Which ankle fractures are treated surgically? When do you treat them?
The simple answer is that unstable ankle fractures are treated surgically.
If both the medial and lateral sides of the ankle are fractured (called a bimalleolar ankle fracture) or if three sides are fractured (including the posterior malleolus, that is a trimalleolar ankle fracture), then surgical open reduction and internal fixation is recommendable.
Fractures of the lateral malleolus alone, when displaced and in combination with a severe injury to the medial, or deltoid ligament, may also be unstable and benefit from surgical fixation.
The timing for surgery is dependent on the skin and soft tissues, and is typically done around a week after the injury, to allow the swelling to minimize and thereby decrease risk for wound problems. The ankle fracture may also be treated within a few hours of the injury, before much swelling has developed.
Dr. Carreira has posted further information about ankle fracture on the treatment page for that injury.