Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You may need this procedure to treat your broken ankle.

There are three bones that make up the ankle joint. They are the tibia (shinbone), fibula (the smaller bone in your lower leg), and talus (a bone in your foot).

Different kinds of injuries can damage the lower tibia, lower fibula, or talus. Only one of these bones might break, or there might be a fracture in two or more of these bones. Sometimes a bone breaks but the pieces still line up correctly. Sometimes the injury moves the bone pieces out of alignment.

Depending on the type of fracture, you may need ORIF to bring your bones back into place and help them heal. The surgery is done by an orthopedic surgeon. This is a doctor who specializes in treating bone, muscle, joint, and tendon problems. During open reduction surgery, the surgeon makes a cut (incision) in the ankle and moves the bone pieces back into the correct position. In a closed reduction procedure, a doctor moves the bones back into place without making an incision.

Internal fixation is a method of reconnecting the bones. This might be done with special screws, plates, rods, wires, or nails. The surgeon puts these into the bones to hold them in the correct position. This prevents the bones from healing in an abnormal way. The surgery usually takes place while you're asleep under general anesthesia.

Some health conditions may make fracturing your ankle more likely. For example, osteoporosis increases the risk of fractures in many older adults. Motor vehicle accidents, tripping or falling, contact sports, and twisting your ankle are some of the more common causes of injuries that can lead to an ankle fracture. People who smoke or who are at a higher weight are more likely to fracture their ankle and have increased trouble with healing.

You might not need ORIF for your fractured ankle. Many people don't. If possible, your doctor will treat your fracture with other treatments, like pain medicine or a cast, boot, or brace.

You probably won't need ORIF unless there's a reason that your fracture might not heal the right way with these other treatments. You're more likely to need ORIF if:

• The pieces of bone are very out of alignment.
• Your broken bone pierced through the skin.
• Your bone broke into several pieces.
• Your ankle is unstable.

In these cases, ORIF can place the bones back into the right position. This increases the chances that your bone will heal the right way. You might need ORIF for a fracture that occurs anywhere along your ankle.

Most people do very well with ORIF for an ankle fracture. But some rare problems can happen. Possible problems include:

• Infection.
• Bleeding.
• Nerve damage.
• Skin problems.
• Blood clots.
• Fat clot (embolism).
• Bones that remain out of position or do not heal well.
• Pain or irritation in the skin and muscles that cover the screws and plates.
• Problems from anesthesia.

There's also a risk that the fracture won't heal in the right way, and you'll need another surgery.

The risk of problems may vary based on your age, how and where your ankle is broken, and any other health conditions you have. For example, people with low bone mass or diabetes may be at greater risk of some problems. People who smoke may also have an increased risk for problems. Ask your doctor about the risks that most apply to you.

ORIF is often done as an urgent procedure. Before your procedure, the doctor will ask about your health history and do a physical exam. You'll have an image taken of your tibia and fibula. This may be an X-ray or a CT scan. Tell your doctor about all the medicines you take, including over-the-counter medicines like aspirin. Also tell your doctor the last time you ate.

Sometimes ORIF is done a little later, after the swelling in the ankle has gone down. You might need to have your ankle held in place so it can't move while you wait for your surgery. Talk to your doctor about how to prepare for the surgery. Ask if there are any medicines you should stop taking ahead of time, like blood thinners. Follow any directions you are given about when to stop eating and drinking before your procedure.

Your doctor can explain the details of your surgery. The details will depend on where the injury is and how severe it is. An orthopedic surgeon and trained assistants will do the surgery. An anesthesiologist will make sure you don't feel pain during the surgery. The surgery may take a few hours. In general, here's what to expect:

• You may get general anesthesia, so you'll sleep through the surgery and won't feel anything. Or you may get local anesthesia and a medicine to help you relax.
• Your heart rate, blood pressure, and other vital signs will be carefully watched.
• After cleaning the affected area, the surgeon makes a cut (incision) through the skin and muscle of your ankle.
• The surgeon brings the pieces of the ankle back into position (reduction).
• Next, the surgeon fastens the pieces of your broken bone or bones together (fixation). They may use screws, metal plates, wires, or pins. (Ask what the surgeon will use for your surgery.)
• The surgeon may make other needed repairs.
• After the bones are secured, the layers of skin and muscle around your ankle are closed up with stitches or staples.

Talk to your doctor about what to expect after surgery. You will have some pain. But pain medicine can help reduce the pain. You should be able to go back to a normal diet quickly. You will likely need an imaging test, such as an X-ray, to make sure the surgery was successful. Depending on how severe your injury is and any other health conditions you have, you might be able to go home the same day.

The doctor might tell you to keep your ankle raised for a certain period of time after surgery. You'll also need to keep your ankle from being able to move for a while. Often, this means wearing a splint, perhaps for several weeks. You'll receive instructions about how to move your leg and whether it's okay to put weight on it.

Follow all your doctor's instructions carefully. You might need to take blood-thinner medicine to prevent blood clots for a little while after your surgery. Your doctor might not want you to take certain over-the-counter medicines for pain. That's because some of these can interfere with bone healing. Your doctor may advise you to eat a diet high in calcium and vitamin D as your bone heals.

After surgery, some fluid may drain from your incision. This is normal. Contact your doctor right away if the drainage is bad. Also let them know if there's increased redness, swelling, bad pain, or loss of feeling in your leg, or if you get a high fever or chills.

Be sure to go to all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.

At some point, you may need some physical therapy to restore strength and flexibility to your muscles. Doing the exercises as prescribed can improve your chances for a full recovery. Many ankle fractures take several months to heal completely. But you should be able to resume many activities before this time.

Before you agree to a test or procedure, make sure you know:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• What side effects or problems are possible.
• When and where you will have the test or procedure.
• Who will do the test or procedure and what that person's qualifications are.
• What may happen if you don't have the test or procedure.
• Whether there are any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you may need to pay for the test or procedure.