A Guide to ORIF Surgery for Ankle Fractures

Ankle fractures can happen when you least expect them, whether it’s a sudden twist while stepping off a curb, a misstep during a run, or an awkward landing from a jump. While some sprains or small fractures may heal with rest, more serious cases can leave the ankle unstable or out of alignment, affecting movement and daily comfort.

In such instances, open reduction and internal fixation (ORIF) surgery may be necessary to restore stability and proper joint function. If you’re wondering what this procedure involves, this guide breaks down each stage so you know what to expect from diagnosis to rehabilitation.

Understanding Ankle Fractures

The ankle joint is formed by three bones: the tibia, fibula and talus. These structures allow the joint to move smoothly and bear weight. A fracture can occur when the ankle is twisted, rolled, or impacted during a fall, sports activity, or road accident.

Common signs of an ankle fracture include:

• Pain and swelling around the joint
• Bruising or visible deformity
• Difficulty walking or standing
• Reduced range of motion or instability

If you experience any of these symptoms, it’s important to seek medical attention. A doctor will typically perform a physical examination and order imaging tests such as X-rays or CT scans to assess the extent and location of the fracture before deciding on treatment.

What Is ORIF Surgery?

Open reduction and internal fixation (ORIF) is a surgical procedure used to reposition and stabilise broken bones so they can heal properly. It consists of two main steps:

• Open Reduction: The surgeon makes an incision to access and realign the fractured bones.
• Internal Fixation: Metal plates, screws, or rods are inserted to hold the bones in place during recovery.

This technique helps restore the joint’s natural alignment and allows for controlled healing. ORIF is usually done under general or regional anaesthesia, depending on the fracture’s complexity and your overall health.

When Is ORIF Treatment Recommended?

Not every ankle fracture needs surgery. Minor or stable fractures often respond well to immobilisation with a cast or brace. However, ORIF may be required when:

• Bones are displaced or no longer aligned
• The fracture involves the joint surface
• The ankle remains unstable despite conservative treatment
• Closed reduction (non-surgical realignment) cannot hold the bones in position

How ORIF Surgery Is Performed

The surgical approach may vary slightly depending on the fracture pattern, but it generally follows these steps:

• Anaesthesia and incision: You’ll receive either regional or general anaesthesia. The surgeon then makes a small incision to expose the fracture.
• Bone realignment: The broken bone fragments are carefully repositioned into their normal alignment.
• Fixation: Plates, screws, or wires are applied to secure the bones in place as they heal.
• Closure and protection: The incision is closed, and a supportive cast or boot is placed to maintain stability.

After surgery, patients are generally advised to avoid putting weight on the foot until imaging confirms that the bone is healing properly. A rehabilitation plan is then introduced to restore movement and strength.

Recovery After ORIF Surgery

Recovery timelines vary depending on the type of fracture and your body’s healing rate. Generally, the process unfolds in several stages:

• Immobilisation: The ankle is supported by a splint, boot, or cast for several weeks to protect the surgical repair.
• Rehabilitation: Once cleared by your doctor, physiotherapy begins with gentle exercises to restore flexibility, improve circulation, and strengthen surrounding muscles.
• Gradual weight-bearing: You’ll slowly start putting weight on the ankle under medical supervision as healing progresses.

Risks and Considerations

As with any surgery, ORIF comes with certain risks, though these are relatively uncommon. Potential complications include infection, delayed bone healing, stiffness, or irritation from the metal implants used during surgery. While such issues are rare, being aware of them helps you take an active role in your recovery. By carefully following your surgeon’s post-operative instructions and attending scheduled follow-up visits, you can significantly reduce these risks and support proper healing.

To learn more, schedule a consultation with Orthopaedic Surgeon Dr Seng Chusheng for a personalised assessment and professional guidance on your recovery journey.

About Dr Seng Chusheng

Dr Seng Chusheng is a consultant orthopaedic surgeon at Axis Orthopaedic Centre, specialising in foot and ankle surgery and knee surgery. He obtained his MBBS and Master of Medicine in Orthopaedic Surgery from the National University of Singapore and is a Fellow of the Royal College of Surgeons of Edinburgh.

Dr Seng trained at the Assal Centre in Geneva, Switzerland, focusing on complex foot and ankle deformities, trauma and minimally invasive techniques. Before entering private practice, he served as a consultant orthopaedic surgeon at Singapore General Hospital and continues as a visiting consultant there. His dedication to patient care earned him the SingHealth Service With A Heart Award.

An active contributor to orthopaedic research, Dr Seng has published in peer-reviewed journals and was awarded the Japanese Orthopaedic Association Travelling Fellowship.