Yesterday I ended my week at the surgery center with yet another patient who had a negative MRI examination for ligament and cartilage damage in their ankle. He had a history of ankle sprains and a minor ankle fracture that did not require surgery years before. In my younger days, I would have slapped him on the back at 6-8 weeks after his fracture and told him to go back to normal activities and exercise as tolerated.
Ankle Arthroscopic Procedure
Now I tell them that there is a high probability that they may have cartilage damage and to pay attention to stiffness in the morning and/or aching pain at night after heavy activity. My patient was one of those fortunate ones that did not ignore these symptoms and had an ankle arthroscopic procedure performed in his 40s instead of “getting by with ibuprofen for years” like my 60 year old patient who had her ankle fused earlier this year.
Ankle Fracture Treatment Without Surgery
About 25% of our practice are follow ups from the emergency room or second opinions. Open fractures (bone exiting the skin and exposed) require immediate surgical attention, but most closed ankle fractures are sent home with crutches, pain pills and referral to a specialist.
Surprisingly for most ankle fracture patients, surgical repair is a low percentage. Non-weight bearing for 6-8 weeks in a cast or cam walker is the standard of care for an ankle fracture that meets the standard of care for normal ankle function after healing. Serial x-rays to view progress every 3 weeks and then physical therapy once it is healed is usually all that is needed if the ‘ankle mortise’ is maintained in the normal anatomical position. Unless the patient has other health problems like diabetes or poor circulation, the bone heals without any type of weakness or scarring. In most cases, the bone is just as strong as before the fracture due to its unique properties and a rich, inherent vascular supply. Both the osteoid (living bone) and calcium phosphate (white, hard portion) completely remodel and replace the debris and ‘dead bone’ within the fracture line.
Ankle Fracture Treatment With Surgery – ORIF
As for surgery, there are different views and variables that make it necessary. It depends on the location, fracture separation distance, rotation, and soft tissue involvement. An MRI is the most common test performed to access all the aforementioned, but a CT (Computed Tomography) is the gold standard for comminuted (multiple fractures) fractures that involve and cross different joints. For the surgeon, this test will show the 3 dimensional positions of all the fracture fragments to best prepare for surgery and order the proper equipment.
From external fixation devices, traditional plates and screws, to simple K-wire pins, there are many ways to repair an ankle fracture. There are 3 bones in the ankle (Tibia, Fibula, and Talus) and fractures can involve one, two, or all three. Below is a simple, oblique fracture repair of the fibula.
Warning: Graphic material
Ankle Surgery Recovery
He was non-weight bearing for 6 weeks, then walking in a cam walker boot for 2 weeks. He was also fortunate enough to not have any ligament or cartilage damage and reported back to the clinic 3 months later that he was biking and running. Although, he still received my warning to pay attention to any of the aforementioned symptoms in the future….
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