Ankle fracture. The ankle: how it is structured, where it is located, functions and possible traumatic injuries Closed fracture of the lateral malleolus on the left without displacement

An ankle fracture is a relatively common injury, often resulting from dislocation of the lower leg, ankle, fall, or sports injury.

To treat an ankle fracture, bone fixation using a plaster cast or surgery is used. Full recovery from a fracture usually takes 8 to 12 weeks. If you suspect you have a fractured ankle, go to the emergency room immediately.

If you have injured your ankle, the following may indicate a fracture:

• pain in the lower leg, foot;
• inability to continue moving;
• swelling of the ankle;
• “crunching” when trying to palpate the injury site;
• deformity of the leg in the ankle area;
• the bone has pierced the surface of the skin (open or complicated fracture).

Sometimes, due to the pain of a broken ankle, a person experiences fainting, dizziness, or a feeling of general malaise.

It can be difficult to distinguish a mild fracture (non-displaced or subperiosteal) from a dislocation or bruise. Therefore, for an accurate diagnosis you need to take an x-ray.

What to do if you have a broken ankle (ankle)

Try to avoid putting any weight on your leg. Ask a friend or relative to take you to the nearest emergency room or call an ambulance. During transport to the car, a helper should support you on the side of your injured leg while you move with the other leg. While waiting for medical attention, it is advisable to apply ice wrapped in a cloth (such as a towel) to the injury site and elevate the leg.

You can take over-the-counter pain medications to reduce pain. Ibuprofen or paracetamol are good choices. In case of an open fracture, you need to call an ambulance.

Treatment of a broken ankle by a doctor

The doctor must provide you with reliable pain relief. For this purpose, injections of painkillers are used, less often - droppers with medicine or inhalation anesthesia.

To confirm the fracture and choose the right treatment tactics, an x-ray examination of the injured leg is necessary. If the bones are displaced in the area of ​​the fracture, the doctor will perform a closed reduction, that is, he will try to return the bone fragments to the correct position, comparing them with each other, without surgery. You should not feel pain during the procedure as the doctor administers thorough anesthesia. Simple non-displaced fractures do not require reduction. Bone realignment helps control ankle pain and swelling and reduces the risk of complications from a fracture.

Once the normal position of the bones has been restored, you will be placed in a plaster cast or splint. You will not be allowed to put any weight on your broken ankle, so you will need crutches to walk. At the emergency room, you will be given pain medication and told when and where you will need to come for an examination. Your broken ankle will then be treated by a traumatologist.

Typically, ankle fractures heal in 6-8 weeks, during which time you will have to be in a cast. After four weeks, you will be able to place some weight on your injured leg or replace the cast with special removable shoes. Before the bones heal, you will have to visit your doctor regularly and have follow-up x-rays taken.

More severe fractures often require surgery to realign the bones. For surgery, general anesthesia (where you are put to sleep) is usually used.

The surgeon makes an incision in the skin near the ankle and returns the bones to their normal position. To fix the fragments, metal plates, screws, knitting needles and other devices are used. The wound is then sutured. This operation is called open reduction with hardware (internal fixation of a fracture). Typically, metalwork is not removed unless it is causing problems.

In rare cases, the surgeon may use an external device to fix broken bones. This procedure is called external fixation. Most people will remain in the hospital for two or three days after surgery.

Recovery after a broken ankle (ankle)

A broken ankle takes approximately 6 to 12 to heal, but it may take longer to fully regain movement in the leg and foot. How soon you can return to work depends on how severe the ankle fracture was and the type of work you do, but most likely you will be unable to work for at least 4 to 6 weeks.

Follow the motor regimen recommended to you by the traumatologist, come for follow-up appointments with the doctor to monitor the progress of the restoration of leg function. Do not wet the plaster.

Ask friends or family members to go shopping for you, as you will not be able to do it yourself. You will, however, be able to move around the house with crutches and use the stairs. You may be referred to a physiotherapist who can show you exercises that will help you develop your leg after the cast is removed and return it to its previous function.

Visit your doctor if:

• The pain increases or does not decrease when taking regular painkillers. Your doctor will be able to prescribe you a stronger pain reliever.
• You experience any other medical problems or want advice about returning to work.
• You are planning to travel by air after surgery for a broken ankle. Recent surgery is a risk factor for deep vein thrombosis, and your doctor can help prevent it.
• You feel tingling or loss of sensation in your toes.
• An unpleasant-smelling discharge appeared from the surgical suture.
• The skin in the ankle or foot area has taken on a bluish tint.
• The ankle becomes very swollen.

The last 4 signs may indicate an infection or a problem with the transmission of nerve signals and blood to the ankle.

Which doctor should I contact if I have a broken ankle?

Go to your nearest emergency room if you suspect you have broken your ankle. This type of fracture is treated by a traumatologist, whom you can choose by reading the reviews on our website.

Ankle injury is a common disease in traumatology and accounts for over 22% of all injuries to the bone structure of the human body. A displaced ankle fracture occurs under the influence of a mechanical shock, a fall from a height, a traffic accident, etc.

Physiological structure of the lower leg

The lower leg joint consists of 3 bones: tibia related to ankle, And fibula, which are a “fork” design. The angle between the outer (lateral) and inner (medial) malleolus is 50°. In relation to the frontal plane, the outer one is behind, the inner one is in front. The bone structure is reinforced by a system of strong ligaments that can withstand a load of more than 400 kg.

Therefore, during injury, they usually tear off from the bone cavity. The ankle is supplied with blood through arteries located in the area of ​​the tibia and fibula. The ankle is also called the ankle.

Why does ankle injury occur?

Violation of the integrity of the ankle occurs due to injury, which can be of a direct damaging nature or an indirect factor of occurrence. Hence the causes of damage are as follows:

• forceful mechanical impact - a blow, an accident, a fall from a height onto the legs or a heavy object falling on the ankle, etc.;
• twisting of the leg when walking, skating, rollerblading, going down stairs, etc.

The injury is accompanied by a violation of the integrity of the bone structure and ligaments, dislocation or subluxation of the ankle.

The occurrence and course of damage is aggravated by a lack of calcium in the body. Microelement deficiency is especially observed in adolescents, pregnant women and people over 50 years of age.

Calcium deficiency occurs when taking oral contraceptives, diseases of organs involved in hormonal processes (thyroid gland, adrenal glands), diseases of the digestive tract, which lead to poor absorption of nutrients and microelements. An improper diet also worsens the condition and density of the skeletal system.

Bone fragility occurs as a result of diseases occurring in the human skeleton of an inflammatory and deforming nature (osteoporosis, tuberculosis, osteopathy, arthritis, etc.).

How does an ankle injury occur?

If the leg is positioned incorrectly or when exposed to an external force, a crunching sound is heard - this indicates a fracture.

Main symptoms of shin bone injury:

• Pain when walking or palpating the movement of the fibula. The nature of the pain is sharp, strong when supporting the leg, the cause of the pain is changes in the periosteum, in which multiple nerve plexuses are concentrated. The pain will provoke shock - a dangerous state of the body in which the victim should be ensured complete immobility and take strong painkillers.
• Swelling. Appears some time after the incident. When pressed, a depression is formed on the skin, which disappears within seconds. The cause of edema is damage to blood vessels. The outflow of blood is prevented by ruptures of muscle fibers and connective elements. Swelling may spread throughout the injured leg.

• If it is disturbed with displacement, blood stasis forms in the heel of the ankle. This sign indicates rupture of blood vessels and hemorrhage.
• Joint dysfunction is accompanied by an abnormal position of the bone structure, an unnatural turn or rotation of the foot. At the same time, the ability to move the foot is limited and causes crunching.

Diagnostics

The examination is carried out by palpating the articulation of the lower leg bones along the entire length, analyzing the neurological and arterial components. X-ray examination of bones is carried out in anterior and lateral projections. X-rays can confirm ligament tears at an oblique angle of 45°. It is advisable to take the image with 20° internal rotation.

Full-view x-rays analyze the injury for abnormalities in the upper tibia and dislocation. Artography or sonography can be performed to study the condition of soft tissues. Factors of injury when analyzing images are considered to be the presence of cracks, bone fragments, enlargement and expansion of surrounding soft tissues, divergence of the joint space or its deformation.

Fracture classifier

Based on the biomechanical features of ankle joint disorders, they are divided into subtypes:

By type of damage:

• open - external injuries are visualized, there are fragments of bone and lacerations of the skin and muscle frame;
• closed - soft tissues are not damaged.

By presence of offset divided into fractures with displacement and without displacement.

Depending on the direction of displacement:

• pronation – the foot turns outward;
• supination - the foot turns inward;
• rotational - the lower leg is turned out with normal stability of the foot.

By localization changes in the bone skeleton of the ankle joint are divided into medial fracture and lateral ankle.

Displaced fracture

A displaced fracture of the lateral malleolus is a pronation injury. An oblique or straight crack forms in the ankle joint. Displacement occurs under the influence of impact force on the foot area. The foot moves outward or vice versa.

Injury manifests itself with standard clinical signs, characterized by the severity of edema and pain syndrome.

X-rays show that the crack is located in the area of ​​the articular bone gap or slightly higher. The bone fragments form the corner of the outer shape. When running obliquely, the line of the crack is located in front of the back of the leg or rises from bottom to top along the movement of the bone.

Assistance is carried out using local anesthesia. The doctor uses pressure to return the displaced ankle and apply a plaster cast. You can rely on the plaster support on the second day. How long should you spend in a cast? The foot heals within a few weeks, at least a month.

A displaced fracture of the inner malleolus with an oblique location of the crack is supination, and with a transverse location it is pronation.

During examination, a sharp protrusion of the tibia is felt. The ankle is pointing away from the center.

An X-ray image shows a crack running through the ankle and tibia. The image shows an ankle that has changed its natural position. The offset focuses downwards and slightly backwards. Fragments of the bone structure of the ankle form a gap more than 7 mm wide.

The doctor compares the bone fragments by pressing the hand on the foot under local anesthetic. An incision is made at the site of fluid accumulation and the hematoma is removed using sterile wipes. Using the levator, the ankle is placed in its original position and attached to the tibia with a bolt. Open wounds are stitched and the foot is fixed with a blind plaster cast.

The bandage is applied up to the knee bend. At the fixation stage, a control photograph is taken. The patient remains in plaster immobilization for up to seven weeks, after which the plaster is removed. The foot is examined for consolidation. If bone fusion has defects, the patient is prescribed a set of health-improving exercises and massage.

Non-displaced bimalleolar fractures are uncommon. Changes occur as a result of foot abduction. Damage to the deltoid ligaments leads to the formation of a crack parallel to the ankle gap. Under the force of the fragments, the supracalcaneal bone breaks off the lateral ankle. The foot is directed inward. If, due to an injury, one of the ankles has changed its natural position, the violation is considered to be displaced.

After a fall, a person cannot stand on his leg and feels sharp, unbearable pain. Can't move his leg. Imaging reveals extensive swelling in the ankle area. On palpation, pain extends to 3-4 cm above the lateral malleolus and 1-1.5 cm below the medial ankle.

Fracture of both ankles

Diagnostics reveals an injury to two ankles: the location of the crack is from bottom to top from the joint gap at the site of the medial malleolus; on the outside ankle, a fracture is visible, passing 1 cm above the articular opening. When displaced, the inside ankle is turned outward and downward.

A double-malleolar fracture without signs of increasing swelling is treated on an outpatient basis. Plaster application is carried out after anesthesia. For a week, the patient is in a horizontal position with the affected leg raised. After this, the patient is allowed to walk on crutches. Healing occurs after 5-6 weeks of treatment. Rehabilitation after a displaced fracture of both ankles takes place after 2 months. During recovery, the victim is prescribed gymnastics and therapeutic massage of the limb.

Fracture of both ankles and tibia

The anatomy of a displaced trimalleolar fracture is characterized by injury to both ankles and the posterior aspect of the tibia. These are common injuries. They affect people over 50 years of age. Deterioration of coordination and skeletal structure are prerequisites for injury.

As a result of increased flexion or extension of the joint, twisting or tucking, a violation of the integrity of the ankle bone system occurs. The axial load when jumping from a great height on the legs puts strong pressure on the ankles, which injures the bone tissue.

The symptoms of the disease are similar to those for bone disorders of this etiology. Structural changes in the foot and tension of the skin in the area of ​​flexion and extension are observed.

The foot is examined using an X-ray machine.

Treatment is aimed at restoring the ankle structure and returning it to functionality.

Attention! This type of fracture can leave a person disabled.

With the closed type, a plaster cast is applied to the foot. The healing period is over 5 weeks, the recovery period is up to 3 months. If the patient has subluxation of the foot and dilation of the “fork,” then surgery is required.

After surgical manipulations and installation of fastening bolts, the doctor sutures the wound and applies plaster fixation. While wearing a plaster cast, the patient undergoes a complex of healing physical procedures and drug therapy.

After removing the fixing bandage, the victim continues rehabilitation measures for recovery, doing therapeutic exercises, receiving massage and physical procedures. Taking specially selected vitamin complexes will strengthen the skeletal system.

Important! The pain syndrome may persist for a year.

After injury

The consequences of injury can affect a person’s overall health and lead to changes in the aesthetic appearance and shape of the ankle.

An injured foot joint is at risk of developing deforming arthrosis. Painful sensations become chronic. There is lameness when walking. The joint becomes less mobile and deformed.

Important! After an ankle fracture, shoes should be supplemented with an orthopedic insole.

The natural load on the foot is restored after 3-4 months. A week after removing the plaster cast, we begin performing a set of exercises aimed at improving joint mobility. The exercises are developed by a physical therapy specialist. Before starting classes, the patient takes a warm foot bath with sea salt to warm up the muscles and relieve swelling.

To improve blood circulation and the functioning of the lymphatic system, the patient undergoes a massage course. The first sessions may give painful sensations, which disappear after the development of muscle muscles and damaged ligaments.

Additionally, we massage ourselves after waking up and before going to bed. To do this, we stroke, knead, bend and straighten the foot. We make all movements carefully and slowly.

We provide assistance before the doctor arrives

The provision of specialized medical care does not occur immediately. Therefore, if a fracture is suspected (pain, swelling, swelling, unnatural position of the foot), we provide first aid to the victim.

Failure to provide timely assistance leads to aggravation of the disease and complications of treatment. While waiting for an ambulance, the patient may experience a painful shock, dislocation or subluxation of the ankle, increased bleeding, dislodged fragments, and a closed bone change mobilized into an open type.

Algorithm of actions when providing medical care:

• Provide the victim with rest and immobility of the foot.
• Call an ambulance.
• Free the injured leg (from debris, objects, shoes, etc.) if this does not aggravate the injury. This action is aimed at preventing the necrotization process. Long-term disruption of the blood circulation of the leg under pressure objects leads to tissue necrosis and subsequent amputation of the limb.
• Give your leg a horizontal position, raising it to a comfortable height. To do this, place a cloth rolled into a roller under your foot. This will ensure blood flow away from the lower limb and reduce the area of ​​swelling.

• If there is an open bone change, bone fragments cannot be removed.
• Apply a cold compress to the site of swelling.
• Make a splint from available items (board, ski, tree branch, etc.) or fix the injured leg by tying it to the healthy one.
• Give painkillers to relieve pain.

To avoid fractures

To prevent injuries to the limbs and any part of the human skeletal system, you need to monitor your diet, lead a healthy lifestyle and exercise every day.

The products should include milk, nuts, meat, fish, vegetables, and fruits.

Sunbathing will ensure the production of vitamin D3, which is necessary for the absorption of calcium. Strengthening muscles and ligaments will prevent severe damage.

Practice shows that a closed fracture of the ankle with displacement is one of the most common injuries. According to statistics, it accounts for a fifth of cases of violation of the integrity of human bones. At risk are women who prefer high heels, professional athletes, ice skating enthusiasts, etc. In the absence of proper treatment, the damage is fraught with serious consequences, so the victim must be given first aid and then taken to the hospital, where, based on the results of the research, doctors will choose a treatment method.

Causes of fracture

1. Direct impact: impact, heavy objects falling on the leg, road accidents, emergencies, etc.
2. Indirect impact: careless walking on stairs or uneven surfaces, sports, skating, twisted foot.

• weak bones in childhood;
• aging of the body;
• hormonal changes associated with menopause or pregnancy;
• unbalanced diet;
• sedentary lifestyle;
• diseases of internal organs: kidneys, gastrointestinal tract, thyroid gland;
• alcohol abuse;
• bone diseases (osteoporosis, arthrosis, etc.), etc.

Important! Practice shows that women are more often injured than men due to the fragility of the bone structure of the ankle. They need to be especially careful: jumping from a height, hitting, or falling can lead to a displaced fracture of two ankles.

Research shows that a balanced diet and moderate exercise help increase bone strength, which reduces the likelihood of an ankle fracture.

Types of fractures

Ankle injuries are classified based on the severity, nature of the injury, and location of the problem.

Depending on the nature, there are two types of fractures:

• Closed - the integrity of the bone (sometimes the joint) is damaged, but the soft tissues are not damaged.
• Open - bone fragments damage soft tissues, causing a bleeding wound to form in the ankle area.

Depending on the location, there are displaced fractures of the outer ankle, injuries to the inner ankle, or two at once (dimalleolar fracture). The order of therapeutic measures depends on the type of injury.

Depending on the form of damage, fractures are divided into avulsion, helical, rotational and others. They can be combined with dislocations and subluxations.

Symptoms of a displaced ankle fracture

• severe pain in the ankle area, sometimes leading to loss of consciousness;
• inability to step on the injured leg;
• the appearance of bruising and swelling;
• Ankle deformity caused by displacement;
• loss of joint mobility (the foot cannot be moved);
• the appearance of a characteristic crunch of bone fragments when palpating the fracture site.

If a displaced fracture is combined with the patient being rotated, he is in an anatomically unnatural position.

Important ! A displaced ankle fracture is characterized by pain of greater intensity than a non-displaced injury.

Ankle injuries are common. Their symptoms are largely similar: fractures, dislocations, and bruises are characterized by severe pain, the inability to step on the leg, and swelling. Only a specialist can distinguish one from the other, so if you receive damage, you should not self-medicate, but should immediately go to the doctor.

Emergency care after a displaced ankle fracture

If a fracture is suspected, the emergency room doctor or an eyewitness to the incident must provide the patient with first aid:

1. Calm the victim and give an analgesic to relieve suffering.
2. Free the injured limb from all pressing objects (shards, debris, etc.).
3. If the fracture is open, you need to apply a sterile bandage to the wound to prevent debris and bacteria from entering.
4. If the victim is wearing trousers, you can cut the leg and relieve the ankle from the pressure.
5. It is recommended to immobilize the limb, for example by tying it to a board. It is recommended to elevate your leg using a cushion. It can be made from a coat or jacket.
6. If the fracture is open and the victim is bleeding heavily, you need to bandage the leg above the wound with a tourniquet.

Important!Under no circumstances should the victim be allowed to stand up, step on the injured leg, or try to walk. Before the ambulance arrives, it is not recommended to take any actions other than those described above.

Features of fracture diagnosis

Simple and complex ankle fractures are diagnosed using an X-ray machine. The doctor takes a picture in three projections: direct, oblique and lateral.

The study helps determine:

• type of injury;
• location of the fracture;
• the distance the bones have moved;
• condition of soft tissues;
• the presence of damage in various elements of the joint.

Important! X-rays are performed at least three times: upon diagnosis, after surgery or conservative therapy, and after rehabilitation. This helps to track the patient's condition over time.

To specify the diagnosis and prescribe treatment for a displaced fracture, additional studies are needed: ultrasound, CT and MRI.

How to treat a displaced fracture?

An ankle fracture can be treated in two ways: conservative and surgical. The first is used in cases where the injury is not displaced or it is possible to place bone fragments in an anatomically correct position.

In conservative treatment, bone realignment is performed manually under local anesthesia. When the foot moves into an anatomically correct position relative to the lower leg, the leg is fixed in a plaster cast. It is applied to the back of the leg and the side of the foot, secured with bandages. The correctness of the reduction and casting is checked using a repeat radiograph.

Direct indications for surgery for a displaced ankle fracture are:

• open and unstable injuries;

• helical and double fractures;
• triple fracture;
• the presence of a large number of bone fragments;
• compression of blood vessels and nerves;
• complications that arise after conservative treatment for bilateral or unilateral damage.

If the surgical method is not used for complex displaced fractures, serious articular defects will form, leading to complete or partial loss of mobility.

Important! For proper fusion of bones during displacement, osteosynthesis is used - special plates, screws, bolts, knitting needles.

The type of bone fixator and surgical treatment technique are selected based on the results of radiography, after a detailed analysis of the injury.

The following operation options are available:

• For a fracture of the lateral malleolus, an incision is made in the projection of the fibula. The doctor removes small fragments and fixes the fragments in an anatomically correct position, securing them with screws or a plate.
• In case of injury to the medial malleolus, an incision is made on the inside of the ankle, the doctor removes small fragments, and then fixes the bones in the correct position with screws.
• If the patient is diagnosed with a bimalleolar fracture, the inner ankle is fixed first, then the outer one. The leg is immobilized with a plaster cast.

For displaced ankle fractures, plate surgery is performed under general anesthesia. The leg is then immobilized by placing a plaster boot on it. After completion of osteosynthesis, repeated surgery is performed to remove the supporting elements (plates, screws, bolts, etc.).

Video

video - Ankle fracture

How long does it take for a broken ankle to heal?

Immobilization means reduce a person’s quality of life, so patients traditionally ask the question: how long to walk in a cast? The exact time frame during which a displaced fracture heals cannot be predicted in advance. The period of wearing a cast depends on the nature of the injury, the age of the patient, and the general condition of his body. It has been noticed, for example, that young people recover much faster than older people.

The average time for bone fusion is as follows:

• ordinary fracture with displacement – ​​4-5 weeks;
• especially complex cases – 3-4 months;
• fracture of both ankles with displacement – ​​at least two months.

How long it takes for a leg to heal after a displaced injury depends on age. The fastest fusion of bones is observed in children (no more than a month), the slowest is in older people (equal to two months or more).

The plaster is removed when x-rays show that the bones have completely fused. To speed up healing, you need to follow all the doctor’s recommendations and avoid putting stress on the injured limb. Removing immobilization devices yourself is strictly prohibited.

Recovery after a fracture

Removing the cast is not the final stage of treatment. When the fixing bandage is removed, rehabilitation after an ankle fracture is required. Its goal is to restore lost mobility of the limb, tone the muscles, and remove swelling.

Rehabilitation consists of three important elements:

Exercise therapy in the recovery period is conventionally divided into two stages: dosed loads and limited motor mode. Gymnastics of the first type can be started 3-4 times after the operation. Its essence lies in the fact that the patient is allowed to move with the help of crutches without using the injured limb.

The second stage of exercise therapy starts after removing the fixing bandage. Its purpose is to develop muscles that have atrophied due to the long stay of the leg in a cast. The main principle of physical education is gradualism. Gymnastics begins with simple activities and ends at the first appearance of discomfort. To begin with, it is recommended to do the exercises by immersing the limb in a basin of warm water: this way you can avoid pain.

Special exercise machines are used for exercise therapy. At home, improvised means are suitable. For example, it is possible to roll a plastic bottle on the floor, use a foot-operated sewing machine, a stick, etc.

The goal of exercise therapy after surgery is to restore an anatomically correct gait. For this purpose, the patient may be prescribed to wear orthopedic shoes. Classes are held with a doctor, during which a special course of physical exercises is developed.

2. Physiotherapy

Physiotherapy relieves swelling of the ankle after a fracture and improves tissue permeability. The patient is recommended to undergo electrophoresis, water procedures, electric shock and other treatment methods.

3. Manual therapy

Massage during the recovery period improves blood circulation in the limb, promotes the speedy return of its motor function, and relieves swelling. You can do it yourself at home, following the recommendations received from your doctor. Care must be taken: the ankle is very sensitive after wearing a cast, and therefore at the slightest discomfort the effect is stopped.

Seeing a doctor for any other type of injury is an essential condition for recovery.

Lack of treatment can lead to partial or complete loss of limb mobility. In order for everything to grow together quickly and correctly, you need to follow the doctor’s recommendations.

The ankle is a part of the ankle joint, representing the protrusions of the lower leg bones on either side above the foot. The ankle area is colloquially called the ankle.

Anatomy

The human ankle has the shape of two bony processes. The lateral (outer) ankle is a formation at the lower end of the fibula, and the medial (inner) is in a similar part of the tibia. The fibula and tibia form the tibia, the part of the leg from the foot to the knee. The ankle is a formative element of the ankle joint - a movable joint between the lower 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 the fork, which is clearly visible in the photos demonstrating the structure of this joint, cover its lower part - the articular surface of the talus of the foot. A durable bone fork allows you to:

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

Thus, the medial ankle is responsible for turning inward without lifting the foot off the floor, and the lateral ankle is responsible for turning outward. The “fork” formed by the outer and inner ankles ensures 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 lateral abduction of the foot - this protects the bones and ligaments from excessive stress.

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

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 their normal position. Without ligaments, the supporting function of the skeleton would be impaired - the bones would simply “move apart” at the places of their articulations.

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

On the lateral malleolus are:

Most often, the cause of decreased mobility in the ankle area is damage to the ligamentous apparatus. The most common injury to the ankle is traumatic injury.

Ankle injuries

Traumatic ankle injuries rank first among all lower extremity injuries. This is due to the high loads placed on the joint of the foot and lower leg.

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

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

Twists of the foot and sharp turns of the leg relative to the foot are accompanied by damage to the ligaments, which can lead to dislocation or, if they are significantly strained, a fracture.

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

The following are particularly susceptible to ankle injuries:

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

Acquired ankle ligament weakness most often occurs as a result of a sedentary lifestyle and sedentary work.

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

Ligament damage

As a result of excessive stretching, either a complete rupture of the ligament or a partial rupture can occur; the latter is often (and not very correctly) called a sprain. Even with micro-tears of the connective tissue in the ligaments, hemorrhages can occur, intercellular fluid can accumulate, resulting in pain that intensifies with exercise - standing, walking.

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

Signs of more significant ligament damage include:

For minor ligament injuries, treatment consists of providing maximum rest to the affected leg and applying cold compresses during the first 24 hours after the injury. In more severe cases, it may be necessary to take painkillers, wear orthoses of various fixations, or undergo surgery.

If you suspect ankle ligament damage, you should consult a doctor as soon as possible. Even if mobility in the ankle is not lost, pain (especially if it does not subside within two days) and swelling may indicate a bone fracture.

Fractures

Ankle fractures are:

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

In displaced fractures, soft tissues are damaged until the muscles and skin are completely torn—this is called an open fracture.

Based on the volume of the lesion, they are distinguished:

• fracture of the lateral malleolus (observed in eight out of ten cases);
• 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 and ankle dislocation, which aggravates the condition and lengthens the period of treatment and rehabilitation.

At the time of the fracture, severe pain occurs in the ankle, and a crunching sound may 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 moving the ankle.

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

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

Treatment consists of taking painkillers and wearing a rigid orthosis or plaster cast. For displaced fractures, surgery is performed.

An ankle fracture requires immediate qualified treatment. Untimely or inadequate treatment of such a fracture can lead to permanent loss of leg function and the development of damage to the ankle joint - arthrosis. Similar complications can develop as a result of irrational treatment of ligamentous injuries, so any ankle injury is a reason to urgently consult a doctor.

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

Due to the fact that the joint (ankle) connects 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 structure is due to the fact that the connection of bones occurs thanks to cartilage, which, in turn, can also be considered as a rather sophisticated system. In addition, normal functionality is ensured by muscles, nerves, thanks to which harmonious and coordinated work occurs, and blood vessels designed to deliver nutrients and oxygen to the tissues.

It is the ankle joint that bears the pressure of the body weight, and its task is to rationally redistribute 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: the tibia and the tibia. Their distal (lower) parts form a depression into which the process of the supracalcaneal (talus) 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;
• lower ends of the tibia.

It must be emphasized that the outer ankle is based on the fibula, namely its distal part, and the inner ankle is based on the tibia. Looking at it in more detail, we should highlight the outer and inner surfaces, as well as the rear and front edges. Its posterior edge contains a notch where the tendons of the peroneal muscles are attached. On 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 it, it is possible to carry out motor functions (walking, running, going up and down stairs);
• the joint is responsible for the normal functioning of the foot;
• allows you to rotate your torso around you, without removing your feet from the floor surface;
• responsible for shock absorption of the torso while walking.

Causes of injuries

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

The following cases can be classified as direct injuries:

• striking the ankle with a blunt or 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);
• falling from a significant height onto your leg.

Most people don’t even think that certain of their actions can affect the condition of bone tissue and increase the risk of pathology. Let's look at a number of factors that increase the chances of a fracture. The most common is calcium deficiency in the body. And this can be caused by an unbalanced diet, in which there are not enough foods containing this element in the diet. A woman taking oral contraceptives may also help.

Physiological causes of injuries

Among the diseases leading to calcium deficiency are:

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

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

Older women often experience fractures. After the onset of menopause, the level of hormones in their bodies, which are also responsible for the regulation of calcium metabolism, decreases.

The most unpleasant factor that can cause a violation of bone integrity even with minimal load are pathological deviations. Such diseases include:

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

It is customary to distinguish three mechanisms of influence on the ankle, as a result of which its integrity is violated: you can rotate the foot in the internal direction (supination injury), you can rotate it externally (protational injury) or it can be obtained when the ankle rotates outward, inward (rotation injury).

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

• Combined fracture. Also known as combined: it happens when several of the described mechanisms act on a limb at the same time.
• Abduction-pronation fracture. It can only occur when the foot is forcibly turned outward, applying considerable force. In this case, the inner ankle may tear 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 slight (within two millimeters) displacement of the bones. If the impact force was significant, a pronounced outward subluxation will occur with 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 occurs as a result of forced flexion of the sole of the foot. This type of injury is uncommon and is rarely accompanied by displacement of fragments. Its characteristic feature is the presence of a triangular bone fragment.

To get the second type of injury, you need to forcefully bend the foot on the back side. It can also occur as a result of a strong blow to the face of the ankle joint. In this case, a triangular fragment will also appear, but in the front side of the bone. Most often accompanied by displacement of bone fragments upward and forward.

• Rotational fracture. Observed as a result of severe inversion of the foot or inward. Often there is damage to two ankles in the articular area. May be accompanied by avulsion of the posterior part of the tibia. This piece will have the shape of a triangle. If the joint rotates outward, then the ankle injury will be helical. The fracture will stretch from the bottom of the bone to the top, and then turn outward. In the case when 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 strong forced rotation of the foot inward. In the process, a separation of the upper end of the outer ankle or its fracture in the joint area occurs. 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 on the inside. If the traumatic force continues to act, it will cause a vertical oblique fracture of the lateral malleolus to appear.

Additional classification

When no bone fragments are displaced during a fracture, the injury is classified as “non-displaced.” If the divergence of the fragments is more than two millimeters, the fracture is called “displaced fragments.”

A closed fracture of the lateral malleolus of the right or left leg 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 outward.

When only one ankle is injured, such a fracture is usually called a unimalleolar, and in the case of injury to both the inner and outer ankles together, it is classified as a bimalleolar. There is a case of disruption 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 (displacement, divergence of the articular fork, ligament injury, subluxation).

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

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, and can radiate away from the affected area;
• increased pain when trying to move the injured leg or during palpation;
• numbness of the injured leg;
• motor dysfunction;
• general weakness, dizziness, nausea;
• limb deformity;
• hematoma;
• swelling or swelling of the affected limb;
• chills and feeling of cold.

If the fracture breaks the integrity of the blood vessels or damages the nerve endings, the skin in the affected area becomes pale and some neurological symptoms may be observed, such as loss of sensation.

As a rule, symptoms make themselves felt quite quickly, almost immediately after 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 a timely manner.

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

If a fracture with displacement of bone fragments is diagnosed, a bluish appearance of the skin in the affected area is observed, although its color may be red-purple. The leg swells, there is an extensive hematoma, and 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 worsening, it is important to provide first aid in a timely and correct manner.

Important! Do not move (twist, straighten, bend) the affected joint under any circumstances. To reduce swelling and pain, you should elevate the limb higher. To do this, carefully lift it, without touching the affected area, and place a pillow, a cushion from a blanket and other objects. This will ensure the outflow of blood and relieve unpleasant symptoms.

A cold compress is also applied for this purpose. Frozen foods from the freezer, small jars or bottles from the refrigerator, or 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 in cloth. This compress is applied for fifteen minutes, after which you need to take a short break and repeat the procedure.

If there is an open wound on the outside with heavy bleeding, you need to stop it immediately by tying the limb with a tourniquet just above the injury site. Before transporting the victim, the limb must be immobilized by applying a splint. To do this, you can use available 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

If you receive any injury that is accompanied by long-term pain and more severe symptoms, it is better to immediately go to the emergency room to avoid a number of undesirable consequences that arise from improper treatment.

Without the use of radiographic examination performed in two projections, a diagnosis cannot be made. In complex or unclear situations, the patient additionally undergoes computer or magnetic resonance imaging of the joint.

Therapy

When an ankle fracture is diagnosed, the doctor decides on the treatment method. The conservative form is used for simple fractures (without displacement). In this situation, there is no displacement of bone fragments, so it is enough to simply immobilize the leg. For this, a plaster cast is used. The duration of its use ranges from four to eight weeks.

The situation with displaced fractures is somewhat more complicated. In this case, the surgeon needs to return all fragments of the damaged bone to their natural physiological position. Reduction can be performed either closed or open (during surgery). Local anesthesia is required during this procedure. If the fracture is aggravated by subluxation, then the traumatologist first sets the joint and then compresses the ankle joint, returning the bones to their normal position. After this, the limb is fixed with a plaster boot, and a control x-ray is taken.

It is recommended to use painkillers and UHF. When the swelling has completely subsided, the plaster cast is circulated (strengthened). Depending on the severity of the injury, the recovery process may take from a month to two. The plaster is removed from the leg only when the bone has completely fused. To check this, control x-rays of the affected limb are taken.

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

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

Negative consequences of injury

Herbs that are not accompanied by displacement of bone fragments pass quickly and are rarely complicated by negative effects. There may be minor aching pain. This is usually due to worsening weather conditions or excessive physical stress on the affected leg. As a result of displacement of fragments, even if they were normally reduced, the injury may be aggravated by dystrophic pain syndrome, in which severe pain is observed in the foot and joint, making it difficult to step on the leg. This pathology occurs as a result of damage to nerve endings and blood vessels. The following therapeutic methods are used to combat the disease:

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

With proper treatment, the pathology disappears within one year.

If the victim does not seek help in time, the negative consequences of such a negligent attitude towards his health develop. The bone tissue heals incorrectly, resulting in constant pain, the limb is deformed, the joint is swollen, motor function is impaired, when moving the patient feels unstable, insecure, and lameness appears. Surgery will be required to eliminate it.

Timely diagnosis, proper treatment and compliance with all the instructions of the attending physician will help you recover from a fracture as soon as possible and return to your normal rhythm of life.

The ankle is the most vulnerable location for traumatic injury. Displaced ankle fractures occur quite often, are difficult to correct and are prone to recurrence. It can occur suddenly even when walking calmly, going down or going up stairs.

Degenerative processes in bone tissue during a fracture of this location play an important role and complicate the course of the disease. Therefore, fractures are more common in older people.

What it is

The ankle is the bony tubercle that projects medially and laterally above the ankle joint. The medial (inner) malleolus is a process of the tibia, and the lateral (outer) ankle is a process of the fibula. The 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 leg and foot. Its structure is bolic and movements can only be made in one plane. Rotation in the joint is not possible at an angle of more than 65˚. Due to the paucity of movement, this joint is the most stable and is able to withstand the load of the entire weight of the human body.

This joint performs a supporting function, is the most powerful shock-absorbing mechanism in the human body, and is involved in any motor activity of the lower limb. Its stability is ensured by the ligaments of the foot: the fibular and deltoid ligaments.

Varieties

An ankle fracture can be divided by anatomical location:

1. Fracture of the outer ankle;
2. Fracture of the inner malleolus;
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 turns outward. In this case, most often there is a fracture of the ankle with displacement of the fibula;
• Pronation. Also called abduction. The opposite of a supination fracture, it involves the inward turning of the foot at the ankle joint. With this type, the medial malleolus is most often affected;
• Rotational fracture. The main mechanism of injury in displaced ankle fractures is that the foot is excessively turned outward or inward, resulting in an impact on both ankles, and damage to the body of the tibia also occurs;
• Flexion. Often isolated fractures, in which there is a direct impact on the dorsum of the foot and, like a fracture along the tibia in the area of ​​its anterior surface, a fracture of the medial malleolus;
• Combined. Occurs through a combination of several mechanisms.

Bimalleolar fracture

A double ankle fracture is the most common type. It can occur as a result of:

1. Adduction or abduction mechanism;
2. Falling on the foot from a high height (with this type, not only a displaced fracture of the ankles occurs, but even an impacted fracture is possible);
3. Rotational mechanism of injury.

A closed triple fracture is also called a Pott-Desto fracture. With this type of fracture, damage occurs not only in the area of ​​the 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 there is a high probability of complications and malunion. Most often, surgery is performed.

Another reason for choosing a surgical treatment method as the most rational is damage to the ligamentous apparatus of the ankle, most often a tear or rupture of the ligaments. Treatment consists of matching the edges of the tear and suturing it.

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 wires 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 leg;
• The open method is by plasticizing the bone itself from the inside.

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

1. Access is provided to the affected bone structure;
2. There is a revision of bone fragments, elimination of pinching (interposition) of soft tissues (ligaments, muscle fibers), suturing of damaged ligaments, stopping bleeding by ligation (ligation) or stitching of damaged vessels;
3. Fixation of bone fragments on a rigid, previously remodeled for a specific patient (specially adjusted) metal, usually 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 cast.

Rehabilitation

• Exercise therapy. From the first days after surgery, exercises with the development of the knee and hip joint of the affected leg are allowed to accelerate blood circulation, prevent blood clots and atrophy of muscle fibers;
• Physiotherapeutic treatment. After removing the plaster, electrotherapy, paraffin applications to the fracture site and other methods, except magnetic therapy, are carried out;
• Massage. If there is a cast, massage the thigh and lower leg, and after removal - the ankle joint. Immediately after removing the cast, 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 take to 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.

Removal of the cast occurs only under the control of an x-ray; in the presence of callus and signs of complete healing of the injury, rehabilitation measures are allowed to begin. Rehabilitation lasts about 3 months.

When can you 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 to walk on crutches to reduce the load on the affected limb.

On average, 2-3 weeks pass after the cast is removed when you can step on your foot. While the joint is developing, 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 and correct rehabilitation, a patient can run after a displaced ankle fracture.

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

How does an ankle fracture occur?

A direct blow to the ankle rarely results in a fracture, but is usually seen when the foot is over-rotated or when landing on it from a great height. At the same time, there are two subtypes: the pronation mechanism of injury and the supination mechanism.

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

• transverse ankle separation;
• fracture of the outer ankle 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 is added to the ankle fracture.

A supination fracture occurs when the foot rolls inward.

In this case, the following may happen:

• transverse avulsion of the outer malleolus;
• displaced oblique fracture of the inner malleolus;
• ligament rupture and foot dislocation.

If you fall on your foot from a height, you can get damage to both ankles at once - a double fracture with displacement. More often than not, a person lands on both feet, causing both ankles to break at once.

Clinical manifestations of displaced trauma

1. The initial symptom of a fracture will be a pronounced pain attack in the ankle joint.
2. Swelling quickly increases 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 is added to the ankle fractures, the foot will still deviate downwards. Any movement in the area of ​​the fracture causes increased pain.
5. If blood vessels are damaged, a rapidly expanding hematoma in the area of ​​injury may occur.
6. In this case, there is no massive bleeding, but mixed shock may develop - both hemodynamic and painful.
7. In this case, there will be a drop in blood pressure, increased heart rate, and pale skin. This is most often observed when both ankles are fractured at once.

X-ray confirmation of fracture

X-ray examination allows us to determine the exact location of the fracture, the presence or absence of displacement, and the free position of fragments. It is necessary to take the picture from several sides - in the anteroposterior and lateral projections.

A transverse fracture is usually not accompanied by displacement, but 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 ensured.
2. To do this, a splint - wooden, wire or pneumatic - is placed on the leg from the foot to the knee joint.
3. If the fracture site is very dirty, you need to wash your leg, preferably with an antiseptic solution. This is done before applying the splint.
4. In case of severe bleeding, a tourniquet is applied to the lower leg for no more than two hours.
5. Pain relief is carried out only by taking drugs orally. Injection analgesics are not recommended due to possible infection of the fracture site.
6. In cases of shock, cardiac support and infusion therapy are necessary. Naturally, these measures are carried out by medical workers right at the site of injury.

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Surgery and other treatments

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

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

Conservative method of therapy

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

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

A non-displaced ankle fracture is an injury that is very easy to get. But not everyone can fully recover after it. 10% of such cases result in disability, especially in elderly patients. This is explained by the fact that during treatment it is not only the bone that is subject to restoration, but also blood circulation, joint function, and also 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 turns into a process: below, in the area of ​​the inner bone, there is an inner ankle, and in the lower part of the outer bone there is an outer ankle. The heel bone and ankle form the ankle joint, which allows a person to walk.

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

• fracture of the medial (inner) malleolus;
• fracture of the lateral malleolus (external);
• displaced fracture of the lateral malleolus;
• non-displaced fracture of the lateral malleolus;
• fracture of the inner ankle without displacement and with displacement;
• Helical fracture of the ankle.

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 injury received may turn out to be a severe bruise or dislocation. If the patient feels pain, and the leg is very swollen and a change in the shape of the joint is observed, then, most likely, in this case there is a fracture. To finally determine this, the patient is sent for an x-ray. In the photograph taken, you can clearly see any flaw on the bone.

Main symptoms

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. Here the displacement is obvious, since it was the damaged bone that broke through the skin and flesh. A closed leg fracture is much more difficult to determine, since the soft tissues are damaged internally, and only the presence of minor hematomas may indicate 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 the location of the bone tissue rupture. When the external ankle is fractured without displacement, the main symptom is severe pain. The person cannot lean on his leg. In addition, there is a slight swelling on the outer part of the lower leg. The ankle joint bends and extends, but such movements are very painful. The pain is especially acute if you try to move your feet in different directions.

With a displaced internal fracture of the ankle, the victim feels sharp pain. Swelling appears from the inside of the lower leg, smoothing out the contours of the ankle. Sometimes the victim is still able to stand on his foot and even take steps, leaning more on the outer side of the foot or heel. Joint movements are limited, pain increases with the slightest attempt to move the limb.

With a displaced medial rupture, the symptoms are very similar to a non-displaced fracture. However, since the soft tissues and blood vessels are damaged, a large number of hemorrhages are observed. This is explained by the presence of arteries in this area. Doctors know of many cases where the symptoms of a fracture were mild and the pain was tolerable. Therefore, the final diagnosis can only be made after studying the x-ray.

First aid

Orthopedic doctor Anatoly Shcherbin:
“It is known that for the treatment of bunions on the feet there are special insoles, correctors and operations that are prescribed by doctors. But we will not talk about them, and those medications and ointments that are 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 compression. After this, you need to try to calm the injured person, and if possible, give him a painkiller. Then you should call an ambulance. It is very important not to make sudden movements and prohibit the victim from standing on the affected limb - this can provoke displacement, which will lead to damage to blood vessels and nerve endings.

It is advisable to fix the sore limb with some available means, and if possible, then with a special transport splint. A suitable means at hand is a wooden board, a piece of reinforcement, etc., which must be tied to the leg with a bandage or regular cloth. In the case of an open fracture, it is advisable 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 inner malleolus, 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 - with its help you can reduce swelling and reduce pain. If possible, care should be taken to ensure that the injured limb is in an elevated position. A roller made with your own hands from scrap materials is suitable for this. It is strictly forbidden to “set” the bone yourself. If necessary, this will be done by a traumatologist who has studied the X-ray results.

Features of treatment

Treatment for a displaced and non-displaced ankle fracture is significantly different. If after examination and x-rays no displacement is detected, a conservative method is used. It involves applying a bandage to a broken bone and then securing it with a bandage. When performing this procedure, there is no need to over-tighten 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 patient’s age. 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, the bones are set into place under local anesthesia, and then a plaster cast is applied. In some cases, if the displacement occurs again, the ankle is fixed in an immobilizer.

For 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 set, and torn vessels and soft tissues are sutured. Subsequent treatment for this type of fracture is the same as for closed fractures. Typically, for all forms of fractures, traumatologists prescribe anti-inflammatory drugs and drugs that stimulate the fusion of bone tissue.

Rehabilitation period

Victims of such injuries are most often concerned with the question: how to quickly heal an ankle fracture and how long it will take to recover. It is worth immediately noting that healing takes different times for each person - it depends on the type of injury and the age of the victim. After the cast is removed, the 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 undergo rehabilitation. Some measures can be carried out even before the cast is removed, others are permissible only when the bandage has already been removed.

One-fifth of all leg injuries involve non-displaced ankle fractures. It can be caused by landing incorrectly on your feet, while engaging in dangerous sports, or by an unfortunate fall that occurs for various reasons.

Many who have broken their ankles are interested in how long to wear a cast and whether it needs to be done at all if the bones do not move. Of course, the decision on treatment and rehabilitation methods is made by the doctor

traumatologist - orthopedist. But statistics say that a plaster cast is almost always prescribed, and the recovery period varies in length.

A person’s reluctance to consult a doctor in a timely manner provokes the development of serious disorders in the musculoskeletal system, causing diseases not only of the legs, but also of the spine.

What is this fracture?

The ankle is the place where the bones of the lower leg meet the foot. In other words, this is an ankle that looks like a bone process that participates in the formation and further motor activity of the ankle joint.

Functions of the ankle joint :

• completely regulates the function of the foot;
• serves as a support for the human body;
• carries out depreciation of the body.

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

There is also its outer part. This happens depending on the type and severity of the injury. It is quite difficult to determine on your own

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

Kinds

Depending on the extent of the damage and its type, a fracture of the outer ankle without displacement or its internal part is classified into several different options. The mechanism of injury also influences our classification of injury.

A closed ankle fracture occurs :

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

Causes of Ankle Fracture

A fracture can only be caused by trauma, which is a mechanical impact on the ankle. However, there are many predisposing factors during which the risk of injury to the leg increases significantly.

Types of injury :

1. Straight.

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

1. Indirect.

Represents a dislocation of the foot in various situations. It can be caused by a lack of stability on the surface (for example, on roller skates, ice skates), as well as when engaging in traumatic sports or carelessly walking along steep steps.

When the risk of 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;
• wearing inappropriate shoes, especially high heels;
• practicing hazardous sports;
• winter season.

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

Symptoms

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

Signs to look out for:

• a loud crunch during injury often indicates a bone fracture;
• if a person breaks his leg, it is pierced by a sharp pain, which does not allow palpation of the injury site and movement of the foot;
• swelling, which is observed in the ankle area, but can spread to the lower leg;
• hematomas from fractures are also extensive;
• inability to move the foot or the entire leg.

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

Video

Video - Non-displaced ankle fracture

First aid for fractures

To reduce pain, you can take a tablet of any analgesic that you have 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 medications.

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

Diagnostics

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

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

• bone fracture line in a contrasting color;
• if there was a ligament rupture, the x-ray shows an unnatural widening of the ankle joint gap or its deformation;
• soft tissues are thicker.

As a rule, these measures are sufficient to make a correct diagnosis and prescribe treatment when a person breaks his leg. At this stage, the doctor can assess the condition of the victim, and also answer the question of how long to walk in a cast and whether it will be necessary at all.

Treatment

For a non-displaced fracture, 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 and vitamin complexes that contain calcium. The patient also needs to establish adequate nutrition. Almost always, after an ankle fracture, a specialist applies a plaster cast. Surgery is rarely prescribed.

Conservative

Conservative treatment involves taking various medications to speed up healing. A plaster cast is also applied for an ankle fracture, which helps the broken bones 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 heals only when plaster is applied correctly. 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 application of plaster can be considered successful.

Then the specialist conducts a second examination using 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 that may have occurred when applying the bandage. On average, plaster 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. Surgery 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;
• joints are already healing incorrectly due to lack of timely seeking help;
• a bimalleolar fracture occurred (that is, 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, suturing damaged ligaments and fascia. After all the necessary manipulations have been carried out, the patient is also given a cast, with which he walks for at least 2 months.

Rehabilitation

Rehabilitation after a fracture includes several main stages, including wearing a plaster cast and taking prescribed medications. After removing all the fixing elements, therapeutic exercises and massage are performed, and physiotherapy may be prescribed. Complete healing depends on a number of factors.

When does a fracture heal fastest?

• young age;
• absence of concomitant diseases of the skeletal system;
• compliance with all medical recommendations, bed rest;
• presence of sufficient calcium in the body.

Recovery after a fracture is also influenced by the quality of additional procedures performed for recovery. The speed of rehabilitation directly depends on the nature and complexity of the injury. On average, after an ankle fracture, full recovery occurs within 3-6 months, sometimes longer.

The complex of rehabilitation measures includes :

The more varied the effects on the body the therapy is, the higher the chances of a complete recovery. The victim needs to listen to all medical recommendations and implement them in a timely manner, then the bones will heal correctly.

You should not make the decision to carry out physical activity on your own, and you should not feel too sorry for yourself by not doing any exercise at all.

Prevention

Half of ankle fractures could be prevented if people practiced injury prevention. Of course, this does not apply to serious accidents, which always happen unexpectedly, but the factors predisposing to a fracture can be eliminated by everyone.

What can be done for prevention:

• Establish a diet enriched with calcium and vitamin D.
• Regular sunbathing, which also contributes to the production of vitamins necessary for the absorption of calcium.
• Avoid risky sports.
• Do not wear heels or do so carefully. You should not run in uncomfortable shoes or walk on uneven surfaces.
• Train your lower leg muscles by doing gymnastics.
• Take measures to gradually reduce excess weight.
• Get examined in a timely manner and treat emerging diseases of the immune and skeletal system.

These measures will help to significantly reduce the risk of fracture in cases where you can get by with a slight dislocation or even just a fright.

Possible complications and prognosis

You should not violate the rules of recovery after a fracture or not consult a doctor at all. This is fraught with the development of serious complications that will subsequently require surgical intervention. And the absence 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 fusion of bones and other problems with the musculoskeletal system. If the joint does not heal properly, the victim will experience 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 fracture. Of course, if it is double-ankle and consists of many fragments, the victim should hope for a miracle. Mild dislocations and subluxations, if promptly contacted by a traumatologist, can be treated without any problems.

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

A high risk of injury is observed in athletes during intense training and, on the contrary, in people leading a sedentary lifestyle. Weakness of the ligamentous apparatus and muscles of the lower leg leads to frequent twisting of the leg and damage to the ankle joint. Women who prefer to wear high-heeled shoes are also at risk for ankle fractures.

What are ankles?

In everyday life, the area of ​​the ankles is called the ankle. The ankles are part of the ankle joint and are the elevations of the bones of the lower leg. The tibia forms the medial malleolus, which is located on the inside of the lower leg. The lateral malleolus is located on the outside of the lower leg and is a bony protrusion of the fibula. In the lower third of the leg, both ankles, like a “fork,” clasp the talus bone. This ensures mobility and stability of the ankle joint.

Location of ankle fractures

The joint is strengthened by strong ligaments, which bear a colossal load during a static position, walking, running, and jumping. Exposure to a force that exceeds the strength of bone tissue causes the formation of a bone defect. Poor nutrition with insufficient calcium intake, obesity, wearing uncomfortable shoes, intense physical activity or a sedentary lifestyle are risk factors for the formation of fractures in the ankle area.

Classification of fractures

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

According to severity they are distinguished:

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

Based on the location of bone fragments, the following are distinguished:

• fracture of the ankle 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 tissue.

Based on the location of the injury, the following are distinguished:

• fracture of the outer malleolus (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 to the medial and lateral malleolus;
• trimalleolar fracture - damage to the medial and lateral malleolus is combined with a defect in the posterior surface of the 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.

A common leg injury is a fracture of the lateral malleolus when the foot rolls in

A fracture in the ankle area 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 duration 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, wound infection with the development of sepsis, fat embolism with damage to the pulmonary or cardiac vessels.

Clinical picture

An ankle injury occurs as a result of a direct blow to the leg with a heavy object or when heavy objects (plates, bricks, iron pipes) fall on the lower limb. In most cases, a fracture develops when the leg is twisted as a result of awkward movements. Clinical manifestations of the disease depend on the mechanism of injury, the severity of damage to bones and soft tissues, and the psychological state of the person.

At the moment of exposure to a traumatic factor, intense pain and crunching appears in the area of ​​damage. However, there are cases where the victim felt delayed pain some time after the fracture. For example, athletes during competitions, which is associated with a high level of adrenaline in the blood, which causes an anesthetic effect.

Swelling of the ankle due to a fracture of the lateral malleolus

Clinical signs of a fracture:

• pain in the area of ​​injury;
• pain increases when moving the leg and feeling the deformed bone;
• inability to step on the leg, impaired motor activity of the lower limb;
• leg deformity, pathological mobility at the fracture site;
• formation of a wound due to an open injury with signs of arterial or venous bleeding;
• formation of a hematoma in the area of ​​a closed fracture as a result of internal bleeding;
• swelling of the ankle, smoothing of the contours of the ankles;
• crepitus (crunching) when feeling the damaged bone.

Swelling of the leg with a fracture of the outer ankle is located on the lateral side of the joint, and with a fracture of the inner ankle it is more pronounced on the medial side of the ankle. Trimalleolar and bimalleolar fractures are accompanied by intense pain, inability to move in the ankle joint, which swells along the entire circumference with spreading pastiness to the lower leg area.

For injuries without bone displacement, the symptoms are similar to the clinical manifestations of dislocation and rupture of the ankle ligaments. For differential diagnosis, instrumental examination methods are used. Displaced ankle fractures have more pronounced manifestations; open injuries do not raise doubts about the diagnosis.

Diagnostics and treatment tactics

If a fracture of the ankles is suspected and the degree of bone deformation 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 examines 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 fracture of the medial malleolus

Timely diagnosis and adequate treatment prevent the development of complications and 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 (Kramer, pneumatic) or improvised (boards, sticks, umbrellas) splints. Arterial bleeding is stopped by applying a tourniquet, and venous bleeding by applying a pressure bandage. The patient is given painkillers to prevent traumatic shock.

Fracture treatment is carried out conservatively or surgically in a trauma hospital. The conservative method is used to treat injuries without displacement or with displacement of bone fragments in case of 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 damaged ankle, which covers the foot and lower leg up to the knee joint. Before and after applying the plaster, x-rays are taken to monitor the correct reposition of the damaged bone areas.

In other cases, surgical intervention is prescribed, in which bone fragments are fixed with screws, knitting needles, or 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 lateral malleolus fracture using a plate

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

After removing the plaster, a control x-ray is taken to ensure proper healing of the bone defect. If the disease progresses positively, patients can step on their feet. To improve blood flow in the injured limb, eliminate ankle swelling, develop the joint and strengthen the leg muscles, massage, physiotherapy, and physical therapy classes are prescribed.

4. Fracture of the lateral malleolus and lower third of the fibula with outward subluxation of the foot and rupture of the tibiofibular syndesmosis.

The doctor should know that the following operations are performed:

Osteosynthesis of the inner ankle using a circular suture around the ankle, a two-bladed nail, a screw;
- restoration of the deltoid ligament - suturing its torn ends, transosseous fixation of the ligament to the site of its tear, plastic surgery from the tendon of the posterior tibial muscle (Guriev’s method);
- restoration of a torn tibiofibular syndesmosis with a tie bolt or screw;
- osteosynthesis of the lateral malleolus and fibula using a nail inserted intramedullary.

With low fractures of the fibula or with fractures of the lateral malleolus, an attempt to eliminate diastasis of the tibiofibular syndesmosis with a tie bolt or screw can lead to valgus placement of the lateral malleolus. In order to prevent this complication, immersion osteosynthesis of fractures of both the lateral malleolus and the fibula in the lower third is indicated.

All of the above operations for complex fracture-dislocations are performed simultaneously in the following sequence:

Osteosynthesis of the medial ankle or restoration of the deltoid ligament;
- osteosynthesis of the posterior edge of the tibia;
- intramedullary osteosynthesis of the fibula;
- restoration of the tibiofibular syndesmosis.

Regarding open ankle fractures, students and clinicians need to know the following:

Pinpoint or small wounds should be treated according to general surgical rules. If there are appropriate indications, the fracture or dislocation is reduced and immobilized in plaster.
- Extensive wounds of the skin and periarticular tissues, especially contaminated ones, with protruding ends of bone fragments and articular surfaces require careful cleaning of the wound area and radical surgical treatment of the wound, often with revision of the ankle joint and washing it with antibiotic solutions. Primary surgical treatment of such wounds can be completed by applying rare sutures to the skin, draining the wound and repositioning the dislocation using the methods described above, which usually does not present difficulties, and plaster immobilization. The operation can be completed with osteosynthesis, the options of which depend on the nature of the damage to the ankle joint.

The student and the doctor should know that the treatment of improperly healed and non-united fractures of the ankles (false joints), the posterior edge of the tibia, persistent diastasis of the tibiofibular syndesmosis and subluxation of the foot, deforming arthrosis of the ankle joint presents immeasurably greater difficulties than the treatment of these injuries immediately after injury.

Remember! All of the listed pathological conditions are a consequence of the treatment of the injury and reflect the failure of conservative or surgical treatment carried out in each individual patient.

These deformities are subject to surgical treatment, but the objectives of this treatment may be different - restoration of anatomical or functional disorders.
- Restoration of anatomical disorders - reconstructive operations: open reposition, osteotomy of improperly fused bone fragments, excision of scar tissue, osteosynthesis (external malleolus or fibula, internal malleolus, posterior edge of the tibia, tibiofibular syndesmosis), plastic surgery of the deltoid ligament.
- Restoration of functional disorders - supramalleolar corrective osteotomy of the tibia, arthrodesis of the ankle joint.

The student and the doctor should know that after conservative or surgical treatment of injuries to the ankle joint, restorative treatment is necessary, which includes therapeutic exercises, massage, and physiotherapy.

5. Therapeutic exercises for ankle fractures.

Therapeutic exercises for patients with ankle fractures are carried out from the first days of injury, regardless of the treatment method used - one-stage closed reduction, skeletal traction, surgical treatment. The complex of therapeutic exercises is conditionally divided into three periods.

The first period begins on the 1st-3rd day after reposition and includes tension in the quadriceps femoris, calf muscles, and movement of the toes. If the patient is in a plaster cast, it is necessary to make flexion and extension movements in the knee joint, sit in bed with the leg lowered, and stand on the healthy leg.

The second period begins after the cessation of plaster immobilization and includes exercises for the ankle joint - extension of the foot, pronation and supination and rotational movements of the foot.

The third period begins from the moment of loading on the injured limb and includes flexion and extension of the foot, squatting on toes, walking on toes and on heels, mechanotherapy. Massage.

Massage accelerates the processes of consolidation of an ankle fracture and restores ability to work. Early massage is performed on the 2-3rd day after injury. If the patient is in skeletal traction, massage the thigh and lower leg; if the patient is in a plaster cast, you can massage the healthy leg, which has a reflex effect. After cessation of plaster immobilization, the lower leg, ankle joint, and foot are massaged.

6. Physiotherapy for ankle fractures.

Physiotherapeutic procedures include:

Warm baths at a temperature of 38° C for 20-30 minutes;
- paraffin, mud and ozokerite applications;
- ultrasound with hydrocortisone;
- iontophoresis with novocaine.

After removing the plaster cast, the patient should bandage the ankle joint with an elastic bandage and wear an orthopedic insole for a year after the injury.

7. Complications and errors in the treatment of ankle fractures.

False joint of the inner malleolus.

Subluxation of the foot.
- Malunion fractures, especially fractures of the posterior edge of the tibia.
- Unresolved diastasis of the tibiofibular syndesmosis.

Deforming arthrosis of the ankle joint. Clinical manifestations of these complications may include:

Pain in the ankle joint, significantly worsening with physical activity;
- swelling of the limb;
- lameness;
- hallux valgus;
- traumatic flatfoot;
- neuritis of the calcaneal branch of the tibial nerve.

Reasons for poor outcomes of conservative treatment of fractures I.L. Krupko and Yu.I. Glebov (1972) are divided into five groups;

The first reason is poor diagnosis of fractures of the ankles and posterior edge of the tibia with displacement of fragments and complex fractures and dislocations in the ankle joint.
The second reason is poor reposition of displaced bone fragments and incomplete elimination of dislocation or subluxation of the foot and rupture of the tibiofibular syndesmosis.
The third reason is secondary displacement of the reduced fragments in the plaster cast, which may be a consequence of decreased swelling when the plaster cast becomes loose, or a consequence of poor immobilization and frequent dressing changes.
The fourth reason is early load on the injured limb.
The fifth reason is the untimely and inadequate use of physiotherapy and therapeutic exercises.

Regarding complications and errors of surgical treatment of ankle fractures, then the doctor needs to know the following.

The possibility of infectious complications - wound suppuration, abscess or phlegmon of the wound area, thrombophlebitis, osteomyelitis, sepsis.
- Incorrectly performed surgical intervention: strong and adequate fixation of all injuries is not ensured, insufficient reposition of a fracture or dislocation.

Vorotnikov Alexander Anatolyevich, Candidate of Medical Sciences, Associate Professor, Head of the Department of Traumatology, Orthopedics and Military Surgery of St. State Medical Academy,
Barabash Yuri Anatolyevich, Doctor of Medical Sciences, Professor of the Department,
Apaguni Artur Eduardovich, Candidate of Medical Sciences,
Anisimov Igor Nikolaevich, Candidate of Medical Sciences,
Mosiyants Vachagan Grigorievich, assistant Enikeev Marat Rafaelevich, assistant.

Catherine

Natalia 18.06.11, 08:28

A year ago I broke my leg. Dislocation and splinter fracture of the left palm. I have coronary heart disease and tachycardia. I had surgery and was put in a cast. I went for dressings and was told that the bones were not put together and they did not heal correctly. As a result, I have “horse foot”. I'm still on crutches! One doctor says to work on the leg, the other says not to try it under any circumstances. I contacted the insurance company. After that, I was asked to come to the hospital with all the tests. After examining my heart, they told me - arrhythmic variant of coronary artery disease, permanent form of atrial fibrillation tachinoform, grade 3 hypertension. achieved degree ARO-1 risk 4. NK 2 tbsp. on N4NA 2A on VOSSI Sop. COPD is moderate to severe. I was denied a repeat operation. What to do? Walk on crutches for the rest of your life?

Among all injuries of the ankle joint, ankle fracture occurs in almost 75% of cases. During this injury, a person loses his ability to work for a long time. An ankle fracture in slightly more than half of all cases requires surgical intervention. When an ankle is fractured, the integrity of the bone is disrupted due to the active impact of a large force on the leg.

Causes

The causes leading to ankle injury can be traumatic, pathological and physiological factors. Traumatic factors include various blows to the limb or injuries due to improper support on the leg, for example, by slipping or tripping, you can twist your ankle. During indirect injuries, tendon dislocation or rupture may also occur. Pathological factors that increase the risk of ankle fractures are:

• taking oral contraceptives for a very long period;
• lack of calcium in the body;
• pathologies of the adrenal glands;
• removal of the parathyroid gland;
• excess vitamin D;
• the presence of atrophic gastritis;
• bone diseases, such as osteoarthritis and osteoporosis;
• insufficient ossification;
• bone oncology;
• osteomyelitis in chronic form;
• tuberculous bone lesions.

Physiological reasons include periods of intense bone growth, pregnancy and old age.

Varieties

There are many types of ankle bone injuries. They depend on the location of the injury, its severity and associated injuries. The human leg has a lateral malleolus, located on the outside, and an inner malleolus, called the medial malleolus. Accordingly, depending on which of them is damaged, a fracture of the lateral malleolus or a fracture of the medial malleolus may occur. Rarely, a bimalleolar fracture may occur. It is very difficult to treat a fracture of this type, and it takes quite a long time for it to heal. In addition, in 15% of such injuries the patient remains disabled.

Ankle fractures are classified as open or closed ankle fractures, depending on whether the skin is broken by bone fragments. An ankle fracture without displacement or with displacement of the bones is equally common. The most dangerous are displaced bimalleolar fractures, since the foot practically hangs on the skin. There may also be an incomplete fracture, simply a crack in the bone, in the presence of which plaster is never applied and surgical manipulations are not used. The healing of the crack occurs quite quickly even without serious treatment.

Clinical picture

Symptoms of an ankle fracture may vary depending on the type of injury. If there is an open fracture, then displacement of bone fragments is always observed, because they are the ones that cause damage to the skin and subcutaneous tissues of the leg. Blood is flowing from the wound, the injury site is very painful.

A fracture without displacement is most often closed. A non-displaced fracture of the lateral malleolus causes bruising and intense pain, but without x-rays 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 leg swells greatly, due to which the ankle itself ceases to be visible. Sometimes the victim does not lose the ability to lean on the 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.

If an external fracture occurs, in which the bone fragments are not displaced, then it becomes painful for the victim to lean on the leg, including the heel area. The outer ankle becomes swollen and severe pain occurs in the joint, especially if the victim tries to turn the foot to the side.

An ankle fracture with subluxation leads to tearing of the ligaments, which causes large internal hemorrhage and the formation of an extensive hematoma, especially if the artery is damaged. Bimalleolar foot subluxation fractures are not only very painful, but also cause hematoma and swelling around the entire ankle joint.

The most dangerous is a bimalleolar fracture, in which a person cannot lean on the affected leg at all or make any movement with the foot. The bone is completely broken off on both sides, and if the damage is open, then such a terrible injury as the separation of the foot can occur. A person with such an injury may even lose consciousness from the resulting painful shock at the site of the bone fracture. In the foot and toes themselves, sensitivity may be impaired or absent altogether, as serious damage to the nerves occurs.

Other symptoms if your ankle is broken:

1. The presence of crepitus - a kind of crunching of bone fragments. This sign can be considered one of the most informative. During palpation, the doctor hears the sound of “crunching snow,” which indicates a fracture of the tibia. At the same time, the person’s painful sensations become stronger, and this may indicate displacement of bone fragments.
2. The foot loses its motor function and stops bending and rotating at the ankle joint. The foot is in an abnormal position, turned in a certain direction.
3. Impaired sensitivity or its absence after an ankle fracture is due to the fact that the nerve pathways are either damaged by a bone fragment or pinched by the resulting swelling and hematoma.

An ankle fracture is a very painful and dangerous injury, especially if both sides of the leg are injured. Delayed contact with a doctor or ignoring his recommendations can lead to serious complications and irreparable consequences.

Providing first aid

An apical fracture of the inner malleolus or outer malleolus requires immediate assistance to the victim. After all, if you ignore the symptoms of injury, the crack can become a complete fracture, and a closed form of injury can turn into an open injury.

Under no circumstances should you palpate the site of injury or forcefully move it, because the number of bone fragments may increase. Very carefully, the leg is lifted from the places above and below the injury and placed on a small cushion. If the victim feels severe pain, he should be given a pain reliever. If no external damage is observed, then a cold compress is placed at the site of injury to relieve pain and relieve swelling.

If tissues and arteries are damaged, it is necessary to apply a tourniquet slightly higher than the wound. You should remember, or better yet, write down the exact time of application of the tourniquet, since it cannot be kept for longer than twenty minutes. The wound itself must be disinfected with an antiseptic solution and covered with a sterile bandage until the ambulance arrives.

No products should be applied under the bandage.

It is necessary to immediately rid the person of shoes on the sore foot, since doing so later will be problematic due to severe swelling. The victim should not be allowed to eat or drink, since a fracture aggravated by displacement requires surgical intervention, before which the person is given anesthesia, and before anesthesia, eating and drinking is prohibited.

Diagnostics

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

• visual inspection of the injury site for the presence or absence of skin damage, assessment of foot deformity, identification of hematomas;
• palpation for crepitus (done very carefully and not always);
• X-ray examination performed from the front and side of the injury;
• magnetic resonance imaging helps to see the condition of 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 treatment that he considers 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 will heal. This depends not only on the treatment and type of injury, but also on the body itself.

Treatment

When an ankle fracture occurs, treatment can be done conservatively or surgically. Without displacement, a fracture does not require surgery, especially if it is closed. Sometimes surgery is not performed even if there is displacement, if the doctor can set the fragments by hand, or if the patient has contraindications to anesthesia and surgery.

Conservative treatment

With the conservative method of treatment, a plaster cast is applied to the sore spot, covering the foot and the entire 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 plaster is applied in such a way as not to compress the tissue. If the patient feels a feeling of tightness or numbness in the fingers after a plaster cast has been applied, it must be loosened.

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

Surgery

Surgery for a fracture of the left ankle or its right part is carried out:

1. If the damage is open;
2. When manual reduction has proven ineffective;
3. If it is impossible to carry out manual reduction due to the large number of fragments, their slight displacement, as well as complete bone fracture;
4. For old fractures that have healed 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 a rupture of the tibiofibular cartilage, as well as the ligaments holding the ankle joint.

The operation, if there is a fracture of the ankle, is done under general anesthesia and is carried out with the aim of restoring the correct shape of the bone, open reposition of fragments, performing osteosynthesis, and also restoring the ligamentous apparatus. After this type of treatment has been completed, 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 painkillers. You can start walking without crutches after four months. At the same time, it may take two years for the leg to fully recover.

The ankles are the bony structure of the lower leg joints that distribute a person's weight to 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 broken ankle is a common injury that is treated at trauma centers. The causes are trauma: direct or indirect.

A direct injury is defined as a blow that falls directly on the leg and causes a fracture of one (external or internal) ankle, or both at the same time (dimalleolar). By indirect we mean an injury that occurs, for example, due to a subluxation of a 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 (intense growth during childhood or puberty, old age, pregnancy and breastfeeding), calcium deficiency, and bone diseases.

Types of Ankle Fractures

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, is accompanied by damage to muscles, skin and other soft tissues from broken bone fragments.

If we consider ankle fractures deeply, the following types are distinguished:

• Open fracture;
• Closed fracture of the outer malleolus or inner 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.

Symptoms accompanying a fracture

General symptoms of fractures:

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

Closed, no offset:

• Severe pain at the site of injury;
• Edema or swelling of the ankle, most pronounced at the site of injury, on the lateral (outer) ankle or medial (inner);
• Difficulty stepping on a sore limb due to pain;
• For a similar reason (pain), the ability to bend and straighten the leg decreases;
• When the inner ankle is fractured, the pain is concentrated exclusively in the indicated area, and when palpated, it radiates to the inner bone. When the outer ankle is injured, when you press on any point of the leg, for example, on the calf muscle, the pain is radiated to the broken place.

Closed, with displacement or subluxation:

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

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

Key steps to help with an ankle injury

• The first thing you need to do when helping with an ankle injury and suspected fracture is to calm down the panic mood - your own and the victim's, and calm down.
• Call an ambulance or rescue team as quickly as possible (if the injury occurred in a remote area, for example, in a forest or mountains).
• Do not allow the victim to put weight on the broken leg by trying to stand or move the limb.
• If pressure from an external factor (log, slab, stones) occurs on a limb, try to carefully free it from interfering factors to avoid additional damage to the leg.
• Arranging the limb in a comfortable position is determined by the injured person independently. It is permissible to place a cushion made from available soft materials (clothing, pillow, sleeping bag, moss) under your leg in the shin area. Thanks to the elevation, the outflow of blood will decrease, which will prevent the formation of severe swelling of the foot, or will slow down the formation.

If there is bleeding from the damaged area, try to stop it. It can be done by cooling the wound, covering it, for example, with snow, ice or another cold object.

It is advisable to apply cold if there is no need to stop bleeding. This will help reduce pain and swelling of the lower leg.

If there is bleeding, you should try to carefully apply a tourniquet in the area above the damaged area; you need to relax it for 15-20 seconds every third of an hour.

Important! If an open type fracture occurs, you cannot even try to set the deformed bone, or remove bone fragments from the wound and take other actions to the affected area, so as not to harm the victim or aggravate the serious condition.

• Splinting. The splint is necessary to fix the foot in a stationary state in order to ensure the safety of subsequent transportation of the injured person.

The tire is made from scrap materials (boards, large branches, plywood, shovel handle, broom); perhaps you have a special tire in your arsenal. Tied with a bandage, belt, rope, or similar to the injured limb. In the case of an ankle injury, it is better to attach the splint to the shin, depending on the affected part of the ankle, from below, on the right or left side of the shin. A correctly applied splint will help avoid aggravation of the injury and simplify the transportation of the patient to the place of qualified assistance.

• When the pain is severe and the victim cannot bear it, give painkillers without narcotic components.
• Transportation of the victim to the place of qualified assistance (trauma center, hospital, paramedic station).

Treatment of an ankle fracture

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

There are methods for treating broken bones:

• Treatment without applying a plaster cast. The method involves the use of therapeutic agents, prescribed for minor injuries. Recovery occurs in approximately 8 weeks.
• Plaster application is used for injuries without displacement, with displacement, with fractures aggravated by dislocation or subluxation. In these cases, the deformed bone is reduced before applying a plaster cast. The bandage is applied to the leg from the foot to the knee. Bone fusion occurs within 2 months.
• Surgical intervention is used for open fractures or for severe ones with subluxation, displacement or dislocation, when the plaster cast is not able to fix the bone fragments, they are displaced. Surgical intervention is indicated in the treatment of improperly fused bones or in cases of complete nonunion. It is imperative to regularly take x-rays of the broken limb to control the correct installation of the bones in place and successful fusion. Full recovery occurs within 1.5 – 2 months.
• A patient with a serious displacement, dislocation or subluxation, whose broken parts of the bones are not fixed in their original places, needs a skeletal traction. In such a situation, a knitting needle with a load is used, the weight of which sometimes reaches 12 kg. After a month, the hood is removed, the patient is given a cast, and bed rest is maintained. Recovery in such severe cases sometimes takes up to six months.

Rehabilitation after an ankle fracture

When the bones heal and the plaster is removed, it is necessary to begin rehabilitation of the limb. After removing the splint, an elastic bandage is temporarily applied in the lower leg area (from the foot to the knee).

If foreign objects placed in the bone (nails, pins, knitting needles) were used to heal the injury, the devices are removed. In certain cases of serious injuries, titanium retainers are used. They are not removed and can serve a person for a long time without causing damage to the body. Fixing elements made from other metals must be removed.

Full weight-bearing of the foot is possible after 3-5 months from the moment the cast is removed. Restoration of foot mobility occurs within a period of 3 months to 2 years. The time gap depends on individual factors: the complexity of the fracture (simple, displaced, subluxated), the age of the patient (the older, the longer the recovery process), compliance with the doctor’s recommendations and maintaining a proper diet.

During the rehabilitation period, the patient is prescribed physiotherapeutic procedures, massage and exercise therapy. These methods for effective rehabilitation are prescribed comprehensively, based on the nature of the injury and the characteristics of the patient.