General considerations
Nonoperative treatment of ankle fractures is usually reserved for inherently stable fractures, but can be indicated for unstable fractures in the presence of local, or general, contraindications to surgery.

Indications

  • Undisplaced or reduced fractures
  • Severe soft-tissue swelling 
  • Patient not fit for surgery
  • Peripheral vascular disease
  • Poor state of soft tissues

Contraindications

  • Dislocated or unstable joint 
  • Inadequate reduction 
  • Severe soft-tissue injury

Advantages

  • Full weight bearing possible
  • Good stability

Disadvantages

  • Risks of cast complications (eg, pressure ulcer, nerve compression) 
  • Risks of immobilization
  • Risk of secondary displacement and post-traumatic arthrosis 
  • Risk of malunion 
  • Possible longer period of rehabilitation