Ankle Fracture Open Reduction and Internal Fixation
What is ankle fracture open reduction and internal fixation?
Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken ankle.
There are three bones that make up the ankle joint. These are the tibia (shinbone), the fibula (the smaller bone in your leg), and the talus (a bone in your foot).
Different kinds of injury can damage the lower tibia, lower fibula, or talus. Only one of these bones might break, or you might have a fracture in two or more of these bones. In certain types of fractures, your bone breaks but the pieces still line up correctly. In other types of fractures, the injury can move the bone fragments out of position.
If you fracture your ankle, you might need ORIF to bring your bones back into place and help them heal. During open reduction surgery, an orthopedic surgeon moves your bone pieces back into the correct position. In a closed reduction procedure, a healthcare provider moves the bones back into place without surgically exposing the bone.
Internal fixation refers to the method of reconnecting the bones. This might be done with special screws, plates, rods, wires, or nails that the surgeon places inside the bones to fix them in the correct place. This prevents the bones from healing the wrong way. The surgery usually takes place while you're asleep under general anesthesia.
Why might I need an ankle fracture open reduction and internal fixation?
Some health conditions may make fracturing your ankle more likely. For example, osteoporosis increases the risk of fracture in many older adults. Motor vehicle accidents, tripping or falling, contact sports, and twisting your ankle are some of the more common sources of injury that can lead to an ankle fracture. Smokers and overweight people are more likely to fracture their ankle and have increased difficulty with healing.
You might not need ORIF if you fracture your ankle. Many people don’t. If possible, your healthcare provider will treat your fracture with other treatments, like pain medicines, casts, boots, or braces.
You probably won’t need ORIF unless there's a reason your fracture might not heal the right way with these other treatments. You're more likely to need ORIF if:
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The pieces of your leg are badly out of position
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Your broken bones punctured your skin
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Your bones broke into several pieces
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Your ankle is unstable
In these cases, ORIF can place your bones back into the right position, increasing the chance that your bone will heal the right way. You might need ORIF for a fracture that occurs anywhere along your ankle.
What are the risks of ankle fracture open reduction and internal fixation?
Most people do very well with ORIF for their ankle fracture. But some rare complications can happen. Possible complications include:
There's also a risk that the fracture won’t heal correctly, and you’ll need to repeat the surgery.
Your own risk of complications may vary according to your age, how and where your ankle is broken, and your other health conditions. For example, people with low bone mass or diabetes may be at greater risk of some complications. Smokers may also have an increased risk. Ask your healthcare provider about the risks that most apply to you.
How do I get ready for ankle fracture open reduction and internal fixation?
ORIF often takes place as an urgent procedure. Before your procedure, a healthcare provider will ask about your health history and give you a physical exam. You’ll have an image of your tibia and fibula taken with either an X-ray or a computed tomography scan. Tell your provider about all the medicines you take, including over-the-counter medicines like aspirin. Also, let your provider know the last time you ate.
In some cases, your provider might do your ORIF a little later, so the swelling in your ankle can go down first. You might need to have your ankle held immobile while you wait for your surgery. Talk to your provider about how to get ready for the surgery. Ask if there are any medicines you should stop taking ahead of time, like blood thinners. You’ll need to not eat or drink after midnight the night before your procedure.
What happens during ankle fracture open reduction and internal fixation?
Your healthcare provider can help explain the details of your surgery. These details will depend on where the injury is and how serious it is. An orthopedic surgeon will do the surgery aided by a team of healthcare providers. The surgery may take a few hours. In general, you can expect the following:
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You may get general anesthesia, so you’ll sleep through the operation and won’t feel anything. Or you may get local anesthesia and a medicine to help you relax.
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A provider will carefully watch your heart rate, blood pressure, and other vital signs.
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After cleaning the affected area, your surgeon will make an incision through the skin and muscle of your ankle.
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Your surgeon will bring the pieces of your ankle back into position (reduction).
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Next, your surgeon will secure the pieces of your broken bones to each other (fixation). To do this, they'll use tools, like screws, metal plates, wires, or pins.
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Your surgeon will make other repairs as necessary.
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After the surgeon and surgery team have secured the bone, the layers of skin and muscle around your leg will be repaired.
What happens after ankle fracture open reduction and internal fixation?
Talk to your surgeon about what you can expect after your surgery. You may have some pain after your procedure. You may be prescribed pain medicines by your healthcare provider. You should be able to resume your normal diet fairly quickly. You'll likely have imaging tests, like an X-ray, to check that the fracture has been repaired correctly. Depending on the extent of your injury and your other medical conditions, you might be able to go home the same day.
Your surgeon might tell you to keep your ankle elevated for a certain period of time after your surgery. You’ll also need to keep your ankle immobile for a while. Often, this means wearing a splint, perhaps for several weeks. You’ll receive instructions about how to move your leg and whether it's OK to put weight on it.
Follow all your surgeon's instructions carefully. You might need to take blood-thinner medicine to prevent blood clots for a little while after your surgery. Your surgeon might not want you to take certain over-the-counter medicines for pain because some of these can interfere with bone healing. They may advise you to eat a diet high in calcium and vitamin D as your bone heals.
You might have some fluid leaking from your incision, which is normal. However, let your surgeon know right away if the draining is bad. Also, let them know if there's increased redness, swelling, bad pain, or loss of feeling in your leg, or if you get a high fever or chills.
Make sure to keep all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.
At some point, you may need some physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your chances of full recovery. Many ankle fractures take several months to heal completely, but you should be able to resume many activities before this time.
Next steps
Before you agree to the test or procedure make sure you know:
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The name of the test or procedure
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The reason you are having the test or procedure
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What results to expect and what they mean
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The risks and benefits of the test or procedure
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What the possible side effects or complications are
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When and where you are to have the test or procedure
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Who will do the test or procedure and what that person’s qualifications are
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What would happen if you did not have the test or procedure
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Any alternative tests or procedures to think about
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When and how you will get the results
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Who to call after the test or procedure if you have questions or problems
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How much you will have to pay for the test or procedure