Abstract
Supination-external rotation (SER) type IV ankle fractures, as classified by Lauge-Hansen (L-H), are highly unstable due to frequent injuries of the deltoid and distal tibiofibular ligaments. These fractures typically require open reduction and internal fixation (ORIF), followed by prolonged immobilization and delayed weight bearing. Such protocols often result in extended recovery periods, delaying the return to competitive sports. In the clinical setting, there is a growing demand for approaches that enable athletes to resume sports quickly. Platelet-rich plasma (PRP) therapy has demonstrated the potential to enhance bone and soft tissue healing. Although PRP is widely used in ligament and tendon injuries, PRP's role in fracture rehabilitation is less well established, and it is often considered supplementary. We report the case of a 17-year-old male high school rugby player who sustained an SER type stage IV ankle fracture during a match. ORIF was performed eight days post-injury using a 1/3 tubular plate and the Ziptight system. Postoperatively, the patient underwent two weeks of cast immobilization and non-weight-bearing rest. After two weeks (postoperative day 15), the cast was removed. Radiographic and ultrasonographic evaluations confirmed the fracture stability without displacement and early callus formation. Based on these findings, full weight-bearing ambulation was permitted under close supervision, as part of a structured rehabilitation plan. By the fifth week, the patient achieved full range of motion (ROM), allowing him to begin jogging. Temporary tendon gliding issues in the seventh week were treated with hydrodissection, which enabled the resumption of partial training. By the eighth week, the patient was cleared for competitive rugby. At the one-year follow-up, he reported no pain, deformity, or functional limitations and had fully resumed his preinjury level of play. This case report highlights the potential of aggressive rehabilitation combined with PRP therapy to expedite recovery in SER type stage IV ankle fractures. Further research is needed to validate these findings in larger cohorts.