Ankle > Ankle Dislocation > Treatments

Open Surgical Repair

Treatment Introduction

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.

Day of 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.

Surgery Procedure [top]

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.

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.

Post-op in Hospital [top]

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.


Recovery-proof your home

   When to call the doctor after surgery

Rehabilitation [top]

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.

Open Surgical Repair
   Treatment Introduction
   Day of Surgery
   Surgery Procedure
   Recovery Room
   Post-op in Hospital
   Home Recovery

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