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.
Methods to fix broken bones surgically
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 the orthopedic surgeon has no other choice than to do an “open reduction”. In this case the patient receives a general anesthetic. Now the surgeon opens up the ankle and reduces the fractured bones into their original position. The surgeon then fixes the bones in this position with metal hardware. The name for this procedure is “open reduction and internal fixation”. There are several methods of fixing broken bones, plates with holes that are used to over-bridge a fracture line and screws are used to fasten the plates onto the bone.
Other surgical methods to fix bone fractures
At other times the surgeon may want to use long screws to overbridge bone fragments. With 2 or 3 well-placed screws at different angles a fracture stabilizes. Sometimes a K-wire can hold a smaller piece of bone in place for a period of time. When there is bony bridging the surgeon removes the K-wire. When fractures go through the joint surface, it is particularly important that the orthopedic surgeon sets the fracture as carefully as possible to lead to a smooth joint surface. 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