Bimalleolar Ankle Fractures

Isearch 2016
Madelyn Delmonte

What I Already Knew/What I Wanted to Know

"It's broken alright, see those two bones? Well, they are supposed to be connected." My
mind was racing trying to make sense of what had just happened. I was just playing volleyball
and landed funny. My ankle swelled to the size of a coconut, and within ten minutes, I was under
a machine, getting x-rays of my ankle. "You're definitely going to need surgery." Many questions
came racing into my mind. This is what sprung my interest in orthopedic surgery and more
specifically, ankle surgery
Before I started my research, I knew that there were three bones that made up the ankle,
the tibia (the largest bone on the inside of the leg and more commonly known as the shin bone,
and used as a weight bearing bone), the fibula (smaller leg bone on the outside of the leg, and
used for balance), and the talus (a small bone located between the tibia, fibula, and heel bone.)
Other than that little information, I did not know much about the ankle or ankle surgery.
I had many questions that came to the top of my head when I was asked, what do you
know. I wanted to know how long I would be restricted from walking, what the total recovery
process would be, what the risks of the surgery were, what the other options were besides
surgery, what would be going into my ankle, and what actually is a bimalleolar ankle fracture.
From these questions, I created my research question: what are the steps of fixing and recovering
from a bimalleolar ankle fracture.
The Story of My Research
I did my research over the course of the whole school year. I was attracted to the topic of
bimalleolar ankle fractures because of my own personal experience with a broken ankle. I started
my research by simply googling ankle fractures. I was surprised when I saw so many search

results. There are many different types of ankle fractures. I briefly reviewed all the types and
decided to specifically research bimalleolar ankle fractures. The first site that I selected was
Ortho Info website. This website provided me with the basics of ankle surgery: the anatomy of
the ankle, causes, symptoms, examinations, and treatment (including surgical and nonsurgical
treatment). This website was very easy to follow, it included many images to help understand
what exactly the ankle looked like: unbroken ankles, broken ankles, and surgically fixed ankles.
The website was easy to follow and easy to understand and read. From there, I built my
vocabulary from online encyclopedias so I could become more familiar with the anatomy of the
ankle and the terminology of surgeries. Lastly, I specified my online searches to more specific
aspects of the surgery. I learned more specifically about the pros and cons of this surgery,
alternate options of the surgery, the most common causes of these ankle fractures, caring
processes, examination processes, goals and risks of surgery, and the recovery process. Also my
older sister, graduate from UVA, let me use her Anatomy workbook to learn more about how
bones fix themselves. This book used a lot more advanced vocabulary than the internet does but
the information was very fascinating and helpful in learning more about my topic.
My interview process did not go as planned it to go. My original plan was to contact my
expert. in a respectable amount of time for him to respond and for us to complete a thorough
interview. My expert was Dr. Stewart, the orthopedic surgeon who fixed my ankle about a year
ago. I had my original draft of interview questions, email, and resume, but did not submit my
revised copy to be approved until two days after the due date. Because of this late submission, it
took longer for them to be approved. Once they were approved, my interview should have
already been completed and I had one week to write a reflection about the experience and what I
learned. I decided to try to still contact my expert. The only problem was, my expert's email was

not easily accessible. I finally was able to contact Dr. Stewart's secretary to access his contact
information but by this time, it was the night before my reflection was due. I learned that all the
steps in this process are connected and because I was late for one assignment, it delayed all my
other assignments and caused me to not be able to interview an expert about a topic that I really
wanted to learn more about. I have learned from this experience and know better to plan ahead
next time.
The Search Results
Before I started my research, I came up with a list of questions to formulate my research
question. What are the steps for fixing and recovering from an ankle surgery. There are many
steps for fixing and recovering from an ankle surgery. I wanted to learn the surgical process of
putting the ankle back together, how to care for the patient before and after surgery, the specific
steps of the recovery process, the complications and the goals of the surgery, and the ways to
identify a fractured ankle.
A bimalleolar ankle fracture is when the fibula and the tibia malleoli break. This break
almost always requires surgery to be fixed properly. According to the Ortho Information
website(n.d.), the surgery is known as an open reduction and internal fixation surgery. A metal
plate, with two or three screws to secure the plate, are used to realign the fibula bone so that the
fractured segments are able to grow back together correctly. On the tibia side, a single screw is
drilled at an angle from under the fracture to the top of the fracture to fix the crack. The tibia
does not need a plate because it is thick enough to be secured by only a single screw. The fibula
is too thin and require a plate.

There are many requirements before the surgery. This surgery requires the patient to go
under. According to the Mayo Clinic website (n.d.), an epidural is given to numb the leg. This
way, the patient will not feel any pain for about a day or two after surgery. This eliminates a great
amount of future pain for the patient. An IV is given to the patient to maintain their hydration and
to administer the anesthesia. Without any major complications, the surgery should take about two
hours. After the surgery, there is a lot of care taking required. This care includes icing and
elevation as much as possible to reduce pain and swelling. Driving is prohibited until the doctor
clears the patient. The cast is not allowed to get wet. Take the medication as the doctor instructs.
The recovery process is as follows. After the surgery is completed, the patients, incisions
are sewn together and the ankle is put in what is known as a soft cast. A soft cast is internally
made of the same materials as a hard cast, however, the outside is wrapped with an ace bandage
instead of the hard, colorful plaster or fiberglass. This type of cast is used so the doctor has easier
access to the incisions to check them every one to two weeks. The patient is non-weight-bearing
while in the soft cast. They must use crutches, a wheel chair, or a scooter. After about 2-3 weeks,
the patient is then put in a walking boot. This boot is removable making it easier for the patient
to shower, ice, and scratch if needed. It also comes with blow up air bags on the sides if the
patient wants more pressure applied to the ankle. The patient is still nonweight bearing in the
boot for about 1-2 weeks. After 1-2 weeks, the patient begins to slowly add weight over 4-6
weeks. After 4-6 weeks, the patient is transitioned into an ankle brace. Once the patient is in a
brace, physical therapy is almost always required in order to regain full motion and stability of
the ankle. Without physical therapy, the patient is at an extreme risk of reinjuring the ankle. The
hardware in the ankle does not necessarily need to be removed unless it causes complications.

Complications of this surgery include any risks that can occur in any surgery: anesthesia,
infection, damage to nerves, bleeding or blood clots. The complications after surgery include
stiffness, weakness, arthritis, problems with healing, the inability to wear certain footwear,
numbness, scar tissue, and lose of joint function. The goals of this surgery are restoring ankle
alignment and stability, reduce the chance of arthritis, reduce chronic pain, reduce disability, and
allow earlier weight bearing. Alternatives to this surgery are trying to reset to bone as best as the
doctor can, letting it heal for about 6-8 weeks and hope that it heals correctly. If it does not,
further surgery is required to fix the bone, extending the recovery time to longer than it would be
to just have the first, original surgery.
According to Bimalleolar Fracture, Ankle, Adult, Displaced (n.d.), there are four ways
that a doctor tests the ankle to diagnose the break. First, there is the x-ray which gives a clear
picture of the bones inside the ankle. Second there is the stress test which is when the doctor puts
pressure on different areas of the ankle to find the most painful areas and decide if further
surgery required. Third is a computed tomography (more commonly known as a CT scan) which
gives doctors a more extensive picture of the ankle. Lastly there is the Magnetic resonance
imaging scan which shows the ligaments and tendons, along with the bones to evaluate if
ligaments and tendons are broken.
In conclusion, after researching, I now know the specific steps of fixing an bimalleolar
fractured ankle, the preparation and caretaking before and after surgery, the specific recovery
processes, the complications and goals of the surgery, and the examination to diagnose the
fracture. The process is definitely a long one, and many complications could occur extending the
recovery time, but in the end, the whole process is worth it. I know that surgery is difficult, but it

has been a year since I broke my ankle, and I dont even notice that I have metal screws and
plates in my ankle.
Growth As A Researcher
I learned a lot while doing this research. I found how much fun it can be researching
something that truly fascinated and excites you. I learned that all the working parts of this
research are all connected which lead to a great final project. Even though I did not complete an
interview, I learned the importance of meeting deadlines. When you dont meet deadlines, it
effects the whole process and final project. This research has been a great experience for me and
a great way to get a small taste of what a senior research project is like. I learned that I do not
have to get all my information from the internet, I can use textbooks and workbooks that will
give just as much information that the internet can give you. Although the internet is more
convenient, the information may not all be valid while updated textbooks are usually almost
always accurate. Some future plans that I might have is studying other types of orthopedic
surgery, anesthesiology, physical therapy when recovering from sports related injuries, how to
fix tears of ligaments, and radiology.
Works Cited
Ankle Fractures (Broken Ankle)-OrthoInfo - AAOS. (n.d.). Retrieved June 06, 2016, from
http://orthoinfo.aaos.org/topic.cfm?topic=a00391
Bimalleolar Fracture, Ankle, Adult, Displaced (ORIF). (n.d.). Retrieved June 06, 2016, from
http://www.sw.org/HealthLibrary?page=Bimalleolar Fracture, Ankle, Adult, Displaced, ORIF
Broken ankle/broken foot. (n.d.). Retrieved June 06, 2016, from
http://www.mayoclinic.org/diseases-conditions/broken-ankle/basics/causes/con-

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