Q. What are the surgical options available for a sprained ankle?

Answered by
Dr. Lokesh
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 18, 2017

Hello doctor,

I am looking for a second opinion for surgical options for a grade 3 sprained ankle. I have attached herewith the MRI results. The results show a ruptured anterior tibiofibular ligament and a partial tear of the posterior tibiofibular ligament with disruption of distal tibiofibular syndesmosis with mild adjacent muscles edema, likely distal tibiofibular syndesmotic injury. They also show posterior talofibular, calcaneofibular and deltoid ligaments sprain. Mild marrow edema at the distal fibula. Tibialis posterior, flexor digitorum longus, flexor hallucis longus tenosynovitis. A small amount of fluid in the tibiotalar joint. Subcutaneous edema around the ankle. Kindly provide your opinion.

#

Hello,

Welcome to icliniq.com.

I have gone through the images you have provided (attachment removed to protect patient identity).

  • I think only the anterior tibiofibular ligament has ruptured and all the other ligaments are sprained only. I would suggest you manage it non-surgically as all the other ligaments are intact,
  • You should get a long leg plaster cast by an orthopedic surgeon and keep it for six weeks. This will help the ligaments heal and also the trauma edema to reduce.
  • You still have sufficient stability as only one ligament is ruptured. So my suggestions remain conservative management provided I see your X-ray films.
  • But, if you are a sports person then only surgical management can be an option. 
  • Do let me know about your profession and your needs as the management also depends accordingly.
  • X-rays will help me guide you with further management.

This professional advice provided by me stands subject to the actual examination of report/image and is based entirely on inputs provided to me. It should be correlated with clinical findings. Regards.

For more information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Thank you doctor,

Do you note the likely "distal tibiofibular syndesmotic injury"? Does that not warrant a surgical intervention in most cases? As regards to the profession, I am into business. I am also into Muay Thai sports. I have attached the X-ray films.

#

Hello,

Welcome back to icliniq.com.

I have gone through your X-ray films (attachment removed to protect patient identity).

  • I saw the X-ray and you seem to have a severe syndesmotic injury on the X-ray and since you are involved in sports too you will surely require surgery.
  • Following are the options of the surgery.
  1. Only screws.
  2. Screws with plate fixation over the fibula.
  3. Bioabsorbable screws which will not necessitate implant removal in the future.
  4. Tightrope fixation can also be done if the surgeon is confident about the procedure. Usually, metal implants will require removal after an average of 12 weeks after the surgery. Tightrope and bioabsorbable screws will not require removal
  • I would also suggest you get a CT (computed tomography) scan done to check for any small avulsion injuries before going for surgery.
  • Follow up in one week.

Regards.

For more information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


Thank you doctor,

Can you give me an indication on the timeframe for recovery? How long will I need to be hospitalized? When can I start walking with crutches? When can I walk unassisted?  What limitations will I have during the recovery period? And also any preferable surgical options based on my specific case?

#

Hello,

Welcome back to icliniq.com.

  • Here are your answers.
  1. Usually four days in the hospital.
  2. Non-weight-bearing with crutches can be started some days after surgery until six weeks.
  3. Partial weight-bearing with crutches for six weeks and then after eight to 10 weeks later you can stop using the crutches depending upon the pain.
  4. Avoid smoking for better healing,
  • I would suggest two tightropes for you as a surgical option, which is a good technique.

For more information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Thank you doctor,

I have done some additional research and I wanted to see if this aggressive approach may also be wise post surgery. Can I have HGH injection supplementation of 1 IU per day to aid recovery? Can I also consider stem-cell therapy to assist recovery? What are your thoughts on the above? Are there any steroidal or other options available regarding healing?

#

Hello,

Welcome back to icliniq.com.

  • HGH (human growth hormone) will not affect healing at all. So, please do not take it. You will be fine with just the surgery. Your surgery only requires soft tissue healing so just doing the surgery with a plaster cast is enough.
  • If you want to enhance the healing then I suggest you include vitamin C tablets along with calcium and vitamin D supplementation. Consult your specialist doctor, discuss with him or her and take the above medicines with their consent.
  • Platelet-rich plasma injections given locally at the site of the injury can be used to assist in recovery with surgery and heal better rather than stem-cell therapy. So, ask your doctor about it in your area regarding its availability.

Regards.

For more information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

 

 


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