Types of ankle fractures and their treatment
An ankle fracture is a violation of the structural integrity of the bones of the distal (farthest from the trunk) of the Department of tibia. In everyday speech the ankle is called the ankle. This anatomical education consists of:
- The lateral malleolus, that is, from the distal fibula bones, which performs the function of holding the ankle joint in the correct position.
- The medial malleolus, that is, bone from bone in the tibia.
Another name for the lateral malleolus is the outer and medial inner. It was the ankle involved in the transmission of the weight load on the foot, so it is equipped with a powerful joint and ligamentous apparatus. Visually, the ankle bone is similar to small cones, located almost symmetrically on the outside and inside of the foot. The ankle joint carries out a movement only in one plane, so a fracture of the ankle is often associated with dislocation or fracture of the foot.
Ankle fractures and their classification
All fractures are divided into two groups on the basis of the integrity of the skin. If integrity is breached, there is formed an open wound, containing the bone fragments is an open fracture. If the soft tissue does not communicate with the environment, it's a closed fracture.
Closed fractures can be complicated by internal damage to blood vessels, muscles, ligaments, joints. Sharp bone fragments shifting, can you cut and rip any type of tissue, causing significant damage to the body. That is why it is important to prevent movement in the affected limb.
In open fractures have bleeding, and when closed is bleeding either under the skin or in layers of other soft tissues. At the ankle are a large number of vessels, joints and nerve endings that need to recover after injury.
From 10 to 15% of patients get disability, because you never can fully recover all the functions of the ankle.
Observed when looking at the foot of the two bumps on the sides of this extremity small and tibia bones.
And between them and the bottom block of the heel bone, talus, cuboid, navicular, and others. Due to the specific characteristics of articulation very often there is a combined fracture of the ankle or of the heel bone. What happen anything broken? Due to the occurrence they are:
- Pathological fatigue or triggered by internal disorders such as osteoporosis, malignant or benign tumorsTB.
- Traumatic, i.e. occurred in the result of a fall, a blow, crushing the bones of the ankle.
The fundamental difference between these two categories lies in the fact that pathological fractures can occur almost spontaneously, they do not require any special stimulus from the outside world. Because of senile brittle bones, even with minimal exposure can occur fracture that leads to a large percentage of injuries among the elderly. Elderly people, the regeneration of bone tissue is generally slower than younger people, so recovery is longer. The degree of violation of the integrity of bone fractures of the ankle are:
- full, that is, the bone is divided into two or more separate bone fragment;
- incomplete, that is, between the bone atomtime the fracture.
The structure of the ankle consists of only small and tibia bones but the talus below. Dwuhlopastny fracture differs in that it includes only damage to the tibia, while trehlopastnye also captures and talus. According to the degree of remoteness from each other of the bone fragments may occur:
- Ankle fracture with displacement, when the bone fragments penetrate through the periosteum and change their position relative to each other.
- Ankle fracture without displacement, when the dice do not leave the space of the periosteum.
The most common cause of injuries to ankles is a drop leg Welt turned feet. The man with the trained muscles and strong bones, will receive a minor injury, but with weak muscles and brittle bones may occur trehlopastnye fracture with subluxation. In order to reduce the likelihood of such damage, you need to use boots with non-slip soles, to be vigilant and to tread the ground carefully. Any fracture plays an important role first aid. From, how well it is rendered often determines the speed of recovery.
The symptoms of fracture and first aid
The diagnosis is based on radiological examination after arrival at the emergency room. Symptoms of ankle fracture:
- the victim feels a sharp pain at the site of injury;
- sometimes you can hear a loud crunching sound of bones break apart;
- the leg is difficult to use as a prop, to walk;
- in the lower part of the leg is formed swelling, which sometimes reaches to the toes;
- changes the color of the skin occurshemorrhage, a hematoma, which is shifting down;
- visually you can observe the deformation of the joints of the leg and foot, bending at an unnatural angle;
- in the case of open fracture wound is formed with a noticeable atomtime bone, with closed fractures with displacement of bone fragments can bulge straining against the skin;
- the skin below the injury pale, can disturb sensitive, there is numbness or tingling;
- the fingers of the foot and ankle lose some of the functions, the victim can not move my toes.
Peculiarities of innervation in all individual, incomplete closed fracture without displacement can bring some people a slight pain. If you suspect a fracture you should immediately go to the emergency room. Open fractures are always painful. The victim will have time to seek medical help. You should call the ambulance immediately. To reduce pain in the following way:
- Non-narcotic pain medication from home, sports, Hiking or car kits to drink water, to tell the ambulance crew the name of the medication and dosage of intake.
- Ice pack from scrap materials (to lay on for 15 minutes, take a break of 5 minutes, to prevent draining of the condensate and the melted water into the wound, lay a cloth between ice and skin).
The injured limb cannot be moved. If the person providing first aid is the skill of the splint, it can be done. But if such a skill is not, it is better not to train.
Incorrectly given first aid complicates the work of the trauma and increases the process of healing a fracture. More than 8 ligaments are within the articular capsule of the ankle, damage to any of them very dangerous for subsequent walking.
Also in the area of the ankle joint are the seven tendons, it is very important to control the limb. During first aid, you can move the victim only if the finding of the place poses a threat to life. In all other cases you need to wait for the ambulance.
Sometimes the pain is so intense that pain relief is required immediately. In the first aid kit has everything you need narcotic and non-narcotic analgesics for the relief of the patient. The choice is made depending on the severity of each individual case, as a rule, is carried outmultiple injections of Novocaine around the injury site (this method is called a blockade). After that, the victim was transported to the emergency room, where diagnosis on the basis of:
- x-ray examination;
- computer and magnetic resonance tomography.
Radiography is conducted in a straight, oblique and lateral projections to Refine the positions of all of the bone fragments. The correct reduction is based on the clear clinical picture of the damage. Special tricky is compression fractures of the ankle, when the distal end of the femur and metatarsal bones are fragmented to the smallest of fragments. This kind of pattern can be observed after crushing legs in the fall from the top is very heavy or bulky items, for example, pieces of rock during the collapse.
Fracture of both ankles with an offset will definitely require magnetic resonance imaging to assess the extent of damage to the joint and ligamentous apparatus.
Ankle fracture: treatment and recovery
The treatment is conservative or operative (depending on the severity of each individual case). Conservative is in plaster, pain, anti-inflammatory and stimulating the growth of bone tissue drugs. A conservative approach is usually selected when the following fractures:
- fracture of the lateral malleolus without displacement costs with conservative treatment;
- fracture of both ankles without displacement subjected to conservative treatment;
- fracture of the internal malleolus without displacement treated conservatively.
Conservative treatment without a reduction takes place only in private injuries, when the position of the bone fragments anatomically correct. Surgical treatment of fractures suggest the following:
- fracture of the internal malleolus with displacement require surgery;
- fracture of the lateral malleolus with displacement of the treated operable;
- surgery is indicated if diagnosed open fracture of the ankle.
To control the successful repositioning again conducted x-rays, and only after that immobilizes the entire back of the leg and foot. To promote healing use fixation of bone fragments by means of special structures, otherwise fracture of the long fuses.
In case of unsuccessful healing of the following possible complications:
- chronic disease of the articular surfaces of the tibia and talus bones, osteoarthritis of the ankle joint;
- false joint at the site of injury;
- abnormalities in muscle controllimb, neurological disorder;
- thrombosis of the veins of the foot, vascular disease.
Trauma to the inner ankle
Fracture of the inner ankle can lead to lameness and chronic pain in the joint due to improper distribution of load on the arch of the foot. Treatment must include physiotherapy treatments for pain relief and speedy recovery. Often the causes of fracture are in violation of metabolism, a deficiency of calcium in the body. Electrophoresis with calcium and hydrocortisone has demonstrated its efficiency. The victim is assigned to the following procedures:
- the impact of interference currents;
- ultraviolet irradiation;
- magnetic therapy;
- laser therapy;
- the use of ultra-high frequencies;
A simple fracture of both ankles heal from two weeks to two months. More complex cases are treated depending on the severity and rate of regeneration of bone tissue. Muscle tension without movement and exercises to develop ankle joint are prescribed by the attending doctor as you progress in treatment. For all the time wear plaster the victim moves with the aid of crutches. You should adjust the diet so that it contained a lot of mineral trace elements, calcium and magnesium. The injured are assigned to a quiet routine, plenty of sleep and rest. To prevent painful complications you need to take responsibility for all recommendations of the attending physician, to carry out their assigned treatment of a fracture of the ankle and to perform exercises of physiotherapy.