Ankle Fractures: Ankle Fracture Management Animation

Ankle Fractures: Ankle Fracture Management Animation

When treating an ankle fracture on the fibular bone, the small bone around the ankle, the goal is to align the bones and fix them in place so they can heal over the next weeks to months. To initially align the bone, the surgeon will use a combination of clamps, provisional screws, as well as manual reduction with their own hands to be sure the bone is aligned for more permanent fixation with a plate.

Once the bone is aligned, the plate is placed, and temporary short pins are inserted to hold the plate steady while the other holes are filled with screws. To place the proper screws in the shallow bone, the surgeon will typically use a depth guide and measure the depth of the bone from the plate to the opposite side. The screw is to exit the bone slightly but not go too far through and can cause impingement on other structures around the ankle.

There are a few types of depth guides in case the surgeon wants to check a few times. Some screw into the plate, and some are hooked onto the other side of the drill hole. The provisional pins are removed and more screws are placed. Some plates have variable angles in which the screws can be placed. This is so the surgeon has the ability to aim in the direction of the fracture to best secure different fragments.

The same steps are followed with a depth gauge, and then further screw placement is carried out. For the larger shinbone, surgeons will place a suture construct through the plate and across the 2 bones. Small metal buttons hold the suture tight across the joint and allow for alignment of the joint as the fracture heals.

Depending on the location and complexity of the fracture, a surgeon may not include screws into every screw hole on the plate, but there should be multiple screws placed both above and below the fracture line for good stability while the fracture heals.