Fractures of the ankle are common injuries, especially in young active people. They are usually the result of a twisting injury. Falls from height and car accidents can result in more serious injuries. Damage to bones is easily seen on Xrays but it is damage to the ligaments and soft tissues which results in the long healing times, swelling and stiffness.
Some are simple fractures that can be treated in a brace, cast or a boot. Stable fractures allow early weight bearing before the fracture is healed. Others require surgery to realign the ankle joint. There are many types and degrees of severity so each injury is assessed individually.
Benefits of surgery
The main reasons to offer surgery for some ankle fractures is to allow optimal bone and ligament healing, good ankle function and reduced long term ankle arthritis.
Physiotherapy may be required once patients are weight bearing. Exercises performed at home on a regular basis are more important than those conducted with the physiotherapist infrequently.
Risks of surgery
The risks of wound infection, deep vein blood clots and nerve injury are all small. Smoking significantly increases these risks and nonunion of the bones (where the bones fail to heal).
Overall, surgery is performed when the risks of surgery outweigh the risks of treatment in a cast.
Ankle fractures are highly variable in the damage to bones and soft tissues, therefore the recovery differs greatly.
The more straightforward fractures take a full 6 months before patients feel recovered to return to their pre-injury level of function.
Fractures with more ligament damage take longer to recover and may not fully do so. Severe joint damage can result in some permanent stiffness and even to arthritis of the ankle. Accurate surgery reduces this risk considerably.
Ankle fracture before surgery Ankle fracture after surgery