Patient discussions
When managing ankle fractures non-operatively with cast immobilisation, patients should be counselled regarding cast care and their specific weight-bearing status. Good cast care includes keeping it dry and not putting anything inside the cast. Patients should also be made aware of the symptoms of deep vein thrombosis (DVT) and compartment syndrome (if the cast is applied too tightly), as well as increasing pain that may arise from cast pressure points.
Following operatively-managed fractures, patients in a cast should also be counselled in cast care and their specific weight-bearing status, as well as monitoring for DVT, compartment syndrome, potential surgical site infection, and pressure points from the cast. Patients undergoing surgery for major extremity trauma should be advised that there may be an increased risk for surgical site infection if they smoke, or have diabetes or obesity.[47][48] Significant alcohol use (i.e., >14 units per week) increases the risk of infection postoperatively.[47][48]
After removal of immobilisation, patients should be advised on self-management about exercise (ankle movement in non-weight-bearing positions) and return to activity.[80] Patients should receive information about expected functional recovery and rehabilitation including advice about return to normal activities such as work and driving. A mechanism should be in place for patients to self-refer to the fracture service if progress is not as anticipated.[7]
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