Open Reduction and Internal Fixation Ankle

Due to the nature of your ankle fracture, you require open reduction and internal fixation. This involves restoring the normal anatomy of the bones of the ankle and holding them in place with plates and screws. Fortunately most patients have an excellent result following ankle fracture surgery and are able to return to most pre-injury activities.

There are a number of steps involved in ankle surgery. These include:

• General anaesthetic, intravenous antibiotics
• Incision over fractures
• Restoration of normal anatomy
• Fixation of fractures with plates and screws
• Check x-ray
• Wound closure with stitches/sutures
• Back slab

All surgical procedures carry some risk. The risk of complications with ankle surgery is low. Some of the risks include:

• Infection
• Problems with wound healing
• Nerve injury – this may result in numbness, tingling and/or pins and needles
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Ongoing pain
• Post traumatic osteoarthritis

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first six weeks

Pain

• Pain relief may be required for up to 4 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications
• A regular blood thinning medication will also be prescribed for 2 weeks

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 2 weeks: Wound review and removal of sutures, change from cast to boot, commence limited rehabilitation
• 2-6 weeks: regular physiotherapy to increase range of motion
• 6 weeks to 3 months: work on swelling reduction, scar massage and mobility. Progress weight bearing
• Full recovery 6-9 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.