Elevate the lower leg on 2-3 pillows for 3-5 days.
X-ray control after reduction confirms the position, but must be repeated after 3-5 days. Redisplacement usually occurs during the early days, as the swelling subsides, and if diagnosed early enough, can often still be corrected non-operatively.
Analgesics and anti-inflammatory drugs should be prescribed, as necessary, during the first few weeks. If analgesia consumption is unexpectedly high, suspect redisplacement, or cast pressure on the skin.
If a cast becomes loose, it should be removed and replaced with a new one. If possible, wait until the fracture has become sticky (+/- 4 weeks) so that the reduction is not lost during the replacement procedure, but check regularly for redisplacement.
Non weight bearing should be maintained for 4-6 weeks. The above-knee cast is maintained for the first 4-6 weeks.
Thereafter, the cast may be changed to a below-knee cast for the remaining period of casting, as determined by the surgical decision-maker. Knee mobilization can be started.
Graduated weight bearing can begin, reaching full weight bearing by 8-9 weeks.
In fractures that required reduction, the plaster cast should not be removed before 9-12 weeks, or before the patient manages to walk pain-free with the cast. In fractures that did not require reduction, the period in the cast can be reduced at the discretion of the surgical decision-maker.
After removal of the cast, rehabilitation should involve dedicated ankle and foot mobilization for a prolonged period. At this stage, it is also advisable to give a non-steroidal anti-inflammatory preparation for several weeks.