Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Ankle Fracture in India


Ankle Fracture is also called as broken ankle. It involves fracture or break of one or more bones of your ankle. It ranges from a small stable break in one of the bones to a severe disruption of ankle bones and ligaments.

Ankle fractures can broadly be classified into two main categories. Firstly it can be due to twisting injury of the ankle or secondly they could be because of the direct impact as in fall from height or crushing injury as in road traffic accidents. Ankle fractures due to twisting injury are known to have relatively less damage to the articular cartilage of the ankle joint and hence they usually recover well. Ankle fractures due to direct impact and crushing are associated with more severe injuries and have worse outcomes.

Ankle fractures are best treated with surgery if the broken fracture have gone out of normal alignment.
It is absolutely essential to line up the broken bones perfectly otherwise you are very likely to develop pain, limp and arthritis in your ankle. Results of treatment of ankle fracture depend upon how well the normal anatomy has been restored. Therefore, the goal of ankle fracture surgery is to re-position the bones back to as they were before the break to prevent the occurrence of arthritis. Some minor ankle fractures can be treated in a special boot or a plaster without surgery. The majority of ankle fractures, however, do require operation. Operation is performed with cut(s) on one or both sides of the ankle. Screws and/or a metal plate are inserted into the bones in order to accurately restore bony alignment. 

Following operation a plaster is applied to your ankle. You are advised mobilise with the help of crutches but without putting any weight through your ankle. The plaster remains until the stitches are removed (at two weeks). Depending upon the type of fixation exercise and other activities are started after this. Walking on the ankle is permitted after approximately six weeks. Physiotherapy, exercises, swimming etc are important parts of the recovery process. They strengthen the leg and develop movement of the ankle.
If the ankle is not repaired correctly or does not heal well, arthritis and deformity of the ankle can occur. Some of these patients will have no other option but to have the ankle surgery re-done. Revision surgery on ankle is done to improve pain, walking and to prevent development of arthritis in the ankle. Dr Bhargava has special interest in reconstructing and salvaging severe deformities of the ankle after unsuccessful fracture treatment. Ongoing pain and swelling in your ankle despite treatment is indicative of persisting problems. Some of the common problems seen in my practice are illustrated below.

Case 1

This 23 year old student sustained a twisting injury to his ankle when he slipped off a footpath. He sustained a bimalleolar fracture and had surgery performed by his local surgeon but he continued to complain of pain. He came to see me 3 months after his operation. X-ray taken (on the left) showed that the fracture was not reduced accurately at the time of his operation. He underwent repeat surgery(x-ray on the right) and this time after proper reduction his pain completely improved and he returned back to all day to day activities.

       
  Fibular Malreduction after Ankle Fracture   Revision fixation of Ankle

Revision Ankle surgery for fibular malreduction

Case 2

This 28 year old man sustained a fibula fracture of his ankle after falling off his motorcycle. This fracture of the fibula was fixed by a local surgeon but he continued to have ankle swelling, pain and limp. He came to see me 4 months after his injury. X-ray taken (on the left) showed that the bone on the outside of the ankle called fibula was left shortened and rotated at the time of surgery. This lead to talar shift and malreduction of his ankle fracture. If left like this it will eventually lead to ankle arthritis and permanent damage. He underwent Fibular lengthening and fixation using tricortical graft.

 
Ankle fracture Malreduction
 
 

Revision Ankle surgery for fibular shortening

 

Case 3

This 22 year old young girl sustained fracture in ankle and distal tibia while playing Basketball. After plaster treatment fracture healed but she continued to have pain in ankle and bending in of her leg and a limp during walking. X-ray varus malunion of distal tibia and fibula. This was corrected by supramalleolar osteotomy and tricortical bone graft. This completely improved the pain in her ankle and made her leg straight. Straightening of her leg improved her walking and limp.

         
   Ankle fracture revision fixation   corrective osteotomy for varus malunion  
Revision ankle surgery for Varus Malunion of Tibia

Case 4 - What is arthritis? How do you get Arthritis?

This 35 year old was involved in a scooter accident. He sustained trimalleolar fracture to his ankle. Subsequently he developed arthritis his ankle. He was in severe pain and was unable to sleep, walk and do his office work. This was treated by Arthroscopic ankle fusion surgery. His pain completely improved and he resumed normal walking.  Previous Ankle Fracture with Arthritis requiring Fusion.

ankle arthritis following ankle malunion
 
ankle fusion for ankle fracture malunion and arthritis1   ankle fusion for ankle fracture malunion and arthritis2
Revision ankle surgery for Varus Malunion of Tibia