Management of displaced ankle fractures

BACKGROUND: Ankle fractures excluding pilon fractures, account for approximately 9% of all fractures with the majority being OTA type B injuries. Although surgeons generally treat undisplaced or minimally displaced injuries nonoperatively and displaced fractures operatively, opinions diverge regarding the management of those displaced fractures with acceptable closed reduction. There is also debate about the use of biodegradable implants in operatively managed ankle fractures, the type and technique of fixation for operatively treated syndesmotic injuries as well as the approach to postoperative rehabilitation. OBJECTIVE: We aimed to review the highest level of available evidence on the operative management of ankle fractures. We focused specifically on studies comparing (1) nonoperative versus operative management of displaced ankle fractures, (2) biodegradable versus metal implants, (3) syndesmotic fixation, and (4) postoperative rehabilitation protocols.