Stability of these fractures depends on location of the fracture in relation to the level of the tibiotalar joint.  Fractures distal to the joint line are less likely to disrupt other bony or ligamentous structures. If there is no associated medial tenderness, these patients may be placed in a posterior mold splint in the ED, made non-weight bearing, and can follow up with orthopedics in 1-2 weeks.

     Injuries at or proximal to the tibiotalar joint are more likely to be unstable.  These injuries require further stability assessment.  This can occur in the ED or at timely follow-up with orthopedics.  These patients should also be splinted and made non-weight bearing upon discharge pending the evaluation by orthopedics.