1. Most Ankle Fractures Are Treated With Plates and Screws
When the fracture involves the lateral malleolus, this is usually fixed with a longitudinal incision along the bone. A plate is placed on the side or back of the fibular bone and secured with screws. Sometimes larger medial malleolus fractures require a plate and screws also. You will be placed into a splint and given crutches after surgery.
2. Screws Alone Can Fix Some Fractures
Medial malleolus fractures can usually be fixed with only one or two screws. The threads in the screws hold the two pieces of bone in place while they are healing. Occasionally, a bigger fragment may need a plate to prevent it from displacing or gliding up. Hence, it is called an anti-glide plate.
3. Dislocations May Require Screws Across the Bones
When the ankle is fractured AND dislocated, the syndesmosis may be disrupted. The syndesmosis is a group of ligaments that connect the two bones of the leg (tibia and fibula) together. When it is torn, the ankle may become unstable and the bones will be splayed apart. A screw or two across the two bones will hold them in place until the ligament is healed. This can take up to 12 weeks. During this time, putting weight on the foot can push the bones apart, so you need to be on crutches for the duration. The screws may or may not need to be removed before you can put weight on the foot. There are newer devices that place a heavy suture across the two bones, instead of using screws, eliminating the need for screw removal prior to weight bearing.
4. Expect a Cast or Boot for at Least 6 Weeks
You will leave the hospital with a short splint on your leg. Afterward, either a short cast (below the knee) or a removable boot will be placed on the ankle to give additional support while the fracture is healing. You may or may not be allowed to move the ankle while it is healing. The benefit of early motion is that it decreases stiffness. The drawback is that the fracture may not heal in the presence of the extra motion. A lot of times, it depends on the quality of the fixation of the plates and screws.
5. Plan to Spend at Least 6 Weeks on Crutches
Bones heal when they are kept still. Putting too much weight on a fracture may cause it to heal slower or even not at all. The purpose of crutches is to take the pressure off the fracture site while it is healing. Otherwise, the plate may bend or the screws may break if you put weight on it too early. Or, if it is a syndesmotic injury, the bones may splay apart before the ligaments have time to heal.
