Ankle fracture surgery repairs broken bones in the ankle joint using internal fixation techniques. During the procedure, an orthopaedic surgeon realigns the fractured bone fragments and secures them with metal plates, screws, or rods to promote healing. This approach helps stabilise the ankle and supports a return to normal mobility over time.
For those considering or preparing for ankle fracture surgery, learning about the procedure, recovery process, and potential outcomes can help set clear expectations. This guide covers everything you need to know, from surgical techniques to rehabilitation and post-surgical care.
When is Ankle Fracture Surgery Needed?
Surgical treatment is recommended for specific fracture patterns where bones are misaligned or unstable. These include:
Displaced Fractures: When bone fragments have shifted from their normal position, disrupting joint alignment and affecting movement. Surgery restores the natural positioning of the bones to support proper healing.
Unstable Fractures: Fractures involving multiple bones or associated ligament injuries that compromise ankle stability. Without surgical fixation, these fractures may not heal correctly, leading to long-term joint dysfunction.
Open Fractures: When a bone breaks through the skin, increasing the risk of infection and requiring immediate surgery. Open fractures need careful wound management alongside fracture stabilisation.
Bi-malleolar or Tri-malleolar Fractures: These fractures involve two or three of the main ankle bones, leading to joint instability. Surgery helps reposition the bones, stabilise the ankle, and support recovery.
Benefits of Ankle Fracture Surgery
Ankle fracture surgery stabilises the joint, supports healing, and helps patients regain movement. Restoring alignment allows a smoother recovery and a return to daily activities.
Restores Bone Alignment: Surgery corrects misalignment by repositioning bone fragments to their proper place. This improves the chances of a smooth recovery and reduces the likelihood of complications such as post-traumatic arthritis.
Allows Earlier Mobility: The use of metal plates, screws, or rods stabilises the fracture, making it possible to begin weight-bearing and physiotherapy sooner than with non-surgical management. This can help prevent muscle weakness and joint stiffness during recovery.
Preserves Joint Function: When fractures are repaired with proper alignment, the ankle joint moves more naturally, reducing the chances of long-term discomfort and movement restrictions.
Surgical Techniques for Ankle Fracture Repair
Different surgical techniques are used depending on the type and complexity of the fracture. The approach chosen will influence how the bones are stabilised, the extent of soft tissue disruption, and the overall healing process. Below are the main methods used for ankle fracture repair.
Open Reduction and Internal Fixation (ORIF)
This is the most commonly used method for ankle fracture repair. The surgeon makes an incision to directly access the fractured bones, carefully realigning them before securing the fragments with metal plates, screws, or rods. ORIF allows direct visualisation of the fracture, ensuring precise positioning and stability.
Minimally Invasive Plate Osteosynthesis (MIPO)
MIPO is a less invasive technique where plates and screws are inserted through small incisions. It reduces soft tissue disruption while ensuring stable fixation. Fluoroscopic imaging guides the placement of implants.
External Fixation
For fractures associated with severe soft tissue injury, external fixation is used. Pins or wires are inserted into the bone through the skin and connected to an external frame. This stabilises the fracture while allowing time for the surrounding soft tissue to heal. Adjustments can be made to the frame as healing progresses.
Preparing for Surgery
Medical Evaluation: Patients undergo blood tests, an ECG, and a chest X-ray to assess their overall health and suitability for surgery. Existing medical conditions and current medications are reviewed to minimise surgical risks.
Medication Adjustments: Blood-thinning medications are temporarily stopped as per medical advice to reduce bleeding risks. Patients with diabetes or other chronic conditions receive tailored guidance on managing their medications before and after surgery.
Fasting Instructions: Patients must avoid food and drink for 6–8 hours before surgery. However, small amounts of clear fluids may be allowed up to 2 hours before the procedure, based on anaesthetic guidelines.
Skin Preparation: The affected ankle must be kept clean and free from any cuts, rashes, or infections. Patients are advised to wash the area as instructed before surgery to reduce the risk of complications.
Step-by-Step Surgical Procedure
Anaesthesia: Surgery is performed under either general anaesthesia or a nerve block, depending on the patient’s condition and the surgeon’s recommendation. Throughout the procedure, the patient’s vital signs are closely monitored to ensure stability.
Surgical Site Preparation: The ankle area is thoroughly cleaned and sterilised. Sterile drapes are placed around the surgical site to maintain a controlled environment during the operation.
Fracture Exposure: The surgeon makes an incision based on the fracture pattern and chosen surgical technique. Soft tissue, blood vessels, and nerves are carefully preserved while accessing the fractured bone.
Fracture Realignment: Bone fragments are repositioned into their correct alignment. X-ray imaging is used during the procedure to confirm that the bones are correctly placed before fixation.
Internal Fixation: Metal plates, screws, or rods are inserted to hold the bones in position. The choice of fixation devices depends on the severity and type of fracture.
Wound Closure: The incision is closed in layers using sutures. A sterile dressing is applied, and a plaster splint is placed around the ankle to provide additional support and protection.
Recovery and Rehabilitation
Recovery after ankle fracture surgery occurs in stages, beginning with post-surgical care and progressing to mobility and strength restoration. Following medical advice and physiotherapy guidelines supports healing and improves long-term movement.
Immediate Post-Surgery Care
The first few days focus on pain relief, swelling control, and protecting the surgical site. Medications and ice application help manage discomfort, while leg elevation supports circulation and reduces swelling.
During the hospital stay, vital signs and circulation in the operated foot are monitored to ensure there are no complications. Patients learn how to use crutches or other walking aids, as weight-bearing is usually restricted at this stage. Proper wound care is essential, and follow-up appointments are scheduled to monitor healing.
Progressive Rehabilitation and Mobility
Rehabilitation begins once the bones start healing, usually around 2–6 weeks after surgery. Initially, physiotherapy focuses on gentle movements to prevent stiffness and improve blood flow. As recovery progresses, weight-bearing is gradually introduced, guided by medical advice.
Over time, exercises become more focused on strengthening the ankle, improving flexibility, and restoring balance. This phase supports a return to daily activities, with adjustments made based on individual progress. Most patients regain mobility within a few months, though high-impact activities may require further rehabilitation.
Potential Risks and Complications
Possible risks include infection, swelling, bleeding, and temporary nerve irritation. Metal implants may cause discomfort in some cases, and joint stiffness or post-traumatic arthritis can develop over time. Blood clot risks are managed with early movement and medication if needed. In some cases, bone healing may take longer, requiring further monitoring or treatment. Following medical advice and rehabilitation plans helps reduce these risks.
Conclusion
Ankle fracture surgery stabilises fractures, restores joint alignment, and supports recovery. Most patients regain mobility and return to daily activities with time and rehabilitation. Following a structured recovery plan, including physiotherapy and post-surgical care, helps improve movement, prevent stiffness, and strengthen the ankle. Gradual weight-bearing and guided exercises support long-term joint function and reduce the likelihood of future complications.
For personalised advice on treatment and recovery, book a consultation today to discuss the best approach for your condition.
