Since the whole body weight has to withstand the ankles, they have a hard time. In addition, this part of the leg is not protected except by the skin. Any blow to this area or an accidental fall during running can lead to a fracture of the external ankle or internal (lateral).
In most cases, the bones grow together wonderfully. The main thing is to correctly connect them so that the anatomy of the ankle is not violated and subsequently it was possible to walk normally without feeling discomfort. This responsibility lies with traumatologists.
Anatomy. How the ankle works
What is an ankle (or ankle)? So in anatomy the farthest tibia is called, 2 parts of the bone (external and internal) form the ankle itself. An ankle fracture disrupts the function of the ankle.
The inner - a thicker bone that forms the lower leg, smoothly passes into a small process. The external thin bone also at the end turns into an elongated ball attached to the foot. These two bone processes are called, respectively, the inner and outer ankle.
Ankle fracture
According to statistics, an ankle fracture is the most common reason for contacting traumatologists. Moreover, an external ankle fracture is approximately 5 times more common than internal ankle damage. In winter, the number of victims of ice is always greater than in summer.
Also, athletes and sports enthusiasts often suffer from fractures when skating or rollerblading, as well as when playing a game of basketball and football. Fracture is a very common occurrence.
Fragility of bones increases the risk of fracture. To increase strength, it is recommended that you exercise or jog from time to time. The ankle or ankle takes on the weight of the person and those loads that arise when the leg muscles are in work.
The risks of fracture are still increased when there are such factors:
- calcium deficiency resulting from malnutrition;
- alcohol abuse
- osteoporosis (decrepitation of bone tissue);
- some diseases of the internal organs, for example, atrophic gastritis;
- lack of physical activity;
- hormonal disruptions in women (menopause, pregnancy);
- osteomyelitis;
- tuberculosis;
- skeletal pathology;
- problems with the thyroid gland or when it was completely removed;
- prolonged use of oral contraceptives.
In women, the ankle is weaker than in men, and therefore more often fractures occur in women, especially those who are in adulthood and have problems with weight.
What damage should ankle fracture be differentiated from? An X-ray should be taken to distinguish bone damage from sprains and tears of the ankle ligaments. A closed ankle fracture can only be felt with pain and swelling.
First aid for a fracture
A person who has broken a limb may need help, especially if it is a severe fracture. The first thing you can do is calm the victim. At first, the person does not feel pain and tries to get up and walk on his own. But if you see that your lower leg is affected, do not let it step on your foot. Ankle fracture is a serious injury. Call an ambulance right away. An open fracture of the ankle with an offset will bleed and someone needs to apply a tourniquet higher than the damage.
Shoes must be removed from the victim. But when the fracture is open, and you are afraid to touch the limb, wait for the ambulance to arrive. If you can, buy a patient a bottle of plain still water and let us drink from time to time a sip. When the ambulance arrives, the doctor will put Cramer's tire and bring him to the hospital.
Ankle fracture. ICD
Medical classification created by experts in many countries. It has its purpose, namely to standardize medical reporting so that it is unified throughout the world.
All bone fractures of the lower leg and ankle joint have the code S82. In particular, according to the current version, an ankle fracture (ICD-10) belongs to class XIX, which is called "Injuries, poisoning and some other effects of exposure." ICD-10 is the latest classification, it is revised for the current 2018 year.
Types and forms of ankle fractures
Is ankle fracture difficult to heal and recover? It depends on what kind of fracture, and how well the person’s endocrine system works. As for the types of fractures of the small and tibia, they are systematized in medicine in this way:
- Supination-adduction fracture - obtained with excessive or even violent tilt of the foot inward.
- Pronational abduction of one ankle - with a violent tilt in the opposite direction, that is, out.
- Rotational - occurs when the leg is too turned in one direction: either inward or outward.
- Isolated extensor anterior margin of bone. Ankle breaks with dorsiflexion of the foot. The displacement of a bone fragment often occurs upward and slightly forward.
- An isolated flexion of the posterior edge of the tibia. Strong plantar flexion or frontal ankle strike. Offset does not occur.
- Combined. Such complex fractures occur with simultaneous exposure to 2 or more traumatic factors.
- There are also two-ankle and three-ankle fractures.
The forms distinguish:
- comminuted fractures;
- tear-off;
- helical;
- fragmented;
- fractures.
When both ankles are damaged and there is a subluxation and the edge of the tibia is damaged, the fracture is called a three-ankle. There are also Pott fractures, when the fracture of the external ankle is combined with damage to the medial ligament, and the foot is displaced outward. At the same time, the fibula is damaged just above the distal area by about 5 cm. Rehabilitation after an ankle fracture in this case will take a long time.
Apical fracture of the external ankle
This is an injury in which only the fibula breaks, while the tibia remains functioning. A person can walk, and only sometimes feels pain. Not too noticeable swelling appears. It happens that people do not even turn to a specialist for help, believing that injury is not dangerous.
But this is not so. Then, in the process of additional studies, negative changes in the nerve can be detected. It is better to go through the entire course of the study and get adequate treatment.
Movement after fracture
The first time after applying gypsum, the leg should be immobilized. But the muscles still need movement. Therefore, it would be nice to get crutches and move around that way at first.
In any case, for a long time you need to wear plaster to immobilize the leg after there was an ankle fracture. Plaster removal occurs when at least a little bone is fused. And it depends on how severe the damage is.
- Fracture without displacement - puts on a brace and is worn for at least 1 month.
- With displacement, they are already putting on gypsum for a period of 6-8 weeks. Depending on how quickly the bone heals.
- With a combined fracture, bone healing takes quite a long time - 4-5 months.
For the bone to grow faster, the body needs help. Firstly, do not burden your sore leg, and secondly, it is important that your menu has enough calcium, which is needed for the fastest recovery. Calcium is found in sesame seeds. If you add them to food as an additive and eat 3 times a day, the body's need for this trace element will be satisfied.
While you are wearing plaster, you should not wash a damaged limb, since plaster is forbidden to wet. But you can buy a specially designed bag that is worn on top of a plaster cast. This pouch repels water, and then it is convenient to wash the lower limb.
Fracture with displacement and without displacement
The clinical picture depends on the severity of the injury. A one-shoe fracture and without displacement looks like a frivolous tear of the ligaments.
How to detect an ankle fracture without displacement?
- The hemorrhage may be local, or it may not be at all.
- Leaning on the foot is often possible, but it hurts.
- A severe fracture sometimes causes edema, which can spread greatly.
- There is a symptom of radiating pain.
The pain may be sharp or cutting. But always intense. Although each patient feels pain differently.
What is a symptom of irradiation? This symptom occurs when the trauma doctor presses a few centimeters above the fracture with his toes, the patient feels acute pain in this place.
If the fracture is displaced, the joint is deformed. It is seen by eye that an angle has formed between the foot and lower leg. A person cannot move independently. When closed with displacement, the bone can stick into the muscles. When soft tissues are damaged, a large hematoma is detected. If the fracture is open, there will be bleeding that needs to be stopped. Heavy bleeding leads to hypotension and loss of consciousness.
Diagnosis and treatment
Before applying plaster for an ankle fracture, you need to undergo an x-ray and, possibly, a few more procedures.
- The x-ray is done in two projections - side and front. After an x-ray, one can see how severe an ankle fracture is; a plate needs to be inserted into the bone or not.
- MRI The fracture site is studied in detail. Since this is not harmful, unlike x-rays, MRI can be done several times. However, for those who have had osteosynthesis, this study cannot be carried out.
- Ultrasound This is an additional study with which you can see the joint cavity.
What treatment is prescribed by a doctor? It depends on whether the ankle fracture is displaced or not weighed. When displacement is not observed, the victim is put in gypsum, ointments are prescribed to speed up the recovery process. These are conservative methods of treatment and they are aimed only at improving the healing abilities of the body. And only a month or two after an ankle fracture, rehabilitation is prescribed.
Surgical intervention. Indications. Recovery time
From the moment the victim arrives at the hospital, he must undergo surgery if he needs it in 3-4 days. The doctor should during this time examine all the data and plan how the bone will be collected.
In general, these types of operations are distinguished:
- Osteosynthesis of the medial ankle. Indications for surgery are supination fractures. The ankle is set with a special nail at a right angle.
- Osteosynthesis of fragments of the tibia.
- Fixation of the tibial joint. When there is a fracture of both the medial ankle and the fibula.
- Osteosynthesis of the lateral ankle. Thus, pronational fractures are operated on.
Why use plates? Sometimes, during accidents, for example, the bones are fragmented, and the trauma surgeon will have to collect the fragments with the help of screws, and give the ankle its anatomical shape again. Then you have to sew up the ligaments.
When a detachment from the inner ankle is found on the x-ray to compare the debris, a titanium plate is placed. She holds bones well and helps for a while. But still it is a foreign object in the leg, and therefore it must be removed as soon as possible. Usually, the metal is recovered somewhere after 3-5 months after surgery.
And also surgical intervention is indicated when the ankle has not grown together correctly and the patient feels constant pain at the fracture site. If you delay the treatment, the patient will be worse, and the recovery period will be significantly delayed.
After the operation to restore the bone, the doctor establishes a plaster in such a way that then you can wash the wound. After all, the wound is disinfected every day for a long time.
It happens that the bones grow together poorly, especially in old age. Then the bone grows together for six months and a year. This means that you need to go to a consultation with an endocrinologist. Poor thyroid conditions lead to bone fusion problems. This means that you need to take additionally some iodized drugs.
Anesthesia for ankle surgery
In a planned trauma surgery, regional anesthesia is usually used. However, the age of the victim, the presence of chronic diseases, and whether alcohol is present in the blood, are taken into account. Doctors know that the condition of a patient with severe blood loss worsens with regional anesthesia, and therefore it is better to use common with mechanical ventilation.
How is drug sleep ensured ? One of the following drugs is administered to a person: Diazepam or Phenazepam from benzodiazepines, possibly Propofol. But it is contraindicated to use "Ketamine", since this substance is a hallucinogen. An anesthetist makes blockade of the femoral and sciatic nerves. Sometimes it is also necessary to relax the patient’s muscles, for this purpose muscle relaxants are used.
The first time after exiting local or general anesthesia, the patient should be monitored. The victim may have some residual effects after the introduction of chemistry.
Violation of the flexion and rotational function of the ankle
It happens that after the gypsum has been removed, it is found that the fusion has happened incorrectly. In this case, some adverse effects are possible. For example, developing ankle arthrosis. Over time, this leads to difficulties in flexion and extension of the foot, to difficulties in walking.
To prevent disturbances, the doctor should check several times to see if all the bones converge accurately after the ankle fracture has been repositioned. To do this, x- rays of the limb are taken every time . Only if everything is correct, then plaster is firmly fixed and the patient is sent home for rest.
Ankle fracture. Rehabilitation
After the plaster or langet is removed, it takes a long time to take care of recovery. A person will attend rehabilitation courses and perform certain exercises to train muscles.
First, a light exercise is performed on the flexion and extension of the foot. The first time, approximately 3 weeks after the injury, small movements of the feet can already be done, but by putting a limb in a basin with warm water. Thanks to warm water it will not hurt so much.
Then you need to gradually complicate the tasks. If the recovery course takes place at home, you can use different objects for exercises - ribbons, with which they gently sip the toe of the foot or a sewing machine with a foot pedal.
Doctors advise doing exercises with a ball. For exercise therapy, you need a chair and a ball or half ball, which the victim must roll on the floor with a sore foot. Then you need to try to take the ball with both legs and raise it. This is a more difficult level.
In general, exercise therapy is better for a special instructor. In the process of training the leg, it is important not to harm, being too zealous. You need to go through these classes to restore normal ankle mobility and the usual gait.
In addition to medical classes, the victim is prescribed electrostimulation of muscles, paraffin baths, hydroprocedures, massage and more. Why do I need rehabilitation for ankle fracture? All these procedures relieve pain, help hematomas resolve, and improve the overall metabolic process in the tissues.
Also, the victim during the recovery period needs to eat more foods containing potassium, calcium and phosphorus. But with the amount of phosphorus you need to be careful. Since its excess does not lead to improvement, but to a decrease in the absorption of calcium.
Massage for injuries and fractures
When and how many times can you massage your leg? Ankle massage can be done from the first days of casting. Soft tissue warming is certainly beneficial, as it improves blood flow and significantly improves skin tone. Soft tissue suffers from a fracture and requires care. This massage can be carried out by relatives of the victim, and he himself, if others do not have time. However, this must be done carefully and correctly so as not to cause harm.
In general, all physiotherapy procedures, the right diet and massage help speed up the time after an ankle fracture, when you can step on your foot.
Disability after surgery
Due to swelling and severe pain, the victim has the right not to go to the main place of work for at least 10 days. Then the medical board meets and decides to close or extend the sick leave. But the patient can not stand on foot for at least 3-4 weeks. The timing of removal of gypsum or langeta depends on the rate of fusion, on the individual characteristics of the body.
So, the landing gear, when the fracture is well fused, will be removed only a month after the ankle fracture without displacement. But even in this case, one cannot talk about good performance if a person earns a living by physical labor. However, if he is engaged in intellectual work, then he can return to work in three weeks, only you can not miss classes in exercise therapy.