The closed fracture of the inner ankle according to ICD-10 is listed under the code S82. This is one of the most common skeletal injuries. It can appear in people of any age and gender, but people of middle and old age suffer more, which is caused by a deterioration in coordination of movements and the general physiological form. The frequency of ankle fractures increases rapidly in the winter, especially during icy conditions.
Fracture classification
This front can occur in the outer part of the ankle, as well as complex fractures. The first type of fracture allows the patient to walk, leaning on a sore leg, the remaining fractures require the application of gypsum and immobilization of the foot.
The surgeon determines the fracture of the inner and outer ankle after an X-ray examination of the patient. As a result, these damages are divided into three groups. This type is determined by external examination and a complete study of the lines that appeared after the damage. This species takes into account the external anatomical and biomechanical result of the injury. This group takes into account the biomechanics of injuries.
Pronational abduction fractures occur after damage and twisting of the foot to the outside. There is a separation of the inner part of the ankle and at the same time a fracture of the outer ankle is formed in the joint area or a few centimeters above this joint. This process can occur inside the fibula. As a result of this damage, a rupture of the ligament occurs with a bone gap of two millimeters. In difficult cases, both ligaments break and dislocation to the outside.
Supination-adduction. Occur after an injury resulting in the foot turning inward. The result is a fracture of the inner ankle of the posterior margin or part of the outer ankle comes off. Bone fracture occurs on the joint higher than with the previous type of fracture. This fracture can damage the lower part of the tibia , sometimes there is a dislocation of the foot inward.
Ankle fractures are rotational. Occur after dislocation of the ankle mainly inward, in rare cases, in the outer part of the leg. In some cases, there is a fracture of both ankles in the joint area. There is a separation of the back of the tibia, a break in the form of a triangle is formed.
Bending isolated fractures. Occur on the back of the tibia. May occur when bones are bent on the sole. Such fractures are very rare. There is no bone displacement in this case, a triangular breaking is present.
Extensor fractures of the anterior edge of the tibia occur as a result of the back bend of the foot. They can also occur when hitting the ankle in front. In this case, a triangular break is obtained on the front of the tibia, the fragments are shifted forward and upward.
Combined fractures of the right inner ankle occur with a combination of several fractures described above. In medical practice, a fracture that occurs on one ankle is also called a single-fracture fracture. If fractures occur on both legs, they are called bipedal. Also, in addition to a fracture of the inner ankle of the right lower leg, there is also a fracture of the tibia, such a fracture is called a three-ankle fracture. In the first two fractures, there are no displacements, in the third type of fractures, displacements, ligament rupture, divergence of the ankle joints, dislocation of the ligaments occur.
These types of ankle fractures often occur in older people, as the composition and strength of their bones deteriorate. These fractures occur in all people who are on slippery ice, as well as in athletes, with various injuries and accidents.
After exposure to the foot of some external strong loads or strokes, a fracture occurs, which is accompanied by a rupture of ligaments, dislocation and the appearance of various fragments of the central bones. These types of fractures due to accidents may not be in a single copy, there may be a fracture of other bones at the same time. In addition to closed ankle fractures, there may be open ankle fractures and crushing of the entire bone.
Symptoms
An internal ankle fracture without displacement is very common. But how to recognize it? Symptoms of an ankle fracture will directly depend on how severe the injury is (whether there are displacements, dislocations, sprains, etc.), as well as the localization of a fracture of the bone. With such a fracture, certain symptoms are distinguished.
Pain
Often the pain during fracture of the inner ankle without displacement makes itself felt right after the person is injured, but there are exceptions, because of some psycho-emotional states, they may not appear immediately (for example, if a person participated in a sports competition and “ on adrenaline ”finished it). Pain sensations are acute, and because of them, a person cannot even fully step on his leg, because the pain intensifies due to an increase in the load on the leg or even when trying to move. All this gives a person great discomfort. If you feel the area of injury during a fracture of the ankle with a displacement, the pain will become sharp. In the case when a person receives a large number of injuries (for example, after an accident), he may experience a phenomenon such as pain shock.
Swelling
After a person received a fracture of the inner ankle with a displacement, his ankle becomes larger, and because of the swelling, the contours of the ankles will be smoothed out, and when you click on the skin, a dimple is formed. If the case is severe, then swelling will spread to the entire leg.
Hemorrhage
A bruise will appear in the area of the fracture, and it will be spread below and on the heel. This symptom is considered the most pronounced with this type of fracture, because the fragments cause severe damage to the soft tissues and blood vessels.
Crepitus and crunch
A person may feel a crunch during an injury. And in the future, if you feel the area of the fracture, then you can notice crepitus.
Ankle failure
It all depends on the severity of the injury; it happens that it is difficult for a person to make even the simplest movements. The victim may observe abnormal foot movements, attempts to move may be accompanied by a crunch, and an abnormal foot position is also noted.
Significant change in foot position
There are also such cases when a person notices changes in the location of the foot, when it moves outward or inward. This symptom can be seen with a severe ankle injury - fracture dislocation.
First aid
These actions must be taken seriously. That is why it is necessary to know how to provide first aid for an internal ankle fracture, the code according to ICD-10 of which is S82. If you get injured or another person, then you can provide first aid, sometimes it can even save a life:
- If there is a negative provoking factor, then it must be eliminated. Such a factor may be, for example, a chip from a car in an accident.
- If possible, an analgesic should be used.
- And if you weren’t injured, then you must make every effort to help the person calm down.
- Immediately you need to call an ambulance.
- Try not to move, it is especially forbidden to lean on a damaged leg.
- Walking is also prohibited.
- If possible, you need to fix the affected leg. You can do this by any means at hand, for example, you can use a board, you need to wind some fabric to it and firmly fix the injured leg. This must be done with all care so as not to damage the ankle even more.
- If we are talking about an open fracture, then sterile gauze or some tissue should be put on the affected area to eliminate the risk of infection.
- If frequent arterial bleeding (pulsating blood of a scarlet hue) is noticed during an internal ankle fracture, in this situation a tourniquet should be applied to the thigh, the bandage near the ankle will not be able to stop the bleeding.
- If the blood is dark in color and without pulsation, then this is a sign of venous bleeding. In this case, you just need to apply a tight bandage to this area.
- If we are talking about a closed fracture, then ice or something cold must be applied to the fracture area. This will help you overcome puffiness, stop the pain syndrome.
- It is forbidden to engage in the repair of damaged bone itself. This should be done by a traumatologist. You can only make the situation worse on your own.
- If possible, the injured leg should be placed above chest level to stop bleeding.
If you follow the above recommendations, you will be able to prevent wound infection, severe blood loss, and other injuries to the ankle.
Treatment
All treatment of internal ankle fractures, the ICD-10 code of which is S82, is divided into two types: conservative and operative. Each of them is selected by the doctor individually, depending on the state of the body.
Conservative treatment
Indications for this type of treatment are: a closed fracture of the medial ankle without displacement of parts of the bone, a fracture with displacement, in which it is possible to conduct a simultaneous closed reposition, separation of the apex of the medial ankle.
Contraindications for surgical intervention: severe diabetes mellitus, senile age, diseases of the nervous system, coagulation disorders, severe heart and vascular diseases.
The main method of conservative treatment is the immobilization of the ankle joint by applying an immobilizing dressing (it is also applied after surgery): plaster cast, rigid ankle orthosis (bandage-immobilizer).
When applying a plaster cast, several rules must be observed: the plaster cast must completely cover the foot and the entire back surface of the lower leg, the langet is fixed in several rounds with bandages: in the lower leg - from the bottom up, and the surface of the foot - from top to bottom. After applying the immobilizing dressing, the patient should not feel numb, squeezed, the dressing should not rub the skin.
In order to control the quality of applying a langeta or an immobilizer bandage, an x-ray is taken, on which the doctor looks to see if bone fragments have shifted during the application of the langeta. The time during which the patient will be in a bandage depends on the type and severity of the fracture and some features of the body (the presence of severe chronic diseases, age). On average, an adult is in a bandage for 6 weeks, children for a month, and older people more than 2 months.
With a closed fracture with a displacement of bone fragments, they are compared. This technique is called closed manual reposition. When it is performed, local anesthesia is performed, and in some cases general. The surgeon and his assistant bend the patient’s leg in the knee and hip joints at a right angle and fix the hip. Further, with one hand, depending on the nature of the fracture, the doctor takes the ankle or heel in front, and the second grabs the lower leg. The foot is given a flexion position, after which the doctor turns the foot into the correct position. Then a restraining bandage is applied.
The duration of wearing a bandage after such a procedure is determined by the results of radiographs. It is forbidden to step on the injured leg, therefore crutches are used for movement. In the first days after removal of the immobilization a cane is used. If gypsum is not applied correctly, complications can occur: deformation of the joint, the formation of a dislocation, a false joint, or a subluxation.
Surgical treatment
Indications for this type of treatment of an ankle fracture (photo is not attached for ethical reasons) are: an open fracture of the ankle, a closed fracture of the ankle with a displacement, about which it is impossible to carry out a closed manual reposition, chronic injuries, severe ruptures of the ankle ligaments. Before surgery, the doctor communicates with the patient and collects an anamnesis to determine the presence of contraindications.
With the help of surgical intervention, very important goals are achieved: with open fractures, bleeding is prevented and the wound is cleaned of impurities, bone parts are compared (reposition), their fixation in the correct position (osteosynthesis), ankle ligaments are restored, and joint functional capabilities are restored.
In most cases, surgery involves an open reposition of bone fragments (restoration of its anatomically correct shape) and their fixation - osteosynthesis (with special bolts, nails, screws).
There are several types of operations for fractures of the inner ankle: osteosynthesis of the tibial joint - a special bolt is inserted at an angle from the outer ankle through the tibia and fibula. Additionally, the tibial joint is fixed with a nail. Osteosynthesis of the medial ankle - at right angles to the inner ankle, a two-lobed nail is inserted to fix it.
With the help of an additional pin, the external ankle is fixed. In the presence of fragments, special screws are used to fix them. An additional method is the use of Kirschner spokes, a wire loop and an anti-slip plate for oblique fractures. After the operation, an immobilizing dressing with access to treat the wound is required. It is also necessary to perform a control x-ray. As a result of surgical operations with fractures of the medial ankle, an excellent result and restoration of joint functions in 90% of cases are observed.
Rehabilitation
After the treatment is completed, a suitable rehabilitation program will be drawn up for the victim with an ankle fracture. Such a program will help to restore former functions as much as possible. Experts recommend the victim:
- Follow a calcium diet.
- Perform therapeutic exercises.
- Attend massage treatments.
- Attend physiotherapy treatments.
It will be necessary to begin to perform certain procedures depending on the complexity of the patient’s fracture. An injured person who has undergone surgery is forbidden to stand on his sore leg. He can be moved with crutches only after about 4 weeks have passed since the surgery. It is also recommended to wear an immobilizing dressing for about several months. After the bandage is removed, you need to bandage the ankle with an elastic bandage.
The metal structures that are used to fix the fragments can only be removed after 5 months during repeated surgery. In the case when titanium products were used to fix bone fragments, the patient can wear them for a long period of time, however, fixatives from other products must be removed in a timely manner.
Usually a week after the victim removed the cast, he needs to do therapeutic exercises to stiffness of the joint is eliminated. The very first exercises are allowed to be performed in a bath with a warm temperature, as well as with the addition of a solution of sea salt. Such a solution will help to cope with puffiness, which will appear with prolonged wear of gypsum.
What exercises to perform the victim, the instructor will decide. Such exercises are selected personally for everyone, and the load should increase with time. After receiving such an injury, the doctor will recommend wearing shoes with orthopedic insoles. And in order to get rid of puffiness, it is necessary that the leg is in an elevated position, and also the victim must do certain exercises with ankle load.
To restore the functioning of nerves, lymph nodes and blood vessels, massage sessions will be recommended to the victim. , . .
Effects
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