Lower limb injuries are very common. Most often, people of age, lovers of heels and wedges, athletes and overly active children suffer from them. In addition, the level of injuries increases in winter, and it is clear why - even the most cautious person can fall during ice.
Injured ankle will make itself felt
If you fail to twist the leg, the ligaments are damaged, the bone can come out of 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 an injury, ligaments can be stretched or torn. The pain may increase and become unbearable. Swelling appears almost immediately, 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 severe that it can be seen even without an X-ray, the foot can be turned inside out. The injured part is hot.
Dislocations of the ankle of varying severity
Injuries are divided according to severity. With a mild degree of severity, only the ligaments are damaged, the displacement of the bone does not occur. But the doctor should not draw final conclusions until the ankle is X-rayed and he will not see exactly what condition the ligaments and bones are in.
With moderate severity, the ligaments are torn, intense pain and severe swelling. Hot skin around the injured joint. With a severe degree, the ligaments are completely torn, the bone comes out of the joint, and a click is heard. It is impossible to step on the leg due to severe pain, severe swelling and extensive hematoma at the site of injury.
It must be taken into account that the risk of re-dislocation increases several times, because the ligaments are stretched and have lost elasticity. Steps must be taken 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 an absolute guarantee that there will be no more dislocation, but still it is better than nothing. In case of dislocation, you need to release the leg from the loads and immobilize it.
If there was a fracture
When a fracture occurs during an injury, the integrity of the bones of the lower leg is broken. In this case, it is necessary to carry out osteosynthesis - this is a surgical intervention in order to restore this integrity. Usually a fracture occurs if the tuck of the leg was inward. This part of the leg suffers most often, because it bears the main load and it has a specific anatomical structure. Such an injurycan lead the patient to disability, especially age patients. When osteosynthesis of the ankle is performed, it is necessary to restore the functionality of the joints, blood circulation and nerve innervation, bones.
Building features
The structure of the lower leg is quite complex, the bone can withstand the heavy weight of the human body. The ankle is the protruding part of the ankle, it consists of the tibia and fibula, they securely fix the talus on 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 that connects the ankle joint and lower leg. The lower part allows you to keep the body upright and support its weight. The ankle joint, like a hinge, connects all bone structures. This unique segment connects the lower leg bones to the foot, thanks to which our movements are smooth. We can bend the sole forward and backward when we walk, and not fall in different directions, withstand heavy loads.
Causes of fracture
Although our bones look thin and fragile, they can actually withstand a lot of weight and impact. But with a very strong direct blow, even 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 already been revised 10 times, and in its latest version there is a clarification on how to establish a diagnosis. If a fracture with an open woundand it was not designated either open or closed, then it should be classified as closed.
People are much more likely to treat a sprained leg, less often with fractures. If the injury is direct, then the fracture is often accompanied by the formation of numerous fragments. Rupture of ligaments of varying degrees often occurs from the fact that a person slipped on ice or on the floor. Often injuries are obtained during outdoor activities: when skiing, rollerblading or skating. Often stumble on steps or uneven surfaces.
Performing surgical correction
In case of minor injuries, the leg is fixed with a cast or special elastic bandages. At the same time, it should not be strongly squeezed, blood circulation should not be disturbed. An ankle fracture in the ICD-10 is code S82.6. The international classification allows verbal formulations to be transformed into codes, they are conveniently stored and used for data analysis.
If you can do without surgery, then doctors perform manual reposition. If the surgeon saw swelling of the ankle and the picture confirmed a complex fracture, then one fixation will not be enough. There are a number of indications for the operation, some of them are planned, others have to be done immediately, as the patient enters the hospital.
Osteosynthesis is performed for open injuries and double fractures. Also in cases where there is a complex rupture of the ligamentous apparatus or a rupture of the tibiofibular part.
Reasons for surgery
Unless necessary, the doctor will not perform surgery onankle osteosynthesis. But most often this procedure is necessary to restore the correct shape of the bone to the patient. The operation is performed in order to stop bleeding or in order to conduct an open reposition of fragments or osteosynthesis. Sometimes the full picture can only be seen when the operation is performed and the bone is seen for what it is.
To restore all the functions of the ankle joint, it is necessary to perform an operation, but even after all the necessary manipulations, the doctor cannot guarantee that the patient will walk without lameness. Some processes after a fracture may be irreversible, because nerve fibers and blood vessels are also affected during the injury. Fracture sites can develop chronic bone disease over time.
Preoperative diagnosis
Preliminary diagnostics is mandatory. Fracture symptoms:
- severe pain on palpation,
- ankle swelling,
- movements are limited or impossible due to pain and foot misalignment.
To reduce painful conditions, the victim is injected with local anesthetics. After the injection, the limb is immobilized, unnecessary movements should not be allowed so that the broken bone does not injure the vessels and tissues. The doctor takes an X-ray and, if necessary, dopplerography. At the last stage, an X-ray is taken in the desired projections.
Can I avoid surgery? Possible Complications
If the operation can be avoided, the doctor will not recommend it. After all, any operation is associated with risks, after which the likelihood of developing pulmonary embolism and deep thrombosis increases. The wound after surgery may not heal well due to the development of soft tissue and skin necrosis.
If the patient did not follow all the recommendations and was not completely at rest, then the implant may become loose and a false joint will form. The main goal of the operation is to reconstruct the articular surfaces as accurately as possible, and osteosynthesis allows this to be done. Without an operation, it is impossible to restore the integrity of the bones, even if it is carried out, it is not always possible to achieve an ideal result. But if nothing is done, then tissue necrosis may begin, and in the future part of the leg will have to be amputated.
Preparation for the operation to restore the integrity of the bones
Up to 15% of bone fractures occur at the ankles. At the same time, nearby bones, cartilage and tendons often suffer. Often it is necessary to perform osteosynthesis of the ankle with a plate due to the displacement of the bone, despite the fact that it was fixed with plaster. Doctors also operate on chronic injuries and improperly fused bones.
When a patient is admitted to the hospital in a general serious condition and has injuries other than a fracture, the operation is not immediately performed. Initially, the victim needs to be stabilized, which may take several days, and only then to carry out osteosynthesis of the ankle. Also, a contraindication to surgery is the poor condition of the tissues and skin in this place, the cause may be a recent infectious disease.disease. Before the operation, the person must be on a 12-hour starvation diet, anti-edematous therapy is carried out. After preliminary preparation, the patient is sent to the operating room.
Operating
The patient is given premedication. Osteosynthesis of the ankle is done under general or local anesthesia. 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 treated and the surgical field is covered with adhesive or linen diapers, usually disposable diapers are used. The operation can take from half an hour to two hours.
In the work, the surgeon performs osteosynthesis of the ankle with screws, uses a plate with a tension loop, if necessary, uses Kirschner wires. 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 the operation, 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 extremities, it does not allow fragments to move, reliably fixes false joints and ununited fractures, and additional immobilization of the limb is not required. The Ilizarov apparatus looks like a strange design in the photo, but it is used even in cases where clients simply want to lengthen the 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 the rest of the instruments. The Ilizarov apparatus in the photo is already assembled, but it consists of separate parts, and working with it requires caution. To insert the wires into the bones, the doctor also drills soft tissues. In no case should burns be allowed so as not to provoke purulent processes, therefore, when drilling, frequent stops should be made. During the introduction, the needles should not come into contact with the napkins, otherwise sterility will be violated.
After the operation, the patient also goes through a period of rehabilitation and recovery.
In the future, the patient will have to undergo another operation to remove the plates and wires from the bones and remove the Ilizarov apparatus, if it was installed.
