Ankle Fracture Surgery on Long Island

What is an Ankle Fracture?

An ankle fracture occurs when one or more of the bones forming the ankle joint break. These injuries are among the most common fractures of the lower extremity and can affect individuals of all ages. The ankle joint is composed of three primary bony structures:

• Lateral malleolus – the outer portion of the ankle, formed by the fibula
• Medial malleolus – the inner portion of the ankle, formed by the tibia
• Posterior malleolus – the back part of the tibia that contributes to ankle stability

Based on the location and number of fractures, ankle fractures are classified as:

• Lateral malleolar fracture – a fracture of the outer ankle bone (approximately 36% of cases)
• Medial malleolar fracture – a fracture of the inner ankle bone (approximately 7% of cases)
• Bimalleolar fracture – fractures involving both the inner and outer ankle bones (approximately 52% of cases)
• Trimalleolar fracture – fractures involving all three malleolar components of the ankle (included within the 52% above)

How Do Ankle Fractures Happen?

Ankle fractures typically occur when forces applied to the ankle exceed its normal range of motion. This often happens when the foot twists, rotates, or bends unexpectedly. Common causes include:

• Twisting the ankle while walking or running
• Landing awkwardly after a jump
• Sports-related injuries
• Motor vehicle accidents
• Falls from a height
• Stepping into a hole or off an uneven surface

When Does an Ankle Fracture Need Surgery?

Not every ankle fracture requires surgical treatment. The decision depends on several important factors, including:

• Whether the fractured bones have shifted out of position
• Whether the ankle joint remains stable
• The number and location of the fractures
• Your overall health, lifestyle, and activity level

Surgery is generally recommended when the fracture is unstable or when the bones are significantly displaced. Proper surgical alignment helps ensure optimal healing, restores joint function, and reduces the risk of long-term complications.

Surgical Treatment Options

The traditional surgical treatment for ankle fractures is known as open reduction and internal fixation (ORIF). This procedure involves making an incision to directly visualize the fracture, reposition the bones, and secure them with plates and screws. While ORIF has produced excellent results for decades, it may be associated with wound-related complications, particularly in patients with diabetes, circulation problems, or fragile soft tissues.

Advances in orthopedic surgery have led to the development of minimally invasive techniques that can achieve excellent outcomes while reducing the risk of complications.

Intramedullary Fixation

For selected fractures of the fibula (outer ankle bone), an intramedullary nail or screw may be used. This technique involves inserting a rod or large screw inside the bone through a very small incision.

Key Advantages:

• Minimal incision – Often requires only one or two small skin openings
• Lower rate of hardware removal – Research shows fewer patients require a second procedure to remove implants (8.7% vs 23.6%)
• Reduced wound complications – Particularly beneficial for patients with diabetes, poor circulation, or advanced age
• Excellent stability – Provides strong fixation while supporting early mobility
• Good functional outcomes – Enables reliable healing and restoration of function

This approach is especially valuable for patients who may be at increased risk of wound-healing complications.

Arthroscopic-Assisted Minimally Invasive Surgery

In some cases, surgeons combine minimally invasive fixation techniques with ankle arthroscopy. An arthroscope is a small camera that allows direct visualization of the inside of the ankle joint.

This technique enables the surgeon to:

• Assess the joint for cartilage injuries
• Identify ligament injuries, including syndesmotic injuries
• Treat the fracture through small incisions with minimal disruption of surrounding tissues

Key Advantages:

• Significantly lower complication rates – Studies report complication rates of approximately 7.7% compared with 27.5% for traditional open surgery
• Lower reoperation rates – Approximately 1.5% compared with 12.5% for open procedures
• Reduced postoperative pain – Patients experience less discomfort during the early recovery period
• Comprehensive treatment – Associated cartilage and ligament injuries can be addressed during the same operation

Percutaneous (Through the Skin) Fixation

For selected fractures, particularly in patients with compromised soft tissues or significant medical conditions, fixation can be performed through very small skin incisions without directly exposing the fracture.

Key Advantages:

• Minimal soft tissue disruption – Reduces injury to surrounding tissues
• Lower infection risk – Especially important in higher-risk patients
• Faster recovery – Less tissue trauma may support quicker rehabilitation
• Reliable fracture stability – Provides secure fixation and dependable healing

The Benefits of Minimally Invasive Techniques

A growing body of research supports the advantages of minimally invasive approaches for appropriately selected ankle fractures.

Reduced Complications:

• Overall complication rates are lower compared with traditional open surgery
• Wound complications occur in only 2.9% to 5.3% of minimally invasive cases
• Infection rates are reduced, particularly in patients with higher medical risk profiles

Less Pain:

• Patients generally experience less postoperative pain during the initial recovery period
• Reduced discomfort often facilitates earlier rehabilitation and mobility

Better Cosmetic Results:

• Smaller incisions result in less visible scarring
• Multiple small scars are often cosmetically preferable to a larger surgical incision

Excellent Functional Outcomes:

• Clinical studies demonstrate outcomes that are comparable to or better than traditional open surgery
• High levels of patient satisfaction have been consistently reported
• Return to daily activities is often similar or faster compared with conventional techniques

Early Weight-Bearing After Surgery

One of the most significant developments in modern ankle fracture care is the recognition that early weight-bearing can be both safe and beneficial following stable surgical fixation.

What Does the Research Show?

• Improved ankle function – Patients allowed to bear weight earlier demonstrated better functional outcomes at both 6 weeks and 4 months after surgery
• Comparable complication rates – Early weight-bearing did not increase the risk of infection, complications, or additional procedures
• Faster return to work – Patients were able to resume normal activities sooner

A major study published in 2025 compared immediate weight-bearing beginning on the first postoperative day with six weeks of non-weight-bearing and found:

• Superior functional outcomes – Significantly improved ankle function scores at 6 weeks
• Similar complication rates – No increase in wound problems, infections, or additional surgery
• Earlier return to work – Faster recovery and return to employment

What This Means for You

Based on strong clinical evidence, many surgeons now recommend:

• Protected weight-bearing within the first 1–2 weeks after surgery, often while wearing a walking boot
• Progression to full weight-bearing in a supportive sneaker around 6 weeks after surgery
• Early ankle motion exercises to reduce stiffness and improve recovery

Your surgeon will tailor these recommendations to your specific fracture pattern and overall health. When the fracture has been properly stabilized, early weight-bearing is generally considered safe and beneficial.

What to Expect: The Surgical Process

Before Surgery

Dr. Efremov will:

• Carefully evaluate your ankle and review imaging studies to understand the fracture pattern
• Discuss the most appropriate surgical technique for your injury
• Explain the potential risks and benefits of treatment
• Address any questions you may have regarding surgery and recovery

During Surgery

• Most ankle fracture procedures take approximately one hour
• Dr. Efremov will utilize the least invasive technique appropriate for your fracture whenever possible
• The fractured bones will be restored to their proper position and stabilized using plates, screws, or rods
• Small incisions will be closed with sutures

After Surgery

Immediate Recovery (First 2 Weeks):

• You will wear a protective boot to support healing
• Keeping the leg elevated will help minimize swelling
• Pain medication should be taken as prescribed
• Many patients can begin protected weight-bearing within the first 1–2 weeks while using crutches or a walker

Early Recovery (2–6 Weeks):

• Continue wearing the walking boot
• Begin physical therapy to improve ankle motion
• Most patients are able to achieve full weight-bearing by approximately 6 weeks

Intermediate Recovery (6–12 Weeks):

• Transition from the boot to regular footwear
• Continue rehabilitation exercises to improve strength and balance
• Gradually return to routine daily activities and walking
• Most fractures achieve complete healing by 12 weeks

Long-Term Recovery (3–6 Months):

• Continue strengthening and conditioning exercises
• Return to sports and higher-impact activities as directed by your surgeon
• Most patients achieve excellent function and mobility within 6 months

Potential Complications

Although minimally invasive techniques reduce complication rates, every surgical procedure carries some degree of risk.

Short-Term Complications (within 4 months):

• Wound infection (approximately 4.4% overall, with lower rates in minimally invasive procedures)
• Blood clots (approximately 1.6% of cases)
• Wound-healing problems (significantly less common with minimally invasive approaches)

Long-Term Considerations:

• Hardware removal may occasionally be required if implants become symptomatic (approximately 17% of patients within 3 years, though rates are lower with intramedullary fixation)
• Post-traumatic ankle arthritis may develop in a small percentage of patients, particularly following severe injuries

Risk Factors for Complications

Certain medical and lifestyle factors may increase the likelihood of complications following an ankle fracture.

• Diabetes, particularly insulin-dependent diabetes
• Smoking
• Peripheral vascular disease (poor circulation)
• Advanced age (over 75 years)
• Open fractures where the bone breaks through the skin
• Obesity
• Other medical conditions that affect healing and recovery

If you have one or more of these risk factors, minimally invasive surgical techniques may offer important advantages due to their lower rates of wound complications and postoperative problems.

Your Surgeon for Ankle Fracture Surgery on Long Island

Kristian Efremov, MD, PhD, is a fellowship-trained orthopedic foot and ankle surgeon. He evaluates and treats ankle fractures for patients across Nassau and Suffolk County at NYU Langone Ambulatory Care East Meadow, 1530 Front Street, Suite 200, East Meadow, NY 11554.

Surgical options covered on this page include intramedullary fixation, arthroscopic-assisted fixation and percutaneous fixation, along with early weight-bearing protocols. The right option depends on your exam, imaging and goals.

Dr. Efremov completed his foot and ankle surgery fellowship at New England Baptist Hospital and is a Clinical Assistant Professor in the Department of Orthopedic Surgery at NYU Grossman Long Island School of Medicine.

To request an appointment, call (516) 324-7500 or read more about Dr. Efremov.

Medical Disclaimer. The information provided on this website is intended for general educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional regarding any medical condition, symptoms, or treatment options.