External Fixation Of An Ankle Fracture

What you should know

  • External (eks-TER-nal) fixation (fik-SA-shun) of an ankle fracture is surgery to repair your broken ankle. An ankle fracture is a break in any of the bones of your ankle. The ankle joint is made up of the tibia, fibula, and talus bones. The tibia and fibula are the two bones in your lower leg. The talus is a square, flat bone on top of the calcaneus (heel bone). The ankle joint lets you move your foot in different directions. External fixation is done when fractured bones are not in their normal positions or are broken into several pieces. It is also done when bones stick out through skin, or when deep cuts reach down to the bones.

  • With external fixation, pins and devices sticking out of the ankle will hold together broken pieces of bone inside it. While being held together, the pieces of broken bone will grow together and get stronger. This may bring back your ankle's usual appearance and your leg's usual length. Physical activities may need to be avoided for some time until your bone heals completely. It may take months to get full function of your leg, ankle, and foot after this surgery. With external fixation, your ankle fracture may be treated and usual activities may be resumed.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.


There are always risks with surgery, such as bleeding and infection. Other parts of your ankle and foot, such as nerves, blood vessels, ligaments, muscles, and bones may be damaged. Your leg, ankle, or foot may become stiff, numb, and weak. Even after a successful surgery, you may still have ankle pain or problems moving your leg or foot. You may have trouble going back to your usual activities, including sports. If left untreated, the pain and problems you may have with your injury may get worse. Your ankle may be crooked and your legs may not be the same length. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

Getting Ready

  • Ask a family member or friend to drive you home after surgery. Do not drive yourself home.

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.

  • If you are a woman, tell your caregiver if you know or think you are pregnant.

  • You may need to have blood and urine tests, and different x-rays taken. You may also need a computed tomography (CT) scan, or magnetic resonance imaging (MRI) of the ankle and foot. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

  • Remove any nail polish.

  • You may be given medicine to help you sleep.

  • Ask caregivers about directions for eating and drinking.

The day of your surgery:

  • Write down the correct date, time, and location of your surgery.

  • What to bring: You may want to bring items such as a toothbrush and bathrobe.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.


What will happen:

  • You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a stretcher to the room where the surgery will be done. You will be asked to lie on your back. General or regional anesthesia may be given to control pain during the surgery. Your leg, ankle, and foot will be cleaned and covered with sheets to keep the surgery area clean.

  • Your caregiver will align the broken bones together by carefully pushing, pulling, and turning the leg, ankle, or foot. He will try to do this without making a cut on your skin. He may have to make small cuts on your skin for bones that are hard to reach. He may use a fluoroscope (x-ray) to help him insert pins and correctly align the bones. Holes may be made on the bones by using a drill to insert screws and long metal pins. These pins will be placed through the affected bones. They will stick out through your skin and other rods and devices will be attached to them. An x-ray may be done to see if the bones were set in the right way. Bandages will be wrapped around the areas where pins were inserted.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your appointment on time.

  • You have a fever.

  • You have a skin infection or an infected wound near the injured ankle.

  • You have questions or concerns about your surgery or condition.

Seek Care Immediately if

  • The problems for which you are having the external fixation get worse.

  • You have a lot more pain or have trouble moving your leg, ankle, or foot.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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