The medial clearspace is a risk factor for secondary dislocation following cast immobilization after closed reduction in closed ankle fracture dislocations

Initial medial clearspace was an important predictor for insufficient reduction in a cast, with 9 mm being identified as the cutoff for critical initial medial clearspace. Therefore, we recommend primary external fixation or acute internal fixation, if the soft tissue allows it for those patients with initial medial clearspace of > 9 mm. This approach may prevent secondary dislocation, reduce swelling, and expedite definitive surgery.