How is movement of an undisplaced ankle fracture with lateral malleolus involvement recommended, and why won't alphabetic movement displace the fracture?

From the Guidelines

For an undisplaced lateral malleolus ankle fracture, early range of motion exercises, including alphabet tracing movements, are recommended to maintain ankle mobility without displacing the fracture. These exercises involve using the foot to "write" letters of the alphabet in the air, which helps maintain ankle mobility without displacing the fracture. Alphabet movements won't displace the fracture because they primarily involve gentle, controlled motion that stays within pain-free ranges. These movements engage the ankle joint without applying significant stress to the fracture site. The lateral malleolus, when fractured but undisplaced, typically remains stable as long as weight-bearing restrictions are followed according to your physician's instructions (often partial or non-weight bearing with crutches or a walking boot for 4-6 weeks) 1. The surrounding ligaments and fibrous tissue help maintain fracture alignment during these gentle movements. Additionally, early controlled motion promotes blood flow to the area, which can accelerate healing, reduce stiffness, and prevent muscle atrophy.

The importance of early mobilization is supported by the British Journal of Sports Medicine, which suggests that functional treatment in the form of exercise and functional support is preferred over immobilization for ankle injuries 1. However, it's crucial to follow your specific healthcare provider's instructions, as recommendations may vary based on the exact nature of your fracture, associated injuries, and individual healing progress. The American College of Radiology also emphasizes the importance of weight-bearing radiographs in assessing fracture stability, particularly for malleolar fractures 1.

Key points to consider when performing alphabet movements for an undisplaced lateral malleolus ankle fracture include:

• Gentle, controlled motion within pain-free ranges
• Avoiding significant stress to the fracture site
• Following weight-bearing restrictions as instructed by your physician
• Promoting blood flow to the area to accelerate healing and reduce stiffness
• Preventing muscle atrophy through early controlled motion.

From the Research

Movement of an Undisplaced Ankle Fracture Lateral Malleolus

• The movement of an undisplaced ankle fracture lateral malleolus is recommended to be non-surgical, as stable fractures of the ankle can be safely treated non-operatively 2, 3, 4.
• The integrity of the 'medial column' (deltoid ligament) is essential for the stability of the fracture, and weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures 2, 5.

Why Alphabet Movement Won't Displace the Fracture

• Alphabet movement, which involves moving the ankle in different directions, is not likely to displace the fracture if the ankle is stable and the medial column (deltoid ligament) is intact 6, 5.
• Non-surgical management produces excellent outcomes if the ankle is stable, and advanced imaging may not be accurate for guiding management 6.
• A structured treatment algorithm can standardize the management of ankle fractures and reduce the number of unnecessary surgical procedures 3, 4.

Treatment Recommendations

• If the ankle is stable, non-surgical management is recommended, and patients can be permitted full weight-bearing 3, 4.
• If clinical/radiographic findings are indicative of ankle instability, surgical fixation options include lateral or posterolateral plating or intramedullary fixation 6.
• Locking plates and small or minifragment fixation are important adjuncts for the surgeon to consider based on individual patient needs 6.