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1067251616000363",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Operative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials - ScienceDirect\n# Operative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Tria",
      "score": 0.7742597
    }
  ],
  "publishedAt": "2026-08-24T17:40:06.577772+00:00",
  "updatedAt": "2026-08-24T17:40:06.577772+00:00",
  "readingMinutes": 6,
  "slug": "ankle-fracture"
}