Surgery for Ankle Fracture
Some ankle fractures are best treated with surgery, called Open Reduction and Internal Fixation, or ORIF. This surgery usually requires hospitalization for at least one night. In some cases it can be done as an outpatient. You will require a general anesthetic or spinal anesthetic.
During the surgery one or two incisions will be made about the inside and outside of the ankle, depending on which bones have broken. The fractured bone ends are exposed, and then put back together, or “reduced”.
The bones are then held together with some combination of screws, wires or plates.
The reason to do surgery is to put the bones back together as close as possible to how they were before they broke.
Day of Surgery
At the end of the surgical procedure the wound is covered and a short leg plaster splint is applied with ankle extended upward. That dressing gives support to your ankle, holding it securely. You should leave that in place until I change it at the first post-operative office visit.
You should keep your foot and ankle elevated as much as possible to minimize swelling.
You will be given crutches or a walker at the hospital, and I want you to not put any weight on that leg for 6 weeks after surgery. In the hospital a physical therapist will instruct you in using the crutches or walker.
You must be Non-Weightbearing on the surgery side for 6 Weeks.
When your pain is under control, and you can safely get around without putting weight on the ankle, you may go home. Do not walk on the splint.
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the splint and dressings, wash your foot, and take out the skin staples or stitches.
I will then put your leg into a short leg cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery. Do not walk on the cast.
The second post-operative visit is usually at the 6 week point. At that time I will remove the cast, and check to make sure that everything is healing satisfactorily. I will get an XRay to see if the bones are healing well. I will then have you go into a CAM Walker, and you will wear that for protected weightbearing for an additional 6 weeks. You must wear it when you do any walking.
I will ask to see you one more time after an additional 6 - 8 weeks. If there are any problems or questions then we will deal with them as they present.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. You should not resume athletic activities for between 4 - 6 months after surgery.
The goal of the surgery is to leave you with a painless ankle that will allow normal activities. You should be able to regain full strength and power in the leg and ankle, and have no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes. It may ultimately take one year for the ankle to reach its full recovery.
Complications can occur with any surgery. Go here for a general discussion of Surgical Complications.
Specific risks of this surgery include nonunion of the bone, the possibility of developing painful arthritis in the ankle, and the possible need to remove the metal implants in the future.