Ankle Fracture Surgery: Plates, Screws, and What to Expect

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

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When Ankle Fractures Need Surgery

Not all ankle fractures require surgical intervention — stable fractures that maintain normal ankle joint alignment can heal with immobilization alone. But unstable fractures, fractures involving the ankle joint surface, fractures with significant displacement, and bi- or trimalleolar fractures typically require surgical fixation to restore ankle anatomy and prevent post-traumatic arthritis. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we provide both surgical and non-surgical management of ankle fractures with individualized approach to each patient’s injury pattern.

Which Fractures Need Surgery?

The key determinant is stability — whether the ankle joint maintains normal alignment under the loading of walking. Isolated lateral malleolus (fibula) fractures with a stable ankle mortise (the ring formed by the tibia, fibula, and talus) can often be managed in a boot with progressive weight-bearing. Medial malleolus fractures, posterior malleolus fractures involving more than 25% of the ankle joint surface, Weber B and C fibular fractures with mortise widening, and all bi- and trimalleolar fractures typically require ORIF. The surgeon’s assessment includes stress X-rays to determine true mortise stability when the clinical picture is ambiguous.

The Surgical Procedure

Open reduction and internal fixation (ORIF) of ankle fractures restores anatomic alignment of the fracture fragments and holds them in position with metal hardware while the bone heals. For fibular fractures: a lateral incision allows placement of a plate and screws along the outer fibula. For medial malleolus fractures: screws or tension band wiring through a medial incision. For posterior malleolus fractures: posterior or anterolateral screws. For syndesmosis disruption (widening between the tibia and fibula): syndesmotic screws or suture button devices restore the interosseous relationship. The hardware remains permanently in most cases — it is not routinely removed unless it causes symptoms.

Recovery After Ankle Fracture Surgery

Non-weight-bearing for 6-10 weeks allows fracture healing before loading. The transition to weight-bearing in a boot occurs when X-rays confirm fracture healing. Physical therapy focusing on ankle range of motion, strength, and proprioceptive rehabilitation begins after weight-bearing is established. Return to light activity typically occurs at 3-4 months; return to sport or demanding physical work at 6-9 months. Swelling persists for 6-12 months after ankle fracture surgery — this is normal and resolves gradually.

Complications and Long-Term Outcomes

Well-performed ankle fracture surgery achieves anatomic restoration that minimizes post-traumatic arthritis risk. Complications include infection, hardware prominence requiring removal, nonunion (failure to heal), and post-traumatic arthritis despite anatomic reduction. Follow-up X-rays at regular intervals monitor fracture healing and alignment. Contact Balance Foot & Ankle at (810) 206-1402 for evaluation and management of any ankle fracture.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Need Ankle Fracture Surgery? Expert Surgical Care in Michigan

Ankle fractures often require surgical fixation with plates and screws for proper healing. Dr. Tom Biernacki is a board-certified podiatric surgeon with extensive experience in ankle fracture repair, ensuring optimal alignment and faster return to activity.

Learn About Ankle Fracture Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Donken CC, et al. Surgical versus conservative interventions for treating ankle fractures in adults. Cochrane Database of Systematic Reviews. 2012;(8):CD008470.
2. SooHoo NF, et al. Complication rates following open reduction and internal fixation of ankle fractures. Journal of Bone and Joint Surgery. 2009;91(5):1042-1049.
3. Schepers T, et al. Current concepts in the treatment of malleolar fractures. Injury. 2012;43(8):1221-1227.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.