What is Open Ankle Fusion

Ankle fusion is a procedure that joins (fuses) together the bones that make up your ankle joint. The procedure uses hardware such as screws, plates, and pins. Bone paste may also be used.

This procedure is usually done to treat ankle arthritis that has not responded to other treatments. Ankle fusion reduces ankle joint pain and movement, which can improve ankle function.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to nerves or blood vessels.
• Failure to heal (nonunion).
• A blood clot that forms in the leg and travels to the lungs (pulmonary embolism).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You may have physical exam. X-rays may be taken.
• Ask your surgeon about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your surgeon instructs you not to.
• You may be given antibiotic medicine to help prevent infection.
• Ask your health care provider how your surgical site will be marked or identified.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes, as told by your surgeon. If you need help quitting, ask your health care provider.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• A tourniquet will be applied around your thigh to reduce bleeding.
• One or two incisions will be made in the front or side of your ankle.
• Your surgeon will open the incision to view the bones of your ankle joint.
• All the tissue between your ankle joints (cartilage) will be removed.
• Your ankle will be placed in the best position for fusion. X-rays may be taken to check the position.
• Bone paste, screws, or metal plates may be used to fuse the bones together.
• The incisions will be closed with staples or stitches (sutures).
• A bandage (dressing) will be placed over the incision.
• A cast, splint, or plastic boot will be placed to hold your ankle in position for healing.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• Your ankle will be raised (elevated).
• You will be given medicine for pain.
• You will be given crutches or a walker to help you move around.
• Do not drive for 24 hours if you received a sedative.

Open Ankle Fusion, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Swelling.
• A boot, splint, or cast on your foot and lower leg.

Follow these instructions at home:

If you have a splint or boot:

• Wear the splint or boot as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint or boot if your toes tingle, become numb, or turn cold and blue.
• Do not let your splint or boot get wet if it is not waterproof.
• Keep the splint or boot clean.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Do not let your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your cast, splint, or boot is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Incision care

• There are many ways to close an incision. For example, an incision can be closed with stitches (sutures) or staples. Follow instructions from your health care provider about:
  • How to take care of your incision.
  • Removing whatever was used to close your incision.
• Once your cast, splint, or boot can be removed, check your incision area every day for signs of infection. Watch for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • If you have a removable splint or boot, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative).
• Ask your health care provider when it is safe to drive if you have a cast, splint, or boot on your foot.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises daily as told by your health care provider or physical therapist.

Safety

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches or a walker as told by your health care provider.
• Remove all throw rugs, electric cords, or other tripping hazards from your house so you can move around safely.

General instructions

• Do not put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.
• Drink enough fluid to keep your urine clear or pale yellow.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.
• Your pain is not controlled with medicine.

Get help right away if:

• You have chest pain or difficulty breathing.
• You have a severe increase in pain or swelling.
• Your toes become very cold, blue, numb, or tingly.
• You have pain, tenderness, or redness in your calf.

Seek Additional Information

American Academy of Orthopaedic Surgeons: www.aaos.org