Ankle injuries occur when the joint is damaged by fractures, dislocations or torn ligaments. While simple sprains or tears of the lateral and medial ligaments can generally be treated conservatively, an ankle fracture or displacement – also known as a talus fracture – usually requires surgical intervention. Such injuries are often caused by falls from great heights or accidents. Likewise, injuries to the syndesmosis, the stabilising ligament between the ankle joints, are often treated surgically.
Overview of the ankle joint
The ankle is a complex joint. It consists of the fibula (calf bone), the tibia (shin bone) and the talus bone. It is stabilised by lateral ligaments, a medial ligament and the syndesmotic ligament (connection between the inner and outer ankle). Injuries to the ankle may result in an ankle fracture, a joint dislocation (ankle luxation), or a syndesmosis or ligament tear.
Ankle breaks that do not involve compound fractures or have far apart fragments can usually be treated with conservative therapy. Lateral or medial ligament tears can also heal without surgery, as long as no bones are affected. Ankle dislocations where neither the joint nor the bones have been injured are also treated conservatively. Ankle fractures that affect the joint or involve a tear of the syndesmosis usually require surgical treatment.
Treatment goal
The main objective of an ankle fracture surgery is to restore the anatomical position and stability of the broken ankle to ensure normal joint function. This effectively prevents long-term complications such as restricted movement or joint wear and tear.
Surgical procedure for an ankle fracture
The intervention for an ankle fracture is often carried out under general anaesthesia or spinal anaesthesia (spinal block). Depending on the procedure, the intervention takes between one and two hours.
First, the fracture is exposed by targeted incisions. This is followed by repositioning, in which the ankle fragments are carefully returned to their original position under X-ray monitoring. As soon as the bone fragments are correctly aligned, they are stabilised in the correct ankle axis by means of a process called fixation, using screws and plates. An angled plate is often used, which fixes the ankle joint fracture at the right angle. If there are any accompanying injuries, such as damage to the syndesmosis or torn lateral and medial ligaments, these will be sutured as part of the intervention. Finally, the surgical wound is closed.
Preparation and precautions
Initially, the exact extent of the ankle fracture is determined by means of an X-ray examination. In more complex cases, computed tomography (CT) or magnetic resonance imagery(MRI) may also be required to obtain a detailed picture of the fracture and possible further injuries.
Before the intervention, the usual medical examinations are carried out, including blood tests, blood pressure measurements and an ECG. If the patient is taking blood-thinning medications, they must be discontinued in good time in consultation with the attending doctor to minimise the risk of bleeding during the intervention. In addition, it is important to fast before the intervention, i.e. not eat solid food for at least six hours before the intervention and not drink fluids for about two hours before the surgery.
Aftercare and recovery
After surgical treatment of an ankle fracture, physiotherapy for ankle mobilisation and movement are carried out early. A gradual increase in the strain on the ankle is essential; full strain can usually be achieved after about six to eight weeks. The healing process of the break is monitored in regular follow-up examinations to ensure that the recovery proceeds according to plan and that any complications are detected at an early stage. Sports activities, workplace activities and driving all require good stability and functionality of the ankle joint in order to avoid overexertion or complications.
Sports activities
Sports activities that place a lot of strain on the ankle, such as jogging or tennis, should not be resumed for at least three months, depending on the individual’s progress and the joint stability.
Workplace activities
Resuming work after an ankle fracture depends on the type of fracture and workplace requirements. For predominantly sedentary work, returning is generally possible after four to six weeks. People who carry out physically demanding work often need a longer recovery period.
Driving
It is only possible to drive safely again when the foot is free of pain and can fully bear weight. Good joint coordination is essential to ensure safe participation in road traffic. If the left ankle is broken and the individual uses a vehicle with automatic transmission, it may be possible to drive again earlier than if the right ankle is fractured.
Overall, the success rate for surgical treatments of ankle fractures is very good. Early onset, targeted physiotherapy promotes mobility and the long-term stability of the ankle, and thus plays a decisive role in the healing process and the operation’s outcome.
Potential complications
Surgery for ankle fractures usually proceeds without major complications. However, as with any surgical intervention, in rare cases side effects such as infections, nerve damage, bleeding or blood clots may occur. In rare cases, the following complications may also arise:
- Talus necrosis: circulatory disorders in the ankle that can cause tissue death, especially in the case of severe injuries or damage to the blood vessels during the intervention.
- Osteoarthritis: wear and tear that can occur over the long term if the joint surfaces are not sufficiently restored after the intervention.
- Pseudarthrosis: false joint formation, which occurs when there is excessive movement between fractured bone fragments and a bone fails to heal.
- Disruption to bone healing: can occur if the broken ankle is strained too soon after the intervention.
