When your ankle dislocates, you commonly suffer
severe fractures in your ankle. As a result, surgery
is required to treat the majority of ankle dislocations,
because your ankle will not be stable enough to
heal in a cast without surgery. The fractured bone
fragments must be put back together in surgery.
Plates and screws are normally embedded into your
ankle to fix the bone pieces together. Surgery needs
to be performed soon after your ankle has been put
back in place because surgeons cannot operate on
an overly swollen ankle. If your ankle swells up
too much, you may have to be checked in to the hospital
and wait four or five days until the swelling decreases.
You should always seek treatment for an ankle dislocation
as quickly as possible after the injury. If you
have an open wound, it usually is considered an
emergency and you would be taken immediately to
surgery.
On the day of your surgery to repair a dislocated
ankle, you typically are taken from your hospital
room to a holding area where the final preparations
are made. The mandatory paperwork is completed,
and your ankle area may be shaved, though this is
not always necessary. If you have not already done
so, you will be asked to remove your watch, glasses,
dentures, and jewelry. You will have the opportunity
to speak with your orthopedic surgeon or an assistant
and meet the anesthesiologist or nurse anesthetist
(a nurse who has done graduate training to provide
anesthesia under the supervision of an anesthesiologist).
An IV (intravenous) line may be placed in your arm
at this time. Then, you will ride on a stretcher
to the operating room. Most patients are not sedated
until they go into the operating room. Here are
some important steps to remember for the day of
your surgery:
Arrange
for someone to drive you home when you are released.
Have
someone bring you a loose pair of shorts, sweatpants,
or other clothing that will fit comfortably over
your short leg cast or splint when you leave the
hospital.
Take
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery.
Distractions such as reading, watching television,
chatting with visitors, or talking on the telephone
can also help.
Open surgical repair of your dislocated ankle
can take between two and three hours to perform,
depending on how many ankle fractures your surgeon
needs to fix in place with screws, pins, or plates.
Spinal anesthesia typically is given to numb you
from the waist down and you usually are sedated
so you sleep through the procedure:
Your
surgeon may have to make multiple incisions. Exposing
your small lower leg bone (fibula), usually requires
a straight lateral incision about 10 to 12 centimeters
long made on the back and outside of your ankle.
A
smaller incision, about five to six centimeters,
usually is made on the inside part of your ankle
to allow access to the bottom of your shinbone
(tibia).
The
bone most commonly fractured during an ankle dislocation
is your fibula. Your surgeon typically fixes your
broken fibula with a plate and screws.
The
bony knob (medial malleolus) on the inside of
your ankle often is fractured as well. Screws
or wires are used to anchor the fractured portion
to the rest of your shinbone.
If
the fractured bones broke the skin, the wound
will be washed out and some of the damaged tissue
may need to be cut away before your incisions
are closed with stitches. A splint is applied
to immobilize your ankle, and you are taken to
the recovery room.
After surgery to stabilize your dislocated ankle,
you will be transported to the recovery room where
you will be closely observed for one to two hours
while the immediate effects of anesthesia wear off.
Your ankle will be immobilized in a splint when
you wake up, and your ankle will be elevated. The
post-surgery ankle splints usually are made of a
“U-shaped” plaster splint on the inside
and outside of your ankle that wraps around your
heel. It immobilizes your ankle, but it can be removed
more easily than a short leg cast. You will not
be able to see the two incisions wrapped in the
splint and there usually is minimal bleeding after
surgery. Open surgical repair of your anklebones
causes a substantial amount of pain. Adequate pain
medications will be prescribed for you. You ordinarily
are hooked up to an intravenous (IV) patient-controlled
analgesia (PCA) device, which delivers pain medications
in safe amounts when you push a button. Some patients
may be prescribed oral or intramuscular pain medications.
You usually can have visitors about a half-hour
after surgery if your physician feels you are in
a stable condition. Your temperature, blood pressure,
and heartbeat will be monitored by a nurse who,
with the help of the doctor, will determine when
you are ready to leave the recovery room and be
transported to the hospital ward for further post-operative
care. In some cases, you may be transported to a
ward for intensive care or heart monitoring if you
have special post-operative medical needs. Most
patients spend one to two days in the hospital before
going home.
After surgical repair of a dislocated ankle, most
healthy patients remain in the hospital from one
to two days. However, some patients may require
a longer stay in the hospital due to pre-existing
medical problems or medical issues that may arise
after surgery. There are small risks of infection
after major ankle surgery. There is not much you
can do to prevent infection because you cannot
remove your splint. But your physician checks
your incision before you leave the hospital and
then again after about ten to 14 days and can
treat any rare incision problems. Each patient
is different and may have different criteria for
being able to go home. In general, the length
of your hospital stay is based on the amount of
pain management you need. You will receive fluids
and medications, through an intravenous (IV) line.
You will continue to receive fluids through the
IV line until you can drink an adequate amount
of fluids without nausea or vomiting. Most patients
can drink something the night after surgery and
eat something more substantial the following morning.
Be sure to ask for pain medications as soon as
you feel pain coming on, because medications are
most effective on pain that is building rather
than on pain that is already present. Your nurses
will not give you more than your doctor has prescribed
and what is considered to be safe. Physicians
prescribe crutches to help you move around without
putting weight on your ankle. The day after surgery,
you typically meet a physical therapist who teaches
you about using crutches and helps you walk around
the hospital using them. You will likely be unable
to bear weight on your ankle for about eight weeks
after surgery. Your physician may obtain X-rays
of your ankle before you leave the hospital. You
should arrange for someone to drive you home when
you are discharged.
Home
Recovery
For four to five days after surgery to repair
a dislocated ankle, you should keep off your feet,
elevate your ankle above heart level, and move
around the house as little as possible. You should
try to rest and avoid too much movement for at
least a week. Crutches usually are prescribed
for about eight weeks so you can keep your body
weight off your ankle. Rest as much as possible
with your ankle elevated. This helps blood drain
away from your ankle and controls swelling. The
more weight you put on your ankle, the greater
your chances of disrupting the healing process
in your anklebones. Household tasks that require
you to be on your feet may be difficult for eight
weeks. It can be helpful to have someone around
the house to help with any physical chores. You
will be instructed to return to your physician’s
office for regular check-ups after surgery. The
dressing inside your post-surgery ankle splint
usually does not need to be changed until the
splint is removed about two weeks after surgery.
A typical follow-up schedule after you leave the
hospital may go as follows:
Ten
to 14 days after surgery - Stitches are removed
and your ankle is put into a short leg cast.
Four
weeks after surgery - Return for a check-up. Possibly
receive X-rays and if necessary, a new cast. You
may return for a check-up after another two weeks.
Eight
weeks after surgery - The cast usually is removed
and you receive a removable brace called a cam
walker or an air cast that can be worn inside
your shoes. When the cast comes off, you can usually
start bearing weight on your ankle, but you may
continue using crutches or a cane if your ankle
hurts or feels weak. Your physician or physical
therapist teaches you basic stretching and range
of motion exercises you can perform at home.
The screws and plates usually remain in your ankle
permanently. However, some people do not have
enough tissue around their anklebones to pad the
screws or pins At least a year usually needs to
go by before you can have any screws or pins surgically
removed. Depending on how well you are able to
strengthen your own ankle, your physician may
prescribe physical therapy to help you regain
mobility.
After eight weeks in a cast, you typically perform
daily range of motion exercises while wearing a
cam walker or air cast. Ankle stretching should
usually be done for about four weeks prior to using
weights to strengthen your ankle. Depending on the
extent of damage in your ankle, you may lose some
of the range of motion that you had before the dislocation.
Your ankle may feel stiff at first, but the pain
should go away as you rebuild your strength. Once
your bones have healed and your strength is equal
in both ankles, you may be able to return to any
sports and activities that you participated in before
the dislocation. This can take from four to six
months after surgery. Everyone heals at a different
rate, and you should begin exercises slowly until
your pain has decreased. Your repaired bones should
be stable before you put stress on your ankle with
walking, running, and other exercise.
To prevent reinjury of your ankle, physicians generally
recommend strengthening the leg muscles that help
support your body weight, including the peroneal
muscles on the side of your leg and your anterior
tibial tendons in the front. Proprioceptive exercises
that train you to balance are helpful after a dislocation.
A common proprioceptive exercise involves balancing
on a BAPS board, which is a flat board that lets
you stand on top of a ball and practice rolling
your ankles in different directions. As long as
your anklebones heal properly, you should have no
restrictions on your activities and sports. Your
anklebones will likely heal around the plates and
screws in the proper position and you should not
be at any increased risk of reinjury. Boots and
high-top sneakers that come up over your ankle may
cause some discomfort. Wearing low-top shoes that
do not contact the screws or pins in your ankle
may help you avoid some pain. If your ankle starts
to hurt during exercise, you should return to your
physician’s office for a check-up. After an
ankle dislocation, there is an increased chance
that some of your ankle’s cartilage may be
damaged, which may place you at a higher risk of
developing arthritis in your ankle. If your physician
suspects you suffered significant cartilage damage,
you may be asked to avoid overusing your ankle in
sports such as distance running that put a lot of
strain on your ankle.
Arrange
for someone to drive you home when you are released.
