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Musculoskeletal Services

Fractured Ankle (Internal Fixation)

IntroductionShow [+]Hide [-]

This information has been designed to give you and your family a basic understanding of what internal fixation of a fractured ankle is and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions, which the doctors, nurses, physiotherapists and occupational therapists will only be too happy to answer.

Why is the operation necessary?

Your ankle joint is like a hinge, it allows you to bend, straighten and rotate your foot. In a healthy ankle joint this movement is smooth and pain free. When a joint becomes damaged due to injury the ankle becomes swollen and painful with restricted movements.

Ankle fractures are very common. Not all fractures are easily treated with the application of a plaster cast. Therefore in many cases internal fixation is required. The most common forms of internal fixation used are screws and plates, however your consultant will discuss with you the most appropriate form of fixation for your type of fracture.

Before the operationShow [+]Hide [-]

You will be admitted to the ward from the Accident and Emergency Department or the Fracture Clinic. The nursing staff will meet you to explain the ward layout and introduce you to your named nurse. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The ward doctor will see you and arrange for your pre-operation tests. These are usually an examination, an x-ray and blood tests. A backslab plaster will be applied in Accident & Emergency to improve your comfort and stabilise the injury.

Your leg will be elevated on a frame or pillows and ice packs applied, this is very important in the first stages of your injury to reduce the swelling which can delay your operation.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have. The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent to undertake the operation. The anaesthetist will discuss the type of anaesthetic best suited to you but usually the procedure is performed under general anaesthetic. A spinal anaesthetic is sometimes used, this means you are numbed from the waist down for the duration of the procedure, a sedative is usually also given to make you feel sleepy. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

The physiotherapist will also come and see you before the operation to teach you the exercises you need to do after the operation, to help you to recover. If you are admitted as an emergency this may not always be possible and they will see you following your operation.

The most important preparation is for you to understand what your operation involves and for you to feel comfortable with your decision. Remember that staff are here to help you and answer any questions you may have.

Day of operationShow [+]Hide [-]

You will not be able to eat or drink for a period of time before your operation. The nursing staff will advise you on admission when you should stop eating and drinking in preparation for your surgery. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and look after you until it is time for your anaesthetic. Once in the anaesthetic room, you will be given an injection in your hand to put you to sleep, if you are having a general anaesthetic. If the anaesthetist has advised you that you are having a spinal anaesthetic then this will be discussed with you fully at the time.

After the Operation and Follow UpShow [+]Hide [-]

The first 48 hours

After a short stay in the theatre recovery area you will return to the ward. When you come back from the operation your ankle will usually be rested in a plaster splint to keep the ankle immobilised and it will still require elevation for a further 48 hours. In some circumstances the plaster splint may be removed earlier to allow early mobilisation.

You may have a ‘drip’ in your arm to ensure that you get plenty of fluids because you are unable to take any by mouth for a short time after the operation. Once you are able to eat and drink normally this ‘drip’ will be removed. This is usually on the first day after your operation.

Once the swelling has subsided you will be put into a below knee plaster. You will have stitches or clips in the wound and these are usually removed at your first outpatient appointment.

Many patients worry about how painful ankle fixation will be and all staff understand this. It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses if you are in pain.

Getting up and about

You will remain in bed with your leg elevated for 48 hours after surgery following this, the splint will be removed. Your surgeon will then decide when you can begin to mobilise.

You will be taught appropriate exercises by the physiotherapist.

The physiotherapists and nurses will help you out of bed and supervise your mobility, walking aids will be required. You will be supervised until you are safe.
Once the swelling has reduced a plaster is applied to protect you from putting any weight on the ankle. You will usually be non-weight bearing for 3 – 6 weeks depending on your x-rays. Once your x-rays are satisfactory a walking heel will be applied to your plaster cast.

What problems can occur?

No operation is without the risk of complications. Your surgeon and therapist will explain any particular risks/complications of you operation before surgery.
Swelling is common after surgery and might be treated by elevation.

Is the operation always successful?

The surgeon’s expectations of your operation will be discussed before surgery (usually when initially seen in outpatients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.

Your discharge

Your length of stay in hospital will vary depending on the swelling at the operation site and on your individual circumstances. Once you are moving around safely on your own, you will be discharged home as soon as suitable arrangements can be made.

Planning for going home begins as soon as you arrive in hospital. If you have any fears or concerns regarding your discharge please discuss these with your named nurse.

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.

If your named nurse feels you and your carer will require extra support she will discuss this with you and with your permission will arrange for you to talk with the hospital social worker and Occupational Therapist.

If you live in the Newcastle area then you will be assessed by the Orthopaedic Discharge Team (ODT) who will assess your suitability for the scheme, which provides a two week supported discharge with nurse, physiotherapy and Occupational Therapy involvement.

Transport home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

The day of discharge

On the day of your discharge your named nurse will give you some things to take home, these will include:

  • A letter for your GP (in some instances this will be posted) This should be handed in to your GP by either a relative or friend on the next working day following your discharge.
  • Medication Any medication you have bought into hospital will be returned to you. You will also be given a 7-day supply of any new medications. The nurse will advise you on how and when to take these.
  • Outpatient Clinic Appointment You will be given an appointment to be reviewed in clinic. If transport is required this can be arranged by contacting your GP providing a weeks notice where possible. If for any reason you are unable to attend your appointment please contact the outpatient department to rearrange the appointment.
  • Care Plan If you have a care package arranged you will receive a copy of the care plan from the Social Worker before your discharge home. This is for your own information.
  • Discharge Record This provides details about your stay and is for your own information.
  • Plaster Instruction (if required) The nursing staff will provide you with instructions on how to care for your plaster once you are at home.
  • Mobility aids It is important that you have your walking aids and any other equipment that you require.
  • Patient information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
  • Valuables Please ensure you have all your valuables with you.

General advice after discharge

You should anticipate at least a 12-week period of convalescence at home before you are able to resume your normal activities
Exercises Your physio will explain the exercise you should do following your discharge and, if appropriate, the ward physiotherapist will arrange an outpatient physiotherapy appointment. When sitting keep your leg elevated on a chair or stool. If possible your foot should be slightly higher than your hip as this will help reduce any swelling.

Work How soon you are able to return to work will depend on the type of job you do. You should discuss this with your consultant when you see him in the outpatient department.

Wound Care Keep your wound and plaster dry. Your stitches or clips will be removed when you attend the Outpatient clinic. You should not bathe whilst you have a plaster in situ, however you may shower if your plaster is covered with a waterproof bag.

Pain Take your painkillers as prescribed. Do not take more than the stated dose. Contact your doctor if you have any pain or swelling in your calf, if you have any chest pain or if you experience increasing ankle pain.

Cars and Driving It is inadvisable to drive while wearing a cast, splint or restrictive bandage. Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision. He will advise when he feels driving will cause you no harm.

Return of equipment

Please return all walking aids to the Physiotherapy Department at the hospital in which you stayed, when they are no longer required. All other equipment should be returned to the loan equipment store it came from, ring them and they will collect it (the numbers are outlined at the back).

Follow up

You will be followed up as an outpatient at regular intervals after your discharge from hospital. Please use this opportunity to ask questions and discuss any concerns you may have. You are also welcome to call the ward for advice, following your discharge from hospital.

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