In a great number of bone procedures of the foot and ankle, your doctor many tell you that they are going to fix the bone with screws to hold them in place. Screws are used to secure two bones or bone fragments together to allow for compression of the bone to promote healing. This not much different than when you screw two pieces of wood together to hold them in place. This compression of bone helps to secure the bone together to produce what is known as primary bone healing. This type of healing is different from secondary bone healing, in that secondary bone healing producers a bone callus while primary bone healing does not. Complete bone healing typically takes 6 to 8 weeks, but may take longer in some cases. Screws also allow for immediate weight bearing in some procedures after surgery or for movement of your foot and ankle to regain strength in your muscles, particularly after a fracture.

These screws are made out of either a high-grade surgical stainless steel or titanium. Screws used in the foot range in sizes from 1.5 mm to 7.3 mm in size and have many different applications from fixation of fractures to arthrodesis procedures.

One of the most commonly asked questions is Will the screws set off metal detectors? The answer is no. These screws are non-magnetic and will not set off metal detectors. Additionally, you with not pick up radio waves. These statements are myths and have no relevance. In having these types of screws in your foot, you can also have a MRI test with complete safety.

Another commonly asked question is whether the screws need to be removed. The answer is maybe. Most screws do not need to be removed unless the screws are have come loose, are causing irritation or you want them removed. In the majority of cases, the screw does not need to be removed and can stay in your foot or ankle forever.

There is only one thing that you need to inform your doctor about if they state they are going to use screws. If you have an allergy to jewelry or metal, particularly silver or costume jewelry, you need to inform your doctor about this before surgery. This is very important because some screws contain nickel, which is a common component of costume and some silver jewelry. If you have a true allergy to nickel or stainless steel, an allergy patch test may need to be performed to determine if you are allergic to titanium.

A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both.

Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Symptoms
An ankle fracture is accompanied by one or all of these symptoms:

• Pain at the site of the fracture, which in some cases can extend from the foot to the knee
• Significant swelling, which may occur along the length of the leg or may be more localized
• Blisters may occur over the fracture site. These should be promptly treated by a foot and ankle surgeon.
• Bruising that develops soon after the injury
• Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured
• Change in the appearance of the ankle – it will look different from the other ankle
• Bone protruding through the skin—a sign that immediate care is needed. Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.

Diagnosis
Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment.

The affected limb will be examined by the foot and ankle surgeon by touching specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.

Non-Surgical Treatment
Treatment of ankle fractures depends upon the type and severity of the injury. At first, the foot and ankle surgeon will want you to follow the R.I.C.E. protocol:

• Rest: Stay off the injured ankle. Walking may cause further injury.
• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Compression: An elastic wrap should be used to control swelling.
• Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.

Additional treatment options include:

• Immobilization. Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
• Prescription medications. To help relieve the pain, the surgeon may prescribe pain medications or anti-inflammatory drugs.

Treatment after fracture has healed:

• Supartz.  Joint lubricating injections to decrease stiffness and breakup scar tissue, this is done once fracture has healed
• Bracing.  Often long term bracing to decrease mechanical stress

When is Surgery Needed?
For some ankle fractures, surgery is needed to repair the fracture and other soft tissue related injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury.

Follow-up Care
It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain.

This is a typical scenario: one of our patients comes in and their foot is swollen, painful, and it's been like this for about 2 weeks.  There is no history of injury.  We take an x-ray and we were able to identify a stress fracture.  How long does it take for the bone healing before they are able to get back to normal shoes and start transitioning back to normal activity?  This can be very frustrating especially if a special vacation is planned.  Also, what can our patients do to help speed up the process. 

This is a common concern at our clinic.  Any of our patients who come in with a fracture or any of our patients who have surgery that involves a bone cut (osteotomy) or a fusion of the joint, they all will require bone healing.

There is the cast and protected weight bearing status.  Additional help includes nutrition with very specific nutrients and bone stimulation device can also be helpful.

The biggest concern is to make certain that the bone healing occurs as timely and fast as possible.  Typical bone healing is about 8 weeks for an adult.  It takes longer as we age and it's less for children.  It also was slowed by smoking and poor nutrition.  In general it's important to protect the bone from excessive motion or stress to allow for stable bridging of bone healing side.  This may involve partial weight bearing non-weight bearing or even full weight bearing with a cast that could be a cast boot or a fiberglass cast.  This type of protected weight bearing also limits excessive motion to help facilitate the bone healing process. 

Regarding nutrition, it is important to take calcium, vitamin D, magnesium and vitamin K-2.  Vitamin K-2 is an interesting vitamin.  This is critical to make certain that calcium goes into the bone, rather than calcifying blood vessels and other parts of the body where it does not belong.  There are other nutrients that can be helpful also.  Because bone healing is such a critical step in the overall recovery process, some of our patients will also take a special supplement called Ortho pro bono.  This is a supplement from the company OrthoMolecular.  It has all the exact nutrients needed for optimal bone healing.  OrthoProBono is taken once in the morning and once at night.  The reason for this is so your body will absorb all the vitamins that OrthoProBono offers.  If you were to take all these vitamins separately, your body would not absorb them effectively.  This is due to the competing nutrients. This can be especially important for our women patients.  Women also tend to have more of a challenge with bone healing than men especially during the aging process.

A bone stimulation device can also be helpful.  These are devices that we prescribe for our patients.  We often recommend these for our patients who are at higher risk for delayed fracture healing.  Insurance may cover the cost of these.   

Our goal is to help our patients that require bone healing to heal as quickly as possible and to do whatever we can to enhance and speed up  the bone healing process.  If you have an injury or need surgery we are happy to help you.  We have patients who come in from all over Washington State and the Northwest.