One in 800 people suffers an ankle fracture every year in the United States. The severity of a broken ankle can range from one break in one bone, which may not stop patients from walking to breaks in several bones that force the ankle out of place. In some cases, ligaments are also damaged when an ankle is fractured, which contributes to the lack of stability.
Ankle ORIF (ankle fracture open reduction and internal fixation) is a type of surgery used to stabilize and heal a fractured bone in the ankle. It is performed on one or more of the 3 bones that make up the ankle joint:
- Tibia (shinbone)
- Fibula (smaller leg bone)
- Talus (a bone in the foot)
Ankle ORIF is typically not a first-line treatment option for fractured ankles. For less severe fractures, health providers will likely recommend more conservative treatments, such as over-the-counter pain medicines, casts or braces and physical therapy. In some cases, an orthopaedic surgeon may try to reposition the fractured bone using manual manipulation through the skin, followed by complete immobilization of the ankle in a plaster cast for a few weeks.
An ankle fracture is considered severe if the ankle becomes completely unstable due to the injury. Patients may be good candidates for ankle ORIF if:
- The ankle bones are significantly misaligned
- The broken bones have punctured the skin
- The bones have broken into multiple pieces
During an open reduction surgery, an orthopaedic surgeon repositions the broken bones back into place to help the healing process. The surgeon may need to make several incisions to reach the bones that need repairing. Internal fixation refers to the method of actually reconnecting the bones, which could involve screws, rods, plates, wires or nails. Patients are given general anesthesia to sedate them throughout the entire surgery.
What to Expect After Ankle ORIF
Following ankle ORIF surgery, patients may need several months to completely heal and they should not bear any weight until the cast is removed. The typical follow-up and recovery schedule following ankle ORIF is as follows:
10 days to 2 weeks. The stitches are removed and the ankle is placed in a short leg cast. The ankle remains immobilized and cannot bear any weight.
2 weeks. Return to the orthopaedic surgeon for a checkup, which may include X-rays and a new cast, if needed.
8 weeks post-op. The cast is removed and patients typically receive a removable brace or an air cast that can be placed inside the shoe. Patients are normally able to bear weight on the ankle at this point, but crutches or a cane might still be used if they’re experiencing pain.
Throughout the recovery period, patients should perform daily range of motion exercises and visit their physical therapist for the prescribed amount of treatment. Good ankle exercises to restore strength and mobility include:
- Ankle extension/flexion
- Ankle rolls
- Resisted ankle extension/flexion
Patients who heed the advice of their orthopaedic surgeon and their physical therapy team have the best chances for a full and speedy recovery, and they should consult with their surgeon before beginning any exercise regimen.