External ankle of the left leg. Ankle. Treatment of ankle fractures. Causes and types of fractures

The ankle is a part of the ankle joint, representing the protrusions of the bones of the lower leg on both sides above the foot. The area of ​​the ankle is commonly referred to as the ankle.

Anatomy

The human ankle has the shape of two bone processes. The lateral (outer) malleolus is a formation at the lower end of the fibula, and the medial (inner) in the same part of the tibia. The fibula and tibia form the lower leg, the part of the leg from the foot to the knee. The ankle is a forming element of the ankle joint - a movable joint between the leg and foot.

The lower ends of the bones of the lower leg, including the ankles, form the upper part of the ankle joint and, like a fork, which is clearly visible in the photos showing the structure of this joint, cover its lower part - the articular surface of the talus of the foot. The robust bone fork allows you to:

• evenly distribute a high load (the weight of the human body) on the bones of the foot;
• move the lower leg relative to the foot in different directions.

So, the medial malleolus is responsible for inward turns without taking the foot off the floor, and the lateral one is responsible for outward turns. The "fork" formed by the outer and inner ankle provides high mobility of the foot during flexion and extension, which provides a person with free movement. At the same time, this structure significantly limits the abduction of the foot to the side - this protects the bones and ligaments from excessive stress.

The articular surface of the outer and inner ankles is covered with cartilage, which ensures free sliding of the articulation bones relative to each other, protecting them from friction-related injuries.

The ankle is surrounded by ligaments - dense and at the same time elastic formations, consisting of bundles of connective tissue that hold the bones of the skeleton in a normal position. Without ligaments, the supporting function of the skeleton would be impaired - the bones would simply “spread apart” at their articulations.

Attached to the medial malleolus is the medial ankle ligament, which connects the tibia of the lower leg to the talus of the foot.

On the lateral malleolus are:

The most common cause of decreased mobility in the ankle area is precisely the lesion of the ligamentous apparatus. Most often, the ankle is subjected to traumatic injuries.

Ankle injuries

Traumatic injuries of the ankle take the first place among all injuries of the lower extremities. This is due to the high loads attributable to the articulation of the foot and lower leg.

When force impacts on the ankle area, it is not the ankle itself (bone tissue) that most often suffers, but its ligamentous apparatus - a partial or complete rupture of the ligaments occurs. Under the influence of higher loads, the bone tissue also cannot withstand - an ankle fracture occurs.

Most often, it is associated with a strong and sharp turn of the foot inward or outward, turning the lower leg around its axis when walking or running. Pronation (turning the foot inward) injury is recorded more frequently than supination (turning the foot outward) and rotational (turning around its axis), and accounts for three-quarters of ankle injuries.

Foot twists and sharp turns of the leg relative to the foot are accompanied by damage to the ligaments, which can lead to dislocation or, with significant tension, a fracture.

Other causes of injuries to this bone include landing on the legs (especially on the heel region) from a great height, a strong blow to the ankle.

Ankle injuries are especially prone to:

• athletes;
• persons engaged in heavy physical work;
• persons with congenital or acquired weakness of the ligamentous apparatus.

Acquired weakness of the ankle ligaments occurs most often as a result of a sedentary lifestyle, sedentary work.

Ankle injuries are often caused by wearing high-heeled or high platform shoes, especially when walking on uneven or slippery surfaces.

Ligament injury

As a result of excessive stretching, both a complete rupture of the ligament and a partial one can occur; the latter is often (and not too correctly) called a sprain. Even with micro-ruptures of the connective tissue in the ligaments, hemorrhages can occur, intercellular fluid can accumulate, and therefore pain sensations appear, which increase with stress - standing, walking.

Sometimes unusually long walking in people leading a sedentary lifestyle leads to sprains, in which case the pain occurs without visible injury (twisting the foot, impact), although in fact damage to the connective tissue occurs.

Signs of more significant ligament damage include:

With minor injuries of the ligaments, the treatment consists in ensuring maximum rest for the sore leg, cold compresses during the first day after the injury. In more severe cases, it may be necessary to take painkillers, wear orthoses of various fixation, and surgery.

If you suspect an ankle ligament injury, you should see a doctor as soon as possible. Even if mobility in the ankle is not lost, pain (especially unabated for two days) and swelling may indicate a bone fracture.

fractures

Ankle fractures are:

• without displacement, when the bone fragments are in place;
• with displacement - with a change in the position of bone fragments.

In case of fractures with a displacement, soft tissues are damaged up to a complete rupture of the muscles and skin - such a fracture is called an open fracture.

According to the volume of damage, they distinguish:

• fracture of the lateral malleolus (observed in eight cases out of ten);
• fracture of the medial malleolus;
• fracture of both ankles (bimalleolar fracture);
• fracture of both ankles with damage to the posterior edge of the tibia (trimalleolar fracture).

In addition, ankle fractures can be accompanied by ligament rupture, dislocation of the ankle joint, which aggravates the condition and lengthens the period of treatment and rehabilitation.

At the time of the fracture, there is severe pain in the ankle, a crunch can be heard.

Fractures of one ankle without displacement and without significant damage to the ligaments are accompanied by:

• pain
• swelling (edema) of the ankle;
• difficulty in ankle movement.

With more extensive damage or displacement of bone fragments, the following symptoms are observed:

With a fracture of one ankle, the edema is more pronounced on the side of the injury, and with a two- and three-ankle fracture, the ankle swells completely, the edema often spreads to the lower leg. In addition, with extensive fractures, movement in the ankle is impossible.

Treatment consists of taking painkillers, wearing a rigid orthosis or a plaster cast. Displaced fractures are treated with surgery.

Ankle fracture requires immediate qualified treatment. Untimely or inadequate treatment of such a fracture can lead to a permanent loss of leg function, the development of damage to the ankle joint - arthrosis. Similar complications can develop as a result of irrational treatment of injuries of the ligamentous apparatus, so any ankle injury is a reason for urgent medical attention.

One of the most vulnerable parts of the body is the foot. Its injuries average 30-40% of the total number of injuries. Quite often, a fracture of the lateral malleolus is diagnosed, which is due to the complexity of its structure and functional features.

Due to the fact that the joint (ankle) holds together the bone elements of the lower leg and the foot itself, a person can perform various movements with the feet, including walking. The complexity of the joint device is due to the fact that the connection of the bones occurs due to cartilage, which, in turn, can also be considered as a rather sophisticated system. In addition, normal functionality is provided by muscles, nerves, due to which well-coordinated and coordinated work takes place, blood vessels, designed to deliver nutrients and oxygen to the tissues.

It is on the ankle joint that the pressure of the body weight falls, and its task is to rationally redistribute the weight while walking. Therefore, it is very important that all elements of the system maintain integrity and function as a single mechanism.

In the structure of the joint, there are two bones of the lower leg: small and tibia. Their distal (lower) parts form a recess into which the process of the supracalcaneus (talar) bone is wedged. This connection forms the basis of the joint and is formed from the following bone components:

• talus block;
• outer and inner ankles;
• the lower ends of the tibia.

It must be emphasized that the outer malleolus is based on the fibula, namely, its distal part, and the inner one is based on the tibia. Considering it in more detail, it is necessary to highlight the outer and inner surfaces, as well as the rear and front edges. Its rear edge contains a recess where the tendons of the peroneal muscles are attached. From its outer side, articular fascia (joint membranes, fibrous connective tissue) and ligaments are attached.

The main functions of this joint include the following:

• is a support for the human body;
• thanks to him, the implementation of the motor function (walking, running, climbing and descending the stairs) is possible;
• the joint is responsible for the normal functioning of the foot;
• allows you to rotate the torso around you, while not taking your feet off the floor;
• responsible for cushioning the torso while walking.

Causes of injury

There are many causes and factors that can cause injury to the lower limb. The most common is an indirect injury when a person twists his leg. In this case, the fracture often turns out to be multi-comminuted, aggravated by the presence of a dislocation or subluxation of the ankle. This can happen with careless walking, especially if the shoes are high-heeled, and the surface is uneven, when skating, regular or roller skates, slipping off the steps. Cases of such injuries are more frequent in the winter season, when the ground is covered with ice.

Direct injuries include the following:

• striking the ankle with a blunt and heavy object;
• strong pressure on the leg from different sides (traffic accident, building collapse);
• forced rotation of the lower leg, while the foot itself remains fixed (sports injury);
• fall from a considerable height onto the foot.

Most people do not even think that one or another of their actions can affect the condition of the bone tissue and increase the risk of pathology. Consider a number of factors that increase the chances of a fracture. The most common is calcium deficiency in the body. And unbalanced nutrition can lead to this, in which there are not enough foods containing this element in the diet. A woman's intake of oral contraceptives may also help.

Physiological causes of injury

Among the diseases leading to a lack of calcium, it is worth highlighting:

• pathology of the adrenal glands;
• some disorders in the work of the kidneys, gastrointestinal tract, in which the substance is poorly absorbed, but is excreted rather quickly;
• lack of vitamin D3 in the body;
• acromegaly: a disease in which the functions of the anterior pituitary gland are impaired, which can lead to the growth of the feet, hands, skull.

There are also quite natural physiological causes of calcium deficiency. For example, in adolescence and childhood, the child's body grows quite intensively and rapidly, so it is very important to monitor its intake with food in sufficient quantities. The same goes for pregnant women and those who are breastfeeding. These processes are associated with a high consumption of this substance, which is a kind of building material for a nascent and developing organism.

Fractures often occur in older women. After the onset of menopause in their body, the level of hormones responsible, among other things, for the regulation of calcium metabolism, decreases.

The most unpleasant factor that can cause a violation of the integrity of the bone, even with minimal load, are pathological abnormalities. These diseases include:

• osteopathy (malformation of the bone);
• deforming arthrosis;
• osteoporosis;
• chondrodysplasia and a number of genetic mutations (Volkov's disease, Paget's disease, Morfan's syndrome);
• tuberculosis of bones and joints;
• arthritis;
• syphilis, leading to the appearance of foci of inflammation in the bone tissue;
• osteomyelitis;
• osteitis;
• the appearance of tumor cells in the bone tissue.

It is customary to distinguish three mechanisms of impact on the ankle, as a result of which its integrity is violated: you can turn the foot in the internal direction (supination injury), you can turn it in the external direction (protation injury) or get it when the ankle is rotated outward, inward (rotation injury).

In this regard, traumatologists distinguish several main types of injuries:

• Combined fracture. Also known as combined: it happens if several described mechanisms act simultaneously on the limb.
• Abduction-pronation fracture. It can only occur when the foot is forcibly turned outward, while applying considerable force. In this case, the inner ankle may come off at the base, and the outer ankle will break near the joint or a few centimeters above it, where the fibula becomes thin. A complication may occur in the form of a rupture of the tibiofibular anterior ligament and a small (within two millimeters) displacement of the bones. If the impact force was significant, there will be a pronounced outward subluxation with a rupture of two tibiofibular ligaments.
• Isolated flexion fracture. In turn, this injury is of two types: the posterior and anterior edges of the tibia.

In the first case, the fracture is obtained as a result of forced flexion of the sole of the foot. Such an injury is rare and rarely accompanied by displacement of the fragments. Its characteristic feature is the presence of a triangular bone fragment.

To get the second subtype of injury, it is necessary to bend the foot with force from its back side. It can also occur as a result of a strong blow to the front of the ankle joint. In this case, a fragment fragment of a triangular shape will also appear, but in the front side of the bone. Most often accompanied by a displacement of bone fragments up and forward.

• rotational fracture. It is observed as a result of a strong eversion of the foot into the internal or. Often there is damage to the two ankles in the articular region. May be accompanied by avulsion of the posterior tibia. This piece will be in the shape of a triangle. If the rotation of the joint is outward, then the injury to the ankle will be helical. The fracture in this case will stretch from the bottom of the bone to the top, and then turn outward. In the event that the acting force continues its pressure, damage and incomplete rupture of the tibiofibular ligaments occur. In addition, an avulsion fracture of the ankle occurs, aggravated by a rupture of the deltoid ligament.
• Adduction-supination fracture. Appears as a result of a strong forced rotation of the foot inward. In the process, there is a detachment of the upper end of the outer ankle or its fracture in the joint area. In this situation, the fracture line runs slightly higher than with an abduction-pronation injury. It may even affect the inner underside of the tibia. Often aggravated by subluxation of the foot to the inside. If the traumatic force continues to act, it will cause a vertical oblique fracture of the lateral malleolus to occur.

Additional classification

When no displacement of the bone fragments occurred during the fracture, such an injury is classified as “without displacement”. In the event that the discrepancy between the fragments is more than two millimeters, the fracture is called "with displacement of fragments."

A closed fracture of the outer ankle of the right tibia or the left is diagnosed only if there is no damage to the skin. An open fracture is characterized by a violation of the integrity of the soft tissues in the affected area, in which bone fragments are visible or even protrude.

When there is damage to only one ankle, such a fracture is called single-malleolar, and in case of injury to both the inner and outer ankles together, it is classified as double-malleolar. There is a case of violation of the integrity of the posterior or facial edge of the tibia with simultaneous damage to both ankles. Then we are talking about a trimalleolar fracture, which is considered severe. Such an injury is often accompanied by additional pathologies (displacements, divergence of the articular fork, trauma to the ligaments, subluxation).

The severity of the pathology, its nature directly depend on the strength of the impact, the mechanism of injury, the individual characteristics of the organism.

Symptoms indicating a fracture

As with any other injury of this kind, an ankle fracture is accompanied by characteristic symptoms:

• quite strong painful sensations that occur at the time of injury and persist for a long time, while they can give away from the affected area;
• increased pain when trying to make movements with the injured leg or during palpation;
• numbness of the injured leg;
• impaired motor function;
• general weakness, dizziness, nausea;
• limb deformity;
• hematoma;
• swelling or swelling of the affected limb;
• chills and feeling cold.

If the integrity of the blood vessels was broken during the fracture, or the nerve endings were damaged, the skin becomes pale in the affected area, and some neurological symptoms may be observed, for example, loss of sensitivity.

As a rule, the symptoms make themselves felt quite quickly, almost immediately after the injury, but in rare cases, some of them may appear after some time. It is extremely important to immediately go to the hospital so that an experienced traumatologist examines the injured leg and diagnoses the fracture in time.

It is not always possible to identify it on your own. For example, when a non-displaced fracture of the lateral malleolus occurs, it can be easily confused with a bruise or sprain by external signs. The damaged area is swollen, there is a slight bruising, but not necessarily. Functional abilities are not lost, a person can walk with an emphasis on the affected leg, and this process is limited to painful sensations. Axial load possible.

If a fracture with displacement of bone fragments is diagnosed, there is a cyanosis of the skin in the affected area, although its color may be red-purple. The leg swells, there is an extensive hematoma, a deformity of the limb appears, which can be determined visually. In rare cases, there is unhealthy mobility or crepitus (characteristic crunching of bone fragments). The victim cannot step on the injured leg.

First aid

To alleviate the general condition of the victim and prevent the situation from aggravating, it is important to provide first aid in a timely and correct manner.

Important! In no case do not move (twist, set, bend) the affected joint. To reduce swelling and soreness, you should raise the limb higher. To do this, it is gently lifted without touching the affected area, and a pillow, a roller from a blanket and other items are placed. This will ensure the outflow of blood and relieve unpleasant symptoms.

A cold compress is also applied for this purpose. Frozen food from the freezer, small jars or bottles from the refrigerator, just cold water will do. Ice should not be applied to bare skin, as this will cause additional injury. Before use, it should be poured into a suitable container or plastic bag, then wrapped with a cloth. Such a compress is applied for fifteen minutes, after which it is necessary to take a short break and repeat the procedure.

If there is an open wound with severe bleeding outside, you need to stop it immediately by pulling the limb just above the injury site with a tourniquet. Before transporting the victim, it is necessary to immobilize the limb by applying a splint. To do this, you can use improvised materials: boards, pipes, thick cardboard. Fixation is performed with bandages, belts, fabric strips and the like. In case of severe, unbearable pain, any non-narcotic pain reliever can be given.

Diagnosis and treatment of pathology

When you receive any injury, accompanied by prolonged pain and more severe symptoms, it is better to immediately go to the emergency room in order to avoid a number of undesirable consequences that occur with improper treatment.

Without the use of an X-ray study performed in two projections, a diagnosis cannot be made. In complex or incomprehensible situations, the patient additionally undergoes a computer or magnetic resonance imaging of the joint.

Therapy

When an ankle fracture is diagnosed, the doctor determines the treatment method. The conservative form is used during simple fractures (without displacement). In this situation, there is no shift of the bone fragments, so it is enough to simply immobilize the leg. To do this, use a plaster cast. The terms of its application range from four to eight weeks.

The situation with fractures with displacement is somewhat more complicated. In this case, the surgeon needs to return all fragments of the damaged bone to their natural physiological position. Reposition can be carried out both in a closed way and in an open way (during the operation). Be sure to apply local anesthesia during this procedure. If the fracture is aggravated by subluxation, then the traumatologist first sets the joint, and then compresses the ankle fork, returning the bones to their normal position. After that, the limb is fixed with a plaster boot, a control x-ray is performed.

It is recommended to use painkillers and UHF. When the swelling subsides completely, circulate (strengthen) the plaster cast. Depending on the severity of the injury, the healing process can take from a month to two. The gypsum is removed from the leg only when the bone is absolutely all grown together. To check this, control radiographic images of the affected limb are taken.

In the case when a multi-comminuted fracture, divergence of the articular fork, subluxation of the foot, the impossibility of fixing the fragments and preventing their displacement by the closed method are observed, it is recommended to perform surgical intervention. It is also applicable in cases where the fracture does not heal, the functional ability is impaired, or the patient is worried about intense pain. To fix the fragments, screws, metal knitting needles, bolts or special nails can be used. After the successful completion of the operation, the incision is sutured in layers, drained, then a plaster cast is applied.

Antibiotics, painkillers, therapeutic exercises and ultrahigh-frequency therapy are prescribed. In the rehabilitation period, it is necessary to strictly follow the recommendations of the attending physician.

Negative effects of trauma

Herbs that are not accompanied by displacement of bone fragments pass quickly and are rarely complicated by negative effects. There may be slight aching pains. This is usually due to worsening weather conditions or excessive physical exertion on the affected leg. As a result of the displacement of fragments, even if they were normally reponed, the injury can be aggravated by dystrophic pain syndrome, in which there are severe pain in the foot and joint that prevent stepping on the foot. This pathology occurs as a result of damage to the nerve endings and blood vessels. The following therapeutic methods of dealing with the disease are used:

• blockade with novocaine;
• paraffin therapy;
• novocaine electrophoresis;
• vitamin therapy;
• physiotherapy.

With the right treatment, the pathology disappears within one year.

In the case when the victim did not seek help in time, the negative consequences of such a negligent attitude towards his health develop. The bone tissue grows together incorrectly, as a result, constant pain appears, the limb is deformed, the joint is swollen, the motor function is impaired, when moving, the patient feels unstable, insecure, lameness appears. Removal will require surgery.

Timely diagnosis, proper treatment and compliance with all the prescriptions of the attending physician will help to recover from the fracture as soon as possible and return to the usual rhythm of life.

The ankle is the most vulnerable location for traumatic injury. Displaced ankle fractures are common, difficult to correct, and prone to recurrence. It can happen suddenly even when walking calmly, descending or climbing stairs.

Degenerative processes in the bone tissue with a fracture of this localization play an important role and complicate the course of the disease. Therefore, fracture is more common in the elderly.

What it is

An ankle is a bony tubercle that protrudes medially and laterally above the ankle joint. The medial (inner) malleolus is a process of the tibia, and the lateral (outer) is the fibula. Anatomical formations are part of the ankle joint, and is the most distal part of the lower leg.

It is formed from the articulation of the bones of the lower leg and foot. By structure, it is lateral and movements can be made only in one plane. Rotation in the joint is not possible at an angle of more than 65˚. Due to the scarcity of movements, this joint is the most stable and is able to withstand the load of the entire body weight of a person.

This joint performs a supporting function, is the most powerful depreciation mechanism in the human body, participates in any motor activity of the lower limb. Its stability is provided by the ligamentous apparatus of the foot: the peroneal and deltoid ligaments.

Varieties

Ankle fracture can be divided by anatomical location:

1. Fracture of the outer ankle;
2. Fracture of the inner ankle;
3. Bilateral fracture;

All fractures, without exception, including ankle fractures, can be divided into open and closed. According to the mechanism of injury, fractures are divided into:

• Supination (adduction). Occurs when the ankle joint is twisted outwards. In this case, most often there is a fracture of the ankle with displacement of the fibula;
• Pronation. Also called abduction. Reverse supination fracture, with it the foot is twisted in the ankle joint inwards. With this type, the medial malleolus is more often affected;
• rotational fracture. The main mechanism of injury in case of a displaced ankle fracture, as there is an excessive inversion of the foot outward or inward, due to which both ankles are affected, the body of the tibia is also damaged;
• Flexion. Often isolated fractures, in which there is a direct impact on the rear of the foot and as a fracture along the tibia in the region of its anterior surface, a fracture of the medial malleolus;
• Combined. It occurs through a combination of several mechanisms.

Bimalleolar fracture

Fracture of two ankles is the most common type. It can happen as a result of:

1. Adduction or abduction mechanism;
2. A fall onto the foot from a high height (with this type, not only a displaced ankle fracture occurs, but even an impacted fracture is possible);
3. Rotary injury mechanism.

A closed triple fracture is also called a Pott-Desto fracture. With a fracture of this type, damage occurs not only in the area of ​​\u200b\u200bthe two ankles, but also along the posterior edge of the body of the tibia. This type of fracture looks like a fork divergence. It is one of the most complex injuries in orthopedics and traumatology.

Plastic surgery for a displaced fracture

Conservative treatment of a displaced ankle fracture is practically impossible, since the likelihood of complications and improper union is high. Most often, surgery is performed.

Another reason for choosing an operative method of treatment as the most rational one is the damage to the ligamentous apparatus of the ankle, most often a tear or rupture of the ligaments. Treatment consists in matching the edges of the gap and stitching.

To prevent recurrence of damage to the ligamentous apparatus, reliable reposition of bone fragments is necessary, which is carried out using osteosynthesis. There are two options for osteosynthesis:

• Closed method - using the Ilizarov apparatus. In this case, the bone is drilled and needles are inserted into it, that is, fixation occurs from the outside. For the ankle, the method is not the most convenient due to the small area of ​​the distal part of the lower leg;
• The open method is by plastic surgery of the bone itself from the inside.

So, the plastic surgery is carried out in several stages:

1. Access to the affected bone structure is provided;
2. There is a revision of bone fragments, the elimination of infringement (interposition) of soft tissues (ligamentous apparatus, muscle fibers), stitching of damaged ligaments, stopping bleeding by ligation (ligation) or stitching of damaged vessels;
3. Fixation of bone fragments on a rigid, previously remodeled to a particular patient (specially adjusted) metal, more often titanium, plate. Strengthening is carried out using a system of screws and screws;
4. Layer-by-layer suturing of the surgical field is performed;
5. Immobilization of the ankle joint with a plaster bandage.

Rehabilitation

• exercise therapy. From the first days after surgery, exercises are allowed with the development of the knee, hip joint of the affected leg to accelerate blood circulation, prevent thrombosis and atrophy of muscle fibers;
• Physiotherapy treatment. After removing the plaster, electrotherapy, paraffin applications on the fracture site and other methods, except for magnetotherapy, are carried out;
• Massage. In the presence of gypsum, a thigh and lower leg massage is performed, after removal - the ankle joint. Immediately after the cast is removed, passive movements are performed in the ankle, massage using anti-inflammatory and warming ointments and gels to accelerate microcirculation and regenerative processes;
• After removing the cast, it is recommended to wear a special bandage on the ankle for additional fixation of the joint.

How long does it heal

A displaced ankle fracture heals on average within 2-2.5 months. In the presence of degenerative bone diseases, the time of wearing the cast is extended to 3 months.

The removal of the plaster occurs only under the control of the radiograph, in the presence of callus and signs of complete fusion of the damage, the start of rehabilitation measures is allowed. Rehabilitation lasts about 3 months.

When can I start walking without crutches?

After removing the plaster cast, rehabilitation begins under the supervision of a physiotherapist. He also sets the time when it is possible to step on the injured limb, depending on the readiness of the ankle joint for the upcoming load, and before that, the patient needs to learn how to walk on crutches to reduce the load on the diseased limb.

On average, it takes 2-3 weeks after the cast is removed, when you can step on your foot. While the joint is being developed, special orthopedic shoes are needed, the main task of which is to prevent re-injury.

Therapeutic walking is one of the main rehabilitation measures to restore ankle function. With timely and adequate treatment, correct rehabilitation, a patient after a fracture of the ankle with a displacement can run.

Rehabilitation should begin even during treatment, while a plaster cast is applied to the leg or skeletal traction is performed. It is important to maintain the physiological circulation of blood and lymph in the injured limb.

How does an ankle fracture happen?

A direct blow to the ankle rarely results in a fracture, mostly from excessive twisting of the foot or landing on it from a great height. At the same time, two subspecies are distinguished here: the pronation mechanism of injury and the supination mechanism.

With a pronation fracture, the foot turns outwards. And in this case, the following damage occurs:

• transverse ankle tear;
• fracture of the outer malleolus in an oblique direction - this option is characterized by displacement of fragments;
• rupture of all ligaments of the ankle joint - in this case, a dislocation of the foot joins the fracture of the ankle.

Supination fracture occurs when the foot is turned inward.

In this case, it may happen:

• transverse detachment of the outer malleolus;
• oblique fracture of the medial malleolus with displacement;
• torn ligaments and dislocation of the foot.

If there is a fall on the foot from a height, you can get damage to both ankles at once - a double fracture with displacement. More often, a person lands on both feet, so both ankles break at once.

Clinical manifestations of trauma with displacement

1. The initial symptom of a fracture will be a pronounced pain attack in the ankle joint.
2. Rapidly increasing swelling at the fracture site.
3. When the lateral malleolus is fractured, the foot deviates outward. Here you can notice a pronounced tension of the skin and palpate or see displaced bone fragments.
4. A fracture of the medial malleolus, accordingly, leads to an inward deviation of the foot. Skin tension and bone fragments will also be observed. If a dislocation joins the fractures of the ankle, then the foot will deviate further down. Any movement in the area of ​​the fracture causes increased pain.
5. If the vessels are damaged, a rapidly increasing hematoma in the area of ​​injury can be observed.
6. There is no massive bleeding in this case, but mixed shock can develop - both hemodynamic and pain.
7. In this case, there will be a drop in blood pressure, increased heart rate, pallor of the skin. More often this is observed with a fracture of both ankles at once.

Confirmation of a fracture radiologically

To find out the exact location of the fracture, the presence or absence of displacement, the free lying of fragments allows x-ray examination. It is necessary to take a picture from several sides - in the anteroposterior and lateral projections.

A transverse fracture is usually not accompanied by displacement, and with an oblique fracture, displacement of the fragments relative to each other can be detected.

First aid

Help for a person with a fracture should be provided immediately after the injury:

1. In order to prevent further displacement of fragments, immobilization of the injured limb is provided.
2. To do this, a tire - wooden, wire or pneumatic - is superimposed on the leg from the foot to the knee joint.
3. In case of severe contamination of the fracture site, it is necessary to wash the leg, preferably with an antiseptic solution. This is done before the splint is applied.
4. In case of severe bleeding, a tourniquet is applied to the lower leg, no more than two hours.
5. Anesthesia is carried out only by taking drugs inside. Injectable analgesics are not recommended due to possible infection of the fracture site.
6. With the phenomena of shock, support for cardiac activity and infusion therapy are necessary. Naturally, these activities are performed by medical workers right at the site of the injury.

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Surgery and other treatments

A displaced ankle fracture is treated only in a hospital setting. In addition to the direct treatment of a fracture, support of the whole body is necessary. For this purpose, painkillers, means to improve microcirculation, vitamins are prescribed.

After removing the cast, a course of preparations containing calcium is necessary to strengthen the bone tissue.

Conservative way of therapy

A simple displaced ankle fracture can be treated conservatively. For this, manual reposition of fragments is used, after which a plaster cast is applied.

According to traumatologists, an ankle fracture is one of the most common bone injuries. Usually, the injury is fixed in winter in those areas where the fight against ice and snow is not given due attention. Also at risk are athletes, children and women who prefer shoes with high heels. Almost all cases of fractures can be explained by the anatomical feature of the ankle, which takes on the greatest weight load.

An ankle fracture without displacement is an injury that is very easy to get. But not everyone can fully recover after it. 10% of such cases end in disability, especially in elderly patients. This is explained by the fact that during treatment, not only the bone is subject to restoration, but blood circulation, the work of the joints, as well as the innervation of the damaged area.

General information

The lower leg consists of two bones: the inner one, which has a significant thickness, and the outer one, which is thinner. Each of them gradually passes into a process: below, in the area of ​​\u200b\u200bthe inner bone, the inner ankle is located, and in the lower part of the outer bone is the outer ankle. The calcaneus and ankle form the ankle joint, thanks to which a person can walk.

At the ankle, bone fragments can either move or not. In this case, damage to soft tissues necessarily occurs. If a closed fracture of the ankle has occurred, only fragments are displaced in the damaged bone. The most common types of ankle fractures include:

• fracture of the medial (internal) ankle;
• fracture of the lateral malleolus (external);
• fracture of the lateral malleolus with displacement;
• fracture of the lateral malleolus without displacement;
• fracture of the inner malleolus without displacement and with displacement;
• screw-shaped ankle fracture.

A traumatologist can establish an accurate diagnosis by conducting a thorough examination of the victim and feeling the affected area. After all, it is possible that the resulting injury may be a severe bruise or dislocation. If the patient feels pain, and the leg is very swollen and there is a change in the shape of the joint, then, most likely, in this case there is a fracture. To finally determine this, the patient is sent for an x-ray. In the picture taken, you can clearly see any flaw on the bone.

Main symptoms

Depending on what type of injury is received, the victim may experience different symptoms. In the open form, when there is a violation of the integrity of the soft tissues and skin, bone fragments protrude from the wound. Displacement is obvious here, since it was the damaged bone that broke through the skin and flesh. A closed fracture of the leg is much more difficult to determine, since the soft tissues are damaged inside, and only the presence of minor hematomas can indicate a severe injury to the limb. A fracture of the lateral malleolus in the absence of displacement is considered harmless in terms of possible complications.

The symptoms that appear depend not only on the type of injury, but also on where the rupture of the bone tissue occurred. With an external ankle fracture without displacement, the main symptom is severe pain. A person cannot lean on his leg. In addition, there is a small edema on the outer part of the lower leg. The ankle joint flexes and extends, but such movements are very painful. The pain is especially acute if you try to move your feet in different directions.

With an internal fracture of the ankle with a displacement, the victim feels a sharp pain. Edema appears from the inside of the lower leg, smoothing the contours of the ankle. Sometimes the victim still manages to stand on his leg and even take steps, relying more on the outside of the foot or heel. Articular movements are limited, pain increases at the slightest attempt to move a limb.

With a displaced medial tear, the symptoms closely resemble a non-displaced fracture. However, since soft tissues and blood vessels are damaged, there is a large amount of hemorrhage. This is due to the presence of arteries in this area. Doctors know many cases when the symptoms of a fracture were mild, and the pain was tolerable. Therefore, the final diagnosis can be established only after studying the x-ray.

First aid

Orthopedist Anatoly Shcherbin:
"It is known that for the treatment of bones on the legs there are special insoles, correctors and operations that are prescribed by doctors. But we will not talk about them, and those medicines and ointments that it is useless to use at home. Everything is much simpler ..."

The first thing to do is to remove the effect of the traumatic factor. For example, in the event of an accident, release the ankle from squeezing. After that, you should try to calm the injured person, and if possible, give him pain medication. Then you should call an ambulance. It is very important not to make sudden movements and forbid the victim to stand on the diseased limb - this can provoke a displacement, which will lead to damage to blood vessels and nerve endings.

It is advisable to fix the diseased limb with some improvised means, and if possible, with a special transport tire. As an improvised tool, a wooden board, a piece of reinforcement, etc., is suitable, which must be tied to the leg with a bandage or ordinary cloth. In the case of an open fracture, it is desirable to apply a sterile dressing to prevent any infection from entering the wound.

If there is arterial bleeding, which can occur in the event of a fracture of the medial ankle, the tourniquet should be applied above the wound itself, preferably on the thigh. It is worth noting that with arterial bleeding, scarlet blood is observed, which pulsates and quickly flows out of the wound. But with venous bleeding, dark blood flows out slowly and without pulsation. In this case, a pressure bandage is required.

In the case of a closed fracture, it is advisable to apply cold to the sore spot - it can be used to reduce swelling and reduce pain. If possible, care should be taken to ensure that the injured limb takes an elevated position. For this, a roller, hand-made from improvised materials, is suitable. It is strictly forbidden to “set” the bone on your own. This, if necessary, will be done by a traumatologist who has studied the results of an x-ray.

Features of treatment

The treatment of an ankle fracture with and without displacement differs significantly. If, after examination and X-ray, no displacement is detected, a conservative method is used. It consists in applying a bandage to a broken bone, followed by fixing it with a bandage. When performing this procedure, it is not necessary to overtighten the bandage so as not to disrupt normal blood flow.

The bandage is applied from top to bottom to the very fingers, and then the bandaging continues in the opposite direction. The victim must wear a cast for at least one and a half months, although the final decision is made by the attending physician, who, when determining the period, is guided by the age of the patient. Immediately after removing the plaster cast, it is necessary to take an x-ray, based on which a rehabilitation course is prescribed.

If the bone is displaced after a fracture, then the conservative method is used only when it is possible to restore the natural position of the bones as accurately as possible. As a rule, under local anesthesia, the bones are set in place on the victim, and then a plaster cast is applied. In some cases, if the displacement has occurred again, the ankle is fixed in the immobilizer.

With an open fracture, surgical treatment is performed. In such cases, it is very important to deliver the victim to the clinic in a timely manner. During the operation, damaged bones are reduced, and torn vessels and soft tissues are sutured. Follow-up treatment for this type of fracture is the same as for closed fractures. Usually, for all forms of fractures, traumatologists prescribe anti-inflammatory drugs and drugs that stimulate the fusion of bone tissues.

Recovery period

Affected by such injuries most often concerned about the question: how to quickly cure an ankle fracture and how long it will take to recover. It is worth noting right away that each person takes a different time to heal - it depends on the type of injury and the age of the victim. After removing the cast, a person cannot fully step on the affected leg for some time.

After a fracture of the right or left ankle, it is very important to go through rehabilitation. Some activities can be carried out even before the cast is removed, others are permissible only when the bandage has already been removed.

Ankle called the place of articulation of the bones of the lower leg with the foot. In other words, this is the ankle, which looks like a bone process involved in the formation and further motor activity of the ankle joint.

Functions of the ankle joint:

• fully regulates the work of the foot;
• serves as a support for the human body;
• performs depreciation of the body.

If its fracture occurs, all functions are completely disrupted, which affects the quality of life of the victim.

There is, as well as its outer part. This happens depending on the type and severity of the injury. Quite difficult to determine on your own.

localization of damage after an ankle fracture, as the leg swells very much, while it hurts everywhere.

Causes of the fracture

The reasons may be different, but the main cause of damage to the bone formation is trauma:

• direct - a blow, as a result of which the joints are damaged and, as a result, an ankle fracture occurs;
• indirect - tucking of the leg is considered indirect damage, the fracture is accompanied by complications.

Only trauma, which is a mechanical effect on the ankle, can provoke a fracture. However, there are many predisposing factors during which the risk of leg injury is significantly increased.

Types of injury:

1. Straight.

Almost always leads to a fracture of the limb. This happens during an accident or when a heavy object falls on the foot.

1. Indirect.

It is a dislocation of the foot in various situations. It can be caused by a lack of stability on the surface (for example, rollerblading, skating), as well as when practicing traumatic sports or inaccurate walking on steep steps.

When the risk of an ankle fracture increases:

• lack of calcium in the body due to poor nutrition, during pregnancy, as well as in adolescence, retirement age and during certain diseases;
• various diseases of the skeletal system;
• overweight;
• diabetes ;
• wearing inappropriate shoes, especially high heels;
• engaging in traumatic sports;
• winter season.

If there are one or more predisposing factors, the likelihood of a closed ankle fracture is significantly increased.

Factors provoking a fracture can be traumatic, physiological and pathological.

Traumatic injuries include mechanical damage to the bone - blows, bruises, accidents or falls. Physiological causes are determined by the active growth of bone tissue, the period of pregnancy and age-related changes in the elderly.

The ankle is the articulation (the so-called "fork") between the lower leg and the foot, located in the lower part of the leg. From the point of view of anatomy, these are processes of the bones of the lower leg that form the articular surface.

An ankle fracture is a serious enough injury that leads to damage to one or more bones that form the ankle joint, which consists of the tibia, fibula and metatarsus.

You can break your ankle under a variety of circumstances. There are three groups of causes leading to damage to the ankle: traumatic, pathological and physiological.

Types of ankle fracture

Fracture of the lateral malleolus is mainly formed due to mechanical impact on the lower limb. The reason is often strong blows, injuries, falling from a height or getting into an accident.

With regards to trauma, it is customary to divide it directly and indirectly, which differ in the severity of the damage, the type of fracture and the therapeutic effect.

Clinical picture

The symptoms of an ankle fracture can vary depending on the type of injury. If there is an open fracture, then there is always a displacement of bone fragments, because it is they that cause damage to the skin and subcutaneous tissues of the leg. Blood flows from the wound, the place of injury hurts a lot.

A fracture without displacement is most often of a closed nature. A non-displaced lateral malleolus fracture is bruising and intensely painful, but without X-ray, it can be confused with other leg injuries, such as a sprain, subluxation, or dislocation.

Signs of injury largely depend on its location. Fractures of the inner ankle without displacement cause severe pain, the inner side of the lower leg swells strongly, due to which the ankle itself ceases to be visible.

Sometimes the victim does not lose the ability to lean on a sore leg, but he can only walk on his heel. And yet, any movement of the leg increases pain on the inside of the leg.

Kinds

There are several types of ankle fractures. Consider the most frequent.

According to the type of damage, open and closed fractures are distinguished. In the first case, you can see bone fragments and a wound that bleeds. In the second case, there are no such injuries, the integrity of the soft tissues is preserved.

According to the presence of bone displacement, injuries are classified into an ankle fracture with and without displacement.

Injuries are also classified according to the location of the injury. So, a fracture of the outer ankle and the inner one are isolated. According to the direction in which the ankle was injured, fractures are divided into pronation, supination and rotation, in which the tucking occurs respectively outward, inward and with rotation.

When other bones are involved or dislocation occurs, ankle fractures can be complicated.

Depending on the scale of the damage and its type, a fracture of the lateral malleolus without displacement or its internal part is classified into several different options. The mechanism of injury also influences us the classification of injury.

The type of ankle fracture is directly related to the mechanism of its receipt. Often, it is enough for a qualified traumatologist to hear how the injury was received and examine the patient in order to make a diagnosis, which is then only confirmed with the help of examinations.

The method of treatment and the duration of the rehabilitation period depend on the severity of the fracture and the development of complications due to injury. The classification of fractures is important for therapy planning, rehabilitation and disease prognosis for recovery.

According to the severity are distinguished:

• open fracture - a bone defect is accompanied by damage to the skin with sharp edges of bone fragments;
• closed fracture - trauma to the bone is not accompanied by the formation of a wound.

According to the nature of the location of bone fragments, they distinguish:

• ankle fracture without displacement - bone fragments are in an anatomically correct position in relation to the longitudinal axis of the bone;
• displaced ankle fracture - bone fragments are located at different angles to the longitudinal axis of the bone, injuring the surrounding soft tissues.

According to the localization of the injury, there are:

• fracture of the external ankle (lateral) - occurs in 80% of cases;
• fracture of the inner ankle (medial) - usually formed as part of complex injuries of the ankle joint;
• bimalleolar fracture - simultaneous injury of the medial and lateral ankle;
• trimalleolar fracture - damage to the medial and lateral malleolus is combined with a defect in the posterior surface tibia;
• a fracture of both ankles with the formation of a dislocation or subluxation of the foot is a complex injury that requires long-term treatment.

Frequent leg injury - fracture of the lateral malleolus when the foot is twisted

An ankle fracture is often accompanied by damage or rupture of the ligaments and tendons of the ankle joint, which complicates the course of the disease and increases the length of the rehabilitation period. In severe cases of open injuries or closed defects with bone displacement, complications appear in the form of hemorrhagic and traumatic shock, infection of the wound with the development of sepsis, fat embolism with damage to the pulmonary or cardiac vessels.

There are many types of ankle bone injuries. They depend on the location of the injury, its severity and associated injuries.

In the human leg there is a lateral malleolus, located on the outside and an inner malleolus, which is called the medial. Accordingly, depending on which of them is damaged, a fracture of the lateral malleolus or a fracture of the medial malleolus can occur.

Rarely, a bimalleolar fracture may occur. It is very difficult to treat a fracture of this type, and it grows together for quite a long time.

In addition, in 15% of such injuries, the patient remains disabled.

Fractures are usually divided into two large groups: open and closed. Closed fracture - without damage to the soft tissues of the leg. Open - on the contrary, it is accompanied by damage to muscles, skin and other soft tissues by fragments of a broken bone.

If we consider ankle fractures deeply, there are types:

• Open fracture;
• Closed fracture of the lateral malleolus or medial malleolus;
• Closed bimalleolar fracture;
• Closed fracture with displacement of the lateral malleolus or medial malleolus;
• Open fracture (sometimes with displacement and subluxation);
• Bimalleolar fracture with displacement, dislocation or subluxation.

There are several types of ankle injuries:

• Open fracture of the ankle with displacement;
• Closed fracture of the lateral malleolus without displacement;
• Closed fracture of the medial malleolus without displacement;
• Closed fracture of the lateral malleolus with displacement;
• Closed fracture of the medial malleolus with displacement;
• Displaced fracture of both ankles;
• Fracture of both ankles without displacement;
• Fracture with dislocation or subluxation of the foot.

Only an experienced traumatologist can diagnose a fracture and determine its type on the basis of an X-ray examination. Practice shows that if closed fractures can be displaced, without displacement, then with an open fracture, displacement of the bones is present in 90% of cases. Numerous bone fragments damage soft tissues.

The tactics of further treatment depends on the type of fracture, its location, concomitant factors. Determined by her doctor. Non-displaced fractures do not require surgical treatment if the patient immediately went to the hospital, but such situations are rare.

It is customary to consider the ankle as a single joint, but in fact, it is composed of two joints: the ankle and the talocalcaneal. The cause of damage can be a sharp or rapid movement of the ankle to the inside or outside. Very often, a fracture accompanies a sprain. Ankle fractures without displacement are divided into the following types:

1. Damage to the outer (lateral) ankle;
2. Damage to the inner (medial) ankle;
3. Fractures of the inner and outer ankle (bimalleolar).

Fractures without displacement are usually closed. Depending on the orientation of the damage, each type is divided into subgroups with a transverse or oblique direction of the fracture line. With a transverse fracture, the lateral surface of the talus presses on the top of the outer malleolus, and as a result breaks it off.

The direction of the fracture has a horizontal orientation. As a rule, the cause of such damage can be a strong tucking of the foot outward. With an oblique fracture of the outer malleolus, the tear line is oriented from the bottom up from the front to the back. This injury can result from foot tucking combined with abduction or from excessive outward rotation of the foot.

In a transverse fracture, tension in the deltoid ligament of the foot causes the medial malleolus to tear at its base or apex. The cause of this type of damage is a strong eversion of the foot to the outside.

An oblique fracture of the medial malleolus occurs when the foot is turned inward due to pressure on the medial malleolus of the calcaneus. As a result, the inner ankle breaks off. The direction of the fracture has an oblique or vertical orientation.

Less common than others in the practice of traumatology is a fracture of the internal and external ankles (bimalleolar). Such a fracture occurs with excessive abduction of the foot. Bimalleolar fractures can be of two types:

• pronation-abduction;
• supination-adduction.

Closed ankle fracture

According to the force of impact on the lower limb and severity, the fractures are divided into closed, open, displaced and non-displaced ankle fractures. And also distinguish unilateral or bilateral damage.

A closed fracture is determined by damage to the bone tissue. An open fracture is characterized by a violation of the integrity of the skin, muscles, blood vessels and bone, often accompanied by bone fragments.

A displaced fracture involves bones, joints, and ligaments. A non-displaced ankle fracture is the mildest type, in which only the bone is injured and treatment is conditioned only by the application of a cast.

According to the mechanism of injury to bone tissue, fractures are distinguished: pronation, supination, rotation. Often there are mixed types of fractures that require serious and timely treatment.

closed* fracture of the lateral malleolus, closed fracture of the medial malleolus, fracture with displacement** of the lateral malleolus, fracture with displacement of the medial malleolus, fracture of both ankles without displacement, fracture of both ankles with displacement, fracture of both ankles with dislocation or subluxation of the foot, open*** ankle fracture.

*closed fracture - a bone fracture without soft tissue damage, **displaced fracture - a fracture in which parts of the bones diverge relative to the axis of the bone under the action of muscle force. ***open fracture - a fracture with damage to soft tissues by bone fragments.

A pronation fracture occurs when the foot is twisted outward.

If all components are present, the pronation pearl is considered complete. Supination fracture occurs when the foot is twisted inward.

avulsion of the lateral malleolus; fracture of the medial malleolus; fracture of the distal tibia; subluxation or dislocation of the foot inward. If all components are present, the supination fracture is considered complete. A rotational fracture occurs when the lower leg rotates around its axis with the foot in a fixed position.

- fracture of the lateral malleolus without displacement (oblique and transverse) - pronation.

- fracture of the lateral and medial malleolus with displacement, dislocation of the foot outward - pronation. - fracture of the medial malleolus, oblique pearl of the tibia without displacement, rupture of the tibiofibular joint, fracture of the fibula and lateral malleolus with displacement, dislocation of the foot inward - supination.

- fracture of the tibia in the distal part, avulsion of the lateral malleolus, rupture of the tibiofibular joint, rupture of the medial ligaments, outward subluxation of the foot - supination. - a fracture with fragments of the fibula in the distal section, a fracture without displacement of the lateral malleolus, an oblique fracture of the tibia in the distal section, avulsion of the medial malleolus, rupture of the tibiofibular joint - supination.

• Ankle fracture with or without displacement of bone fragments.
• Ankle fracture with dislocation, subluxation or without dislocation of the foot.
• Open or closed fractures.
• Fracture of the external ankle, internal or a combination of both.

Signs, treatment and methods of rehabilitation after an ankle fracture

Damage to the lower leg, in which there is no displacement, is characterized by the ability to move the injured limb, but with limitations.

There are some signs of a fracture:

• mild pain;
• large swelling of the leg;
• the formation of bruises and bruises in the injured area.

Closed and open fractures. With closed forms of damage, only the integrity of the bone is violated, vessels and tissues are not injured; when open, a wound is formed that bleeds heavily. Since the ankle is located in an area where there are large vessels, the victim can lose a large amount of blood. It is very important to stop the bleeding process as quickly as possible.

Fragments protruding outward can shock a person, psychological and pain shock is possible. After an ankle fracture and before the arrival of doctors, it is imperative to provide first aid to the victim.

Ankle fracture is one of the most common types of injuries associated with a violation of the integrity of the bones of the lower extremities.

Symptoms

Common symptoms include:

• limb numbness;
• severe pain, which most often appears not in the damaged area, but in another area;
• nausea;
• dizziness, weakness;
• feeling cold, chills;
• lack of mobility in the joint.

Displaced ankle injury:

• acute pain;
• severe swelling of the lower leg;
• lack of motor function in the leg.

When the inner part of the ankle is displaced:

• swelling;
• sharp pain;
• inability to stand and move independently.

Increased symptoms after an ankle fracture is a good reason to seek help from a doctor as soon as possible. This will allow timely treatment to begin, which will prevent improper bone fusion, as well as a number of other problems. You can identify a serious foot injury by several main symptoms.

Signs to look out for:

• a loud crunch during an injury often indicates a broken bone;
• if a person breaks his leg, it pierces a sharp pain, which does not allow palpation of the injury site and moving the foot;
• edema, which is observed in the ankle area, but can pass to the lower leg;
• hematomas in fractures are also extensive;
• inability to move the foot or the whole leg.

In most cases, a complex of similar symptoms indicates a leg fracture and requires seeking qualified treatment. However, the victim can be given first aid before the arrival of the medical team.

General symptoms of fractures:

• The victim feels acute pain, radiating not only in the injured ankle;
• The joint of the foot loses mobility, gradually becomes numb;
• The worsened condition of the injured is accompanied by weakness, dizziness, nausea;
• Feels chilly and cold.

Closed, no offset:

• Severe pain at the site of injury;
• Swelling or swelling of the ankle, most pronounced at the site of injury, on the lateral (outer) ankle or medial (inner);
• Difficulty stepping on a diseased limb, due to pain;
• For a similar reason (pain), the ability to bend and unbend the leg is reduced;
• In case of a fracture of the inner ankle, the pain is concentrated exclusively in the indicated area, when palpated, it radiates to the inner bone. In case of an injury to the external ankle, when pressing on any point of the lower leg, for example, on calf muscle the pain radiates to the broken spot.

Closed, displaced or subluxated:

• Sharp and extremely severe pain at the site of injury;
• Severe swelling and swelling of the ankle, lower leg;
• Deformation of the bones of the foot;
• Impossibility of independent movement;
• Inability to step on the injured foot.

Open fracture of the ankle: similar to the closed type, complicated by the appearance of a laceration and bleeding (sometimes extremely heavy).

Signs of a fracture of the ankle of the lower leg are presented in the plate.

Table 3. Symptoms associated with a fracture.

According to traumatologists, an ankle fracture is one of the most common bone injuries. Usually, the injury is fixed in winter in those areas where the fight against ice and snow is not given due attention.

Also at risk are athletes, children and women who prefer shoes with high heels.

Almost all cases of fractures can be explained by the anatomical feature of the ankle, which takes on the greatest weight load.

An ankle fracture without displacement is an injury that is very easy to get. But not everyone can fully recover after it.

10% of such cases end in disability, especially in elderly patients.

This is explained by the fact that during treatment, not only the bone is subject to restoration, but blood circulation, the work of the joints, as well as the innervation of the damaged area.

General information

Ankle fracture is a complex but fairly common injury.

The lower leg consists of two bones: the inner one, which has a significant thickness, and the outer one, which is thinner.

Each of them gradually passes into a process: below, in the area of ​​\u200b\u200bthe inner bone, the inner ankle is located, and in the lower part of the outer bone is the outer ankle.

With an open fracture of the ankle, bone fragments can either move or not. In this case, damage to soft tissues necessarily occurs. If a closed fracture of the ankle has occurred, only fragments are displaced in the damaged bone. The most common types of ankle fractures include:

• fracture of the medial (internal) ankle;
• fracture of the lateral malleolus (external);
• fracture of the lateral malleolus with displacement;
• fracture of the lateral malleolus without displacement;
• fracture of the inner malleolus without displacement and with displacement;
• screw-shaped ankle fracture.

Main symptoms

X-ray of an internal ankle fracture with displacement

Depending on the type of injury received, the victim may experience different symptoms.

In the open form, when there is a violation of the integrity of soft tissues and skin, bone fragments protrude from the wound. Displacement is obvious here, since it was the damaged bone that broke through the skin and flesh.

A closed fracture of the leg is much more difficult to determine, since the soft tissues are damaged inside, and only the presence of minor hematomas can indicate a severe injury to the limb.

A fracture of the lateral malleolus in the absence of displacement is considered harmless in terms of possible complications.

The symptoms that appear depend not only on the type of injury, but also on where the rupture of the bone tissue occurred. With an external ankle fracture without displacement, the main symptom is severe pain.

A person cannot lean on his leg. In addition, there is a small edema on the outer part of the lower leg. The ankle joint flexes and extends, but such movements are very painful.

The pain is especially acute if you try to move your feet in different directions.

With an internal fracture of the ankle with a displacement, the victim feels a sharp pain. Edema appears from the inside of the lower leg, smoothing the contours of the ankle.

Articular movements are limited, pain increases at the slightest attempt to move a limb.

With a displaced medial tear, the symptoms closely resemble a non-displaced fracture. However, since soft tissues and blood vessels are damaged, there is a large amount of hemorrhage.

This is due to the presence of arteries in this area. Doctors know many cases when the symptoms of a fracture were mild, and the pain was tolerable.

Therefore, the final diagnosis can be established only after studying the x-ray.

First aid

The first thing to do is to remove the effect of the traumatic factor. For example, in the event of an accident, release the ankle from squeezing.

After that, you should try to calm the injured person, and if possible, give him pain medication. Then you should call an ambulance.

It is very important not to make sudden movements and forbid the victim to stand on the diseased limb - this can provoke a displacement, which will lead to damage to blood vessels and nerve endings.

As an improvised tool, a wooden board, a piece of reinforcement, etc., is suitable, which must be tied to the leg with a bandage or ordinary cloth.

In the case of an open fracture, it is desirable to apply a sterile dressing to prevent any infection from entering the wound.

The main symptomatology of the disease is severe enough severe pain. All the symptoms present and their appearance depend on the severity of the damage. In case of damage carried out without displacement, the picture is a bruise or tear of the ligaments.

Hemorrhage of soft tissues at a fracture

It is possible to timely identify a fracture of the inner ankle with the help of certain signs that develop immediately and have a pronounced character.

Diagnostics

Diagnostic measures include a survey, examination of the victim, as well as the implementation of various examinations. It is almost impossible to visually assess how badly the ankle is damaged, whether the outer or inner part has been fractured. For these purposes, an x-ray is used, which is carried out in three projections (direct, oblique and lateral).

If there is a fracture, on the x-ray you can see:

• a line of bone fracture in a contrasting color;
  
• if there was a rupture of the ligaments, an unnatural expansion of the ankle joint gap or its deformation is observed on the x-ray;
  
• soft tissues are thickened.
  

As a rule, these measures are enough to make the correct diagnosis and prescribe treatment when a person has broken his leg. At this stage, the doctor can assess the condition of the victim, as well as answer the question of how much to walk in a cast and whether it is needed at all.

If a fracture of the ankles is suspected and the degree of bone deformity is identified, an X-ray examination of the ankle joint is performed in direct, lateral and oblique projections. In complex clinical cases, computed tomography (CT) is prescribed, which studies bone damage in more detail.

The formation of hematomas and concomitant damage to soft tissues (ligaments, muscles, nerves, blood vessels) requires magnetic resonance imaging (MRI).

The yellow arrow indicates a displaced medial malleolus fracture.

Timely diagnosis and adequate treatment prevent the development of complications and the appearance of disability. Therefore, after a fracture, the victim should be immediately taken to the hospital by calling an ambulance.

During transportation, the injured limb is immobilized using standard (Cramer, pneumatic) or improvised (boards, sticks, umbrellas) splints. Stop arterial bleeding by applying a tourniquet, and venous bleeding by applying a pressure bandage.

Give the patient painkillers to prevent traumatic shock.

Fracture treatment is carried out conservatively or surgically in a trauma hospital. The conservative method is used for the treatment of injuries without displacement or with displacement of bone fragments with absolute contraindications to surgery (heart and kidney failure, diabetes mellitus).

Bone fragments are compared with each other under local or general anesthesia. A plaster splint is applied to the injured ankle, which captures the foot and lower leg up to the knee joint.

Before and after the plaster is applied, X-rays are taken to control the correct reposition of damaged bone areas.

In other cases, surgical intervention is prescribed, in which bone fragments are fixed with screws, knitting needles, titanium plates. Then a plaster cast or a specialized bandage made of metal or hard plastic is applied. Treatment with limb immobilization lasts from one to two months.

Surgical treatment of a fracture of the lateral malleolus with a plate

How long the cast will last depends on the age and severity of the injury. In children, therapeutic immobilization usually lasts no more than a month, in young people - an average of 1.5 months, and in old age, immobilization of the leg is carried out for 2 months. The most difficult is considered a trimalleolar fracture, which is accompanied. Treatment of such an injury can take up to 3 to 4 months.

After removing the plaster, a control x-ray is taken to make sure that the bone defect has healed correctly. With positive dynamics of the disease, patients can step on the foot. To improve blood flow in the injured limb, eliminate swelling of the ankle, develop the joint and strengthen the muscles of the leg, massage, physiotherapy, and exercise therapy are prescribed.

Remedial gymnastics exercises are developed individually for each patient. Training is carried out in special groups at hospitals and rehabilitation centers.

Self-study is recommended - rolling a bottle or a tennis ball with the foot, walking alternately on toes and heels, grabbing small objects with the fingers of the sore leg. The recovery period is as important for recovery as timely diagnosis and treatment.

An ankle fracture is one of the most common musculoskeletal injuries. If you seek medical help early and follow all the doctor's recommendations at each stage of the treatment process, the injury has a favorable outcome and rarely leads to disability.

The student and the doctor must know the principles of treatment of ankle fractures and the method of repositioning dislocations and subluxations of the foot.

In order to prescribe the correct treatment, the doctor needs to establish the type of injury. To do this, he conducts a series of studies:

• visual examination of the injury site for the presence or absence of skin lesions, assessment of foot deformity, detection of hematomas;
• palpation for crepitus (done very carefully and not always);
• x-ray examination conducted in front and side of the injury;
• magnetic resonance imaging helps to see the condition of the ligaments, joints, muscles, nerves and blood vessels;
• computed tomography reveals any changes in the structure of bone tissue;
• ultrasound examination shows changes in the cavity and structure of the joints.

Having made a diagnosis, the doctor prescribes the treatment that he considers the most effective in this situation. Having heard what kind of fracture occurred, you should not immediately ask the doctor how long the treatment will last and how quickly the fracture heals. It depends not only on the treatment and type of injury, but also on the body itself.

Before the victim enters the hospital, it is necessary to provide him with complete rest, preferably by fixing the position of the limb with the help of improvised means.

In the presence of the above symptoms, to diagnose the presence and type of fracture, it is necessary to conduct

Rice. 6.

X-ray of a healthy ankle joint, direct projection.

Tibia - tibia, Talus - talus, Fibula - fibula, medialis malleolus - medial malleolus, lateralis malleolus - lateral malleolus.

Radiography is performed at the beginning to clarify the diagnosis, after surgery, after rehabilitation to assess the effectiveness of the treatment and recovery.

Bone fracture line: oblique, longitudinal and spiral. It can be determined on one or several bones, depending on the complexity of the fracture.

The expansion of the gap of the ankle joint appears when the ligaments are torn. Depending on the group of damaged ligaments, the expansion of the gap is noted in the corresponding part.

Deformation of the gap of the ankle joint in the form of a wedge is detected with subluxation of the foot. The presence of displacement of bone fragments on radiographs is determined in the form of various combinations of bone planes.

Soft tissue thickening in the area of ​​the fracture On radiographs of ankle fractures, there may be various changes, it depends on the type of fracture and the mechanism of injury.

computed tomography (CT), magnetic resonance imaging MRI (allows you to assess not only the condition of the bones, but also the condition of the ligaments, tendons, muscles, blood vessels and nerves), echography (ultrasound) of the ankle joint allows you to assess the condition of the hematoma of the soft tissues, ligaments and muscles. Rice. 7. MRI section of the ankle joint, normal

Fig.7. X-ray of the right ankle joint, direct and lateral view. Closed fracture of both ankles with displacement of the lateral ankle and subluxation of the foot forward, damage to all groups of ligaments of the ankle joint (supination mechanism of injury).

1 - fracture line with displacement of the lateral malleolus,

2 - fracture line without displacement of the medial malleolus,

3- deformity of the ankle joint gap, which indicates damage to the ligaments of the lateral and medial groups,

4- displacement of the ankle joint forward,

5 - subjective sign of damage to the tibiofibular joint.

Rice. 8. Direct radiograph of the left ankle joint. Fracture of both ankles with outward subluxation of the foot, damage to the medial group of ligaments and tibiofibular joint.

• Inspection: visual and clinical evaluation of the injured limb segment as noted above.
• Radiography: a standard method for diagnosing fractures of any type and localization, for a correct assessment of damage, it is performed with the capture of the distal and proximal joints from the site of injury;
  - a picture of the bone is performed in the anterior and lateral projections;
  - is carried out at each stage of treatment (after a fracture, a few weeks after the application of a plaster cast or surgery, and after a few months to assess the processes of consolidation).
• MRI: does not carry a radiation load and can be performed multiple times;
  - allows you to more accurately assess the location of the fracture;
  - contraindicated after metal osteosynthesis.
• CT: the most informative method for diagnosing fractures;
  - allows you to examine the fracture area in layers and identify any pathology of the skeletal system;
  - carries a strong radiation load and is performed according to strict indications.
• X-ray densitometry: allows you to determine the mineral density of the bone and is the standard in the diagnosis of osteoporosis;
  - indicated for frequent fractures.
• Ultrasound: is an additional method and allows you to evaluate the cavity and structures of the joint.

Treatment

Treatment involves the return of all the functions that should be performed by the limb. So that the leg does not remain motionless forever, it is necessary to follow the recommendations of the doctor!

Treatment is carried out in accordance with one of the main methods - conservative or surgical.

With conservative treatment of injuries that are accompanied by displacement, after the removal of edema, the fragments may be displaced. Other disadvantages of the method include the impossibility of eliminating subluxation of the ankle joint and a long rehabilitation period. The type of treatment is selected by the doctor, based on the type of injury and its nature.

Treatment without plaster. For mild fractures, therapy alone is sufficient. The method is characterized by a quick recovery, which usually takes 6 to 8 weeks.

Plaster overlay. This method of treatment is suitable for fractures in which there is no displacement of fragments. Gypsum is applied to the knee in the form of a boot.

For displacements, a plaster cast is used, the damaged joint is set under anesthesia. If the x-ray shows the normal state of the damaged area, the bandage is worn for 2-2.5 months, it all depends on the severity of the injury.

Operative treatment. The operation is done only with severe injuries of the ankle, when the plaster bandage fails to connect the fragments. For chronic, unsuccessfully treated or untreated fractures, surgical treatment is also performed.

The operation can be performed on the 2nd or 5th day after the ankle injury. When the fragments are displaced, an operation is also prescribed. In order to control the process of fusion of fragments, periodic radiography is required. Full recovery occurs in 1.5-2 months.

Skeletal traction. The implementation of this method is necessary when bone fragments cannot be kept in one place, with dislocations and extensive displacements.

A needle is inserted through the calcaneus, to which a load weighing 5-12 kg is suspended and gradually reduced. Some time after traction (usually 3-4 weeks), a plaster bandage is applied to the area affected by the injury.

The patient needs bed rest, the observance of which is necessary throughout the entire period of treatment. Disability can persist up to 6 months. In most cases, recovery occurs after 4 months.

With a fracture without displacement, treatment is usually not very long. However, therapy is still necessary. This will prevent improper fusion of bone and muscle tissue, which can affect a person's future life. Treatment must be comprehensive.

The traumatologist prescribes painkillers, fortified complexes that contain calcium. Also, the patient needs to establish a good diet. Almost always, after an ankle fracture, a specialist applies a plaster cast. Rarely, surgery is indicated.

conservative

Conservative treatment is the use of various medications for speedy healing. A cast is also applied for a broken ankle, which helps the broken bones to heal properly.

In what cases is conservative treatment prescribed:

• if there is no displacement of the joints;
• there is minor damage to the ligaments of the foot;
• there is no possibility of surgical intervention.

The bone grows together only with the correct imposition of gypsum. It is applied to the entire surface of the lower leg and foot, fixing the joints in a physiological position. After the procedure, the patient should not experience strong pressure on the leg, a feeling of heaviness, friction or numbness of the lower limb. In this case, the gypsum application can be considered successful.

Then the specialist conducts a second examination on an X-ray machine, which helps to assess the position of the bones in the cast. At this stage, you can see the displacement of the bones, which may have occurred when the dressing was applied. On average, gypsum is applied for 1-2 months or according to indications.

Operational

Sometimes it is indicated to treat a limb after an ankle fracture with surgery. The operation is prescribed in severe cases, when alternative therapy has not brought positive results or the specialist sees that it does not make sense.

When is the operation performed:

• during open fractures;
• complex fracture with numerous bone fragments;
• the joints are already growing together incorrectly due to the lack of timely seeking help;
• a bimalleolar fracture occurred (that is, an injury to both limbs at the same time);
• ligament rupture.

The main goal of surgical intervention is to restore the anatomical location of the bones and all its fragments, stitching together damaged ligaments, fascia. After carrying out all the necessary manipulations, the patient is also put in a cast, with which he walks for at least 2 months.

When an ankle fracture occurs, treatment can be conservative or surgical. Without displacement, a fracture does not require surgery, especially if it has a closed form.

Sometimes surgery is not performed even if there is displacement, if the doctor can set the fragments with his hands, or if the patient has contraindications to the administration of anesthesia and the operation.

Conservative treatment

With a conservative method of treatment, a plaster is applied to the sore spot, capturing the foot and the entire back of the lower leg. Fixation occurs starting from the bottom of the lower leg, while the foot, on the contrary, begins to be fixed from above.

The gypsum is applied in such a way as not to pinch the tissue. If the patient feels a feeling of tightness or numbness of the fingers after the plaster cast has been applied, then it must be loosened.

After the plaster has been applied, the patient is allowed to move only using crutches. Relying on a diseased limb is prohibited. After the cast is applied, the patient is given an x-ray to see if the bone is aligned correctly and if there has been a secondary displacement of the bone fragments.

Surgery

The operation for a fracture of the left ankle or its right department is carried out:

1. If the damage is open;
2. When manual reduction proved ineffective;
3. If it is impossible to carry out manual reposition due to the large number of fragments, their slight displacement, as well as the complete separation of the bone;
4. With chronic fractures that have grown together incorrectly;
5. During an ankle fracture, combined with other fractures of the same leg;
6. With a fracture of the ankles on both sides;
7. During the rupture of the tibiofibular cartilage, as well as the ligaments that hold the ankle joint.

The operation, if there is a fracture of the ankle, is done under general anesthesia and is performed in order to restore the correct shape of the bone, open reposition of fragments, osteosynthesis, and restoration of the ligamentous apparatus. After this type of treatment has passed, you can get out of bed no earlier than a month later, using crutches.

Treatment for an ankle fracture is quite lengthy and includes taking anti-inflammatory and pain medications. It is allowed to start walking without crutches after four months. At the same time, it may take two years for the full recovery of the leg.

The ankles (ankles) are the bony structure of the lower leg joints that distribute a person's weight on the feet. The thinnest part of the leg consists of two components: the lateral (outer) and medial (inner) ankles. Visually, they look like a large process on the outside of the ankle and a small one on the inside.

According to statistics, a leg fracture in the ankle is a common injury that is treated in trauma centers. The causes are trauma: direct or indirect.

A direct injury is a blow that falls directly on the leg and causes a fracture of one (external or internal) ankle, or both simultaneously (bimalleolar). Under the indirect understand the injury that happened, for example, in connection with the subluxation of the leg. In everyday life, it occurs in people more often than direct trauma.

There are indirect causes that increase the risk of an ankle fracture. These include physiological deficiencies (intensive growth during childhood or puberty, old age, pregnancy and breastfeeding), calcium deficiency, bone disease.

The basis of any treatment for a fracture of the limb is the restoration of previous functions, before the moment of injury.

There are methods for treating broken bones:

• Treatment without the imposition of a plaster bandage. The method consists in the use of therapeutic agents, prescribed for mild injuries. Recovery occurs in about 8 weeks.
• Plaster casting is used for injuries without displacement, with displacement, with fractures, weighted by dislocation or subluxation. In these cases, before applying a plaster cast, the deformed bone is set. The bandage is applied to the leg from the foot to the knee. The fusion of bones occurs within 2 months.
• Surgery is used for open fractures or in severe cases with subluxation, displacement or dislocation, when the plaster cast is not able to fix bone fragments, they are displaced. Surgery is indicated in the treatment of improperly fused bones or in cases of complete nonunion. Necessarily, to control the correctness of the installation of the bones in place, successful fusion, it is necessary to regularly take an x-ray of a broken limb. Full recovery occurs in a period of 1.5 - 2 months.
• A skeletal traction is required for a patient with severe dislocation, dislocation, or subluxation, whose broken pieces of bone are not fixed in place. In such a situation, a spoke with a load is used, the weight of which, sometimes, reaches 12 kg. A month later, the hood is removed, the patient is put in plaster, bed rest is maintained. Recovery in such severe cases is sometimes delayed up to six months.

The therapeutic effect in apical, lateral and medial fractures is determined by the severity of the injury, the degree of damage, and the type (open or closed).

Plaster cast is usually applied, in difficult cases, surgical intervention is used if the fracture is accompanied by displacement or fragmentation of the bone tissue.

Features of therapeutic tactics are presented in the table.

Table 5. Methods of therapy.

Wearing orthoses

The ankle is a process of the leg bone that is involved in the formation of the ankle joint. According to statistics, it is this part of the human body that is injured much more often than others. One of the varieties is an ankle fracture without displacement.

Varieties of damage

It is customary to consider the ankle as a single joint, but in fact, it is composed of two joints: the ankle and the talocalcaneal.

The cause of damage can be a sharp or rapid movement of the ankle to the inside or outside. Very often, a fracture accompanies a sprain.

The direction of the fracture has a horizontal orientation. As a rule, the cause of such damage can be a strong tucking of the foot outward.

With an oblique fracture of the outer malleolus, the tear line is oriented from the bottom up from the front to the back.

This injury can result from foot tucking combined with abduction or from excessive outward rotation of the foot.

Treatment of ankle fractures

In addition to the first aid methods listed above, a few more important details should be added.

After providing first aid for an ankle fracture, the victim is examined in a medical institution, where a traumatologist determines the type of fracture and selects further tactics for the treatment and rehabilitation of the patient.

In the treatment of a fracture, conservative or surgical treatment is used. But, given the complexity of the ankle joint, fractures in this area also occur complex, which requires surgical intervention.

Conservative treatment of ankle fracture

There are two fundamentally different approaches to the treatment of an ankle fracture: conservative and surgical. Indications for conservative measures (imposition of a plaster splint) include:

• Closed fracture of one or two ankles without displacement of bone fragments and without rupture of the ligamentous apparatus;
• With adequate repositioning of fragments by a traumatologist;
• The impossibility of performing surgical intervention (severe comorbidity, refusal of the victim from the operation).

A plaster splint is applied along the back surface of the lower leg and on the entire plantar part of the foot, after which it is securely fixed with a regular bandage. Such a splint should not strongly squeeze the lower leg, as this can lead to acute circulatory disorders in the injured limb.

After applying a plaster splint, it is necessary to perform repeated radiography to exclude displacement of bone fragments.

It is important to understand that the removal of the cast occurs only after 6-12 weeks and it depends on the degree of bone consolidation, the complexity of the fracture and the formation of bone callus, which is periodically assessed using x-ray control.

That is, to the question of how much to be in a cast with an ankle fracture, the answer is from 1.5 to 2.5 months. While wearing a plaster splint, in no case should you step on your foot, as this can cause a repeated displacement of all the same fragments and surgical intervention.

Recovery after a fracture can last from 2 to 12 months. It depends on the general condition, age, metabolism of vitamins and micro / macro elements, as well as the complexity of the fracture itself.

• Complete rupture of the ankle ligaments;
• Complete dislocation of the foot, combined with displacement of fragments;
• Open fracture;
• Various complex fractures (old, repeated, separation between the tibial joint, Dupuytren's fractures);
• Active bleeding;
• The formation of an extensive hematoma.

• Prevention of infection: prescribing antibiotics and regular wound dressings.
• Pain relief: pain relief and comfort for further treatment.
• Treatment of concomitant pathology.

Conservative therapy

Operations for a fracture of the ankle, ankle are required for open injuries and for serious violations of the integrity of the bone with displacement. Surgeons-traumatologists set the bones, reshape the joint.

After applying a plaster cast, calcium preparations are prescribed to the patient. Their intake helps to improve the process of bone regeneration. The price of medicines is indicated on the diagram.

Putting a cast on an injured leg

Ankle fracture is always accompanied by the imposition of a plaster splint. It is used if there is no displacement, bone fragments and when surgery is contraindicated.

The duration of wearing a cast depends on the age of the victim, the severity of the ankle fracture. As a rule, children for 1 month, adults from 6 weeks, the elderly from 2 months.

The plaster bandage is removed after the final healing of the tissues and the fusion of the bones. To do this, the doctor takes an x-ray. At the time of the splint, you should move around with crutches, then holding on to the cane. In the early days, it is advisable not to strain your leg.

• The first 10 days after limb fixation, UHF therapy, magnetotherapy and interference currents reduce tissue swelling and reduce pain due to the acceleration of microcirculation. Magnetotherapy is contraindicated in MOS. More about indications and contraindications of magnetic therapy.
• 10-45 days of ultraviolet irradiation of the limb (suberythemal and erythemal doses) to improve bone regeneration and sufficient production of vitamin D.
• 45-90 day interference currents with a frequency of up to 100 Hz to enhance local metabolism.

First aid

After an ankle fracture, if there are appropriate signs, first aid is required. The victim needs to be treated correctly and in a timely manner. This is important, because the consequences can be quite serious, a closed injury can take an open form.

It is forbidden to touch the damaged joint. The leg should be slightly raised by placing a small roller under it. In case of severe pain, the victim can be given an anesthetic. If the fracture is closed, something cold should be applied to the injured area: the pain will not be so strong, it will be possible to remove the swelling.

When soft tissues or arteries are damaged, a tourniquet should be immediately applied above the resulting wound and the victim should be assisted by qualified specialists.

It is not necessary to give the person water, drinks, or food, as in some cases the patient is anesthetized. Be sure to immediately remove the injured foot from the shoes. The foot gradually swells more and more, and over time it becomes difficult to remove shoes.

With an open fracture, do not touch the wound or try to insert the damaged bone into place.

To reduce pain, you can drink a tablet of any analgesic that is on hand or inject it intramuscularly, which is more effective. For example, Nurofen, Ketanov, Analgin, Diclofenac and others. You should make sure that the victim has no contraindications to taking these funds.

If the injury was due to a traffic accident, you should not remove the victim from the car yourself. Such actions are justified only if a person continues to be in danger (for example, a fire has occurred).

Often people get injured on the street. The presence or absence of negative consequences and all further treatment depend on the correctness of first aid. If you fell on slippery ground in winter or twisted your leg badly, you should not immediately try to get up.

At this time, the body experiences a painful shock, numerous protective reactions are activated. rising, you will feel a noticeable dizziness, nausea, darkening in the eyes. There is a high probability of a repeated fall due to disorientation in space.

Do not immediately try to stand on a sore leg, this can provoke a displacement of a broken bone. It is advisable to remain still until the ambulance arrives. Call on the help of those around you.

If you find yourself in the role of a witness to a fall, the main thing is not to harm the victim with your actions. You need to do the following:

1. Immediately call an ambulance;
2. Do not let the patient stand on the injured leg;
3. Release the limb from squeezing factors - foreign objects, shoes, tight clothes (a fracture always provokes swelling of the tissues, then it will be even more difficult to remove the shoes);
4. Place a hard roller under the knee of the sore leg (it can be formed from clothes, improvised means) to ensure normal blood supply to the limb;
5. With an open fracture, it is strictly forbidden to touch the wound;
6. In case of bleeding, it is desirable to apply cold to adjacent intact tissues, form a tourniquet above the wound;
7. Fix the leg with the help of improvised means - sticks, boards. If there is nothing suitable nearby, you need
8. Fix the sore leg to the healthy one;
9. After the arrival of the ambulance doctors, bring them up to date.

If an injury has occurred and there is a suspicion of a fracture of the ankles (pain, disruption of the ankle joint, swelling, hematoma), then the patient must be taken to a trauma center. Better call an ambulance.

But before the arrival of doctors, it can take more than a dozen minutes, and if this is a rural area, then hours. Therefore, it is necessary to begin providing first aid before the ambulance arrives.

the transition of a closed fracture to an open one, displacement of bone fragments, traumatic or painful shock, increased bleeding, dislocation or subluxation of the foot, damage to blood vessels and nerves by bone fragments, and others.Principles of first aid for suspected ankle fractures:

Complications after MOS surgery and their treatment

You should not break the rules of recovery after a fracture or not go to the doctor at all. This is fraught with the development of serious complications, which subsequently require surgical intervention. And the lack of surgery, in turn, leads to a number of even more serious problems.

Patients who neglected the recommendations of specialists are often diagnosed with arthrosis of the joints, the formation of a false joint due to improper bone fusion, and other problems with the musculoskeletal system. If the joint has grown together incorrectly, the victim has lameness, constant pain in the legs and the inability to move normally without discomfort in the ankle.

The prognosis for recovery depends on the severity of the resulting fracture. Of course, if it is two-ankle and consists of many fragments, the victim should hope for a miracle. Light dislocations and subluxations, with timely access to a traumatologist, are treated without any problems.

Ankle fracture accounts for up to 20% of cases among injuries of the musculoskeletal system and up to 60% of damage to the bones of the lower leg. According to statistics, this is the most common injury to the lower extremities. In most clinical cases, an ankle fracture occurs in children and elderly patients, which is associated with age-related features of bone tissue.

• False joint in the specified anatomical region;
• Irreversible changes in the joint (arthrosis);
• Habitual dislocation of the ankle;
• Deformation of the normal ratio of the small and tibial bones of the ankle;
• Ankle contracture.

Prevention of ankle fractures

Half the cases of ankle fractures could be prevented if the person practiced injury prevention. Of course, this does not apply to serious accidents, which always occur unexpectedly, however, it is quite possible for everyone to eliminate the factors predisposing to a fracture.

Accidents that can lead to injury are often impossible to prevent. Like M. A. Bulgakov: “Annushka has already bought sunflower oil, and not only bought it, but even spilled it” (quote from the novel “The Master and Margarita”).

But you can prepare your body in such a way that the risk of fracture is reduced in case of injury.

Sunbathing will allow the skin to produce vitamin D3, which promotes the absorption of calcium in the body. Therefore, it is necessary to walk daily in the fresh air during the daytime, to sunbathe moderately.

Gymnastics with the inclusion of exercises for the muscles of the lower leg, ankle and foot will help form a frame of strong muscles and ligaments that will protect bones and joints from damage. Timely detection, treatment and prevention of chronic and inflammatory diseases of the osteoarticular system.

Be healthy.

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why the Internet sell ah?

Yulek26 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official site. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then, it's OK! Everything is in order - exactly, if payment upon receipt. Thank you so much!!))

- this is a violation of the integrity of the ankles as a result of a traumatic effect. It usually occurs when the foot is turned inward or outward. Manifested by pain, swelling, bruising, limitation of support and movement. In some cases, crepitus, deformity and pathological mobility are observed. To clarify the diagnosis, an x-ray of the ankle joint is prescribed. Treatment is often conservative: according to indications, reposition is carried out, a plaster cast is applied to the ankles. If closed reduction fails, surgery is required.

General information

Fractured ankles are one of the most common skeletal injuries. It can occur in patients of any age and gender, but middle-aged and elderly people are more likely to suffer, due to a deterioration in coordination of movements and general physical form. The frequency of ankle fractures increases sharply in winter, especially during icy conditions. Damage may or may not be accompanied by ligament rupture, subluxation, and displacement of fragments. It happens one-, two- or three-ankle. The prognosis, as well as the tactics and timing of treatment, depend on the characteristics of the fracture.

Pathology can be combined with fractures of other bones of the limbs, chest injury, TBI, pelvic fracture, blunt abdominal trauma, kidney damage, etc. Isolated ankle fractures are usually closed. With a combined injury, open injuries and crush injuries are often observed. Treatment is carried out by traumatologists.

The reasons

Usually, an ankle fracture is an isolated injury, resulting from a shortening of the leg. Less commonly, pathology is found as part of a combined injury. In the latter case, the fracture may be caused by a blow, a fall of a heavy object, or compression of the ankle joint during a road or industrial accident.

Classification

Depending on the mechanism of damage in traumatology and orthopedics, the following types of ankle fractures are distinguished:

• Pronation-abduction. Occurs when the foot is turned outwards forcibly. Tearing of the medial malleolus at the base is characteristic, in combination with a fracture of the lateral malleolus at the level of the joint or 5-7 cm above it, in the thinnest part of the fibula. Possible rupture of the anterior tibiofibular ligament with a slight (1-2 mm) divergence of the tibia. In severe cases, there is a rupture of both tibiofibular ligaments with the formation of a pronounced outward subluxation.
• Supination-adduction. They occur when the foot is forced to turn inwards. Characterized by a fracture of the lateral malleolus at the level of the joint or detachment of the top of the lateral malleolus. The fracture line of the medial malleolus is located higher than with pronation-abduction fractures, and often captures the lower inner part of the tibia. Possible subluxation of the foot medially.
• Rotational fractures. Formed with excessive eversion of the foot (as a rule, outwards, less often - inwards). Usually there is a fracture of both ankles at the level of the joint, with forced exposure, it is also possible to tear off the posterior edge of the tibia with the formation of a triangular fragment.
• Isolated flexors fractures of the posterior edge of the tibia. They are formed during forced plantar flexion of the foot, they are detected very rarely. Accompanied by the formation of a triangular fragment. There is usually no offset.
• Isolated extensor fractures of the anterior margin of the tibia. They are formed during forced dorsiflexion of the foot or with a direct blow to the front surface of the ankle joint. With such an injury, a triangular fragment is formed not along the posterior, but along the anterior surface of the tibia, usually there is an anterior and upward displacement of the fragment.
• Combined (combined). Occur with the simultaneous action of several of the above mechanisms.

In clinical practice, fractures of one ankle are called single-malleolar fractures, fractures of both ankles (internal and external) are called bimalleolar fractures, fractures of both ankles and the anterior or posterior edge of the tibia are trimalleolar. One- and two-malleolar injuries in 50-70% of cases are not accompanied by displacement of the fragments. Trimalleolar fractures are classified as severe injuries, with them, as a rule, there is a pronounced displacement, divergence of the fork of the ankle joint, subluxation and rupture of the ligaments.

Symptoms of an ankle fracture

Ankle fracture treatment

Reposition and plaster immobilization

The main task in the treatment of ankle injuries is the exact restoration of the disturbed anatomical relationships between the various elements of the ankle joint, since without such restoration the normal functioning of the joint is impossible. With fractures without displacement, the ratio between the elements of the joint is not disturbed, so it is enough to apply a plaster cast for a period of 4-8 weeks. For fractures with displacement, a one-stage closed reposition is performed.

Reposition is carried out under local anesthesia in a hospital setting. When the joint is outwardly subluxated, the traumatologist presses with one hand on the outer surface of the joint, and with the other, on the inner surface of the lower leg above the ankle. After reduction of the subluxation, it compresses the fork of the ankle joint, eliminating the divergence of the tibia. With subluxation of the joint inside, similar manipulations are performed, but the hands of the traumatologist are located on the contrary: one is on the inner surface of the joint, the second is on the outer surface of the lower leg above the ankle.

If the posterior edge of the tibia is damaged, the foot is brought forward, producing dorsiflexion, if the anterior edge is damaged, backward, producing plantar flexion. Then a plaster boot is placed on the leg in the hypercorrection position and control images are taken. The patient is prescribed painkillers and UHF. After the edema subsides, the plaster circulates. The period of immobilization depends on the nature of the injury and is 4 weeks for single-malleolar fractures, 8 weeks for bimalleolar fractures, and 12 weeks for trimalleolar fractures.

Surgery

The indication for surgical intervention is the unrecoverable displacement of the ankles, subluxation of the foot and divergence of the fork of the joint, as well as the impossibility of holding the fragments in the correct position. In addition, operations are performed with non-united fractures, intense pain, severe dysfunction and statics. With fresh injuries, surgical intervention is usually carried out 2-5 days after the injury, with old ones - in a planned manner.

The inner ankle is fixed with a two-bladed nail or screws. With ruptures of the tibiofibular syndesmosis, the tibia bones are brought together using a long screw or a special bolt. To fix the outer ankle, a nail or knitting needle is used. In case of fractures of the posterior and anterior edges, osteosynthesis of the ankles is performed with a screw or nail. Then the wound is sutured in layers and drained, a plaster is applied to the leg. In the postoperative period, antibiotic therapy is carried out, analgesics, UHF and physiotherapy exercises are prescribed. After removing the plaster, measures are taken to develop the joint.

Forecast and prevention

Ankle fractures without displacement, as a rule, heal well and do not cause inconvenience to patients in the future. Sometimes there are mild pain associated with a change in the weather or with a significant load on the joint. With properly repaired fractures with displacement, post-traumatic dystrophic pain syndrome occasionally develops - severe pain in the foot and ankle joint, making it impossible to support the leg. The cause of the development of this syndrome are vascular and neurotrophic disorders. Treatment is conservative - electrophoresis with novocaine, paraffin, novocaine blockades, exercise therapy and vitamin therapy. Recovery usually occurs within a year.

The outcome of unrepaired ankle fractures with displacement is constant pain, deformity and swelling of the joint, limitation of movement, instability and uncertainty when walking, lameness. Deforming arthrosis develops rapidly, which makes it even more difficult to support and move in the ankle joint. In such cases, reconstructive operations are required, which may include excision of scar tissue, osteosynthesis using various metal structures, the use of bone grafts and ligament plastics. Prevention consists in taking measures to reduce the level of injuries.

Every year, a huge number of people turn to doctors with ankle injuries due to sports and childhood injuries, walking in high heels. Traditionally, their number increases during periods of ice. This is due to the anatomical structure of the limb, as a result of which it is the ankle that is most loaded when walking. Fractures can be with or without displacement. In the first case, the symptoms are not expressed, which complicates the diagnosis.

General information

Under the ankle, or ankle means the lower protruding part of the lower leg. It consists of two bone growths, which are located respectively near the outer and inner parts of the foot. Physicians distinguish two departments in the ankle:

• lateral, external - part of the fibula;
• medial, internal - process of the tibia.

Both departments form an ankle fork.

note

In medical practice, a fracture of the inner and outer ankle is distinguished.

The reasons

An ankle fracture can be caused by direct or indirect trauma. In the first case, a blow is applied to the bone, for example, due to an accident, a fight, a fall of an object on a limb. In the second, the “tucking” of the leg is to blame, which violated the integrity of the bone. Most often this happens on a flat slippery surface - on ice, tiles. Injuries also happen while skating, when running on uncomfortable shoes.

Some diseases and pathological conditions exacerbate the situation:

• lack of calcium caused by malnutrition, intake, vitamin D3 deficiency;
• diseases of the adrenal glands, kidneys, acromegaly, disorders of the digestive tract, thyroid gland, which impair the absorption of calcium;
• elderly and adolescence, pregnancy and lactation, which cause a physiological lack of calcium;
• diseases of the skeletal system or diseases that affect the skeletal system - bone neoplasms, chondrodysplasia,.

Symptoms of an ankle fracture

Ankle fractures cause:

The severity of symptoms depends on the severity of the condition. In this case, the following factors are important - the presence of displacement, sprain, the zone of bone fracture.

Kinds

Depending on the location of the damage, doctors distinguish:

• fracture of the medial malleolus;
• lateral fracture.

Such fractures can be open and closed, as indicated by the condition of the skin. The location of the broken bone pieces indicates the presence or absence of displacement.

In addition, the traumatologist pays attention to the mechanism of injury, diagnosing:

• pronation fracture - when there was a twisting of the foot outward;
• supination - when tucking the foot inward;
• rotational - the code of the lower leg turned around its axis with a stationary foot.

Ankle fracture with and without displacement, other types

In medical practice, the most common diagnoses are:

• fracture of the lateral malleolus;
• inner ankle;
• ankle fracture with displacement;
• ankle fracture without displacement.

Fracture of the lateral malleolus involves damage to the fibula, as a result of which the symptoms of the injury may not be fully felt. This is explained by the fact that this bone does not take on heavy loads and is attached to the tibia. The most striking sign in such cases is swelling of the ankle.

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Due to the absence of other symptoms, patients often refuse diagnosis and treatment. As a result, damage to the peroneal nerve and other consequences of trauma are the last to be detected.

A fracture of the medial malleolus entails a violation of the integrity of the tibia. In this case, traumatologists distinguish:

• Direct fracture, or pronation, when the foot is turned outward, and the deltoid ligament is stretched.
• oblique- there is also a supination of the foot, and a piece of the inner ankle is broken off above the calcaneus.

There are cases when the integrity of the inner and outer ankles is violated. Then a marginal fracture is diagnosed - one of the most severe injuries that requires long-term treatment and a long period of rehabilitation.

A displaced fracture is the easiest to diagnose, since the pain in this case is pronounced and does not subside even after taking painkillers. The picture is complemented by pronounced edema, crepitus. The displacement of broken fragments makes such a fracture open, since their sharp edges damage the skin. Most often, such injuries are received by athletes, skydivers when falling from a height.

Fractures without displacement can be oblique or transverse.. They do not have pronounced signs, as a result of which the victims may not even be aware of their existence. At such moments, tolerable pain and swelling around the ankle may occur, which do not interfere with walking. Taking them for a dislocation, patients refuse medical care, which often only aggravates the situation.

First aid for a broken ankle

Any of the signs of an ankle fracture is a reason to seek immediate medical attention.. Prior to this, the victim is advised to provide first aid.

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To eliminate the risk of complications, it is better to call an ambulance team, which will take the patient to the hospital.

First aid for an ankle fracture includes:

Errors during the provision of first aid entail negative consequences for the victim, as well as an increase in the duration of the period of treatment and rehabilitation.

Possible complications:

• displacement of broken parts of the bone;
• increased bleeding;
• the transition of a closed fracture to an open one;
• or subluxation of the foot;
• pain or traumatic shock;
• damage to nerves, blood vessels.

Diagnostics

As a rule, a preliminary diagnosis is possible after examination and questioning of the patient. Meanwhile, in addition, the doctor recommends undergoing x-rays in three projections:

• straight - performed in the supine position with the leg bent at the knee;
• oblique - lying on a healthy side with legs bent at the knees, between which a pillow is placed;
• lateral - lying on a sore side with limbs bent at the knees, when the damaged one is placed in front.

It is also performed at all stages of treatment and rehabilitation to control their quality.

If necessary, other diagnostic methods are possible:

• ankle;

Treatment for an ankle fracture

Therapy for an ankle fracture can be conservative or surgical. Everything depends on the gravity of the situation.

Conservative treatment

Conservative treatments are possible when diagnosed with:

• closed fracture without displacement;
• minimal ligament damage;
• a fracture with a displacement, in which one-stage closed reduction is possible.

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Conservative treatment is also indicated in cases where the patient has contraindications to a surgical operation, whether it is diabetes mellitus, old age, diseases of the heart and nervous system.

Closed fracture without displacement - a reason for applying an immobilizing plaster bandage on the back of the leg and foot. To exclude the risk of displacement of bone fragments after the imposition of gypsum, the victim is prescribed x-rays. Subsequently, he is forbidden to step on a sore leg, recommending the use of crutches when walking.

It should be noted that such a bandage for ankle fractures is not always superimposed. In some cases, it can be replaced with plastic or metal immobilizer bandages. The term of wearing the bandage depends on the severity of the condition and ranges from 4 to 8 weeks. Remove it only after the control picture.

If there was a fracture with a displacement, before applying the plaster, a closed manual reposition is performed - the fragments are compared. Before manipulations, anesthesia or anesthesia is done. Then the leg is bent at the knee and at the hip at a right angle. With one hand, the surgeon takes the heel and ankle in front, and with the other - the lower leg from below, behind and on the sides, as a result of which a counter-traction is created.

Thus, the doctor returns the foot to its normal position and applies an immobilizing bandage. The term of wearing a plaster in this case is determined individually.

Surgical intervention

Operations are performed with:

• fractures of both ankles;
• open fractures;
• complex injuries;
• fracture more than - and fibula more than a third;
• complex ruptures of ligaments;
• old fractures.

Surgery allows you to:

The type of operation depends on the nature of the damage. The surgeon may:

• fasten the tibiofibular junction if fractures of the medial malleolus and fibula have occurred. In this case, a bolt is fixed through the fibula and tibia at an angle from the lateral malleolus. With the help of a drill, channels are made for the introduction of devices.
• Perform osteosynthesis of the medial malleolus if supination fractures are diagnosed. In this case, a two-blade nail is inserted at a right angle, fixing the medial malleolus. The lateral one is fixed with a pin, and the fragments with screws.
• Perform osteosynthesis of the lateral malleolus in case of pronation fractures. In such cases, a pin is passed along the axis of the fibula through the lateral malleolus, and the medial one is fixed with a nail.
• Perform osteosynthesis of tibial fragments if there are fractures along the posterior part of the lower end. For fastening use a long screw.

Subsequently, a plaster is applied to the limb in such a way as to leave access to the wound. At the end of the operation and during rehabilitation, the quality of bone fusion is monitored by radiography.

Rehabilitation after an ankle fracture

• calcium diet;
• massage;
• physiotherapy exercises;
• UVR, warm baths, mud applications, magnetotherapy, electrophoresis with calcium preparations and other physiotherapeutic procedures.

After the operation, the victims are allowed to move on crutches only after 3-4 weeks, and they are recommended to wear an immobilizing bandage for another 8-12 weeks. After removing the cast, the ankle is advised to be bandaged with an elastic bandage for some time.

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Metal devices for fixing bone fragments are removed after 4-6 months at the time of the second operation, although this does not apply to titanium products that can remain in the body for many years.

A week after the removal of the plaster, the patient is sent to therapeutic exercises, which allows the development of the joint. The first classes are held with the use of a warm bath with sea salt, as it relieves swelling resulting from wearing a cast.

The load increases gradually, and a set of exercises is developed by a specialist individually for each patient. It usually includes ankle movements, rolling a ball on the floor, holding objects with your toes, walking on your heels, swimming, cycling. In addition, the victim is recommended to purchase shoes with an orthopedic insole.

Massage helps restore the functioning of nerves and blood vessels. When performing it, the specialist can use anesthetic gels to eliminate discomfort. Physiotherapy procedures speed up the rehabilitation process.

An ankle fracture is a common and dangerous injury that requires a long period of treatment and rehabilitation. In case of ignoring the advice of doctors, the condition is aggravated by complications that can lead to improper bone fusion, flat feet, and lameness.

Lateral fracture of the ankle without displacement is an injury typical for athletes and people with increased stress on the ankle. At the first symptoms of a problem, you should contact a traumatologist, if necessary, apply a primary tightening bandage. An undisplaced ankle fracture does not require surgery. Often, a plaster cast is sufficient for restoration.

Causes of injury

Wearing tight and uncomfortable shoes increases the risk of fractures

An ankle fracture is one of the most common bone injuries. She is put in third place after cranial wounds and broken hands. Traumatic factors:

• wearing uncomfortable shoes: with a high hard top, narrow, with a thin heel (often there is a fracture of the outer ankle without displacement);
• inattention when walking on uneven surfaces;
• crossing hilly terrain at high speed;
• household bruises;
• sports training;
• falling objects on the ankle.

Feature - when injured, the patient's bones do not change their original position, therefore, the symptoms of such an injury are weaker than with bone crushing or an open fracture.

Symptoms

An accurate diagnosis can only be made with the help of x-rays. In the initial diagnosis, a fracture is indicated by:

• Severe pain in the ankle. It interferes with walking, sharply gives in the leg, does not allow you to fully step on it, bend or move the foot. It can be cutting, throbbing, dull, but most often it is deaf, with flashes when pressed or walking.
• Edema. It is accompanied by reddening of the skin or its bluish tint. Both manifestations indicate rupture of soft tissues and possible damage to the bone.
• The appearance of hematomas. Extensive subcutaneous hemorrhages at the site of a bruise or other injury indicate a massive rupture of blood vessels. It can be caused by a partially displaced bone.
• Ankle dysfunction. A person can not only step on the foot because of pain, but also has problems transmitting nerve signals to the damaged part of the limb.
• Numbness. If a nerve is affected or a person experiences pain shock, the area around the fracture will become partially or completely numb.

Since the symptoms are nonspecific, it is imperative to take an x-ray to clarify the diagnosis. In case of suspicion of internal hemorrhage and severe damage to soft tissues, an ultrasound method is used.

Diagnosis based on image results

The study is carried out in several stages.

The patient puts his foot on the research unit. The supply of X-rays is turned on, a picture is taken, if necessary - in different projections. There can be four of them in total: from above, from the angle of the sole, one at a time from the sides of the ankle.

The results obtained are reviewed for non-compliance with the norm.
Possible types of fractures:

• double (two parallel bones are broken);
• closed (no external bleeding);
• marginal (insignificant part of the bone, lateral segment is affected);
• external or open (with tissue rupture and bleeding).

After the diagnosis is clarified, the patient is usually put in a cast.

Hospital treatment

Treatment of a fracture in a hospital is required only in severe cases.

If desired, the patient can stay in the clinic, especially if an additional operation is performed to install a pin or remove fragments (both bone and a foreign object). However, often after the plaster is applied, the patient goes home, but he must be observed by the attending physician.

The next appointment is scheduled in 1-2 weeks - the time sufficient for 50% healing of the injured bone. The attending physician examines the state of the plaster, checks whether it has shifted and whether it is pressing on the vessels, leading to severe swelling. If necessary, the pad is replaced, and the patient is sent for re-examination using x-rays.

A subperiosteal fracture requires special attention because it is easy to miss on the x-ray. If an oblique fracture of the ankle without displacement occurs, the frequency of visits to the doctor increases. And with a marginal fracture of the outer ankle without displacement, special attention is paid to the removal of edema and swelling of the soft tissues.

Important! Frequent exposure to X-ray radiation is detrimental to the body. To compensate for the effect of radiation, a course of iodine-containing drugs may be prescribed.

Features of plaster overlay

If there is no displacement of the bone, the cast will hold the injured ankle in place with pressure. The plaster is applied in such a way that the bones are fixed in the correct position.

Features of wearing a cast for an ankle fracture:

• a fixative is bought on the gypsum on its own in order to avoid its shift when walking;
• you should limit the load on the injured limb, but it is better to completely eliminate it by buying crutches;
• the pad may hang slightly on the leg to avoid pinching the blood vessels, but at the point of contact with the joints and protrusions of the bone should fit snugly.

If the instructions are violated, the union will go slower, it will take more time to recover.

Rehabilitation Therapy

An external fracture of the ankle bones requires additional measures to speed up the healing process and allow the patient to get back on their feet as soon as possible. The recovery course consists of exercise therapy, physiotherapy and therapeutic massage.

Also, if necessary, appointed:

• electro- and photophoresis;
• hydromassage;
• electrical muscle stimulation.

The procedures are performed by a specialist, the course lasts 2-3 weeks. The procedures are aimed at restoring endurance and muscle convergence, tissue regeneration, strengthening bones and improving blood circulation.

The first massage sessions are also carried out by a specialist. He shows how to perform it correctly, then the patient repeats this algorithm on his own at home. Self-massage consists of circular movements from the heel towards the hip bones. Before starting the procedure, the skin around the injury should be gently rubbed.

Exercise therapy is a set of exercises aimed at restoring limb functions.

Exercise therapy is prescribed after the removal of all restraining dressings.

The complex consists of exercises for stretching the muscles and flexibility of the joints. The main elements are lifting on toes, heels, walking in this position, twisting the foot. Such rehabilitation is aimed only at improving the condition of soft tissues and muscles.

Recovery time

Complete healing of the bone occurs no earlier than a month later. In mild cases, the plaster is removed after 2 weeks, replacing it with an orthosis. The retainer must be worn for at least 10 days. If part of the bone is displaced during healing, grows together incorrectly, the course of treatment begins anew.

For complex fractures, plaster will have to be worn for 1-3 months. The exact period is calculated individually, taking into account the general state of health, the age of the patient, the conditions of therapy. The child recovers faster, the elderly slower.

The use of exercise therapy, physiotherapy and medicines with calcium in the complex accelerates the regeneration process by 30-40%. Bed rest in the early days eliminates the possibility of re-traumatization. Proper nutrition adds about 10-15% more to the speed of rehabilitation and allows you to remove the cast earlier.

With properly selected therapy, the patient will quickly restore motor functions, will not receive complications in the form of chronic pain or lameness.

It is important to fully comply with the doctor's instructions, to avoid stress during the period of therapy. Buying orthoses will be an excellent prevention both during the healing period and after it.