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| Fractures of the Ankle | |
Fractures of the ankle range from
relatively minor twisting injuries to those that are associated
with violent disruption of the ankle. There are two different mechanisms
of injury which have different effects on the structure of the ankle.
The first one is where there is a twisting mechanism and the body
rotates around the foot. The other is where there is a crushing
type mechanism that impacts the foot. The ankle consists of the inner aspect of the tibia (the medial malleolus), the outer aspect of the ankle (the fibula), and the bone underneath the ankle (the talus). There are many different varieties and grades of severity of ankle fractures. These may involve only the medial malleolus, only the fibula, or both bones (which is called a bi-malleolar fracture). At times the talus may completely pop out of the ankle joint associated with the fracture. We call this a fracture dislocation. If the shape and anatomy of the ankle are not accurately restored, the cartilage lining of the ankle will be disturbed. This will inevitably lead to arthritis. Therefore, the goal of treating all ankle fractures is to re-position the bones to prevent the occurrence of arthritis. Some minor ankle fractures can be treated in a boot or a cast without surgery. The majority of ankle fractures, however, do require operative treatment. Surgery is performed with incision(s) on one or both sides of the ankle. Screws and/or a metal plate are inserted into the medial malleolus and the fibula in order to accurately restore or reduce the fracture alignment |
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| Following
surgery, a bandage with plaster is applied to the ankle. The bandage
remains until the stitches are removed (usually about two weeks).
At that time exercise activities are initiated. No walking on the
ankle is permitted for approximately six weeks. At that time protective
walking (with a removable boot or brace) may be allowed. Physical
therapy exercises, swimming and biking are important parts of the
recovery process. They strengthen the leg and develop movement of
the ankle. |
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If the ankle is not repaired correctly
or does not heal well, arthritis and deformity of the ankle can
occur. Some of these patients will have no other option but to have
the ankle surgery re-done. Dr Myerson has developed techniques for
salvaging very severe deformities of the ankle after unsuccessful
fracture treatment. The image on the left is that of a fractured ankle which had been treated with attempted screw and plate fixation. This did not heal correctly, and the ankle became deformed and if left untreated, will develop severe arthritis. This was corrected with a complete reconstruction of the ankle restoring the alignment. |
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