Ankle Fracture Surgery

What is an ankle fracture?

The upper part of the ankle joint comes from the tibia (shin) and the fibula (outer leg). The tibia forms the front, rear and inner part of the ankle joint. The lower fibula forms the outer part of the ankle joint.  The ends of these bones are called malleoli. There are two malleoli on the tibia (medial and posterior) and one on the fibula (lateral).
 
Ankle fractures occur when the malleoli are broken. These fractures are very common. Ankle fractures can happen after falls, car accidents or twisting of the ankle. One, two or all three malleoli can be broken.  
 
Symptoms of an ankle fracture are pain, swelling, bruising and problems with ankle motion. X-rays help show which need treatment from an orthopedic surgeon.
 

What are the goals of ankle fracture surgery?

The main goal of surgery is to get the ankle joint to heal with a normal shape. Once the ankle is put back together, the next

Above, a bimalleolar ankle fracture before surgery. Below, the ankle fracture after it has been fixed.
 step is to regain normal movement. The long-term goal of repairing a broken ankle is to decrease the chances of ankle arthritis in the future.
 

What signs indicate surgery may be needed?

When the ankle fracture is unstable or in bad position, surgery is needed to repair the ankle. In some cases, the bones of the ankle may poke through the skin. These are called open ankle fractures and require surgery.
 

When should I avoid surgery?

Ankle fracture surgery is not needed if the ankle is in position and stable despite the fracture. Ankle fracture surgery may be too risky when patients have a severe medical condition.
 

General Details of Procedure

Antibiotics are given shortly before the start of the surgery. Once the patient receives antibiotics and anesthesia, the surgery can safely begin. Incisions are made through the skin of the ankle where the bones are broken. The breaks in the bone are then repositioned and held there with implants. After the ankle fracture is repaired, the patient’s leg is placed in a protective splint made of plaster. Some patients can go home after surgery the same day while others may stay overnight in the hospital.
 

Specific Technique

Most ankle fracture surgery involves open reduction and internal fixation (ORIF). An incision is made over the ankle to see the fractured bones. Like a jigsaw puzzle, the pieces of the broken bones are placed back together (open reduction). The broken bones are then held together (internal fixation) in this correct position with metal plates and/or screws. This internal fixation provides stability so movement can begin shortly after surgery as the ankle fracture heals.
 

What happens after surgery?

Surgical treatment of ankle fractures allows patients to regain ankle function while the bones and joint heal. Immediately after surgery, your ankle will be immobilized for a few weeks. Once the wounds are healed, you will be fitted for either a cast or a boot. Many surgeons use a removable boot. The boot protects the ankle as it heals but can be removed to allow washing, wound checks and icing.
 
Once the broken bones start to heal, you can put weight on the ankle. This starts in the boot. You are then allowed to wean out of the cast or boot. You can return to normal activities once the bones are fully healed. Some patients may need physical therapy for their ankle to regain full movement and strength. While everyone is different, it can take up to a year after surgery for some patients to regain full ankle function.
 

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
 
Problems after ankle fracture surgery include ankle joint stiffness, weakness and arthritis. Possible complications after ankle fracture surgery include infection and problems with healing. The chances of these are higher for patients with certain medical conditions, medicines and lifestyles.  Factors that increase risks after ankle fracture surgery include diabetes, steroid use and cigarette smoking. 
 

Frequently Asked Questions

Will my ankle hardware (plate and/or screws) have to be removed at some point?
Plates and screws used to fix an ankle fracture are not removed as long as they are not causing problems. Most people do not have problems with the plate and screws. They are not regularly removed since this would involve another surgery. Rarely, the plate and screws can cause some pain or irritation. When this happens, the hardware may be removed after the fracture is healed.
 
Will I be awake for my surgery?
There are different types of anesthesia for ankle fracture surgery. Some patients are put asleep. Others can be injected with numbing medicine to make the ankle numb. You may only need to be made sleepy during the surgery so you don’t move.
 
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.