San Francisco Ankle Surgeon Explains Ankle Fracture Surgical Treatment
Whether you roll you ankle stepping of a curb wrong in downtown San Francisco or slip and fall on a hiking trail in the Marin Headlands, if you break your ankle, you need treatment. Ankle fractures don’t heal predictable without surgery. If you are young and active, surgical repair of the broken ankle is you best hope of staying active and avoiding debilitating ankle arthritis in the future.
Left image: Xray of an ankle with broken tibia shown by the arrow (right side of the xray) and broken fibula shown by the two arrows (left side of the xray).
Right image: Repaired broken ankle with plates and screws placed by San Francisco podiatrist Dr. Christopher Segler during surgery to stabilize the broken bone. Two screws were used to stabilize the broken tibia.
There are many specific types of ankle fractures that ankle doctors (podiatric surgeons and orthopedic surgeons) use to determine the severity of the ankle fracture. The specifics of the fractures should not really be all that important to patients because there are only so many treatment choices. Basically you can place a cast on the broken ankle and hope it heals in the correct position or put the bones back in the correct position in surgery.
The ankle is complex joint where the tibia (shin bone), fibula (outside ankle bone) and the talus bone (the bone in the top of the foot that sits in the ankle joint) all come together to allow your foot to move under your leg when you walk or run. The majority of ankle fractures usually involve a break in the fibula bone. But sometimes both the fibula and tibia can be broken. In general, it takes more force to break both.
Treatment for most ankle fractures will require surgery. The reason is that many times the ankle bones move out of position when the break. If the bones heal in the wrong position, ankle instability, ankle arthritis or delayed bone healing can result. The goal of ankle fracture treatment is to stabilize the broken bone fragments so that the bone can heal. Most often this involves the foot surgeon placing stainless steel or titanium screws and plates in the bone for stability.
In order to fix the broken ankle, an anesthesiologist will make you comfortable and monitor you while under general anesthesia. The surgeon then repairs the broken ankle bones and closed the incision. A combination or dissolving stitches and non-dissolving stitches are most often used to close the surgical incisions.
At the end of the surgery your surgeon will place a cast, splint, or fracture boot on your leg to protect the repair. It is important to follow the surgeon’s directions regarding use of crutches, not walking on it, elevating, etc. Most ankle fracture surgeries will require that you use crutches and don’t walk on the broken ankle for 6-8 weeks. It takes about that long for bone healing to occur, even when stabilized with screws and plates.
About 2 weeks after your surgery, you doctor foot doctor will start to think about taking out the stitches. Once healing is beginning to show up on your ankle x-rays, you will be instructed to start some range of motion exercises and physical therapy to get the ankle moving again.
The rehabilitation after ankle surgery is a critical component of your recovery. No matter what, you will lose some strength in your leg after you have been immobilized in a cast or splint. Your ankle will likely feel very stiff when the cast is removed. This is all expected, but can be corrected. Physical therapy and home exercise programs will help you get past the stiffness and weakness in the ankle as you recover.
It seems than many people who have ankle fracture surgery want to know if the screws and plates cause pain. The answer in most cases is no. The hardware that your surgeon places in the bone does not usually cause any pain. Reactions to the screws and plates is very rare as well. There are some times however where certain shoes or boots can rub on the hardware and cause irritation of the overlying skin.
If this happens, it is usually a simple procedure to remove the screws and or plates from the ankle. Ankle hardware removal is most often an outpatient surgery. There is usually no overnight hospital stay needed.
Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.