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Surgeon and Author, Dr. Stuart Gold,
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About Dr. Stuart Gold, MD


Ankle Fracture Surgery For Broken Ankle

March 30th, 2011

For those of you needing ankle fracture surgery, I hope this helps you evaluate your broken ankle and your surgical options.

The ankle joint is comprised of the tibia, or shinbone, the fibula, which is a small bone located on the ankle’s outer side, and a bone in the foot called the talus. The parts of the tibia that are part of the ankle are the medial malleolus, or inside of the tibia, and the posterior malleolus, or the back of the tibia. The point where the fibula connects in the ankle is called the lateral malleolus.


Ankle Surgery Screws

The lateral malleolus can be fractured at various points. The precise location of the fracture and the stability of the ankle are major determinants in deciding whether surgery is necessary. The surgeon may use a plate and screws attached to the side of the fibula to stabilize the joint. If the bone has fragmented, the surgeon may place a rod inside the fibula to realign the fragments of bone and hold them in place while healing occurs.

Surgery for a fractured medial malleolus is normally indicated if the bones are so misaligned that they cannot be treated successfully with a cast or if there is instability in the joint. If the joint has an indentation or impaction, a bone graft may be used to repair it, which may reduce the patient’s risk of arthritis. The nature and scope of the fracture will determine which of the various techniques the surgeon will choose, but screws, plates, or wires may be used to reduce and hold he fracture in place until as it heals.

A fracture of the posterior malleolus is seldom the only injury the patient receives. The lateral malleolus often breaks as well, since it shares many of the same ligaments. Occasionally, the medial malleolus is fractured as well. Most doctors recommend surgery if the broken part comprises more than one-fourth of the joint size. As a rule, the larger the fractured piece, the greater the chances that the ankle will be unstable. In addition, if more than two millimeters or so misplaces the bones, the cartilage covering the posterior malleolus may not heal properly. This can cause uneven, increased pressure and lead to arthritis in the ankle. The surgeon may screw plates onto the tibia or insert screws parallel to the foot to reduce and hold the bones together.

A fracture can involve one, two, or all three of the ankle’s malleoli, and can occur at any point along the malleolus. The more fractures the ankle suffers, the more unstable the joint becomes. In the event of multiple fractures, each type is generally treated with the same techniques available for an isolated fracture.

Most patients can expect a lengthy recovery period. It can take as long as three months to resume normal activities, excluding sports. Full recovery from more complex ankle fracture surgery can take up to one year. Each patient, however, must be individually evaluated. Patients should not place weight on the ankle until told to do so by the surgeon, since it can lead to failure of the surgery if the fragments move. It is equally important to perform any exercises prescribed by the physician or to attend any physical therapy sessions he recommends. Otherwise, the ankle may become stiff or weak.

Until next time,

Stuart

About the Author: Dr. Stuart Gold, M.D. is a board certified orthopedic surgeon who has 23 years experience specializing in sport injuries, joint replacement, arthritis and limb salvage. As the Director of the Orthopedic Institute, Dr. Gold recently published The Patient's Guide To Orthopedic Surgery to help patients better understand the challenges, risks and opportunities of orthopedic care.

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