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Ankle Fracture Surgery

Have you had a twist or injury which has broken your ankle or a bone in your foot? Not sure whether you need surgery?

I’m here to help.

Is there a difference between a fracture and a break?

I’m often asked “what’s the difference between a fracture and a break?”.

There’s no difference between the two. Both mean the bone has lost its structural integrity and has broken.

The terms can be used interchangeably.

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What is an ankle fracture?

The ankle joint is a joint made by the meeting of three bones; the tibia (which is your main shin bone), the fibula (the bump of bone you feel on the outside), and the talus bone (connects the foot and responsible for up and down movement).

The tibia and fibula form the roof and sides of arch shape of the ankle joint and they are bound together by a fibrous structure called the syndesmosis. The talus bone sits within the arch.

The bony prominences that you feel on the inside and outside of part of the ankle are known as the medial malleolus and the lateral malleolus. There is also a posterior malleolus which you can’t feel because its deep inside at the back of the ankle joint.

It’s often the malleolus areas of the ankle which are involved in an ankle fracture.

If you have a violent twist through ankle (e.g. if you roll your ankle badly), not only can this tear the ligaments that support the ankle, it can also break the malleoli, the back part of the tibia bone, or even the talus bone. By far the most common bone to be broken is the fibula. If the injury is more severe, the medial malleolus can be fractured. And finally, the posterior malleolus fails and fractures.

In general, the more severe the initial injury, the worse the outcome. We will discuss what can happen to your ankle after a fracture later.

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Will I need surgery for my ankle fracture?

Some simple breaks in the ankle (such as a little ‘pull-off’ or ‘avulsion’ fracture of the lateral malleolus) may mend without surgery, either in a plaster cast or a boot.

Many ankle fractures are, however, best treated with surgery, in order to restore the alignment of the bones and the ankle’s stability.  If you’ve broken more than one of the ankle bones, or there is additional damage to the syndesmosis, you’ll likely require surgery.

If you’re diabetic and have an ankle fracture, I may be more likely to suggest surgery, because diabetes can impair fracture healing. It is important to remember that having diabetes increases the risks of surgery too and increases the risks of getting a post-operative wound infection.

What are the symptoms of an ankle fracture?

Some patients may break the ankle if they roll the ankle whilst going over on a pavement curb, but many break the ankle playing sport, e.g. during a nasty football tackle.

If this happens to you, you may feel a ‘cracking’ sensation, you’ll experience some severe pain, bruising and some swelling that comes on quickly. You probably won’t be able to put your weight on your foot, or if you can walk a little, it will be very unpleasant.

How is an ankle fracture diagnosed?

If ankle fracture is suspected, then an X-ray will determine if there are bony breaks.

In my experience, an MRI scan may also be needed to determine if there has been any damage to the syndesmosis, ligaments and tendons, which are important for structural stability of the ankle.

If the ankle fracture is very complex, then I might also like you to have a CT scan, so that we can look at the fracture in 3D.

What happens during ankle fracture surgery?

Ankle fracture surgery is usually carried out under a general anaesthetic, so you’ll be asleep. A carefully planned incision is made at the site of the fracture (e.g. over the lateral malleolus), and any small bone fragments are removed, the ends of the broken bone are put into correct alignment and are fixed in place with a specially designed metal plate and screws.

The metal plate and screws are usually made out of a special titanium alloy or a special surgical grade stainless steel. They are designed to stay in for life but in people with slim ankles, they can become prominent once the swelling has settled down. Sometimes the prominence of metalwork can also be a source of pain due to rubbing of adjacent tendons, ligaments or skin.

What happens after the surgery?

At the end of the procedure, the incision will be closed with surgical staples or sutures. The ankle will then be bandaged before being placed in a splint.

Following this period of recovery, you will usually need to wear a boot or cast. In general, you will need to avoid putting your weight on the affected ankle for anything from 2-6 weeks following the ankle fracture surgery procedure depending on your type of fracture and how strong your bone is. You will gradually begin to put more weight on the ankle as your recovery progresses. Resting and elevating your ankle will help with pain and swelling during your recovery.

You’ll be advised to start physio once you’re ready, and this is designed to strengthen the ankle and improve its range of movement. Follow-up appointments involving an x-ray are scheduled to ensure your progress is on track.

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What are the risks of the surgery?

As with any type of surgery, ankle fracture surgery does present a small risk of complications, such as; bleeding, infection, nerve damage and skin issues, as well as ankle stiffness and weakness following the procedure.

As with all foot surgery, it is common for minor discomfort and swelling to persist for some months after surgery and is completely normal. This swelling will eventually completely subside with time and can take up to 12 months but often goes well before this.

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What my patients say

I felt really comfortable with Dr Ajis, He went through everything with me on the consultation and on the day of my operation. He is a very nice guy and has such a friendly approachable face, He makes you feel you’re in good hands. He is a great professional and I would highly recommend him. 

What my patients say

I felt really comfortable with Dr Ajis, He went through everything with me on the consultation and on the day of my operation. He is a very nice guy and has such a friendly approachable face, He makes you feel you’re in good hands. He is a great professional and I would highly recommend him. 

Ankle pain can be distressing, especially if you're not sure what options are open to you. If you're wondering if surgery could help you, book an appointment.

* Routine private appointments either face to face or remotely are available

Call the urgent appointments hotline 0333 050 8662

Hear what our patients have to say

Mr Ajis is a great surgeon, he listens to any concern you may have and explains what is going to happen also gives great care... He suggested a fairly new procedure that wasn't available on the NHS but he pushed me through and he and his team have worked wonders, I am now healing very well and pain-free in my ankle after 6 years!

Written by a patient at BMI Goring Hall Hospital

Mr Ajis was very informative and reassuring about my surgery. He was professional at all times and allowed time for me to have all my questions answered without feeling rushed.

Written by a patient at BMI Goring Hall Hospital

I saw Mr Ajis after sustaining a fracture of my 5th metatarsal which had not healed after a year. The pain was unbearable. He saw me promptly and took the time to explain my condition with the help of x-ray images with assurances that he could fix the problem. I was advised by other clinicians to be patient and wait for the fracture to heal on its own. Mr Ajis said that healing would be highly unlikely without intervention. After numerous emails and 'phone calls to him he constantly...

...spent the time reassuring me and patiently going over the intended procedure. To date after seeking advice and guidance from Mr Ajis, his secretary and the Physio Team and the insertion of a plate my fracture has united I walk well, without pain and I have joined a walking group.

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