What are the indications for referring a patient with an ankle fracture to secondary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Indications for referring a patient with an ankle fracture to secondary care include:

  • Uncertainty about the stability of a unimalleolar ankle fracture, which requires orthopaedic follow-up within 2 weeks.
  • Any ankle fracture that may require surgical intervention, with surgery ideally performed on the day of injury or the next day.
  • Open wounds, fracture dislocations, or vascular injury associated with the ankle fracture.
  • Failure of symptoms to improve 6 weeks after injury, warranting further specialist review.

These criteria ensure appropriate specialist assessment and management, including decisions about surgery and ongoing care .

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