Lower limb injuries are very common. Most often, they suffer from people of age, lovers of heels and wedges, athletes and overly active children. In addition, the level of injuries rises in the winter, and it is understandable why - even the most cautious person can fall during the ice.
An injured ankle will make itself felt
If the leg is unsuccessfully tucked, the ligaments are damaged, and the bone can exit the joint. It is simply impossible not to notice such a problem, an ankle injury is accompanied by pain, which intensifies even more after exertion. During injury, you can stretch or tear the ligaments. The pain can manifest on the rise and become unbearable. Almost immediately, edema appears, internal hemorrhages are possible.
During a dislocation, you can hear a characteristic click, the mobility of the foot is impaired. Sometimes the dislocation is so strong that it can be seen even without an X-ray, the foot can be turned inside out. In the damaged part, the leg is hot.
Ankle dislocations of varying severity
Received injuries are divided by severity. With mild severity, only ligaments are damaged, bone displacement does not occur. But the doctor should not draw final conclusions until the ankle x-ray has been taken and he will definitely not see in what condition the ligaments and bones are.
With moderate severity, the ligaments are torn, intense pain and severe swelling. Around the injured joint is hot skin. In severe cases, the ligaments are completely torn, the bone leaves the joint, and a click is heard. It is impossible to step on the foot due to severe pain, severe swelling and extensive hematoma at the site of damage.
It should be borne in mind that the risk of re-dislocation increases several times, because the ligaments are stretched and have lost elasticity. We need to take measures to prevent re-injury: wear shoes with a heel that is well fixed, do not wear high-heeled shoes and constantly perform exercises aimed at stretching the muscles of the feet and calves. This prophylaxis cannot give a 100% guarantee that there will be no dislocation anymore, but nevertheless it is better than nothing. With a dislocation, you need to free your leg from stress and immobilize it.
If a fracture occurs
When a fracture occurs during an injury, the integrity of the bones of the lower leg is violated . In this case, it is necessary to carry out osteosynthesis - this is an surgical intervention in order to restore this integrity. Typically, a fracture occurs if the turn of the leg was inward. This part of the leg suffers most often because it has the main load and it has a specific anatomical structure. Such an injury can lead to disability, especially for older patients. When ankle osteosynthesis is performed, it is necessary to restore the functionality of the joints, blood circulation and nervous innervation, bones.
Structural features
The structure of the lower leg is quite complex, the bone can withstand a large weight of the human body. The ankle is the protruding part of the ankle, consists of the tibia and fibula, they reliably fix the talus from all sides, which combines many small elements and ligaments. Thanks to her, a person can walk quickly and stop abruptly. It is the main support connecting the ankle joint and lower leg. The lower part allows you to keep the body upright and hold its weight. An ankle joint, like a hinge, connects all bone structures. This unique segment connects with the foot of the leg bone, thanks to him our movements are smooth. We can bend the sole and back and forth when we walk, and not fall in different directions, we can withstand heavy loads.
Causes of fracture
Although our bones look thin and brittle, in fact they can withstand heavy weight and impacts. But with a very strong direct blow, even the bones break. A car accident or a fall from a height can lead to an ankle fracture. ICD 10 included this injury in the list of diseases, and it has its own encoding. The international classification of diseases has been reviewed 10 times, and in its latest version there is a clarification on how to establish a diagnosis. If a fracture with an open wound and it was not designated neither open nor closed, then it should be classified as closed.
People are much more likely to handle having their legs turned up, with fractures less often. If the injury is direct, then the fracture is often accompanied by the formation of numerous fragments. Rupture of ligaments of varying degrees more often comes from the fact that a person slipped on ice or on the floor. Often injuries occur during outdoor activities: when skiing, rollerblading or skating. Often stumble on stairs or uneven surfaces.
Surgical correction
With minor injuries, the leg is fixed with plaster or special elastic bandages. At the same time, it should not be strongly squeezed, blood circulation cannot be disturbed. An ankle fracture in ICD-10 is under the code S82.6. The international classification allows verbal formulations to be transformed into codes; they are conveniently stored and used for data analysis.
If it is possible to do without surgery, then doctors carry out manual reposition. If the surgeon saw ankle swelling and the picture confirmed a complex fracture, then just fixing would not be enough. There are a number of indications for the operation, some of them are planned, others have to be done as soon as the patient enters the hospital.
Osteosynthesis is performed with open injuries and a double fracture. Also in those cases when there is a complex rupture of the ligamentous apparatus or rupture of the tibia.
Reasons for Surgery
Without the need, the doctor will not perform ankle osteosynthesis surgery. But most often this procedure is necessary to restore the patient to the correct bone shape. The operation is performed to stop bleeding or in order to conduct an open reposition of fragments or osteosynthesis. Sometimes a complete picture can only be seen when an operation is being performed and the bone is visible as it is.
To restore all the functions of the ankle joint, it is necessary to carry out the operation, but even after all the necessary manipulations have been performed, the doctor will not be able to guarantee that the patient will walk without limp. Some processes after a fracture may be irreversible, because nerve fibers and blood vessels still suffer during trauma. In places of fracture, chronic bone diseases can develop over time.
Preoperative diagnosis
Preliminary diagnostics are required. Symptoms of a fracture:
- palpation severe pain,
- ankle swelling,
- movements are limited or impossible due to pain and improper foot position.
To reduce painful conditions, local painkillers are injected into the victim. After the injection, the limb is immobilized, unnecessary movements must not be allowed so that a broken bone does not injure blood vessels and tissues. The doctor makes an x-ray and, if necessary, dopplerography. At the last stage, an x-ray is taken in the desired projections.
Is it possible to avoid surgery? Possible complications
If surgery can be avoided, the doctor will not recommend it. After all, any operation is fraught with risks, after it increases the likelihood of developing pulmonary embolism and deep thrombosis. The wound after surgery can heal poorly due to the development of necrosis of soft tissues and skin.
If the patient did not adhere to all the recommendations and was not completely at rest, then the implant may become loose and a false joint will form . The main purpose of the operation is to most accurately reconstruct the articular surfaces, and osteosynthesis allows this to be done. Without the operation, it is impossible to restore the integrity of the bones, even after performing it, it is not always possible to achieve the ideal result. But if nothing is done, then tissue necrosis can begin, and in the future part of the leg will have to be amputated.
Preparing for an operation to restore bone integrity
Up to 15% of bone fractures occur in the ankles. At the same time, nearby bones, cartilage and tendons suffer quite often. Often it is necessary to perform ankle osteosynthesis with a plate due to bone displacement, despite the fact that it was fixed with gypsum. Doctors also operate on chronic injuries and improperly fused bones.
When the patient is admitted to the hospital in general serious condition and has other injuries other than a fracture, the operation is not immediately performed. Initially, the victim needs to be stabilized, it can take several days, and only then perform ankle osteosynthesis. Also a contraindication to the operation is the poor condition of the tissues and skin in this place, the cause may be a recently transferred infectious disease. Before surgery, a person should be on a 12-hour fasting diet, anti-edema therapy is performed. After preliminary preparation, the patient goes to the operating room.
Operation
The patient is premedicated. Ankle osteosynthesis is done under general anesthesia or local. The patient is in the supine position, the knee joint of the operated leg is slightly bent. A hemostatic tourniquet is applied to the thigh. The entire limb is processed, and the surgical field is lined with adhesive or linen diapers, disposable diapers are usually used. The operation can last from half an hour to two hours.
In the work, the surgeon performs osteosynthesis of the ankle with screws, uses a plate with a tensioning loop, if necessary, uses Kirchner knitting needles. All materials must be sterile, they are selected in accordance with the injury. After operative access, a method of work is chosen, most often it is osteosynthesis of the fibula with screws and a plate. After surgery, the patient goes through a recovery period.
Using the Ilizarov apparatus
This device is widely used in traumatology, with its help correct the curvature of the legs, their proportions. It is used for fractures of the limbs, it does not allow fragments to move, reliably fixes false joints and non-healing fractures, and additional immobilization of the limb is not required. The Ilizarov apparatus in the photo looks like a strange design, but it is used even in cases where customers just want to lengthen their limbs.
All parts of the device are made with high quality, but you need to be careful when assembling it. On the day of installation, it is sterilized with other instruments. The Ilizarov apparatus in the photo is already assembled, but it consists of individual parts, and working with it requires caution. To insert the spokes into the bones, the doctor also drills soft tissues. In no case should burns be allowed so as not to provoke purulent processes, so when stopping you need to make frequent stops. During the introduction, the knitting needles should not be in contact with napkins, otherwise sterility will be impaired.
After the operation, the patient also goes through a period of rehabilitation and recovery.
In the future, the patient will have to go through another operation to remove plates and knitting needles from the bones and remove the Ilizarov apparatus, if it was installed.