As I spoke about is a previous blog, I was preparing to repair an ankle fracture that a local high school baseball player sustained while slipping on ice. I wrote about the etiology, or causes of ankle fractures and what could happen if it went untreated versus treating it conservatively and surgically.
Well, this patient and their parents elected to have the ankle repaired. In the orthopedic foot and ankle world, it is known as an open reduction and internal fixation of the ankle. After the patient elected to have it surgically repaired, they needed medical clearance and blood work. The blood work is important because it can give the physician pertinent information on the patient’s health such as infection, illness or bleeding disorders. This patient was a non-smoker and 280 lbs. The patient’s parents signed his consent after I went over the x-rays and reviewed his possible risks and complications. Oh yeah, there are risks and the patient and physician can potentially encounter complications. Some of the complications associated with this surgery can be infection, non-healing of the wound or bone, re-fracture, fixation failure (this is where the screws and plates fail), numbness, chronic swelling, increased pain, and complex regional pain syndrome, better know as RSD (reflex sympathetic dystrophy). Well, the patient was healthy!!!!
I met the patient at the hospital on a cold Wednesday morning and it was early. I love to do early surgeries because I am awake and full of Starbucks. The patient was anxious, but calm for a 17 year old. The mother and father were a little anxious, but I always try to have a conversation that is not related to the surgery and try to have a laugh before a case. To my many patients, I do have a good time and good laugh. Ha Ha!!!
The patient was brought into the operating room and was placed in the hands of our highly trained anesthesiologist and was put under general anesthesia. This type of anesthesia is the best choice, especially for relaxation of muscles and pain control.
We proceeded to place the patient in the proper position and this patient is tall and quite heavy, but proportionately built. Man, I was tired from just moving the patient! The patient tolerated the procedure and I reduced the ankle while they were under the general anesthesia. This is entails distracting the ankle fracture fragments and putting back into alignment. Once the fracture is put back into alignment, bone clamps are used to temporarily hold the fracture in place and we take intraoperative pictures to the position. His reduction looked GREAT! We used what we call a 5 hole, 1/3 neutralization plate and 5 screws. This will allow the fracture to stay in place without placing too much compression on the fracture. Prior to putting in the last screw, I examined the ankle joint and saw that there was some instability in the lower part of the ankle. The placement of the last screw was just above the ankle joint to provide stability and healing of the lower part of the ankle, and this is known as a transyndesmotic screw.
The patient was placed in a posterior splint and they were instructed not to walk on the ankle. The patient was seen after the procedure and he was doing very well…
Next month, we will see how the patient survived the first month!!! Please look for “Part 3” to this blog collection about ankle fractures.
If there are any ankle injuries, our physicians are highly trained to repair any ankle injuries or ailments. Please think of Affiliated Foot and Ankle Center, LLP for your foot and ankle conditions. We have locations in Howell, Edison and Monroe, NJ and have been providing top quality foot and ankle care for over 20 years….
It does take some coordination to use crutches and being an athlete I have mastered the use of crutches in 2 weeks. It is ironic that I am a Physical Therapist for 
This weekend was the New Jersey Marathon at Pier Village in Long Branch. I saw a lot of athletes all shapes and sizes were running to compete their best.
