When more power is exerted onto the ankle like with a fall downstairs, one of the bones of the ankles like the tibial or fibular bone, or sometimes even both bones can fracture. With an undisplaced fracture of only one bone a general practitioner can handle that by putting on a cast for 3 to 4 weeks and then ordering physiotherapy for remobilization. However, in the case of more complicated fractures or fracture dislocations it is advisable to consult an orthopedic surgeon.
Sometimes the surgeon might just reduce the fracture under a general anesthetic (called “closed reduction”) and put the ankle into a below knee cast. In other cases an operative procedure might have to be done (an “open reduction”) where under a general anesthetic the ankle is opened up surgically and the fractured bones are reduced into their original position and fixed in this position with metal hardware. This is also called “open reduction and internal fixation”. There are several methods of fixing broken bones (thanks to health.allrefer.com for this link) plates with holes that are used to over-bridge a fracture line and screws are used to fasten the plates onto the bone. At other times a long screw can be used and with 2 or 3 well placed screws at different angles a fracture can be stabilized. Sometimes a smaller piece of bone might be held in place with a K-wire for a period of time until bony bridging is secured at which time the K-wire can be removed. With fractures that go through the joint surface it is particularly important that the fracture is set as carefully as possible to lead to a smooth joint surface, as the success of doing so is directly related to the success in postponing post traumatic osteoarthritis from setting in. During the recovery phase braces or a roboboot may be required and physiotherapy treatments for reactivation are also essential.
1.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 49.
2. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
3. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
4. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
5 . Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/ Several topics can be found under this link by entering the term you search for.
6. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008