Ankle fracture fixation is an operation to realign and stabilise broken bones in the ankle using metal plates and screws. It is one of the most common trauma operations and is needed when the fracture is displaced or the ankle joint is unstable.
Incisions are made over the broken bone(s) — the outer ankle bone (lateral malleolus), inner ankle bone (medial malleolus), or both. The fracture fragments are realigned and fixed with metal plates and screws. If the syndesmosis (the ligament between the two leg bones) is damaged, a screw or suture button is placed to hold the bones together. The operation typically takes one to two hours.
Surgery is recommended when the ankle fracture is displaced or unstable — meaning the bones are not in a satisfactory position for healing in a plaster cast alone. A displaced ankle fracture that heals in a poor position can lead to long-term pain and arthritis.
Stable, undisplaced fractures can be treated with a plaster cast or walking boot for six weeks. Close monitoring with repeat X-rays ensures the fracture remains in a satisfactory position.
Surgery may be performed urgently or after a few days to allow swelling to settle. Standard pre-assessment. Fasting before surgery.
The aim is to restore the normal anatomy of the ankle joint, allow the fracture to heal in the correct position, and enable earlier rehabilitation. Most patients achieve good functional outcomes.
Ankle swelling is expected for several months.
Some loss of ankle movement compared to the uninjured side is common.
The plate and screws may be felt under the thin skin of the ankle.
Many patients notice discomfort in the ankle during cold or damp weather.
The skin around the ankle is thin and swelling can compromise healing. Elevation is crucial.
Wound or deep infection around the metalwork.
The fracture may fail to heal or heal in a poor position.
Small sensory nerves may be damaged, causing numbness around the ankle.
DVT despite preventive measures.
Arthritis may develop in the ankle joint over time, depending on the severity of the original injury.
General or spinal anaesthesia, usually with a local anaesthetic ankle block for post-operative pain relief.
A plaster cast or boot is worn for six weeks. Weight-bearing depends on the fracture and fixation — your surgeon will advise. Physiotherapy begins after cast removal to restore movement and strength. Return to driving at eight to twelve weeks. Full recovery takes three to six months or longer. Metalwork removal is only performed if it causes problems.
Wound check at two weeks. X-ray and review at six weeks. Further appointments as needed.
Approximately 20–30% of patients choose to have ankle metalwork removed due to prominence. This is usually done after the fracture has fully healed.
There is an increased risk of ankle arthritis after a fracture, particularly if the joint surface was involved. Good surgical realignment reduces this risk.
Usually at eight to twelve weeks, once the cast is removed and you can safely control the pedals.