Ankle Fractures: Not As Simple As Most Think!
Ankle fractures are very common and can occur from very simple injuries such as an innocent twist or sprain to high energy car accidents. Ankle injuries can damage bones, ligaments, and the joint lining (cartilage). There are many different types of ankle fractures and they all require different specialized treatment. So how do you know what you should do? Here is our advice:
Ankle Injury Advice – What To Do First?
If you injure your ankle and experience pain, swelling and difficulty walking, we recommend you stay off the ankle and attend an Emergency Room or Urgent Care as soon as possible for initial evaluation and care. This normally involves getting an x-ray of the ankle to determine if there are obvious fractures and you will be advised on initial treatment likely in the form of a brace, splint and or crutches as determined necessary by the evaluating practitioner.
Dr H treats all fractures, even if they do not require surgery. So, if you have a fracture you need to see Dr H and TheAnkleMD team and we recommend you call our appointment line 1833 ANKLEMD 24/7.
I Have A Fracture, What Next?
There are many different types of ankle fractures. Some you can walk on immediately in a boot and do not require surgery and some require surgery to avoid long term problems. Determining whether an ankle fracture requires surgery is a complex process and frequently requires advanced imaging such as a CT scan. Dr H’s goal is to always avoid surgery for his ankle fracture patients but failing to recognize and treat surgical ankle fractures appropriately can lead to rapid post traumatic arthritis in the ankle which will result in chronic pain, swelling and potentially the inability to walk. Dr H has a special weightbearing CT scanner in his office and in most instances, we can get a CT scan of your ankle at your first appointment and therefore get an answer about how you need to be treated quickly and easily.
No Surgery! – Always Our Goal – So What Next?
Although Dr H is a surgeon, his primary goal is to always manage fractures non surgically, if it possible.
The exact treatment for ankle fractures can vary depending upon your fracture type, but in general you will need to be in a boot with limited weight bearing for 6 weeks. You will then likely be allowed to advance your weight in the boot over another 2-4 weeks. Most patients are in a brace and tennis shoe by 10 weeks and then returning to sports at 4 months. However, the ankle can be sore and swollen for 6 months to a year.
If it is your driving foot, you will not be able to drive for up to 3 months. The AnkleMD team will provide you with many resources to make this process easier for you but it is still very inconvenient. We have a very aggressive treatment and rehab protocol to get you back walking, driving, working, and playing sport as soon as possible.
I Need Surgery – What Next?
We’re sorry that you need surgery but the good news is you are in great hands with Dr H. Dr. H’s passion and area of expertise is the minimally invasive treatment of ankle fractures with the goal of getting you the absolute best result with the quickest recovery possible and that’s what we aim to give you.
Dr. H will explain exactly what your particular fracture pattern requires, and this will often depend upon your CT scan. In general, the following is true for most surgical ankle fractures:
- Surgery is normally an outpatient procedure (in and out same day)
- It takes about an hour to perform and you will be asleep
- Dr will frequently use a mini camera (arthroscope) to check the lining of your joint (cartilage)
- Your bones are normally fixed with modern metal devices through the smallest incisions possible
- Dr H also checks and repairs all of your ligaments which is key to a successful surgery
- You will be a splint (soft cast) for at least 2 weeks and need to be housebound and low key
- At 2 weeks you will normally go into a removeable boot and start therapy and showering
- At 6 weeks you will normally start walking in the boot
- At 10 weeks you will normally get out of the boot
- No driving for up to 3 months (right foot)
- At 3-4 months you will normally be allowed to start impact exercise
- At 4 months you normally have a green light to do almost everything
- The ankle can be swollen and painful for up to 6 months to a year
- We will provide you with help and resources to make this as manageable as possible
Does the Metal Have to Come Out?
Good question. The answer is no! Most of the time it does not need to be removed. It can stay in there forever and should not cause you any problems. Occasionally patients can feel the metal under the skin which can be irritating and thus warrants removal with another surgery.
Dr. H has pioneered modern techniques and devices which are much lower profile and sit inside the bone instead of on top of it and therefore very few of his patients can ever feel the metal and thus do not require another surgery which is a win for everyone!
What About Long Term, Problems?
All ankle fractures carry a risk of long-term stiffness and arthritis due to damage to the joint lining (cartilage) at the time of injury, even if your fractures are fixed perfectly. This risk is low, and most fractures do not lead to arthritis. Dr H believes there are many different ways to decrease the risk of long term stiffness and arthritis problems which is why he one of very few surgeons to employ a very aggressive comprehensive evaluation and treatment process that normally involves the following:
- Pre op CT scan
- Intra operative examination of the joint cartilage (arthroscopy)
- Minimally invasive incisions
- Ligament damage assessment and repair
- Aggressive early physical therapy
Our goal is always to get you the best short and long term result and we go the extra mile every time to make sure your ankle will be as perfect as it can be!
Take a look at our ‘Minimally Invasive Treatment of Ankle Fractures’ page to see how we aim for perfection every time.