Ankle Fracture Surgery
Have you had a twist or injury which has broken your ankle or a bone in your foot? Not sure whether you need surgery?
I’m here to help.
Is there a difference between a fracture and a break?
I'm often asked "what's the difference between a fracture and a break?".
There's no difference between the two. Both mean the bone has lost its structural integrity and has broken.
The terms can be used interchangeably.
What is an ankle fracture?
The ankle joint is a joint made by the meeting of three bones; the tibia (which is your main shin bone), the fibula (the bump of bone you feel on the outside), and the talus bone (connects the foot and responsible for up and down movement).
The tibia and fibula form the roof and sides of arch shape of the ankle joint and they are bound together by a fibrous structure called the syndesmosis. The talus bone sits within the arch.
The bony prominences that you feel on the inside and outside of part of the ankle are known as the medial malleolus and the lateral malleolus. There is also a posterior malleolus which you can’t feel because its deep inside at the back of the ankle joint.
It’s often the malleolus areas of the ankle which are involved in an ankle fracture.
If you have a violent twist through ankle (e.g. if you roll your ankle badly), not only can this tear the ligaments that support the ankle, it can also break the malleoli, the back part of the tibia bone, or even the talus bone. By far the most common bone to be broken is the fibula. If the injury is more severe, the medial malleolus can be fractured. And finally, the posterior malleolus fails and fractures.
In general, the more severe the initial injury, the worse the outcome. We will discuss what can happen to your ankle after a fracture later.
What are the symptoms of an ankle fracture?
Some patients may break the ankle if they roll the ankle whilst going over on a pavement curb, but many break the ankle playing sport, e.g. during a nasty football tackle.
If this happens to you, you may feel a ‘cracking’ sensation, you’ll experience some severe pain, bruising and some swelling that comes on quickly. You probably won't be able to put your weight on your foot, or if you can walk a little, it will be very unpleasant.
How is an ankle fracture diagnosed?
If ankle fracture is suspected, then an X-ray will determine if there are bony breaks.
In my experience, an MRI scan may also be needed to determine if there has been any damage to the syndesmosis, ligaments and tendons, which are important for structural stability of the ankle.
If the ankle fracture is very complex, then I might also like you to have a CT scan, so that we can look at the fracture in 3D.
Will I need surgery for my ankle fracture?
Some simple breaks in the ankle (such as a little ‘pull-off’ or ‘avulsion’ fracture of the lateral malleolus) may mend without surgery, either in a plaster cast or a boot.
Many ankle fractures are, however, best treated with surgery, in order to restore the alignment of the bones and the ankle’s stability. If you’ve broken more than one of the ankle bones, or there is additional damage to the syndesmosis, you’ll likely require surgery.
If you’re diabetic and have an ankle fracture, I may be more likely to suggest surgery, because diabetes can impair fracture healing. It is important to remember that having diabetes increases the risks of surgery too and increases the risks of getting a post-operative wound infection.
What happens during ankle fracture surgery?
Ankle fracture surgery is usually carried out under a general anaesthetic, so you’ll be asleep. A carefully planned incision is made at the site of the fracture (e.g. over the lateral malleolus), and any small bone fragments are removed, the ends of the broken bone are put into correct alignment and are fixed in place with a specially designed metal plate and screws.
The metal plate and screws are usually made out of a special titanium alloy or a special surgical grade stainless steel. They are designed to stay in for life but in people with slim ankles, they can become prominent once the swelling has settled down. Sometimes the prominence of metalwork can also be a source of pain due to rubbing of adjacent tendons, ligaments or skin.
What happens after the surgery?
At the end of the procedure, the incision will be closed with surgical staples or sutures. The ankle will then be bandaged before being placed in a splint.
Following this period of recovery, you will usually need to wear a boot or cast. In general, you will need to avoid putting your weight on the affected ankle for anything from 2-6 weeks following the ankle fracture surgery procedure depending on your type of fracture and how strong your bone is. You will gradually begin to put more weight on the ankle as your recovery progresses. Resting and elevating your ankle will help with pain and swelling during your recovery.
You'll be advised to start physio once you're ready, and this is designed to strengthen the ankle and improve its range of movement. Follow-up appointments involving an x-ray are scheduled to ensure your progress is on track.
What are the risks of the surgery?
As with any type of surgery, ankle fracture surgery does present a small risk of complications, such as; bleeding, infection, nerve damage and skin issues, as well as ankle stiffness and weakness following the procedure.
As with all foot surgery, it is common for minor discomfort and swelling to persist for some months after surgery and is completely normal. This swelling will eventually completely subside with time and can take up to 12 months but often goes well before this.
From the moment I met Mr Ajis, after a long and difficult time with a non-healing fractured ankle, I knew I was in the very best hands. From the initial diagnosis through scans, complex surgery, post-operative care and now sign-off but not dismissal, support and help with the beginning of rehab Mr Ajis has been outstanding. I cannot thank him enough nor speak more highly of him. A wonderful surgeon and brilliant consultant.
My experience all the way from consultation to operation was seamless.
Mr Ajis is a very warm friendly and professional man.
I went to Bognor War Memorial hospital on the advice of my GP practice because I had pain in my foot and could not walk properly. I was advised an M R I scan and to go back for a referral by my GP. I was then advised only physiotherapy could refer me. Physiotherapy told me that it would be months before I was seen if I was ever seen.
I turned to Mr Ajis. He immediately knew the problem and his diagnosis was correct verified by MR I a stress fracture of the cuboid bone . He offered me a new operation filling the fracture A sub-Chondroplasty. Prior to the Op I wore a boot to help me walk. A week after the operation I continued with the boot. I gradually mobilised and three weeks after the operation went on holiday. I needed assistance at the airport. 3 1/2 weeks later on my return I needed no such assistance and was walking comfortably. Eight weeks postop I do at least 10,000 steps a day and consider myself pretty much back to normal . Thank you Mr Ajis.
was referred to Mr Ajis with the possibility of requiring an operation on my foot following a fracture. I found him to be professional kind and caring. After discussion with him I elected to follow his advice and have the operation. I felt that he had given me options and I felt involved in my care.
He and his secretary (Sandra Tomkins) were both very helpful and accessible throughout the follow up process.
I have now made a full recovery and could not fault the care that I have received.
Thank you Mr Ajis. Eight weeks postop I do at least 10,000 steps a day and consider myself pretty much back to normal . Thank you Mr Ajis.
Mr Ajis performed surgery on my ankle after I suffered a trimalleolar fracture in Nov 2018. I am delighted with the outcome of the surgery and my recovery has exceeded expectations. At 3 weeks post-op, I was allowed to start partial weight bearing and at 6 weeks I was walking unaided without a limp. At 2 months post-op I was able to go skiing again.
Mr Ajis is very professional and I had total confidence in his opinion and advice. He was very clear about the outcomes and what to expect and gave me lots of information at every stage. I would highly recommend him as a surgeon.
I was referred to Mr Ajis following a broken ankle when it was discovered that I had ruptured my Achilles tendon. He explained thoroughly that there was a 2.5cm gap and that, as considerable time had elapsed, the operation might not work but that he would do his
upmost. Fortunately for me he was able to mend the rupture and, following careful and sympathetic supervision of using a specialist boot and instruction, my ankle has recovered some six months later. Being in my mid seventies, this has pleasantly surprised me and I am back playing golf and sailing and looking forward to the next skiing season thanks to his professional care, encouragement and humorous support throughout.
Inearly June I suffered a severe high-impact injury and smashed my heel into many pieces and in some places, powder. Knowing Mr Ajis from his excellent work on my wife's feet, I contacted him and was transferred to his care at BMI Goring Hall.
Mr Ajis was direct and tells things as they are although he put me at ease and gave me confidence that he would do his utmost to fix the problem. During the operation he discovered the injury was worse than expected however with a new German Titanium plate, some American "poly-filler" and some fantastic surgery, he has transformed the misshapen thing into a foot. His technique has also left minimal scarring.
Post-operation, Mr Ajis continues to direct and improve my healing and I am making a remarkable recovery. Without his expertise I am not sure how this would have turned out.
I recommend Mr Ajis to anyone and cannot thank him enough.
Ankle pain can be distressing, especially if you're not sure what options are open to you. If you're wondering if surgery could help you, book an appointment.
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