Non-adherent antibacterial dressing is applied as a first layer. Sterile undercast padding is placed from toes to knee. Extra side and posterior cushion padding is added.
A three-sided plaster splint is applied. The anterior area is left free of plaster to allow for swelling. Make sure that the medial and lateral vertical portions of the splint do not overlap anteriorly and that the splint does not compress the the popliteal space or the calf.
The plaster is then wrapped with more undercast padding.
The entire construct is then wrapped with elastic bandages.
If external fixation is left in place to support the fixation, then modifications will be needed to the dressing and immobilization.
The patient should be counseled to keep the leg on a cushion and elevated. Remember not to elevate the leg too much as it may impede the inflow. The ideal position of the foot when the patient is supine is half way between the waist and the heart. While seated, the foot should be on a cushion and elevated, but if badly swollen the patient must be supine since elevating the foot while seated is not as effective in decreasing the swelling.
The OR dressing is usually left in place and not changed until the first postoperative visit at 2 weeks, when x-rays are obtained once the dressing is removed. If any complication is suspected (e.g., infection or compartment syndrome) the dressing must be split and if necessary removed to allow full inspection.
Strict non-weight bearing should be maintained until there is evidence of healing, a minimum of 3 months.
If one should use a removable functional orthosis instead of cast, it may be removed daily to begin gentle range of motion.
Formal physical therapy should not begin in the early postoperative period.