The ankle consists of the inner aspect of the tibia (the medial
malleolus), the outer aspect of the ankle (the fibula), and the bone underneath the ankle
(the talus). There are many different varieties and grades of severity of ankle fractures.
These may involve only the medial malleolus, only the fibula, or both bones (which is
called a bi-malleolar fracture). At times the talus may completely pop out of the ankle
joint associated with the fracture. We call this a fracture dislocation.
If the shape and anatomy of the ankle are not accurately restored, the cartilage lining of
the ankle will be disturbed. This will inevitably lead to arthritis. Therefore, the goal
of treating all ankle fractures is to re-position the bones to prevent the occurrence of
arthritis. Some minor ankle fractures can be treated in a boot or a cast without surgery.
The majority of ankle fractures, however, do require operative treatment. Surgery is
performed with incision(s) on one or both sides of the ankle. Screws and/or a metal plate
are inserted into the medial malleolus and the fibula in order to accurately restore or
reduce the fracture alignment.
Following surgery, a bandage with plaster is applied to the ankle. The bandage remains
until the stitches are removed (usually about two weeks). At that time exercise activities
are initiated. No walking on the ankle is permitted for approximately six weeks. At that
time protective walking (with a removable boot or brace) may be allowed. Physical therapy
exercises, swimming and biking are important parts of the recovery process. They
strengthen the leg and develop movement of the ankle.
If the ankle is not repaired correctly or does not heal well, arthritis and deformity of
the ankle can occur. Some of these patients will have no other option but to have the
ankle surgery re-done. Dr Myerson has developed techniques for salvaging very severe
deformities of the ankle after unsuccessful fracture treatment.
