Understanding When Surgery is Right – Ankle Fractures

There are lots of ways to injure your ankle. Did you trip off a curb? Land on it wrong? Didn’t see the hole there? Because of this, each ankle injury is different—some don’t require surgery while others do. How do you know when surgery is right?


Assessing the Damage. There are three bones that make up the ankle joint—the tibia (the shin bone), the fibula (the smaller lower leg bone), and the talus (the bone that sits between the leg bones and the heel bone. A broken ankle can mean that just one of these bones is fractured or that multiple bones are fractured and/or displaced. If you injure your ankle and can’t walk on it, you’ll have to have x-rays taken to find out what’s going on.


If only one bone (either the tibia or the fibula) in the joint is fractured but not displaced, the ankle can sometimes heal on its own in about six weeks. In cases like this, patients need to wear a fracture boot that allows you to put weight on the ankle and get around while the joint heals.


If more than one of the ankle bones is fractured or displaced, surgery will be necessary. Displacement doesn’t allow for equal weight distribution, which is essential for a healthy, functioning ankle. A surgeon must align the bones and set them with plates and screws so they can heal in their correct, natural position. The healing time for more complex ankle fractures varies widely from case to case.


Risks and Considerations. If surgery is necessary, you have to be sure the ankle is ready for the procedure. Excess swelling, which is extremely common with ankle fractures, makes performing surgery more dangerous. In the case of swelling, it’s best to ice and elevate the ankle for a few days before surgery.


Another risk of ankle injuries is misalignment. As I said previously, all the bones in the ankle joint have to be lined up properly to avoid complications, such as severe arthritis later on in life. If a patient’s ankle heals with the bones in the wrong position, their doctor will most likely have to rebreak and reset the bones. That means starting all over again, and no one wants that!


Recovery. Whether or not your ankle fracture requires surgical correction, your recovery will involve both a fracture boot and physical therapy exercises. The boot can be removed several times a day to complete range-of-motion exercises. As a rule, it’s important to keep a joint in motion while it’s healing so that you don’t lose any mobility or function.


Excess swelling also delays recovery, so it is best to keep the leg elevated as much as possible to keep the blood from collecting in the joint. In addition, I work with my patients to improve their balance and bone strength. This helps to avoid preventable injuries in the future.