The ankle joint is complex as it is made up of several bones - the tibia, fibula and talus. An ankle fracture is considered to be 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
Fracture of the ankle joint occurs as a result of a sharp increase in the load or giving it an unnatural position. Most often, injury occurs in the following cases:
- In a traffic accident, when there is a lot of pressure on the ankle joint due to impact or deformation of the vehicle.
- Tucking the foot in or out. This can happen when falling from a great height, bad jumping, while playing sports.
- Due to a blunt blow of great force into the areajoint.
- Falling on the foot of a heavy object.
When turning the leg inward, a fracture of the medial malleolus occurs, outwards - the lateral malleolus. When twisting the leg 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.
Types 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 formed 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. Complex injuries require surgical intervention. Most often, cracks occur, the treatment of which consists in the correct and timely immobilization and application of plaster for a certain period of time.
The following varieties are distinguished by the type of fracture line:
- oblique;
- longitudinal;
- transverse;
- T-shaped;
- U-shaped;
- star-shaped.
Traumatologist must accurately determine the type of fracture, as subsequent treatment depends on it.
ICD classification
This abbreviation stands for International Classification of Diseases. This is a regulatory document that contains data on diseases, pathologies and injuries. According to ICD 10, an ankle fracture has the followingclassification:
- ICD 10 S50 - internal closed ankle fracture;
- ICD 10 S51 - internal open ankle fracture;
- ICD 10 S60 - external closed ankle fracture;
- ICD 10 S61 - external open ankle fracture.
Determining the type of fracture makes it possible to prescribe the correct treatment.
Symptoms
According to the ICD, a fracture of the ankle joint has the code S50-61 and is accompanied by the following 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 injured limb.
- Large hematoma.
- When the ankle joint is fractured with a displacement, the deformity of the limb is noticeable.
- Unnatural foot position.
- Unpleasant crunching sound that occurs when probing a limb, which indicates the presence of bone fragments.
- An open fracture shows bone sticking out of a bleeding wound.
Open fractures are dangerous for bleeding, which can cause pain and hemorrhagic shock. Closed injuries are easier to treat, but require X-rays to diagnose a fracture, as symptoms may mimic those of sprains or torn ligaments.
Diagnosis
In order to accurately determine the nature of the injury, the traumatologist carefully listens to complaintspatient, and also examines the injured limb. After that, it is necessary to take x-rays in two projections - direct and lateral.
If an ankle fracture is accompanied by sprains or cartilage damage, the following tests are scheduled:
- Ultrasound diagnostics, with which you can examine the degree of tissue damage from the inside.
- Computer tomography is an expensive, but extremely informative procedure that provides the most accurate information about bone and cartilage damage.
- Arthroscopy is an invasive method of examining articular tissue, which is carried out by introducing instruments with a camera that display an image on a monitor screen.
These modern methods provide an accurate clinical picture of the injury, which helps to prescribe the right treatment.
First Aid
The consequences of an ankle fracture can be deplorable if emergency care 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 a state of rest for the injured person. To do this, it is necessary to help him take a horizontal position and immobilize the affected limb. In this case, it is desirable to straighten the leg at the knee joint and fix it with a stick, scarf, scarf. This is necessary forprevent further injury to surrounding tissues and reduce pain.
- To exclude pain shock, the injured person 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 there is a high probability of hypothermia of the soft tissues.
- When bleeding from a wound, apply a tourniquet above the wound. With a small loss of bodily fluid, clean cloth dressings can be dispensed with.
You need to remember that you should not try to set an open fracture yourself. 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 the traumatologist is to ensure the proper fusion of bone tissue. For this, a cast is applied to the fracture of the ankle joint. The leg is in a fixed position for 1.5-2 months. Immediately after the plaster is applied, the patient is prescribed painkillers that alleviate the condition.
In severe trauma with displacement, the time of wearing a cast increases to 4-5 months. This may also require surgery to remove bone fragments and return the displaced limb to its original position.
Need for surgery
Ankle fractureICD 10 S50-61 code can be complex and cannot be restored by simple medical procedures. In this case, surgical intervention is necessary. The integrity of the bone is restored using metal plates with fixation screws.
The operation is performed in several stages:
- An x-ray is required to assess the severity of the injury.
- Large bone fragments are connected with metal plates and a screw, small ones are removed.
- This whole structure compresses to lock the ankle in the correct position.
- Sometimes during the operation it is found that the affected limb will have a shorter length than the he althy one. This may be due to severe fragmentation of the bone and the removal of a large amount of debris. In this case, an implant can be installed in the form of a screw that is screwed into the bone and replaces the missing part of the limb.
After surgery, the patient is immobilized for 12 months. At this time, no load should be given to the injured leg, otherwise a second operation may be necessary. After the expiration of the prescribed period, the metal plates are removed, and a plaster cast is applied to the leg. With it, the patient can move with the help of crutches. After removal of the cast, the patient is allowed a small load on the affected limb.
Rehab
Fracture of the ankle joint with or without displacementrequires post-traumatic recovery of mobility. This is possible in case of proper bone fusion. For rehabilitation, the following activities are carried out:
- Applying a plaster splint after removing the bandage. It must be worn for 3-4 weeks after the cast has been removed. The splint provides rest to the limb, but does not completely immobilize it.
- Taking calcium supplements to speed up bone healing. To restore cartilage, it is recommended to eat aspic.
- Despite the possible pain, the patient is advised to move the injured leg. If the plaster has not yet been removed from it, you can move the knee joint, this will ensure normal blood flow to the limb.
- Massage is recommended to improve blood circulation in the injured leg.
- Therapeutic exercise is allowed under the supervision of the attending physician.
- The first attempts to walk should be done with two crutches and support on a good leg. Stepping on the affected limb is gradually allowed.
After an ankle fracture, it is important not to give it heavy loads immediately, otherwise the healing period may be delayed for a long time. In addition, rehabilitation should take place under the supervision of the attending physician, who determines the maximum allowable load.
Physical exercise
Gymnastics is also part of the rehabilitation after a fracture of the ankle joint ICD code 10 S50-61. At the same time, it differs significantly during periods of wearing a plaster cast.bandage and after its removal. The following exercises are allowed during the immobilization period:
- Tension of the muscles of the leg above the knee.
- Flexion and extension of the arms, swings.
- Torso tilts in different directions.
- Movement of he althy limb.
- Moving the fingers of the injured limb.
- Dangling the injured leg off the bed and moving the knee joint.
These exercises are designed to avoid blood stasis, which can occur as a result of a long period of inactivity.
After the plaster is removed, the patient is prescribed other exercises of therapeutic exercises. First they are performed under the supervision of a doctor, and then allowed at home:
- walking with varying heel and toe pressure;
- performing circular movements with the ankle joint;
- flexion and extension of the foot;
- rolling a tennis ball, stick, water bottle with an injured foot;
- attempts to grab and hold small objects with the fingers of the injured leg;
- swing the leg at the knee and hip joints.
The doctor selects exercises in such a way as to start rehabilitation with small loads. Gradually, the severity of gymnastics increases. The main task of performing exercises is to develop the joint after prolonged 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, thanks to gymnastics, blood flow and metabolism in the limbs improve.
The consequences of injury
In some cases, complications of a fracture of the ankle joint are possible. They may appear due to untimely medical care or their inadequate quality. Possible consequences of injury:
- Incorrectly fused bones with their incorrect fixation. In this case, it is necessary to break the joint again in order to give it the correct shape.
- Fracture nonunion threatens with disability, as 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 cartilage, which leads to changes in the joint. The disease makes it difficult to move and causes constant pain.
- Violation of the quality of walking - lameness, swelling of the limb appears.
- Infection in the wound with improper or untimely medical care threatens the development of an inflammatory process, which can eventually develop into sepsis.
Unfortunately, it is impossible to prevent an injury, but it is in the power of a person to strengthen bones and make them less fragile. To do this, you need to lead an active lifestyle, but you need to train the joint before heavy loads.
In addition, it is important to eat plenty of foods containing calcium and vitamins, because with a lack of this mineral, the 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.
