Ankle Fracture Surgery
The most severe types of ankle fractures are successfully repaired with the help of ORIF (open reduction internal fixation). Plates and bones are used to ensure that the bones are healed in proper position. Severe ankle fractures involve complete cracks in your bones and displacement of the bones into improper positions. Fractures in the base of your tibia and your fibula can be highly unstable, especially when the bones shift position. Fractures that occur with damage to one of the main ligaments providing support for your ankle, called the deltoid ligament, typically are considered unstable injuries and require surgery. Your physician typically needs to make an open incision and reconstruct the bones in your ankle to properly treat a major ankle fracture. This is a surgery done in two parts:
- The broken bone is put back into place
- Screws, rods, plates, and pins are used to hold it together
Preparing for ORIF Surgery for Ankle Fracture
You may not get much time between getting an ankle fracture and undergoing surgery, but the actions you take before surgery may have a significant effect on the outcome of ORIF surgery for ankle fracture.
- You will be prescribed a supporting device to make your movement around the house more comfortable. This may include crutches or household items.
- Any changes in your overall health such as fever or infections must be notified to your surgeon. You must also notify them about any medications that you are taking for the same.
- Talking to someone who has already undergone the ORIF surgery will help you understand the surgery better. You should have an elaborated conversation about the potential risks and benefits of ORIF surgery for ankle fracture with your surgeon too.
- It is advisable to have a second opinion from a qualified surgeon before undergoing the ORIF procedure to fix broken ankle.
- You can check if the surgeon is board-certified or eligible, you can call American Board of Orthopedic Surgery.
Before your ORIF surgery you may have:
- Physical examination to check the affected nerves and blood circulations around the fractured ankle site.
- X-ray, MRI and CT scan to evaluate the broken bone and surrounding structures of ankle.
- Blood test.
- Tetanus shots if they are not adequately immunized.
You may be asked to stop certain medications up to a week in advance of your ORIF surgery for ankle fracture.
You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.
Keeping a good mind frame can help ease any anxiety or nervousness about undergoing a surgery.
How Long Does the ORIF Procedure for Ankle Fracture Last?
Depending on the different bones of ankle joint that your surgeon needs to fix in place, an ORIF or open reduction and internal fixation of your ankle fracture can take between two and three hours to perform.
Ankle Fracture Surgery- ORIF Procedure: How is it Done?
Spinal anesthesia typically is given to numb you from the waist down, and you usually are sedated so you sleep through the procedure.
Your surgeon may have to make multiple incisions. Exposing your fibula usually requires a straight lateral incision about ten to 12 centimeters long made on the back and outside of your ankle. Usually a smaller incision, about five to six centimeters is made on the inside part of your ankle to allow access to the medial malleolus.
Most commonly fractured bone is the lower portion of your fibula. Your surgeon typically fixes your broken fibula with a plate and screws.
The bony knob (medial malleolus) on the inside of your ankle can be fractured as well. Screws or wires are used to anchor the fractured portion to the rest of your shinbone.
Similar fixation is used on any other areas that may be fractured in your ankle.
If the fractured bones broke the skin, the wound will be washed out and some of the damaged tissue may need to be cut away before your incisions are closed with stitches. A splint is applied to immobilize your ankle, and you are taken to the recovery room.
After the ORIF Procedure
Your blood pressure and breathing will be monitored. You will be closely observed till the immediate effect of anesthesia wear off. Your ankle will be in a splint and elevated when you wake up. This surgery usually can cause substantial amount of pain and so adequate pain control measures would be taken including patient-controlled analgesia (PCA) device, which delivers safe amount of pain medication when you push a button. Your blood pressure, temperature, and heartbeat will be closely monitored and depending on your progress, you will be transferred for postoperative care. If your surgeon feels you are stable, you can have visitors within about half an hour of your surgery. In case of special post operative needs, you may be transported to another ward for intensive care or heart monitoring. Most patients who undergo ORIF to fix fractured ankle spend about one to two days before discharge to home.
Most healthy patients remain in the hospital for a day or two. Patients with preexisting health problems may stay longer. There is a risk of infection after the ORIF surgery. Your physician should check your incision before you leave and should call you for a follow up within 10-14 days. In general, the amount of your stay will depend on the amount of pain management you need. IV line would be set until you can drink fluids without feeling nauseated. You will be prescribed crutches to help you move around without putting weight on your ankle. Weight bearing on the ankle would not be allowed for about 6 to 8 weeks. You may have to take an x-ray of your ankle before you leave the hospital.
Home Care After Discharge Post ORIF Procedure
- After you go home, you should try to do the following to achieve a smoother recovery following ORIF surgery for fractured ankle.
- Take care of your dressing to prevent infection. A bandage with a plaster splint is applied to the ankle until the stitches are removed in 2 to 3 weeks.
- Getting enough rest will help you recover sooner after ORIF.
- Following your ORIF procedure for ankle fracture, increase your activity level as recommended by the doctor. Being active will boost the blood flow and help prevent constipation.
- Avoid putting weight on the fractured ankle bone.
- Depending on the type of work you do, you should take off from work.
- Do not take bath, swim, use a hot tub, or soak your affected limb until your incision is healed. This takes about 1 to 2 weeks.
- You can eat normal diet. If your stomach is upset, try bland and low-fat food like plain rice, boiled chicken, toast, and yogurt.
- Take pain medicines exactly as directed.
If you were on blood thinners like Coumadin or Plavix, make sure you ask your doctor when can you start them again and take these medicines exactly as your doctor wants you to take.
Around 10 to 14 days post ankle fracture surgery -ORIF, the stitches are removed and your ankle is put into a short leg cast. After about 8 weeks the cast is removed and you receive a removable brace called cam walker or an air cast that can be worn inside your shoes. Your physician or physical therapist teaches you the basic exercises that you can perform at home.
Once your fractured ankle has healed, the bone should be just as strong as it was before the fracture. To prevent re-injury, you should strengthen the muscles and tendons around your ankle. Athletes should use up-to-date equipment. To prevent ankle fractures, you should try to play on good, level fields, courts, or tracks. If your ankles are already weak, avoid playing on uneven surfaces. Another preventive technique is choosing the right footwear. Proper fit, support, and design for specific sports should be taken into consideration. Some shoes have built-in medial and lateral supports, which may assist in preventing injury. Soccer shin-guards with circular pads on the bony sides of the ankles may prevent direct bruise or trauma to the bone. Hockey players should wear extra ankle padding to help avoid injury from sticks and skate blades. Adding calcium supplements to the diet may help women with osteoporosis strengthen their ankle bones. If your ankle starts to hurt during exercise, you should return to your physician’s office for a check-up.
Contact Your Healthcare Provider If:
- You develop a fever.
- Your cast gets wet.
- Your cast or splint begins to smell.
- You have more pain or swelling.
- Your skin is itchy, swollen, or has a rash.
- You have chest pain or trouble breathing that is getting worse over time.
Anything else that you find is unusual with your health, you must contact your doctor
Risks of ORIF Surgery
- Risk of infection like any other surgical procedure.
- Painful retained hardware.
- Non-union or failure to heal.
- Post traumatic arthritis.