Open reduction ankle surgery involves open surgery on fractured ankles. Doctors will realign ankle bones and may install internal fixations to keep them in place as they heal.

Recovery from open reduction ankle surgery may take several weeks and involves slowly recovering strength and motion. Complications can result in reduced strength and further operations.

This article explains what to expect from open reduction ankle surgery, including who may benefit from it and the potential risks.

A screen showing medical imagery of a person's foot before surgery.-2Share on Pinterest
Cavan Images/Raffi Maghdessian/Getty Images

Open reduction ankle surgery is a kind of surgery that doctors may recommend for treating ankle fractures. An ankle fracture is when at least one ankle bone breaks.

There are three bones in each ankle, including:

  • the tibia (shinbone)
  • the fibula (calf bone)
  • the talus (ankle bone)

Most fractures involve the tibia or fibula.

The purpose of open reduction ankle surgery is to help these fractures heal in the correct position. This may be necessary if an ankle fracture causes the bones to move out of place.

Open reduction is the process of using open surgery to rearrange fractured bones. Doctors will begin by placing a person under anesthetic. They will then make incisions to reach the bones before moving the bones back into their proper location.

As the American Academy of Orthopaedic Surgeons (AAOS) explains, doctors sometimes combine open reduction ankle surgery with internal fixation. Healthcare professionals may call this open reduction and internal fixation (ORIF) surgery.

Internal fixation refers to the implants doctors use to hold the bones in the correct positions. These may include:

  • plates
  • screws
  • nails
  • wires

If a person is unsuitable for internal fixation or requires additional stability, a doctor may use external fixation devices, such as external wires and pins.

Doctors may also use casts or splints to reduce some of the simplest ankle fractures. In this case, a person may not require surgery.

Because open reduction takes place under anesthesia, doctors may recommend a period of fasting before surgery.

Anyone undergoing open reduction surgery should discuss this with a doctor. They also need to let them know what medications they are currently taking.

Before surgery, individuals should try not to put any weight on the affected ankle. They should also arrange for help getting to and from surgery and any necessary assistance at home.

Anyone who undergoes open reduction ankle surgery will require some recovery time. The Massachusetts General Hospital provides the following guidance about recovering postsurgery:

  • 0 to 3 weeks: The person needs to avoid putting weight on the affected ankle and may need to wear a boot or cast. They may also need to learn techniques to manage their movement during recovery. They may benefit from crutches or a rolling knee walker.
  • 3 to 6 weeks: Individuals may begin to apply more weight on the affected ankle but may still need to wear a boot or cast. They will use exercises to increase their ankle and foot’s range of motion and strengthen their muscles.
  • 6 to 12 weeks: A person needs to continue with exercises to increase their range of motion and may still need to wear a boot or cast. They may also need to begin exercises to improve balance. They should avoid anything that causes twisting or impact on the ankle.
  • 12+ weeks: If the bone has healed, the person may be able to take off their boot or cast. They may need to continue their ankle exercises and may also incorporate exercises to improve sport-specific movements.

It may take as long as 6 months before people fully recover and can return to their usual activities.

According to the AAOS, ORIF has several benefits over alternatives, including:

  • shorter hospital stays
  • shorter recovery period
  • a lower risk of bones healing improperly
  • a lower risk that bones heal in the wrong place

In spite of these advantages, ORIF comes with a number of risks.

Health experts explain that ankle fractures almost always cause a loss of strength and range of motion as well as a reduced capacity for muscle contractions. Complications of surgery may include:

  • long-term stiffness
  • swelling
  • instability
  • chronic pain
  • painful hardware
  • nerve injury

ORIF and postoperative physical therapy may help minimize these changes but may not completely reduce them. Like any surgery, ORIF may pose risks such as infection, pain, or an allergic reaction to anesthesia.

A 2020 study suggests that people who receive outpatient open ankle surgery have a lower risk of strength than those receiving the equivalent inpatient care.

Outpatient surgery is when someone can return home on the same day of the surgery. Inpatient surgery involves longer hospital stays. People receiving outpatient open ankle surgery had lower rates of the following:

However, people who may have a higher risk of surgery complications may be more likely to have inpatient surgery, which may explain these results.

Both settings can provide favorable results, but a person with a lower risk of complications from the outset may be more likely to have outpatient surgery.

Open reduction ankle surgery involves open surgery to rearrange broken ankle bones. Doctors may suggest it for people who have ankle fractures.

This surgery increases the likelihood that the bones will heal properly and in the right location.

Initial recovery from surgery takes many weeks, while complete recovery may take up to 6 months. There are also some risks to the surgery, including improper healing and the need for future surgeries.