British
Orthopaedic
Association
AFFIX PATIENT DETAIL STICKER
HERE
NHS Organisation………………….
Attending Consultant……………….
Forename…………………………..
Job Title……………………………
Surname……………………………
Hospital Number…………………...
D.O.B…../……./……
OPERATION: ……. Ankle Open Reduction and Internal
Fixation (ORIF) –lateral malleolus
+/- diastasis screw
PROCEDURE: You have broken a bone in the outer part of your ankle. Your
surgeons feel that the bone will have the best chance of healing if it is held in place
with a plate and screws.
If your ankle is too swollen, it may be more sensible to wait until the swelling has
gone down. This may even be up to a week after the accident. In the mean time you
will have to keep your leg up (elevated) most of the time to help the swelling go
down.
The fibula is a bone that runs down the outer side of your shins. The fibula forms part
of the ankle bone and is important. This has been broken and will need to be fixed.
You will be seen by the surgeon the day before or the day of the operation. If you
have any questions now is the time to ask them.
When you are asleep in theatre, a tight inflatable band (tourniquet) will wrap around
your thigh. This should lessen the amount of bleeding. It is important. The surgeon
will then clean your skin with antiseptic solution and clean towels (drapes) will be
placed around you’re the ankle. The surgeon will make a straight thin cut (incision)
over the outer part of the ankle. This is through the skin, tissue and down to the bone.
The bone will then be moved around until its position is as close to as normal. X-rays
will be used to check this position. When the surgeon is happy with the position, the
bones will be fixed with a thin metal plate, which is held to the bone with screws.
The skin can then be closed. This is usually with dissolvable stitches under the skin
(sutures). Some surgeons may use stitches above the skin (which will need to be
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removed in 7 to 10 days). Some surgeons prefer metal clips – like staples. All can be
as effective as the others, but it comes down to surgeon’s preference. When you wake
from theatre, you will have a cast on your leg.
It is very important to keep your leg up even after the operation. If you don’t do this,
the leg can swell become painful, the wound may break down and develop infection.
The physiotherapists will help you learn how to walk with crutches. When the cast
comes off, they will also show you exercises. It is important to follow these.
***Please note that a junior surgeon with adequate training or supervision may
perform your operation***
ALTERNATIVE PROCEDURE: Some ankle fractures may be left in a plaster cast
to set by natural bone healing.
Your surgeons feel that your fracture will best be treated with an operation. You may,
of course, seek a second opinion.
However, if some bones are not fixed properly, they may cause delayed bone healing
or mal-union, and this may cause long term pain, disability and arthritis.
RISKS
As with all procedures, this carries some risks and complications.
COMMON (2-5%)
LESS
Pain: your ankle will be painful after the operation. Keeping it up will
help decrease the swelling and therefore the pain. In some rarer
cases, the pain may be long term.
Bleeding: may occur if there is damage to a vessel. This is usually
minimal and can be stopped at the time of operation. Very
occasionally a blood transfusion or iron tablets may be
necessary.
Numbness: the skin around ankle may be temporarily or more
permanently numb due to damage to small nerves.
Stiffness: and osteoarthritis may continue. This may require vigorous
physiotherapy and or repeat surgery.
COMMON (1-2%)
Infection: the wound site may become red, swollen and painful. There may
also be discharge. If this occurs, antibiotics may need to be
given. If the metalwork becomes involved, it may be removed.
There may be spread of the infection to bone or blood (sepsis).
Again antibiotics may be necessary.
Delayed surgery: this may be necessary as the swelling at time of initial
operation maybe too great to proceed.
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Removal of metalwork: this may be necessary if it becomes infected or painful or
damages the skin. Similarly, the metalwork can be removed
for better comfort and movement once bone has healed
satisfactorily.
If a special screw called a diastasis screw is used, this may
need to be removed around 3 months after the bone has
healed. Your surgeon will discuss with you.
RARE (<1%)
Compartment syndrome: this is a build up pressure within the lower leg and can cause
pain, nerve damage, blood vessel damage and muscle damage.
If this occurs, an emergency operation will have to be
performed to prevent death of tissue of the lower leg/ foot.
Damage to the skin under the tourniquet: this may require dressing, surgery or skin
graft. There may also be numbness of the skin under the
tourniquet, this is usually temporary
Abnormal wound healing: the scar may become thick, red and painful (keloid or
hypertrophic scars ). This is more common in AfroCaribbean people.
Conformation of consent :
The doctor has explained the above complications, risks and
alternative treatments to me as well as not having the procedure.
I hereby give my consent for the above procedure
Signature………………………………………………….
Conformation of name…………………………………………….
Date………./…/200…
I also give consent for my notes and data to be used in any studies and trials in the
future
□
NAME of SURGEON (Capital letters)………………………………..
SIGNATURE of SURGEON………………………………………….
POSITION……………………………………………………………..
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If you have any complaints about your treatment or your care, you are
always encouraged to discuss them with your surgical team.
However, if you wish to complain to the trust, each hospital will have a
PALS or Patient Advise and Liaison Service. The head nurse on the ward or
out patients’ clinic can direct you to them. The PALS team will treat all
complaints seriously.
I give permission for my notes or any data taken from the operation to be used in any
further or current research
Signed……………………………Date……………….