Open reduction internal fixation, ankle

Type of Procedure: Outpatient

Length of Procedure: 1-2 hours

Anesthesia: Regional nerve block with general anesthesia or sedation

Medications: Oxycodone or Norco for pain, aspirin 81 mg twice daily for 3 weeks to lower risk of blood clots, ondansetron for nausea

Follow-up appointments: 2 weeks, 6 weeks, 12 weeks

Time Non Weight Bearing: 4 weeks if only outside bone (fibula) fixed; 6 weeks if fibula and tibia fixed or syndesmosis or deltoid ligament repaired

Time to Driving: When off narcotics for left ankle unless you have a clutch, 8-10 weeks for right ankle

Ankle fractures: General facts

• Usually from twisting injuries or direct blows
• Higher energy injuries (car accidents and falls from height) are associated with injury to the surrounding cartilage and ligaments)

Ankle Anatomy

• The ankle joint is composed of three bone and is normally U-shaped
• The inner bone is the tibia which has two prominences called the medial malleolus (inside) and posterior malleolus (back)
• The outer, smaller bone is the fibula and forms the lateral malleolus (outside)
• The talus is the bone underneath the tibia and fibula
• The ankle joint is responsible for up and down movement
• Ankle fractures can involve one or two bone and involve the ligament on the inside of ankle (deltoid) or ligament between the two bones (syndesmosis)

Treatment of an ankle fracture

• If the ankle complex is broken in more than one place (bones or ligaments), it is not stable and can move around
• If the shape of the ankle is not properly restored, the cartilage in the ankle wears away leading to arthritis
• The goal of surgery is to restore the alignment and stability of the ankle, lowering the risk of arthritis
• Surgery involves incisions on one or both sides of the ankle
• Screws and/or a metal plate are used to hold the bones in place
• Occasionally we use a suture device to repair the alignment of the tibia and fibula

Before Surgery:

1. Elevate extremity
2. Ice the affected ankle
3. Do not put weight on the ankle

After Surgery:

1. Immediately after:
   1. In splint below the knee (do not get splint wet)
   2. Elevate the leg, Ice, take pain medication
   3. No weight (use crutches, walker, knee scooter, or wheelchair)
2. 2 week appointment:
   1. Stitches come out and steri-strips placed
   2. Placed into boot
   3. Begin moving the ankle on own at home
   4. May run soapy water down incisions but do not scrub or soak
   5. No weight allowed after this visit
3. 6 week appointment:
   1. Begin placing weight on leg in the boot (unless instructed otherwise)
   2. Start physical therapy to work on strength and motion
   3. Transition from boot to gym shoe at 9-10 weeks with help of therapist
   4. Can go into a swimming pool and use stationary bike (seated)
4. 12 week appointment:
   1. Begin running and jumping if cleared by Dr. Dean
   2. Continue physical therapy