Indications, Postoperative Management, and Advances in Ankle Fracture Fixation

Abstract

Ankle fracture management continues to be an evolving process, particularly with regards to identifying unstable fracture patterns, improving fixation techniques, and optimizing postoperative management. The most accurate method to identify unstable ankle fractures based on preoperative imaging remains controversial and further prospective studies with functional outcomes and well-defined instability parameters are still needed. Several studies have investigated advanced fixation techniques, however, standard nonlocking, one-third tubular plates can still be used for the majority of fractures. Locking plates may provide a biomechanical advantage in patients with osteoporotic bone and intramedullary fibular nails may be beneficial in patients at risk for postoperative wound complications. With regards to postoperative management, the long-term benefit of early weight-bearing has yet to be proven and the need for venous thromboembolism prophylaxis remains without consensus and should be based on individual patient risk stratification. Level of Evidence: See Instructions for Authors for a complete description of levels of evidence.