Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

🩺 Medically Reviewed by: Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist | Last Updated: April 2026 | Reading Time: 14 min

Quick Answer: Ankle fractures range from stable, single-bone breaks treated in a walking boot to complex multi-bone injuries requiring surgical fixation with plates and screws. The ankle joint involves three bones — the fibula (lateral malleolus), tibia (medial malleolus and posterior malleolus), and talus — and proper alignment is critical because even 1mm of talar shift reduces ankle contact area by 42%. Most ankle fractures heal in 6–12 weeks with appropriate treatment, but full recovery takes 3–6 months.

📑 Table of Contents

• Ankle Joint Anatomy and Why Fractures Matter
• Types of Ankle Fractures
• Weber and Lauge-Hansen Classification Systems
• How Ankle Fractures Are Diagnosed
• Conservative Treatment: When Surgery Isn’t Needed
• Surgical Treatment: ORIF and Fixation Options
• Recovery Timeline and Weight-Bearing Progression
• Rehabilitation After Ankle Fracture
• Complications and Long-Term Considerations
• Special Fracture Patterns
• Foot Care Products for Ankle Fracture Recovery
• Frequently Asked Questions
• Sources

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Ankle Joint Anatomy and Why Fractures Are Serious

The ankle is an engineering marvel that bears your entire body weight while allowing the precise dorsiflexion and plantarflexion needed for walking, running, and jumping. The ankle mortise — the socket formed by the distal tibia, medial malleolus, and lateral malleolus (fibula) — cradles the dome of the talus with remarkable precision. This bony architecture, reinforced by a complex ligament system including the deltoid ligament medially, the anterior and posterior tibiofibular ligaments (syndesmosis), and the lateral collateral ligaments, creates stability while permitting smooth motion through approximately 20 degrees of dorsiflexion and 50 degrees of plantarflexion.

What makes ankle fractures particularly consequential is the joint’s extremely low tolerance for malalignment. Research by Ramsey and Hamilton demonstrated that just 1mm of lateral talar shift reduces tibiotalar contact area by 42%. This means even small amounts of residual displacement after fracture healing create dramatically increased focal pressure on the articular cartilage, accelerating post-traumatic arthritis. This finding is the fundamental reason why anatomic reduction — perfect or near-perfect restoration of joint alignment — is the goal of all ankle fracture treatment, whether conservative or surgical.

Ankle fractures are among the most common orthopedic injuries, with an annual incidence of approximately 187 per 100,000 adults. They occur across all age groups but show bimodal peaks — younger adults sustaining high-energy injuries from sports and motor vehicle accidents, and older adults experiencing low-energy fractures from falls, often complicated by osteoporosis that makes fixation more challenging.

Types of Ankle Fractures

Lateral malleolus (fibula) fractures are the most common ankle fracture pattern, accounting for approximately 60–70% of all ankle fractures. The fibula is the smaller bone on the outside of the ankle, and it breaks when the foot rolls outward (eversion) or twists under load. Isolated lateral malleolus fractures below the level of the syndesmosis (Weber A) are typically stable injuries that can be treated without surgery. Fractures at or above the syndesmosis level (Weber B and C) may involve disruption of the important tibiofibular ligaments that hold the ankle mortise together.

Medial malleolus fractures involve the bony prominence on the inside of the ankle — the distal extension of the tibia. These fractures often occur in combination with lateral malleolus fractures (bimalleolar pattern) and are rarely isolated injuries. When they do occur alone, they typically result from a direct blow or an eversion-external rotation mechanism. The medial malleolus serves as the attachment point for the deep deltoid ligament, making its anatomic restoration important for medial ankle stability.

Bimalleolar fractures involve both the lateral and medial malleoli and represent an inherently unstable injury pattern. The ankle mortise has lost its structural integrity on both sides, allowing the talus to shift within the joint. Nearly all bimalleolar fractures require surgical fixation to restore anatomic alignment and prevent accelerated post-traumatic arthritis from chronic talar malalignment.

Trimalleolar fractures add a posterior malleolus fragment — a piece of the posterior distal tibia — to the bimalleolar pattern. These are high-energy injuries with three-point failure of the ankle mortise. The posterior malleolus fragment is particularly important because it contributes to the weight-bearing surface of the tibial plafond. Fragments involving more than 25% of the articular surface or causing posterior subluxation of the talus generally require separate fixation.

Pilon (tibial plafond) fractures represent the most severe end of the ankle fracture spectrum. These high-energy injuries — typically from axial loading mechanisms like falls from height or motor vehicle accidents — shatter the weight-bearing surface of the distal tibia into multiple fragments. Pilon fractures often have significant soft tissue injury, articular cartilage damage, and metaphyseal comminution that make surgical reconstruction extremely challenging. Staged treatment protocols with initial external fixation followed by delayed definitive fixation are often required to allow soft tissue recovery before extensive surgical exposure.

Weber and Lauge-Hansen Classification Systems

The Weber classification is the most commonly used system and categorizes fractures based on the level of the fibula fracture relative to the ankle syndesmosis. Weber A fractures occur below the syndesmosis, are typically stable with intact tibiofibular ligaments, and usually respond well to conservative treatment. Weber B fractures occur at the level of the syndesmosis — these are the most common pattern and require careful assessment because the syndesmosis may or may not be disrupted. Weber C fractures occur above the syndesmosis, indicating disruption of the tibiofibular ligaments and creating an unstable injury that almost always requires surgical fixation.

The Lauge-Hansen classification is more complex but provides insight into the mechanism of injury and helps predict associated ligament injuries. It uses a two-word designation: the first word describes the position of the foot at the time of injury (supination or pronation), and the second describes the direction of the deforming force (adduction, external rotation, or abduction). For example, the most common pattern — supination-external rotation (SER) — describes a supinated foot subjected to external rotation force, producing a characteristic sequence of injuries from the anterior tibiofibular ligament to the fibula to the posterior malleolus to the deltoid ligament.

How Ankle Fractures Are Diagnosed

Diagnosis begins with clinical examination — assessing swelling, deformity, tenderness to palpation over bony landmarks, and neurovascular status of the foot. The Ottawa Ankle Rules provide validated clinical decision guidelines that help determine which patients require radiographic evaluation: imaging is indicated when there is bone tenderness at the posterior edge of either malleolus, inability to bear weight for four steps immediately after injury and in the emergency department, or tenderness over the navicular or fifth metatarsal base (which may indicate associated midfoot injury).

Standard radiographs include anteroposterior (AP), lateral, and mortise views (AP with 15–20 degrees internal rotation). The mortise view is critical because it allows assessment of the medial clear space — the gap between the medial malleolus and the talus — which should be equal to or less than the superior clear space (normally less than 4mm). Widening of the medial clear space indicates deltoid ligament disruption and joint instability, even if the medial malleolus appears intact on radiographs. Stress radiographs under gravity or manual external rotation can reveal occult instability in questionable cases.

CT scanning provides detailed assessment of fracture patterns, articular involvement, and posterior malleolus fragment size that may not be apparent on plain radiographs. CT is particularly valuable for trimalleolar fractures, pilon fractures, and syndesmotic injuries where surgical planning requires understanding the three-dimensional fracture anatomy. MRI is occasionally used to evaluate ligament integrity, particularly the deltoid ligament and syndesmosis, when clinical and radiographic findings are equivocal.

Conservative Treatment: When Surgery Isn’t Needed

Not all ankle fractures require surgery. Stable fracture patterns with maintained anatomic alignment of the ankle mortise can be successfully treated with immobilization and protected weight-bearing. The key determination is stability — whether the fracture pattern allows the talus to remain centered within the ankle mortise during healing without surgical intervention.

Isolated stable Weber A fractures — fibula fractures below the syndesmosis with no medial tenderness and normal mortise alignment — are the best candidates for conservative management. Treatment typically involves a short period in a posterior splint followed by transition to a CAM walker boot for 4–6 weeks. Early weight-bearing as tolerated is generally permitted because the syndesmosis remains intact and the fracture pattern is inherently stable.

Stable Weber B fractures — at the syndesmosis level but without medial injury — can also be treated conservatively with close radiographic monitoring. Initial immobilization in a below-knee cast or CAM boot is maintained for 6 weeks with serial radiographs at 1, 2, and 6 weeks to confirm maintained alignment. Any evidence of displacement or widening of the medial clear space during follow-up warrants conversion to surgical fixation. Stress radiographs at the initial evaluation help identify occult instability that would favor early surgical intervention.

Conservative treatment at Balance Foot & Ankle follows an evidence-based protocol: initial posterior splint with leg elevation for swelling management, transition to definitive immobilization once swelling subsides (usually 5–7 days), serial radiographic monitoring at defined intervals, structured transition from immobilization to supportive footwear, and graduated physical therapy for range of motion and strength restoration.

Surgical Treatment: ORIF and Fixation Options

Open reduction and internal fixation (ORIF) is indicated for unstable ankle fracture patterns — bimalleolar fractures, trimalleolar fractures, Weber B fractures with medial injury or syndesmotic disruption, and all Weber C fractures. The goal is anatomic restoration of the ankle mortise with stable internal fixation that allows early range of motion while protecting the healing bone.

Lateral malleolus fixation is most commonly performed with a one-third tubular plate and screws applied to the posterior or lateral surface of the distal fibula. The plate acts as a neutralization plate, buttressing against the deforming forces while the anatomically reduced fracture heals. An interfragmentary lag screw may be placed through or independent of the plate for oblique fracture patterns to achieve compression at the fracture site. In elderly patients with osteoporotic bone, locking plates provide improved screw purchase and more reliable fixation.

Medial malleolus fixation typically uses two partially threaded cancellous screws (4.0mm) placed perpendicular to the fracture line, providing interfragmentary compression. Alternatively, a tension band wire technique or a small buttress plate can be used for comminuted or vertically oriented fracture patterns where screw fixation alone may not provide adequate stability. The surgeon must ensure the articular surface of the medial malleolus is anatomically reduced and the deltoid ligament attachment is preserved.

Syndesmotic fixation is required when the tibiofibular syndesmosis is disrupted. After the malleolar fractures are fixed, the syndesmosis is assessed with intraoperative stress testing (Cotton test or external rotation stress) under fluoroscopy. If unstable, one or two syndesmotic screws are placed through the fibula, both cortices of the tibia (tricortical) or all four cortices (quadricortical), approximately 2cm above the joint line. Some surgeons now prefer flexible fixation with a suture-button device (TightRope) that allows physiologic syndesmotic motion while maintaining reduction.

Recovery Timeline and Weight-Bearing Progression

The recovery trajectory depends on fracture pattern, treatment method, bone quality, and patient compliance. Understanding the general timeline helps patients plan for work, driving, and activity resumption while respecting the biological reality of bone healing.

Conservative treatment timeline: Stable fractures treated without surgery typically follow a 6-week immobilization period with progressive weight-bearing based on the specific fracture pattern. Weber A fractures may allow immediate weight-bearing in a boot, while stable Weber B fractures may require 2–3 weeks of non-weight-bearing followed by progressive loading. Radiographic healing is confirmed at 6 weeks, and transition to supportive shoes with orthotics begins. Physical therapy runs from weeks 4–12, focusing on range of motion, strength, and proprioception. Most conservatively treated patients return to full activity by 10–12 weeks.

Surgical treatment timeline: After ORIF, patients are typically non-weight-bearing in a splint for 2 weeks, then transition to a CAM boot. Weight-bearing progression varies: simple bimalleolar fixation may allow partial weight-bearing at 2–4 weeks, while syndesmotic fixation often requires 6 weeks of strict non-weight-bearing. Full weight-bearing in the boot is usually achieved by weeks 6–8, with transition to shoes by weeks 8–10. Physical therapy begins early for range of motion (often within the first 1–2 weeks for gentle ankle pumps) and intensifies after weight-bearing is initiated. Return to full activity typically occurs at 3–6 months post-surgery.

Return to driving: For left ankle injuries with automatic transmission, driving may be possible within 2–4 weeks if pain and medication permit. Right ankle injuries require full weight-bearing and adequate dorsiflexion strength before driving is safe — typically 6–10 weeks for conservative treatment and 8–12 weeks for surgical cases. Braking reaction time should be tested in a controlled environment before resuming regular driving.

Rehabilitation After Ankle Fracture

Rehabilitation is arguably as important as the fracture treatment itself. Even with perfect anatomic reduction, prolonged immobilization causes significant ankle stiffness, muscle atrophy, and proprioceptive loss that must be systematically addressed to achieve a good functional outcome.

Phase 1 — Early mobility (Weeks 1–6): Begins with gentle toe and knee range of motion to maintain circulation and prevent deep vein thrombosis. Ankle alphabet exercises and gentle plantarflexion/dorsiflexion within pain tolerance start once the surgical wounds have healed (usually week 2–3 for surgical patients). Isometric exercises — pushing the foot against resistance without actually moving the ankle — help maintain muscle activation without stressing healing bone or hardware.

Phase 2 — Progressive loading (Weeks 6–12): As weight-bearing progresses, physical therapy intensifies with standing calf raises (bilateral to unilateral), theraband resistance exercises in all planes, stationary cycling, and pool-based exercises. Proprioception training on stable surfaces progresses to wobble boards and foam pads. Scar mobilization and manual joint mobilization address adhesions and capsular restrictions that limit range of motion. Most patients achieve functional dorsiflexion (at least 10 degrees) and near-normal plantarflexion during this phase.

Phase 3 — Functional return (Weeks 12–24): Advanced strengthening, sport-specific training, plyometric progression, and return-to-running protocols characterize this phase. Single-leg balance activities, agility drills, and progressive impact loading prepare the ankle for full activity demands. Patients are educated on long-term protective strategies — appropriate footwear, prophylactic ankle bracing for sports, and maintenance strengthening exercises — that reduce the risk of re-injury and post-traumatic arthritis progression.

Complications and Long-Term Considerations

Post-traumatic arthritis is the most significant long-term complication of ankle fractures, developing in 15–40% of patients depending on fracture severity and quality of reduction. The ankle joint has unique cartilage properties — thinner cartilage with less compliance than the hip or knee — making it particularly vulnerable to altered mechanics after injury. Maintaining anatomic alignment through proper treatment and supporting the joint with quality orthotics can slow arthritis progression, but some degree of degenerative change is common after significant ankle fractures.

Chronic ankle instability can develop after ankle fractures, particularly when associated ligament injuries are not adequately addressed during initial treatment. Persistent feelings of the ankle “giving way,” recurrent swelling after activity, and difficulty on uneven surfaces suggest ongoing instability that may benefit from physical therapy, bracing, or in some cases, surgical ligament reconstruction. Early proprioceptive rehabilitation and consistent use of supportive footwear help prevent chronic instability.

Hardware irritation is reported in 20–30% of patients after ankle ORIF, most commonly from the fibula plate and screws which lie just beneath the thin lateral ankle skin. Symptomatic hardware can be removed after fracture healing is confirmed (typically 12–18 months post-surgery) through a straightforward outpatient procedure. Syndesmotic screws may need earlier removal (10–12 weeks) if they are causing pain or limiting ankle dorsiflexion, though some surgeons now use absorbable screws or suture-button devices to avoid this issue.

Wound complications and infection occur in approximately 5–10% of surgically treated ankle fractures and are higher in patients with diabetes, peripheral vascular disease, open fractures, or tobacco use. The medial approach is particularly vulnerable due to limited soft tissue coverage. Surgical timing is important — operating through severely swollen tissue (positive wrinkle test absent) dramatically increases wound complication rates, which is why many surgeons delay definitive fixation until soft tissue swelling has subsided, using temporary spanning external fixation or splinting in the interim.

Special Fracture Patterns

Maisonneuve fracture is a particularly dangerous pattern that is frequently missed on initial evaluation. This injury involves a proximal fibula fracture (near the knee) combined with disruption of the interosseous membrane and complete syndesmotic injury at the ankle. The ankle radiographs may show only widening of the medial clear space with no visible distal fibula fracture, leading clinicians to underestimate the severity. Always palpating the proximal fibula during ankle injury evaluation and obtaining full-length tibia/fibula radiographs when proximal tenderness is found prevents this diagnostic pitfall.

Ankle fracture-dislocations require emergent reduction, often in the emergency department before formal imaging. The displaced talus can compress neurovascular structures and create severe soft tissue tension that leads to skin necrosis if not promptly reduced. After closed reduction and splinting, definitive surgical planning can proceed once soft tissue swelling is manageable. These high-energy injuries carry higher rates of post-traumatic arthritis regardless of treatment quality.

Diabetic ankle fractures present unique challenges. Peripheral neuropathy may mask pain, leading to delayed presentation and continued weight-bearing on a fractured ankle. Peripheral vascular disease compromises healing, and diabetes itself impairs bone metabolism and immune function. Treatment thresholds are lower — many diabetic ankle fractures that might be treated conservatively in non-diabetic patients are fixed surgically to ensure alignment is maintained. Extended immobilization periods and closer follow-up are the standard of care for diabetic ankle fracture patients.

Foot Care Products for Ankle Fracture Recovery

Recovery from an ankle fracture requires consistent support, pain management, and swelling control. These podiatrist-recommended products address the specific challenges of post-fracture rehabilitation and the transition back to full activity.

PowerStep Orthotic Insoles — Post-Fracture Stability and Support

PowerStep Pinnacle orthotic insoles are essential during the critical transition from CAM boot to regular footwear after ankle fracture. The semi-rigid arch shell provides the structural support that protects the healing ankle from excessive pronation forces — the same forces that stress the ankle mortise and syndesmosis. After weeks of immobilization, the foot’s intrinsic muscles have atrophied significantly, and the PowerStep insole compensates for this temporary weakness by providing external biomechanical control. The EVA foam base with dual-layer cushioning absorbs impact forces that would otherwise transmit directly through the healing fracture site. We recommend PowerStep insoles for every ankle fracture patient transitioning from boot to shoes, and many patients continue using them for months after full healing to maintain proper alignment during the extended recovery period.

Doctor Hoy’s Natural Pain Relief Gel — Fracture Site Pain Management

Doctor Hoy’s Natural Pain Relief Gel provides targeted topical pain relief that is particularly valuable during ankle fracture rehabilitation. The natural arnica and menthol formula offers effective analgesic and anti-inflammatory action without the systemic side effects of oral medications. During physical therapy sessions, applying Doctor Hoy’s before exercises reduces pain enough to allow productive range-of-motion work — critical in the early weeks when ankle stiffness is the primary barrier to recovery. For patients with surgical hardware, Doctor Hoy’s cooling effect helps manage the discomfort from plates and screws that often becomes more noticeable as activity increases during rehabilitation. The non-greasy, fast-absorbing formula works well under compression garments and can be reapplied throughout the day as needed.

DASS Compression Socks — Post-Fracture Edema Control

DASS graduated compression socks address one of the most persistent and frustrating aspects of ankle fracture recovery — chronic swelling. Ankle edema after fracture and surgery can persist for 6–12 months and is the primary cause of ongoing pain, stiffness, and difficulty fitting into shoes. DASS 20–30 mmHg graduated compression improves venous return and lymphatic drainage, measurably reducing circumference and improving comfort. We recommend starting DASS compression as soon as the surgical incisions are healed and continuing daily wear throughout the entire rehabilitation period. Many patients find that afternoon and evening swelling dramatically decreases with consistent morning-to-evening compression use, allowing more productive physical therapy sessions and faster functional recovery.

🎯 Complete Recovery Kit: Our ankle fracture patients achieve the best outcomes using all three Foundation Wellness products together. PowerStep insoles provide the structural support that protects the healing ankle during the boot-to-shoe transition, Doctor Hoy’s gel manages pain during the intensive physical therapy phases, and DASS compression controls the persistent post-fracture edema that otherwise delays rehabilitation. This combination addresses the three pillars of fracture recovery — support, pain control, and swelling management.

🔑 Most Common Mistake: The biggest mistake ankle fracture patients make is neglecting rehabilitation once the bone has healed. Bone healing at 6–8 weeks is just the beginning — the ankle joint, surrounding muscles, and proprioceptive system need months of structured work to return to pre-injury function. Patients who skip physical therapy or stop exercises once they can walk without pain have significantly higher rates of chronic stiffness, re-injury, and post-traumatic arthritis. Complete your entire rehabilitation program, even when the ankle feels “good enough.”

⚠️ Warning Signs — Seek Immediate Care: After ankle fracture or surgery, contact your doctor immediately if you experience sudden worsening pain that is not relieved by elevation and ice, calf swelling or tenderness (possible deep vein thrombosis), toes that become numb, cold, white, or blue, wound drainage that is cloudy or foul-smelling, fever above 101°F, or a feeling that the ankle has “shifted” or feels unstable in the boot or cast. These may indicate compartment syndrome, blood clot, infection, or loss of fracture reduction requiring urgent intervention.

Watch Dr. Tom Explain Foot Care Products for Recovery

https://www.youtube.com/watch?v=A11FFjCXAX4

Frequently Asked Questions About Ankle Fractures

How do I know if my ankle is broken or just sprained?

While both injuries cause pain and swelling, fractures typically involve more severe pain, inability to bear weight, visible deformity or abnormal positioning, and tenderness directly over bone rather than soft tissue. However, some fractures cause surprisingly mild symptoms while severe sprains can be extremely painful. The Ottawa Ankle Rules guide the need for X-rays: if you cannot take four steps after the injury or have tenderness at the back edge of either malleolus, imaging is recommended to rule out fracture.

Will I need surgery for my ankle fracture?

Not necessarily. Stable, non-displaced fractures — particularly isolated Weber A and stable Weber B fibula fractures — can often be treated with a boot or cast without surgery. Surgery is recommended when the fracture is displaced, the ankle mortise is widened, multiple bones are broken (bimalleolar or trimalleolar patterns), or the syndesmosis is disrupted. Your podiatrist or orthopedic surgeon will assess stability through examination and imaging to determine the best treatment approach.

How long until I can walk normally after an ankle fracture?

Most patients transition from boot to regular shoes between 6–10 weeks for conservative treatment and 8–12 weeks for surgical cases. However, walking normally — without a limp — typically takes 3–4 months as strength, range of motion, and proprioception are gradually restored through rehabilitation. Full functional recovery, including return to sports and high-impact activities, usually occurs between 4–6 months.

Should I keep the hardware (plates and screws) in or have them removed?

Most ankle fracture hardware can remain permanently without issues. Removal is only recommended when hardware causes symptoms — pain, swelling, or difficulty with shoe wear due to the plate being palpable under thin ankle skin. About 20–30% of patients eventually elect hardware removal, typically performed as an outpatient procedure 12–18 months after the initial surgery once complete bone healing is confirmed.

Will I develop arthritis after an ankle fracture?

Post-traumatic arthritis develops in 15–40% of ankle fracture patients, depending on fracture severity and quality of reduction. Simple, well-reduced fractures have the lowest risk. Anatomic surgical reduction, proper rehabilitation, consistent use of supportive footwear and orthotics, and maintenance of healthy body weight are the most effective strategies for minimizing arthritis progression. If arthritis does develop, many non-surgical treatments can effectively manage symptoms for years before joint replacement or fusion becomes necessary.

Sources

1. Ramsey PL, Hamilton W. “Changes in tibiotalar area of contact caused by lateral talar shift.” Journal of Bone and Joint Surgery. 1976;58(3):356-357.
2. Stiell IG, et al. “Implementation of the Ottawa ankle rules.” JAMA. 1994;271(11):827-832.
3. Donken CC, et al. “Surgical versus conservative interventions for treating ankle fractures in adults.” Cochrane Database of Systematic Reviews. 2012;8:CD008470.
4. Michelson JD. “Fractures about the ankle.” Journal of Bone and Joint Surgery. 1995;77(1):142-152.
5. Bauer M, et al. “Malleolar fractures: Nonoperative versus operative treatment — A controlled study.” Clinical Orthopaedics and Related Research. 1985;199:17-27.

Think You May Have an Ankle Fracture?

Dr. Biernacki at Balance Foot & Ankle provides comprehensive ankle fracture evaluation and treatment — from initial diagnosis through complete rehabilitation. Early evaluation ensures the best possible outcome for your recovery.

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• 📋 New Patient Information

Ankle Fracture Treatment in Michigan

Whether your ankle fracture requires casting or surgical fixation, accurate diagnosis and proper treatment are essential for a full recovery. Our podiatric surgeons treat all types of ankle fractures at our Howell and Bloomfield Hills offices.

Learn About Ankle Fracture Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995;77(1):142-152.
2. SooHoo NF, et al. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am. 2009;91(5):1042-1049. doi:10.2106/JBJS.H.00653
3. Donken CC, et al. Surgical versus conservative interventions for treating ankle fractures in adults. Cochrane Database Syst Rev. 2012;(8):CD008470. doi:10.1002/14651858.CD008470.pub2