The ankle joint is complex, as it consists of several bones - tibia, fibula and talus. A fracture of the ankle joint is considered damage to one or more bones, as well as ligaments and the joint capsule that connects them. This type of fracture is one of the most common.
Causes of injury
An ankle fracture occurs due to a sharp increase in the load or giving it an unnatural position. Most often, an injury occurs in the following cases:
- In a traffic accident, when there is a lot of pressure on the ankle joint due to an impact or deformation of the vehicle.
- Turning the foot in or out. This can happen when falling from a great height, unsuccessful jumps, during sports.
- Due to a blunt shock of great strength in the joint area.
- Drops on the foot of a heavy object.
When turning the leg inward, a fracture of the medial ankle occurs, outward - a lateral ankle. When the legs are twisted due to external forces, both ankles are damaged. In the event of a fall from a height and landing on the heels, an injury to the talus occurs.
Varieties of fractures
Depending on the type of injury, adequate treatment is prescribed. Open fractures of the ankle joint are accompanied by fragmentation of the bones, which greatly complicate the healing process. In addition, infection of the resulting wound and pain shock are often connected to this type of injury.
Closed ankle fractures are much more common than open ones. They may be accompanied by displacement of the damaged bone. Complicated injuries require surgery. Most often, cracks occur, the treatment of which consists in the correct and timely immobilization and application of gypsum for a certain period of time.
By the type of fracture line, the following varieties are distinguished:
- oblique;
- longitudinal;
- transverse;
- T-shaped;
- Y-shaped;
- star-shaped.
The traumatologist must accurately determine the type of fracture, since subsequent treatment depends on it.
ICD classification
This abbreviation stands for International Classification of Diseases. This is a normative document that contains data on diseases, pathologies and injuries. According to ICD 10, an ankle fracture has the following classification:
- ICD 10 S50 - internal closed fracture of the ankle;
- ICD 10 S51 - internal open fracture of the ankle;
- ICD 10 S60 - external closed fracture of the ankle;
- ICD 10 S61 - external open fracture of the ankle.
Determining the type of fracture makes it possible to prescribe the correct treatment.
Symptoms
According to the ICD, an ankle joint fracture has the code S50-61 and is accompanied by such manifestations:
- Severe pain that does not stop for a long time.
- Increased pain when trying to touch or stand on the lower leg.
- Severe swelling of the lower part of the damaged limb.
- Large hematoma.
- With an ankle fracture with a shift, deformation of the limb is noticeable.
- Unnatural foot position.
- An unpleasant crunchy sound that occurs when probing a limb, which indicates the presence of bone fragments.
- With an open fracture, a bone protruding from a bleeding wound is visible.
Open fractures are dangerous bleeding, which can cause pain and hemorrhagic shock. Closed injuries are easier to treat, however, they require radiography to diagnose a fracture, as the symptoms may be similar to the manifestations of sprains, ligament ruptures.
Diagnostics
In order to accurately determine the nature of the injury, the trauma doctor carefully listens to the patient’s complaints, and also examines the damaged limb. After that, it is necessary to make x-rays in two projections - direct and lateral.
If an ankle bone fracture is accompanied by sprains or damage to cartilage, the following studies are prescribed:
- Ultrasound diagnostics, with which you can examine the extent of tissue damage from the inside.
- Computed tomography is an expensive, but extremely informative procedure that provides the most accurate information about damage to bone and cartilage.
- Arthroscopy is an invasive method for examining articular tissue, which is carried out by introducing instruments with a camera that display the image on the monitor screen.
These modern methods provide an accurate clinical picture of the injury, which helps to prescribe the correct treatment.
First aid
The consequences of an ankle fracture can be disastrous if emergency assistance is not provided in a timely manner. The first step is to call a medical team that will provide qualified assistance and deliver the victim to the hospital. While waiting for doctors, it is recommended to perform the following activities:
- Provide rest for an injured person. To do this, you need to help him take a horizontal position and immobilize the affected limb. In this case, it is desirable to straighten the leg in the knee joint and fix it with a stick, scarf, scarf. This is necessary to prevent further trauma to the surrounding tissues and reduce pain sensations.
- To exclude pain shock, the injured must be given painkillers. For these purposes, you can use "Ketanov", "Analgin", "Ibuprofen." In addition, ice can be applied to the fracture site. It is important that there is a layer between the limb and the ice, otherwise the likelihood of hypothermia of the soft tissues is high.
- When bleeding from a wound, a tourniquet must be applied above the wound. With a slight loss of body fluid, you can do with clean cloth dressings.
It must be remembered that you should not try to correct an open fracture on your own. This can only be done by qualified doctors in a hospital setting.
Injury treatment
Closed fractures of the ankle joint without bone displacement are considered the simplest. The main task of a traumatologist is to ensure proper bone growth. For this, gypsum is applied to the fracture of the ankle joint. In a fixed position, the leg is 1.5-2 months. Immediately after applying the cast, the patient is prescribed painkillers that relieve the condition.
In severe injuries with an offset, the wearing time of the cast increases to 4-5 months. In this case, surgery may also be necessary to extract bone fragments and return the displaced limb to its original position.
The need for surgery
Fracture of the ankle joint code according to ICD 10 S50-61 can be complex and not subject to recovery by simple medical procedures. In this case, surgical intervention is necessary. The integrity of the bone is restored using metal plates with fixing screws.
The operation is performed in several stages:
- An x-ray must be taken in order to assess the complexity of the injury.
- Large fragments of bone are connected using metal plates and a screw, small ones are removed.
- This whole structure is compressed in order to fix the ankle joint in the correct position.
- Sometimes during the operation it is found that the affected limb will have a shorter length than a healthy one. This may be due to strong fragmentation of the bone and the removal of a large number of debris. In this case, an implant can be installed in the form of a screw, which is screwed into the bone and replaces the missing part of the limb.
After surgery, the patient is in an immobilized position for 12 months. At this time, you can not give any load to the injured leg, otherwise a second operation may be necessary. After the due date, the metal plates are removed, and a plaster cast is applied to the leg. With her, the patient can move with crutches. After removing the cast, the patient is allowed a small load on the affected limb.
Rehabilitation
Ankle fracture with or without displacement requires post-traumatic recovery of mobility. This is possible in case of proper bone fusion. The following measures are taken for rehabilitation:
- Applying a plaster cast after removing the bandage. It must be worn for 3-4 weeks after removing the cast. Langeta provides rest of the limb, but does not completely immobilize it.
- Taking calcium supplements for faster bone growth. To restore cartilage, it is recommended to eat jellied meat.
- Despite the possible painful sensations, the patient is recommended to move his injured leg. If gypsum has not yet been removed from it, you can move the knee joint, this will ensure a normal flow of blood to the limb.
- A massage that improves blood circulation in an injured leg is recommended.
- Physical therapy is allowed under the supervision of a physician.
- The first attempts to walk should be carried out with the help of two crutches and support on a healthy leg. Gradually allowed to step on a sore limb.
After a fracture of the ankle joint, it is important not to give it large loads immediately, otherwise the healing period may be delayed for a long time. In addition, rehabilitation should take place under the supervision of a physician who determines the maximum allowable load.
Physical exercise
Gymnastics is also part of the rehabilitation after fracture of the ankle joint code ICD 10 S50-61. Moreover, it differs significantly during periods of wearing a plaster cast and after removing it. During the period of immobilization, the following exercises are allowed:
- The muscles of the legs above the knee.
- Flexion and extension of the arms, swings.
- Torso in different directions.
- The movement of a healthy limb.
- Finger movements of an injured limb.
- Hanging a sore leg from the bed and knee joint movement.
These exercises are aimed at avoiding stagnation of blood, which can occur as a result of a long period without movement.
After the cast is removed, the patient is prescribed other exercises of therapeutic gymnastics. First, they are performed under the supervision of a doctor, and then are allowed at home:
- walking with variable pressure on the heel and toe of the foot;
- performing circular movements of the ankle joint;
- flexion and extension of the foot;
- Skating with an injured leg of a tennis ball, stick, water bottle;
- attempts to grab and hold with your fingers the injured leg of small objects;
- leg swings in the knee and hip joints.
The doctor selects the exercises in such a way as to begin rehabilitation with small loads. Gradually, the severity of gymnastics increases. The main task of the exercises is to develop a joint after a long fixation in a stationary state. If it is not performed, then muscle atrophy is possible, which entails disability and the inability to move normally. In addition, gymnastics improves blood flow and metabolism in the limbs.
Consequences of injury
In some cases, complications of an ankle fracture are possible. They may appear due to untimely medical care or their inadequate quality. Possible consequences of injury:
- Incorrectly fused bones with incorrect fixation. In this case, it is necessary to break the joint again in order to give it the correct shape.
- Failure of the fracture threatens with disability, since the gap between the bones is filled with connective and cartilage tissue, which makes walking impossible.
- Deforming arthrosis is a disease that thins and then destroys the cartilage tissue, which leads to changes in the joint. The disease makes it difficult to move and constantly causes pain.
- Violation of the quality of walking - lameness, swelling of the limb appears.
- Getting into the wound of the infection with incorrect or untimely medical care threatens the development of the inflammatory process, which can eventually develop into sepsis.
Unfortunately, it is impossible to prevent the occurrence of trauma, however, it is within the human power to strengthen bones and make them less fragile. To do this, you need to lead an active lifestyle, but it is necessary to train the joint before heavy loads.
In addition, it is important to consume a large number of foods containing calcium and vitamins, since with a lack of this mineral bones become brittle and brittle. It must be remembered that calcium is best absorbed with vitamin D, so you should spend a lot of time in the sun.