© Mr Amer Karim (2016)

Mr Amer Karim


 MBBS(London), DIC(Orth Eng), MD(Res)                

FRCS(Trauma & Orth), FRSA(UK)

  

Consultant Trauma & Orthopaedic Surgeon


Full British Training & Specialist Certification



Ankle Fracture (Broken Ankle)



What is an ankle fracture?


The ankle is  a complex joint made up of 3 main bones. When you sustain an ankle fracture, it can involves one or more of these bones. The more bones that are involved, the more complex the fracture.


Ankle fractures can also occur in growing children, these fractures are different from the ones normally found in adults and require different operations and treatments.


Generally, the better your health and mobility before an ankle fracture, the quicker the more complete the recovery after the surgery.


How do ankle fractures occur?


They are usually as a result of twisting injuries around the ankle, caused by a slip or through sport. However high energy injuries such as falls or car accidents can also cause them.


What are the treatment options?


The treatment of an ankle fractures depends on the type of fracture sustained and the position of the fracture:


 If the bones are broken, but in perfect alignment, then an operation can be avoided and the ankle can be treated in plaster with close monitoring to ensure that the bones do not shift. Of course you cannot put any weight through the leg for 6 to 8 weeks until the bones heal.


 In some fracture configurations, the misaligned bones can be realigned with a simple manipulation and then treated in plaster with close monitoring to ensure that the bones do not shift. Of course you cannot put any weight through the leg for 6 to 8 weeks until the bones heal.


 In some cases the misaligned bones cannot be realigned with a simple manipulation, or because of patient choice, an operation is performed. Here the bones are realigned under direct vision and fixed (pinned) using plates and screws under x-ray guidance. Afterwards you will be in a plaster, but for only 2 weeks to let the wounds heal. Afterwards you will still be walking with crutches, but will be able to put some weight through your ankle and should be back to normal by 6 weeks.


The decision to leave, manipulate or fix an ankle fracture depends on the type of the fracture


All decisions regarding treatment will be discussed with you and your family prior to the operation. I will also answer any questions you have before you sign a consent form so you are fully informed and can make the best decision for you.


What happens before the operation?


Prior to any surgery, your ankle may be manipulated with some analgesia and sedation on the ward or in A&E to put it into a better position. Ankles that are left misaligned, even before surgery, are more swollen and painful and have more complications afterwards compared to ankles that have been realigned.


Your leg will also be elevated and iced to reduce the swelling. You will also be in a temporary supporting plaster. you are encouraged to move your toes to keep blood circulating.


If your foot feels tight, numb, goes blue or becomes very painful, then please inform the staff urgently as your plaster may have become too tight and should be released immediately.


Surgery can only be performed once the swelling around the ankle has subsided, otherwise it can be difficult to close the wounds after the operation and the risk of infection is higher. In cases of severe swelling, it sometimes takes 10 days of strict elevation in hospital to bring the swelling down.


Don't worry, a delay of less than 2 weeks prior to surgery does not affect the final outcome, in fact a short delay to let the swelling subside is preferred.


I have blisters around my ankle, what now?


In some cases of high energy ankle fractures, patients can develop blisters around the ankle. These so called "fracture blisters" are a sign of the severe soft tissue injury sustained around the ankle. An operation can not and should not be performed until they have fully subsided, or the risk of wound problems and infection is very high. Your leg will be elevated in a plaster until all the blisters have settled. You may also be started on antibiotics, depending on the condition and appearance of the blisters.


Again, no surgery will be performed until the blisters have all healed.


Are there any risks?


With any operation there are risks, ankle fractures are serious injuries and so there are some risks that you need to be aware of. The chances of these complications are low, usually less than 2%, however if they do occur, they are serious and so you should be aware of them:


 Bleeding during or after the surgery (you may also require a blood transfusion)

 Infection

 Neuro / Vascular injury

 Blood clots in the legs (DVT) or lung (PE)

 Chest infection

 Urine infection

 Haematoma (blood collection in the muscles)

 Heart failure, heart attack or stroke

 Non-union of the fracture

 Further fracture

 Prominence / tenderness over metalwork


The procedure is made as safe as possible through experience and I have performed hundreds of these operations without incident.


Rehabilitation after Surgery?


After the surgery, you will be left in bed to recover from the anaesthetic for the first day. The day after the surgery you should start sitting out in a chair and walking with aids and the help of the physiotherapists. You will probably be in hospital for about 3 to 5 days.


You will only be discharged from hospital once you are safe to do so. Upon discharge, it is advisable to stay with an able family member who can assist you while you continue your recovery. You should walk often and commence physiotherapy at home. Your wound stitches will be removed in about 2 weeks and you should keep the wound dry and covered up until then.


It takes 6 to 8 weeks for the bones to mend, but up to 12 months to fully recover from an ankle fracture.


Sometimes once an ankle fracture has fully healed and all the swelling has gone, the metalwork used to fix the fracture can become prominent and painful. In this case, a much smaller operation is recommended to remove the metalwork. This will be discussed with you in more detail at follow up.


Follow up?


I will see you in my outpatient clinic 2 weeks after the surgery to check the wound and remove the stitches. I will then arrange regular long term follow up in my clinic to monitor your progress, depending on the surgery performed. Should you wish to see me sooner or if you have any other questions, please phone my secretary and she will book you in at a time of your convenience.


Want more information ?


More information can be found on my website:


www.amerkarim.com