I suspect my sister may be suffering an ankle fracture that actually occurred during surgery (she had an ankle replacement) but nobody’s talking. Should I say something before she goes back to this same surgeon? Maybe she should be seeing someone else for her follow-up care.

It doesn’t happen very often but ankle fracture during (or after) a total ankle replacement (TAR) is possible. Every effort is being made to reduce the number of these cases. For example, in a recent study from Germany, surgeons reported that their own work improved over time. There were a total of 503 patients who received one of two different types of ankle replacements.

In the first 100 cases, the rate of intraoperative fractures (those that occurred during the surgery) went from three out of every four patients down to one of every three. By the end of the study, only two per cent of the last 100 patients experienced an intraoperative periprosthetic (around the implant) fracture. These may have occurred as a result of improper implant size or position, mechanical overload of the implant, or weakening of the bone from the surgery.

What made the difference for the two surgeons who performed these 503 ankle replacement procedures? There were several possible factors contributing to the improved results. The surgeons did gain experience over time. Operative techniques improved as did surgical instruments. And even the implant designs improved over time. Some patients still developed post-operative fractures but these were from stress (overload) and trauma (injury).

As results following total ankle replacement continue to improve, more and more surgeons will choose ankle replacement over ankle fusion (called arthrodesis). Preserving motion and function (especially in younger, active patients) is the number one reason for this choice. And along with the increasing number of candidates for total ankle replacement may come an increasing number of periprosthetic ankle fractures (both intraoperative and postoperative).

Your sister can always ask the surgeon for more details about her own fracture (cause, location, type) and the proposed treatment. There is nothing wrong in getting a second opinion either. The decision whether to stay with the original surgeon for follow-up may depend on the information she receives at her follow-up appointmant and her confidence in the current surgeon.