FIGURE 40.10 Evaluation and diagnosis of traumatic ankle injuries TREATMENT Fractures Fracture reduction is usually accomplished by reversing the mechanism of injury Closed reduction and cast immobilization may be appropriate for displaced fractures; if reduction cannot be achieved or maintained with casting, open reduction internal fixation may be necessary (see Chapter 111 Musculoskeletal Trauma ) Some displacement can be accepted in younger patients because of their ability to remodel Two studies have suggested that children with nondisplaced S-H type I, type II, and avulsion fractures of distal fibula may benefit from less conservative therapy; those treated with crutches, a 5-day period of nonweight bearing, and the use of a removable ankle brace (e.g., an air-stirrup ankle brace or an elastic bandage) were able to return to normal activity sooner than those in whom short leg casts were used Patients in these studies advanced their activities as tolerated S-H type III and IV injuries involve the articular