There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).
If there is an injury in your foot, your orthopaedic foot and ankle specialist will take X-rays to see if you have a fracture. X-rays will identify most fractures but some smaller and more subtle fractures may require CT or MRI scans to be seen. Not all fractures require surgery, and your orthopaedic specialist will help determine how your fracture should be treated.
The displaced fractured bone fragments are realigned as well as possible into their anatomic positions and secured with implants, most of which are metal. Implants used to secure the fracture may include pins, wires, screws and plates. Once the fracture has been stabilized the incision is stitched closed, a sterile dressing is added and the foot is placed into a cast, splint, boot or post-operative shoe.
In some instances, and for some fracture types, the alignment of the fractured bone can be restored with a closed manipulation of the foot under X-ray. If good fracture alignment can be achieved with this method, the fracture is then fixed with appropriate implants through one or more small incisions. This is referred to as percutaneous fracture fixation. The advantages of this technique include smaller incisions, reduced trauma to the tissues, reduced disruption of the blood supply to the bone, and less postoperative pain.
The specific techniques of foot fracture surgery vary widely based on the bone that is injured and the fracture pattern. Here are some examples of typical fracture surgeries:
Calcaneus (heel bone): Fractures of the heel bone can involve disruption of the joint between this bone and the ankle bone, also called the talus. Surgery is often needed to restore the anatomy and realign the joint surface. Significant swelling usually comes with this fracture, so it’s best to wait a week or more until the swelling has gone down. The surgical technique involves either a mini open incision or and extensile L-shaped incision over the heel . The fracture is realigned, concentrating on the joint surface, and fixed with a plate and/or individual pins or screws.
Talus (ankle bone): Fractures of the ankle bone typically divide it into two large fragments referred to as the head and the body. More severe injuries can include dislocations of nearby joints. The typical surgical technique usually involves one or two incisions over the area just below the ankle. If there are dislocations, these are fixed, and the head and body fragments of the ankle bone are restored to their proper alignment. Screws or a plate and screws are used to hold the pieces in place. Because of their peculiar anatomy and blood supply, the chances of having complications are high.
Navicular: The navicular is a bone on the inside of the midfoot. A common fracture causes the bone to break into two fragments. The surgical technique involves an incision over the fracture. The fracture is realigned to restore its anatomic position and secured with screws or a plate and screws.
Cuboid: The cuboid is a bone on the outside of the midfoot. Typically a cuboid fracture is due to a compression injury and results in shortening of the outside of the foot. The goal of surgery is to restore the anatomy of the cuboid, and as a result restore the length of the outside of the foot. This may be done with a plate and screws directly applied to the bone or with another method. The hardware can then be removed once the fracture has healed.
Metatarsals: There are five long bones in the foot which serve as bony struts between the toes and the midfoot. Some metatarsal fractures can be treated without surgery, but displaced fractures may benefit from surgery. Sometimes two or more metatarsals can be fractured as a result of a significant injury. The repair involves an incision over the fractured metatarsal. Additional incisions may be necessary for multiple fractures. The fractures are fixed with pins, screws or a plate, or combination.
Phalanges: The bones of the toes are called phalanges. Most phalangeal fractures can be treated without surgery, however displaced fractures that result in deformity of the toes may benefit from surgery. The technique involves placing the toe into anatomic alignment and then using a pin inserted through the tip of the toe to hold the fracture together. The pin can be removed in four to six weeks once the fracture has healed enough.
The upper part of the ankle joint comes from the tibia (shin) and the fibula (outer leg). The tibia forms the front, rear and inner part of the ankle joint. The lower fibula forms the outer part of the ankle joint. The ends of these bones are called malleoli. There are two malleoli on the tibia (medial and posterior) and one on the fibula (lateral).
Ankle fractures occur when the malleoli are broken. These fractures are very common. Ankle fractures can happen after falls, car accidents or twisting of the ankle. One, two or all three malleoli can be broken.
Symptoms of an ankle fracture are pain, swelling, bruising and problems with ankle motion. X-rays help show which need treatment from an orthopedic surgeon.
. Swelling around the fracture is an important guideline for a orthopaedic surgeon about the timing of surgery. If there is an excessive swelling around the ankle then it is better to wait till the wrinkles re appear once the swelling decreases. Antibiotics are given shortly before the start of the surgery. Once the patient receives antibiotics and anesthesia, the surgery can safely begin. Incisions are made through the skin of the ankle where the bones are broken. The breaks in the bone are then repositioned and held there with implants. After the ankle fracture is repaired, the patient’s leg is placed in a protective splint made of plaster.
Weight bearing is usually started in a progressive manner from 4-6 weeks onwards.
Most ankle fracture surgery involves open reduction and internal fixation (ORIF). An incision is made over the ankle to see the fractured bones. Like a jigsaw puzzle, the pieces of the broken bones are placed back together (open reduction). The broken bones are then held together (internal fixation) in this correct position with metal plates and/or screws. This internal fixation provides stability so movement can begin shortly after surgery as the ankle fracture heals.
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