Needing surgery to fix a broken ankle is an experience that can create a lot of distress and uncertainty. Even when everything goes well, there are certain aspects of the recovery that can be a cause for concern. How large will the incision be and will it heal properly? Will the metal plates and screws be felt under the skin? How long until the foot can bear weight?
Traditionally, ankle fracture surgery requires a long incision over the outside of the leg to expose the fracture site. Plates and screws are needed to hold the bones in place, but these can be felt underneath the skin. Lastly, traditional ankle surgery usually requires a period of non-weight-bearing of anywhere from two to six weeks. In certain patients, such as those with diabetes or heart problems, these concerns can be strong enough that surgery is completely avoided, leaving a patient with a mal-aligned ankle.
Thankfully, newer techniques have been developed and are used here at CMD that allow for a small incision, hardware that you cannot feel and adequate stability that provides for safe and immediate weight bearing. By using a rod placed inside the bone through a small incision at the tip of the ankle, large incisions and prolonged recovery times are avoided.
Using X-ray guidance, a starting point at the tip of the fibula is established and a small incision at the tip of the ankle is made. Using multiple X-ray images, the correct trajectory up the fibula and across the fracture site is established with a guidewire. Placement of the guidewire is the most important aspect and judging the correct position is the most difficult part of the surgery. Once the drill is passed over the guidewire, everything is removed and the rod is inserted into the fibula. It is then secured in place with the locking mechanism and a small screw. The rod is also built with a space for doing a syndesmosis repair which some ankle fractures require.
Post-operatively, patients are put in a boot and allowed to bear weight right away with crutches for support. Once the small incision has healed, patients can get the leg wet and begin physical therapy.
By David Mandil DPM