Return to Play
Return to play depends on both the ankle fracture and the athlete. Motivated athletes can generally return to sports with documentation of fracture healing and return of normal strength and motion. The goal of rehabilitation should be symmetric range of motion and 85% of contralateral strength before returning to the sport. [14]
The first phase of rehabilitation is restoration of motion and pain-free ambulation after cast immobilization. During the first several days after cast removal, crutch-assisted ambulation can assist the patient in gaining motion and in preventing ankle reinjury secondary to weakness. After the return of passive motion, active motion and active-assisted motion should begin, along with a strengthening program. Particular attention is devoted to the recovery of peroneal and gastrocnemius complex strength. Proprioception and balance training are also an important part of the overall rehabilitation program and have been shown to be effective in reducing the risk for recurrent ankle injury.
Complications
Nonunion or delayed union is the most common complication of ankle fractures requiring referral to an orthopedist.
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Diagram showing the typical locations for ankle fractures occurring from the 4 major injury mechanisms (SA= supination adduction, SE= supination external rotation, PA= pronation abduction, PE= pronation external rotation). Note that the SE fracture is shown as a dashed line, since it is best seen in the lateral projection.
