Frequently Asked Questions

Dad's surgeon has said, "No" to surgery for a broken ankle (on the inside joint of the heel bone). Since Dad is a smoker, they are going to try a more conservative route. Is this really a reason to turn somebody away from a more secure fracture treatment?

The ankle is a very complex joint and a bad break affecting the joint itself can lead to considerable pain and disability. Older age and certain health factors can add misery to an already difficult situation. That's been the case with intraarticular (inside the joint) calcaneal fractures. The calcaneal bone is your heel bone. It sits right under the tibia (lower leg bone) and right above the talus and forms part of the ankle joint. A break on the inside of the joint at the heel is referred to as an intra-articular calcaneal fracture. Surgery to fix a fracture affecting this area in an older patient has traditionally had a dismal record for recovery. Results are unpredictable. This uncertainty is a major reason why many surgeons recommend conservative (nonoperative) care for a fracture of this type -- especially in anyone over age 65. Tobacco use and especially cigarette smoking has clearly been proven as a negative risk factor in healing. This is true for bone healing as well as soft tissue wound repair. The risk of malunion, nonunion, infection, and poor wound healing is much higher for a smoker compared with a nonsmoker. And if there are other health risks, the surgeon may be firm in recommending conservative care. Health problems that can compromise results of surgery could include problems such as diabetes, high blood pressure, and heart or lung disease. These are the most common side effects of long-term cigarette smoking. Anyone with poor circulation, or decreased immune function is also at increased risk for poor outcome after a fracture of this type. You can trust your father's surgeon to make a recommendation that is in his best interest. The "No" is for a reason. You might feel better if you were able to consult with the surgeon and find out more about the risks your father faces in having this type of injury. Knowing why a nonoperative approach was advised would be helpful for everyone in accepting this decision.

Trevor Gaskill, MD, et al. Comparison of Surgical Outcomes of Intra-Articular Calcaneal Fractures by Age. In The Journal of Bone and Joint Surgery. December 15, 2010. Vol. 92-A. No.18. Pp. 2884-2889.

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