I have had a devastating month. Fell down the stairs when I slipped on one of the cat’s toys. Broke my ankle on both sides. Surgery 10 days later. Now I’m finally able to think straight and have a million questions for the surgeon. Don’t see her again for a month. Started checking on-line for answers to my questions. First one — when will they take the screws out?

All post-operative care, whether it’s how much weight you can put on the foot, when to start physical therapy, or if/when the screws come out are determined by the surgeon. The decision is based on the type and extent of injury as well as what had to be done in surgery to repair or reconstruct the ankle.

At the time of the surgery, the surgeon looked to see if the joint cartilage was affected. This is a major determining factor in what and how the surgery is done. The presence of loose fragments (usually bits of bone, cartilage, or other debris) require removal and affect post-op decisions.

Likewise, a impacted fracture (broken ends of the bone compacted against each other or displaced (separated apart) must be handled differently during surgery with careful follow-up after surgery.

Sometimes the patient can put weight on the foot right after surgery but full weight-bearing isn’t usually allowed for several weeks. It may be necessary to wear a cast for six to eight weeks (sometimes longer). If there is any concern about the stability of the ankle, the patient will be transitioned from a cast to a walking boot.

Joint motion exercises are started around six weeks post-op for those who didn’t have a cast or when the cast is removed. The surgeon uses X-rays to see how well the bone is healing and advise the patient and therapist when to advance weight-bearing, joint range-of-motion, and exercises.

Hardware (e.g., screws, metal plates, wires, rods, locking plate system) used to fix (hold) the fracture stable during healing is often removed eight to 10 weeks later. The goal is to remove the screws or other instrumentation before bone and scar tissue grow over and around it making removal more difficult. Timing is important because removing it too soon could leave the ankle unstable.

In some cases, it may be necessary to leave the hardware in permanently. The choice to leave the hardware in may be made right from the start based on how and why it is being used. Or that management approach may become more apparent as follow-up X-rays are taken and the condition of the healing fracture is seen.

This is one question that will ultimately be answered by your surgeon. Having this information will help you focus your questions more specifically when the time comes for your next appointment. Good luck!