Ankle Fracture Fixation — KEVIN PARVARESH, MD

Pain Medications

In most cases local or regional nerve blocks will provide 8-12 hours of numbness.
As soon as you start to feel the numbness wearing off, begin taking oral pain medication.
Take Tylenol 500mg one tab every 8 hours.
Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.
If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).
If you still have pain after all of the above, take a second Norco tab.
Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.
DO NOT exceed 3500mg of Tylenol over 24 hours.
It is illegal to drive or operate machinery with narcotic medications.
Do not combine alcohol or other sedatives with narcotic medications.
You do not need to take pain medications once you no longer have pain.
You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.

Other Medications

Take Aspirin 325mg one tab once a day for the first 4 weeks to prevent blood clots.
Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).
Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

Use crutches to assist with ambulation.
You may not put any of your weight on your operative extremity for the first 6 weeks.
Elevate your operative extremity above the heart as much as possible to decrease swelling.
Avoid prolonged periods standing to prevent excessive pain and swelling.

Recovery Equipment

Cold Therapy

We recommend cold therapy use as much as possible in the first two weeks.
Cold therapy units may be used continuously as instructed.
Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.
Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Therapy Plan: Twice per week for 0-3 months, once per week for 3-6 months

ROM Progression

Splint on at all times for 0-2 weeks for soft tissue healing.

Passive ankle motion for 2-6 weeks after surgery with gentle progression.

Progress ankle motion from 6-12 weeks with the goal of full symmetric range of motion at 12 weeks.

Weight Bearing Progression

Initially NO weight bearing 0-6 weeks after surgery

For simple fractures weight bearing may start earlier but requires surgeon clearance
Progress weight bearing over weeks 6-8 with the goal of removing crutches at 8 weeks
Do NOT progress to one crutch - gait must be pain free and non-compensatory to remove both crutches
The ankle boot must remain in place for at least 6 weeks

Initial Post-Operative Physical Therapy Visit

Phase 1 Physical Therapy (2-6 weeks): protect the joint, fracture healing

NO open-chain exercises
Manual therapy 20+ minutes per session, stationary bike 20-60 minutes/day (NO resistance)
Soft tissue mobilization, ankle mobilization, isometric exercises, core strengthening
Boot in place at all times while ambulating

Phase 2 Physical Therapy (6-12 weeks): progressive strengthening

Wean out of boot and off crutches after 6 weeks
Gradually progress weight bearing as above
Tactile and verbal cueing to enable non-compensatory gait patterning
Soft tissue mobilization, ankle mobilization, isometric exercises, core strengthening

Phase 3 Physical Therapy (12-24 weeks): return to pre-injury level and sport