The most common method is putting a screw across the fracture site for compression. Once positioned, there are a variety of ways to fix (stabilize) the bones. clotted blood is removed) and the bones are put back together, hopefully in the exact position (anatomic alignment) that they were in prior to the fracture. The soft-tissues (tendons, muscles, ligaments) are dissected down to the fracture site. To fix a fracture on the outside of the ankle, (lateral malleolus fracture) an incision is made on the outside of the ankle, essentially along the line of the fibula (the prominent bone on the outside of the ankle). Figure 1: Displaced fibular fracture with displaced ankle joint Procedures Lateral Malleolus Fracture (Distal Fibula Fracture) If the syndesmosis is disrupted, then the ankle joint will be unstable and surgery is usually indicated. One injury that may occur in conjunction with an ankle fracture is a disruption of the syndesmosis. A syndesmotic injury is a disruption of the strong fibrous ligaments that hold the fibula and tibia together, near the ankle joint. If the fracture causes the lower bone of the ankle joint (talus) to be displaced by 1 millimeter or more the joint surface of the ankle will be “mismatched” and ankle arthritis will tend to develop over time. If an ankle fracture has lead to a displaced or unstable ankle joint, (Figure 1) then surgery is indicated for most patients (some high-risk patients may not be surgical candidates). The ankle is not a joint that tolerates any displacement as this will lead to uneven loading of the ankle joint, and the subsequent development of ankle arthritis (loss of joint cartilage) in a short period of time.
The procedure is often described as an ankle fracture open reduction internal fixation (ORIF).
Ankle fracture surgery is indicated for patients who suffer a displaced unstable ankle fracture involving either the bone on the inside of the ankle (the medial malleolus), the bone on the outside of the ankle (the lateral malleolus which is also known as the fibula), or both.
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