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General guidelines

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.

The above-knee cast is maintained for the first 4-6 weeks.


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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 now be started.

Non weight bearing should be maintained for 4-6 weeks. Thereafter, graduated weight bearing can be started, reaching full weight bearing by 8-10 weeks.

The plaster cast should not be removed before 10-12 weeks, or before the patient manages to walk pain-free with the cast.

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.