Types of Ankle Fractures
Fractures of the ankle range from relatively minor twisting injuries to those which are associated with violent disruption of the ankle, which may occur in motor vehicle accidents and falls from a height.
There are two different mechanisms of injury which have different effects on the structure of the ankle. The one is where there is a twisting mechanism where the body rotates around the foot and the other is where there is a crushing type mechanism where there is an impact of some sort on the foot, for example in a motor vehicle accident.
Those with severe impact from motor vehicle accidents and falls from a height have the worst prognosis since there is often damage to the cartilage lining of the ankle.
The ankle consists of the inner aspect of the tibia (the medial malleolus) the outer aspect of the ankle (the fibula), and the bone underneath the ankle (the talus).
There are many different varieties and grades of severity of ankle fractures. These may involve only the medial malleolus, the fibula, or both bones (which is called a bi-malleolar fracture). At times the talus may completely pop out of the ankle joint associated with the fracture, in which case we call this a fracture-dislocation.
Treatment of an Ankle Fracture
- If the shape and anatomy of the ankle is not accurately restored, the cartilage lining of the ankle is disturbed which will inevitably lead to arthritis.
- The goal of treating all ankle fractures is to reposition the bones in some way so as to reduce the occurrence of arthritis.
- Surgery is performed with incision(s) on one or both sides of the ankle. Screws and/or titanium plates are inserted into the medial malleolus and the fibula in order to accurately restore or reduce the fracture alignment.
- In the majority of cases, a minimally invasive procedure (ankle arthroscopy) is also performed to clean the inside of the ankle
Ankle Fracture Surgery Recovery - Postoperative Recovery
- Following surgery, most patients will be allowed to bear weight immediately in a surgical boot
- You can drive if the left ankle is fractured by 5-7 days and 6-8 weeks if it is the right ankle.
- Most times you will be allowed to walk as soon as you are comfortable in a walking boot.
- Exercise activities are initiated in a swimming pool at 4 weeks, on a stationary bike at 6 weeks, and on machines supervised by a physical therapist at 8 weeks.
- Physical therapy exercises, swimming, and biking are important as part of the recovery process to maximize the strengthening of the leg and movement of the ankle.
- It will take about 3 months before the ankle starts to feel comfortable, and swelling and will persist for about 6 months.
Ankle Fracture Surgery Recovery - Specific Post-Operative Course
- Foot is wrapped in bulky bandage and splint, or in a removable fracture boot
- Ice, elevate, take pain medication as needed
- Bloody drainage through bandage is expected.
- Do not get the leg wet
- First follow-up in the office, X-rays are taken, dressing changed, sutures are removed (oftentimes resorbable sutures are used)
- Start movement of the ankle out of the boot
- You can shower, provided the incision is clean and dry
- Do not soak the foot until the incision is completely dry
- Start stationary bike
- Start physical therapy for a few months to get back strength and movement
- Full walking in sneakers is permitted.