Ankle fractures are a very common injury, usually the result of a sports snag that involves twisting or falling — often on a soccer or football field, or increasingly a pickleball court, or in the winter slipping on ice.
Broken ankles happen in equal numbers to men and women, young and old, with younger people more likely to sustain an athletic-related injury and older adults more often a non-contact slip or fall.
The classic treatment to repair a fractured ankle involves a fairly large incision and repair with plates and screws. Endeavor Health orthopaedic trauma specialist Alexander Crespo, MD, is among leading surgical experts using the latest, minimally invasive technology to repair ankle fractures, significantly improving outcomes for his patients.
Ankle fractures can involve breaking one or both of the fibula, the long bone on the outside of the leg or the medial malleolus, the bone on the inside of the ankle. Broken fibulas are the most common ankle fractures, which may also involve damage to ligaments. The area of the ankle around the fibula also contains muscles and tendons, which are often aggravated by the plates and screws implanted in traditional repairs.
“Unfortunately, these procedures have led to high rates of tendonitis, persistent pain and a significant number of second surgeries to remove the plates and screws six months to a year after the original surgery when the bone has healed,” said Dr. Crespo.
The blood supply to the ankle can also be tenuous, leading to potential problems for wound healing of larger incisions. The situation is more challenging for patients who smoke, have diabetes or other conditions that compromise vascular supply, explained Dr. Crespo. The large incision also leads to persistent swelling and many patients have significant swelling for three months following surgery.
Latest technology improves outcomes
All of these factors point to a need for a new and improved way to repair ankle fractures. Emulating the latest technology used to repair broken femurs (that were once fixed with plates and screws), a fibula intramedullary nail (i.e., metal rod inserted into the hollow center of the fibula) was developed for surgical repair of ankles.
“This technology allows for much smaller incisions, stronger implants and has led to much quicker healing and significantly lower wound complication rates,” said Dr. Crespo. The rates of second surgeries to remove hardware are only 1-3% compared with the 10-15% after traditional repairs with plates and screws, he added.
Postoperative swelling is also markedly better as there is less soft tissue disruption using the fibular nail for repair.
“It’s just much less surgery than the old way. Younger patients get back to work sooner and older patients have less wound complications,” said Dr. Crespo. Patients start rehabilitation sooner, which is important for athletes anxious to get back to their sports and activities.
While many surgeons are still using the traditional method of plates and screws, Dr. Crespo now uses the latest technology for 95% of his ankle repair procedures. “This is the coming wave, and it offers major benefits for patients,” he said.
Related Articles
