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.

Three bones 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 2 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 alignment.

If you fracture your ankle, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces during surgery, so they are back in their proper alignment. In a closed reduction, a healthcare provider physically moves the bones back into place without surgically exposing the bone.

Internal fixation refers to the method of physically reconnecting the bones. This might involve 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 abnormally. The entire operation usually takes place while you are asleep under general anesthesia.

Why might I need an ankle fracture open reduction and internal fixation?

Certain medical 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 more conservative treatments, like pain medicines, casts, or braces.

You probably won’t need ORIF unless there is some reason your fracture might not heal normally with these conservative treatments. You are more likely to need ORIF if:

• The pieces of your leg are significantly out of alignment
• Your broken bones punctured your skin
• Your bones broke into several pieces
• Your ankle is unstable

In these cases, ORIF can place your bones back into their proper alignment, increasing the chance that your bone will heal properly. 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. However, some rare complications do occasionally happen. Possible complications include:

• Infection
• Bleeding
• Nerve damage
• Skin complications
• Blood clots
• Fat embolism
• Bone misalignment
• Irritation of the overlying tissue from the hardware

There is also a risk that the fracture won’t heal properly, and you’ll need to repeat the surgery.

Your own risk of complications may vary according to your age, the anatomy of your fracture, and your other medical 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 emergency or urgent procedure. Before your procedure, a healthcare professional will take your health history and do a physical exam. You’ll have an image of your tibia and fibula taken, with either an X-ray or a CT scan. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines like aspirin. Also, let your healthcare provider know the last time you ate.

In some cases, your healthcare providers 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 healthcare 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 avoid food and 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 professionals. The whole operation may take a few hours. In general, you can expect the following:

• You will 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.
• A healthcare provider will carefully watch your heart rate, blood pressure, and other vital signs during the operation.
• After cleaning the affected area, your surgeon will make an incision through the skin and muscle of your ankle.
• Your surgeon will bring the pieces of your ankle back into alignment (reduction).
• Next, your surgeon will secure the pieces of your broken bones to each other (fixation). To do this, he or she will use tools like screws, metal plates, wires, or pins.
• Your healthcare provider will make other repairs as necessary.
• After the healthcare provider 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 healthcare provider about what you can expect after your surgery. You may have some pain after your procedure, but you may be prescribed pain medicines by your healthcare provider. You should be able to resume your normal diet fairly quickly. You will likely get imaging, like an X-ray, to verify that the fracture has been repaired properly. Depending on the extent of your injury and your other medical conditions, you might be able to go home the same day.

Your healthcare provider 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 brace, perhaps for several weeks. You’ll receive instructions about how to move your leg and whether it is OK to put weight on it.

Follow all your healthcare provider’s instructions carefully. You might need to take medicine to prevent blood clots (a blood thinner) for a little while after your surgery. Your healthcare provider might not want you to take certain over-the-counter medicines for pain because some of these can interfere with bone healing. Your healthcare provider may advise you to eat a diet high in calcium and vitamin D as your bone heals.

You might have some drainage from your incision, which is normal. However, let your healthcare provider know right away if the draining is severe. Also, let your healthcare provider know if there is increased redness, swelling, severe 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

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