Ankle Fracture: General Facts
An ankle fracture can range from a relatively minor twisting injury to high energy trauma. Those with high energy, such as in a motor vehicle crash or with high falls, have a worse prognosis because they place the articular cartilage of the joint at much higher risk. Ankle fractures from sports such as basketball, soccer, or football, are considered lower energy injuries.
The Role of Arthroscopy in Treating Ankle Fracture
In the February 2019 issue of Inside AANA eNewsletter, the Arthroscopy Association of North America (AANA) published an Introduction and Point about the role of arthroscopy in treating ankle fractures. The Introduction was written by Thomas F. Golden, M.D. and Casey Pyle, D.O., while the Point was written by Richard D. Ferkel, M.D.
As a member of the AANA, Dr. Dominic Carreira has shared links to these two pieces as he supports and agrees with the positions posted by the authors. (They are both in PDF format.)
Patient-Focused Study: Use of Narcotics in Treatment
Summer 2018: At Peachtree Orthopedics, Dr. Carreira and his colleagues are currently undertaking two important studies of ankle fractures related to their outcomes.
The first study is a careful study of the use of narcotics. This topic is an important one given the national abuse epidemic. A new educational program which was started in July 2018 is being studied to compare patients’ use of narcotics.
Secondly, as part of a study led by the Multicenter Arthroscopy Study of the Ankle and Foot (MASTAF), those patients with ankle fractures who undergo arthroscopy to address injuries inside the joint may also be enrolled. The MASTAF research project is a multi-center trial of ankle arthroscopy. Dr. Carreira is a founding member of MASTAF.
All patients have the option of enrolling (or not) in these studies, and participation is truly optional.
Dr. Carreira is actively involved in developing the field of foot and ankle and contributing further to the treatments of broken ankles.
Video of an Ankle Fracture
The above video shows the fracture of an ankle caused by a skate boarding fall.
Treatment of an Ankle Fracture
If the shape and anatomy of the ankle is not accurately restored, the cartilage lining of the ankle is disturbed which may lead to arthritis.
For a broken ankle, the goal of treatment is to realign the bones in their normal position and hold them in place, typically using plates and screws. Proper alignment of the bones helps to prevent arthritis.
Surgery is performed with incisions on one or both sides of the ankle, and depending on the severity of the fracture, arthroscopy may be beneficial to assess and treat articular cartilage damage inside the joint. The arthroscopy typically adds just a few minutes to the procedure and does not prolong recovery. Through arthroscopy, the cartilage injury, which can lead to early arthritis and ankle pain, can be treated at the same time as the fractured ankle bones. A microfracture technique can be performed for deep cartilage lesions and loose bodies, or fragments of cartilage, may be removed.
Inpatient vs. Outpatient Surgical Treatment of Ankle Fractures
A recent study conducted by the Northwestern University Feinberg School of Medicine examined inpatient vs outpatient surgical treatment of ankle fractures. According the report produced from the study, there were a number of medical benefits to the conducting outpatient surgery on a variety of ankle fractures.
Postoperative Recovery Following Ankle Fracture Surgery
Following surgery, a bulky splint is applied to the ankle until the stitches or staples are removed at approximately two weeks.
If the left ankle is broken, you can drive once you once you have stopped taking narcotics. For the right ankle, driving can be started at 4 to 6 weeks.
No weight-bearing is permitted until 4 to 6 weeks.
At 4 weeks, exercise activities are initiated in a swimming pool and on a bike. At 6 weeks, a gradual increase in activities is recommended.
Timeline Following Ankle Fracture Surgery
- Foot is wrapped in bulky splint
- Ice, elevate, and take pain medications
- Expect numbness in the foot for 12 to 24 hours
- Bloody drainage through bandage is common
Use crutches, walker, wheelchair or roll-a-bout, do not change dressing/splint
- First follow up in the office, X rays taken, dressing changed, sutures are removed
- A removable boot is applied, and range of motion out of the boot is started 3 times per day out of the boot
- Showering is permitted, provided the incisions are clean and dry. No bathing or swimming unless the wound is completely intact, as determined by Dr. Carreira.
- Start physical therapy as prescribed
- Particularly in Florida where sandals are commonly used and socks are less frequently used, keeping the incisions covered until there is full skin healing is important to prevent superficial infections.
4 – 6 weeks
- You may start swimming in a pool.
- You can bear some weight in the pool if there is no discomfort or pain
- Continue physical therapy to return to all activities
- Full walking is permitted with gradual progress to full weight-bearing in the boot (over 1 week), then gradual progress to a shoe (over 1 week). The timing of progress is dependent on pain.
Photos of Ankle Fracture
Before and After X-Rays Showing Ankle Fracture Repair
Talus (Ankle) Fracture Treated with Arthroscopic Assistance
The above photo shows a talus (ankle) fracture treated with arthroscopic assistance. Of note, the screw fixation is noted on the X-ray.