Treatment of patients presenting early
The aim of any reduction (early or late) is to correct the displacement.
Treat the patient as soon as possible, when the deformity is typical, late swelling has not yet appeared and adequate anesthesia can be administered.
Use gravity to help to reduce the fracture.
The patient lies supine on the table, with the lower leg hanging over the end of the table.
Hold the heel of the injured foot with the forefoot pointing upwards as shown and lift the externally rotated leg. In this procedure the weight of the leg will, in many cases, reduce the posterior and the lateral displacement automatically. If the mechanism of injury was external rotation of the foot relative to the leg, internally rotating the foot relative to the leg should reduce the fracture. Further pressure against lateral malleolus is usually unnecessary.
If the mechanism of injury was abduction, adducting the foot should reduce the fracture.