During the holidays, everyone goes outdoors to have fun, but the orthopedic surgeons on duty in the emergency department always encounter some unlucky people who are unlucky enough to have a good time – ankle sprains, which are almost the most common type of orthopedic emergencies, accounting for about 25% of skeletal muscle injuries, the majority of which are lateral ligament injuries. The RICE principle is a classic for emergency treatment of ankle sprains: Rest: stop walking and let the injured area rest to reduce further damage; Ice: lower the temperature of the injured area to reduce the inflammatory response and muscle spasm and to relieve pain and inhibit swelling. Each time 10-20 minutes, more than 3 times a day, pay attention not to directly apply ice to the affected area, available wet towel wrapped in ice to avoid frostbite. Apply ice only within 48 hours after the injury. Compression: Wrap the injured ankle joint with an elastic bandage and apply appropriate pressure to reduce swelling. Be careful not to apply excessive pressure, as this may increase the swelling and ischemia of the limb far from the wrap. Elevation: Elevate the limb above the heart position to increase venous and lymphatic return, reduce swelling and promote recovery. But is the RICE principle enough for ankle sprains? Which patients need immobilization? Which patients need surgery? Obviously, RICE is only the principle for emergency management of ankle sprains (within 24-48 hours), so what is the subsequent management? Grading of ankle sprains: There are usually 3 grades of ankle injuries based on the mild to moderate severity of the injury. Grade 1: Stretching of the ligaments exists, with only microscopic damage to the ligament fibers and mild pain. Weight bearing is possible as long as it is tolerated; no splinting; isometric contraction exercises are possible; full range of joint mobility exercises and muscle strength training can be performed if tolerated. Grade 2: Partial rupture of ligament fibers, moderate pain and swelling, limited mobility, and possible joint instability. Immobilization with splinting or bracing, physical therapy, and muscle and joint mobility exercises are required. Grade 3: Complete ligament rupture with significant swelling and pain and joint instability. Braking and rehabilitation are the same as for grade 2, but the rehabilitation time is longer and in a few cases surgery is required. Non-surgical treatment POLICE principles: In 2012, the British Journal of Sports Medicine recommended replacing the current RICE principles of ankle injury treatment with POLICE: Protect, Optimal loading, Ice, Compression, Elevation. Early activity. It has been suggested that for grade 1 and 2 ankle sprains, joint mobility exercises and gradual weight bearing after a few days can lead to a faster recovery from the ankle sprain. In grade 3 ankle sprains (complete ligament tears), there is evidence to support early braking within 10 days of injury, after which ankle motion is initiated. Of course, many scholars still support 2-3 weeks of braking in patients with grade 3 injuries. The general recommendations are Phase 1, 1 week RICE principles of rest to protect the ankle and reduce swelling; Phase 2, weeks 2-3, gradual return of joint mobility, strength and flexibility; and Phase 3, over the next few weeks to months, gradual return to sports, beginning with sports that do not require twisting of the ankle and eventually returning to sports. Medication The available evidence recommends only non-steroidal anti-inflammatory drugs to control pain and inflammatory response. It is worth noting that there is no clear evidence to support all topical medications and manipulative rubbing for revision. Surgical Treatment Only a very small number of patients with grade 3 injuries require surgical treatment after months of failed systematic non-surgical treatment. These patients are typically those with severe injuries, significant instability, and high motor demands. Ankle instability usually presents with a positive anterior drawer test and a positive talar tilt test, as well as a positive talar tilt test on orthogonal inversion stress films of the ankle, and MRI for ligament tears. The anterior drawer test and talar tilt test are performed at a later stage to better determine the stability of the ankle joint. Arthroscopic or open reconstruction can be considered for surgical approach to repair the ligamentous structures.