General considerations
Nonoperative treatment of ankle fractures is usually reserved for inherently stable fractures, which is typical of B1 fractures, but may be indicated for unstable fractures in the presence of local, or general, contraindications to surgery.

Indications

  • Undisplaced or reduced fractures
  • Severe soft-tissue swelling 
  • Poor general condition of the patient (high anesthetic risk)
  • Peripheral vascular disease

Contraindications

  • Dislocated or unstable joint 
  • Inadequate reduction 
  • Shortening, malrotation and axis deviation of the fibula
  • Open fractures with 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