Open Reduction And Internal Fixation Of An Ankle Fracture

What you should know

• Open reduction (re-DUK-shun) and internal (in-TER-nal) fixation (fik-SA-shun) (ORIF) of an ankle fracture is surgery to repair a 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 helps you move your foot in different directions. ORIF is usually done when the fracture is large, and when nerves and blood vessels are damaged. It may be done when fractured bones are not in their normal positions or are broken into several pieces. A failed attempt to repair the ankle fracture without open surgery may also need an ORIF.
  
  
• During ORIF, your caregiver may use wires, screws, plates (strips of metal), and pins to align broken bones. These special tools are used to hold the pieces of bones together while they grow together and get stronger. Your caregiver may also place bone chips into spaces between or around the fracture. After surgery, you will need to have a cast or splint that covers your lower leg, ankle, and foot. Physical activities will need to be avoided for some time until the affected bone heals completely. It may take months to get your leg, ankle, and foot working again after this surgery. With an ORIF, 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.

Risks

• There are always risks with surgery, such as infection or bleeding too much. Other parts near your ankle, 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 have problems moving your leg or foot. You may have trouble going back to your usual activities, including sports.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If left untreated, the pain and problems you have with your ankle may get worse. Your ankle may be crooked, or your legs may not have the same length after healing. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your 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 may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using 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.

Treatment

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 surgery will be done. General or regional anesthesia may be given to control pain during the surgery. You will be asked to lie on your back. Your leg, ankle, and foot will be cleaned and covered with sheets to keep the surgery area clean.
  
  
• An incision (cut) will be made on the skin over the affected area to show the broken bone. Once seen, your caregiver will carefully align and put the broken bones back together. He may use wires, screws, small metal plates, or pins to hold the bones together. Damaged blood vessels, nerves, and ligaments will also be repaired. X-ray pictures may be taken to see if the bones were aligned properly. The incision will be closed with stitches (threads) and covered with bandages. Your caregiver may put on a cast or splint to keep your leg, foot, and ankle from moving for a period of time.

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 a wound near the injured area.
  
  
• You have questions or concerns about your surgery or condition.

Seek Care Immediately if

• The problems for which you are having the open reduction and internal fixation get worse.
  
  
• You have a lot more pain or have trouble moving your ankle, leg, or foot.

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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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