Because the ankles have to bear all the weight of the body, they have a hard time. In addition, this part of the leg is not protected by anything except the skin. Any impact to this area or an accidental fall while running can result in a fracture of the outer ankle or the inner (lateral) ankle.
In most cases, the bones heal remarkably well on their own. The main thing is to connect them correctly so that the anatomy of the ankle is not disturbed and subsequently you can 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 most distant part of the tibia is called, 2 parts of the bone (external and internal) form the ankle itself. A broken ankle impairs ankle function.
Internal - a thicker bone that forms the lower leg, smoothly passes into a small process. The outer thin bone also at the end turns into an oblong ball attached to the foot. These two bone processes are called, respectively, the inner and outer ankle.
Ankle fracture
According to statistics, a fracture in the ankle area is the most common reason for contacting traumatologists. Moreover, a fracture of the external ankle is approximately 5 times more common than damage to the internal. In winter, the number of victims due to ice is always greater than in summer.
Athletes and sports enthusiasts also often suffer from fractures when skating or rollerblading, as well as when playing basketball and football. Fracture is very common.
Bone fragility increases the risk of fracture. To increase strength, it is recommended to perform exercises or a run from time to time. The ankle or ankle takes on the weight of the person and the stress that occurs when the muscles of the legs are at work.
Fracture risk is even higher when these factors are present:
- calcium deficiency due to malnutrition;
- alcohol abuse;
- osteoporosis (decrepitude of bone tissue);
- some diseases of the internal organs, such as atrophic gastritis;
- lack of exercise;
- hormonal disruptions in women (menopause, pregnancy);
- osteomyelitis;
- tuberculosis;
- skeletal pathology;
- problems with the thyroid gland or when it was completely removed;
- long-term use of oral contraceptives.
Women's ankles are weaker than men's, and therefore fractures are more common in women, especially those who are in adulthood.aged and has weight problems.
From what injuries should an ankle fracture be differentiated? It is worth taking an x-ray to distinguish bone damage from sprains and ruptures of the ligaments of the ankle joint. A closed fracture of the ankle 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 to calm the victim. At first, a person does not feel pain and tries to get up and walk on his own. But if you see that the shin is hurt, do not let it step on the foot. Broken ankle is a serious injury. Call an ambulance right away. An open, displaced ankle fracture will bleed and someone needs to apply a tourniquet above the injury.
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 the patient a bottle of plain non-carbonated water and let us drink from time to time in a sip. When the ambulance arrives, the doctor will splint Kramer and bring him to the hospital.
Ankle fracture. ICD
Medical classification created by experts from many countries. It has its own goal, namely to standardize medical reporting so that it is uniform throughout the world.
All fractures of the bones 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 "Injury, poisoning and certain other effects of exposure." ICD-10 ismost recent classification, revised to current 2018.
Types and forms of ankle fractures
Is it difficult to treat and recover a broken ankle? It depends on what kind of fracture, and how well the person's endocrine system works. As for the types of fractures of the fibula and tibia, they are systematized in medicine in this way:
- Supination-adduction fracture - obtained by excessive or even violent inclination of the foot inward.
- Pronation-abduction of one ankle - with a forced tilt in the opposite direction, that is, outward.
- Rotational - occurs when the leg turns too much in one direction: either inward or outward.
- Isolated extensor anterior margin of the bone. The ankle breaks when the foot is dorsiflexed. Displacement of a bone fragment often occurs upward and slightly forward.
- Isolated flexor posterior margin of the tibia. Strong plantar flexion or impact on the ankle from the front. No offset occurs.
- Combined. Such complex fractures occur when 2 or more traumatic factors are simultaneously exposed.
- There are also bimalleolar and trimalleolar fractures.
The forms are distinguished:
- comminuted fractures;
- tear-off;
- helical;
- shattered;
- fracture-dislocation.
When both ankles are damaged and there is subluxation and the edge of the tibia is damaged, the fracture is called trimalleolar. There is also a fracturePott, when the fracture of the lateral malleolus 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 lateral ankle
This is an injury in which only the fibula is broken, while the tibia remains functional. A person can walk, and only sometimes feels pain. There is not too noticeable swelling. It happens that people do not even seek help from a specialist, believing that the injury is not dangerous.
But it's not. Then, in the process of additional studies, negative changes in the nerve may be detected. It is better to immediately complete the entire course of the study and receive adequate treatment.
Movement after fracture
The first time after the plaster is applied, the leg must be immobilized. But the muscles still need to move. Therefore, it would be good to get crutches and move around in this way at first.
Anyway, it takes a long time to wear a cast to immobilize your leg after you've broken your ankle. The plaster is removed when the bone grows at least a little. And it depends on how bad the damage is.
- Fracture without displacement - a splint is put on and worn for at least 1 month.
- With displacement, a cast is already being put on for a period of 6-8 weeks. Depending on how fast the bone heals.
- With a combined fracture, healing of bone tissue takes a rather long time - 4-5months.
In order for the bone to heal faster, the body needs help. Firstly, do not burden the 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 a supplement and eat 3 times a day, the body's need for this trace element will be satisfied.
While you are wearing a cast, do not wash the injured limb, as the cast is not allowed to be wetted. But you can buy a specially designed bag that is put on top of the cast. This bag repels water, and then it is convenient to wash the lower limb.
Fracture with and without displacement
The clinical picture depends on the severity of the injury. A one-malleolar fracture without displacement looks like a minor torn ligament.
How to identify a non-displaced ankle fracture?
- Hemorrhage may be local, or it may not be at all.
- Leaning on the foot is often possible, but painful.
- A severe fracture sometimes causes swelling, which can spread widely.
- There is a symptom of irradiation of pain.
Pain can be sharp or cutting. But always intense. Although each patient experiences pain differently.
What is a symptom of irradiation? This symptom occurs when the traumatologist presses his fingers on the leg several centimeters above the fracture, the patientfeels a sharp pain right there.
If the fracture is displaced, the joint is deformed. It can be seen by eye that an angle has formed between the foot and the lower leg. A person cannot move independently. When closed with an offset, the bone can dig into the muscles. When soft tissues are damaged, a large hematoma is found. If the fracture is open, there will be bleeding that needs to be stopped. Profuse bleeding leads to hypotension and loss of consciousness.
Diagnosis and treatment
Before applying a cast for a broken ankle, you need to undergo an x-ray and possibly a few more procedures.
- X-ray is done in two projections - lateral and anterior. After the X-ray, you can see how severe the ankle fracture is, whether the plate should be inserted into the bone or not.
- MRI. The site of the fracture is studied in detail. Since it is not harmful, unlike an x-ray, an MRI can be done several times. However, for those who have had osteosynthesis, this study cannot be performed.
- Ultrasound. This is an additional study that can be used to see the joint cavity.
What treatment does the doctor prescribe? It depends on whether the ankle fracture is aggravated or not aggravated by displacement. When no displacement is observed, a plaster is placed on the victim, 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 the ankle fracture, rehabilitation is prescribed.
Surgery. Indications. Recovery timeline
From the moment the victim is admitted to the hospital, he must undergo surgery within 3-4 days if he needs it. During this time, the doctor must study all the data and plan how the bone will be collected.
In general, these types of operations are distinguished:
- Osteosynthesis of the medial ankle. The indication for surgery is supination fractures. The ankle is set with a special nail at a right angle.
- Osteosynthesis of fragments of the tibia.
- Fixation of the tibiofibular joint. When there is a fracture of both the medial ankle and the fibula.
- Osteosynthesis of the lateral ankle. This is how pronation fractures are operated on.
Why use plates? Sometimes, during accidents, for example, the bones are crushed, and the traumatologist has to collect the fragments with the help of screws, to give the ankle its anatomical shape again. Then the ligaments have to be sewn up.
When an X-ray shows a tear from the inner ankle to match the debris, a titanium plate is placed. It holds the 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 removed sometime after 3-5 months after the operation.
And also surgical intervention is indicated when the ankle has grown together incorrectly, and the patient feels constant pain at the fracture site. If the treatment is delayed, the patient will be worse, and the period of his recovery will be much longer.will drag on.
After the operation to restore the bone, the doctor adjusts the cast in such a way that the wound can be washed later. After all, the wound is disinfected every day for a long time.
It happens that the bones grow together badly, especially in old age. Then the bone grows together for half a year, and a year. This means that you need to go to a consultation with an endocrinologist. A poor thyroid condition leads to problems with bone healing. This means that you need to take some additional iodinated drugs.
Anesthesia for ankle surgery
In elective 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 general ventilation with ventilation.
How is drug-induced sleep provided? The person is given one of the following drugs: Diazepam or Phenazepam from the benzodiazepines, possibly Propofol. But it is contraindicated to use "Ketamine", since this substance is a hallucinogen. The anesthesiologist makes a 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 patient should be observed for the first time after coming out of local or general anesthesia. The victim may show some residual effects after the administration of the chemo.
Violationflexion and rotation function of the ankle
Sometimes, after the plaster is removed, it turns out that the fusion has happened incorrectly. In this case, some adverse consequences are possible. For example, developing arthrosis of the ankle. Over time, this leads to difficulty in flexion and extension of the foot, and difficulty in walking.
In order to avoid violations, the doctor must several times check whether all the bones converge accurately after the reduction of a displaced ankle fracture. To do this, X-ray images of the limb are taken every time. Only if everything is correct, then the cast is securely fixed and the patient is sent home to rest.
Ankle fracture. Rehab
After the cast or splint is removed, it takes a long time to take care of the restoration. The person will attend rehabilitation courses and perform certain exercises to train the muscles.
First, light flexion and extension of the foot is performed. At first, approximately 3 weeks after the injury, small foot movements can already be done, but by placing the limb in a basin of warm water. Warm water will make it less painful.
Then you need to gradually complicate the tasks. If the recovery course is being carried out at home, you can use various exercise items - tapes that gently pull the toe of the foot or a sewing machine with a foot pedal.
Doctors advise doing ball exercises. For exercise therapy you need a chair and a ball or half-flatthe ball, which the victim must roll on the floor with a sore leg. Then you need to try to take the ball with both feet and lift it. This is a more difficult level.
In general, exercise therapy is better to have a special instructor. In the process of training the leg, it is important not to cause harm by overzealous. You need to take these classes to restore normal ankle mobility and your usual gait.
In addition to therapeutic exercises, the victim is also prescribed electrical muscle stimulation, paraffin baths, hydroprocedures, massage and more. Why is rehabilitation needed for a broken ankle? All these procedures relieve pain, help hematomas dissolve and improve the overall metabolic process in 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 leads not to an improvement, but to a deterioration in calcium absorption.
Massage for injuries and fractures
When and how many times can I massage my foot? Massage on the ankle can be done from the first days of plastering. Warming up the soft tissues is certainly useful, as it improves blood flow and significantly improves skin tone. Soft tissue suffers from a fracture and needs to be taken care of. This massage can be carried out by the relatives of the victim, and by himself, if others do not have time. However, this must be done carefully and correctly so as not to cause harm.
In the end, all physiotherapy, proper diet and massage helps to speed up the time after an ankle fracture when you can step on your foot.
Workability 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 commission meets and decides on the closure or extension of the sick leave. But the patient cannot stand on his leg for at least 3-4 weeks. The timing of the removal of a cast or splint depends on the rate of union, on the individual characteristics of the body.
So, the splint, when the fracture heals well, will be removed only a month after the ankle fracture without displacement. But even in this case, one cannot speak of good working capacity if a person earns a living by physical labor. However, if he is busy with intellectual work, then he can return to work in three weeks, but you can’t skip exercise classes.
