General considerations
Nonoperative treatment of ankle fractures is usually reserved for inherently stable fractures, which is not typical of fractures with a medial component, 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
  • Poor state of soft tissues

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