Ankle fracture and ankle joint injury: treatment methods and rehabilitation. Lateral fracture. Symptoms of an ankle fracture Incomplete fracture of the lateral malleolus without treatment

Ankle fracture– the most common bone injury; it is this problem that traumatologists encounter in 20% of cases of all skeletal injuries and up to 60% of all injuries of the lower leg. The peak of such changes occurs in the winter, especially in populated areas where it is “not customary” to deal with snow and ice in a timely manner. Children, athletes, and women in heels also make a significant contribution to these statistics.

Frequent cases of fractures of the ankle are associated with its anatomical feature, the greatest weight load on this part of the leg.

It is easy to “earn” an ankle fracture, but it is not always possible to fully recover from it, and in 10% of cases such fractures can lead to disability, especially in adult patients. This is due to the fact that in the treatment of such a fracture it is necessary to restore not only the integrity of the bone, but also the normal functioning of the joints, blood circulation and innervation of the fracture area.

Anatomy of the ankle

- the only anatomical structure connecting the foot with the bones of the lower leg. It is a complex, strong connection of bones.

Features of the ankle joint:

• connection in a joint like a hinge;
• trochlear joint (movement of the joint in one plane: bending back and flexing the sole, rotation of the foot, the radius of these movements is up to 65 degrees); slight lateral movements in the joint are possible only during flexion of the sole;
• stable joint (this feature allows it to withstand heavy body weight);
• interacts with other joints: subtalar and talocalcaneal-navicular;

• ensuring the function of the foot,
• support for the human body,
• walking, running, going down stairs,
• body shock absorber when walking,
• turns the body around its axis without lifting the feet from the ground, etc.

• outer ankle,
• inner ankle,
• distal ends of the fibula and tibia,
• talus block.

Rice. 1. Schematic representation of the bony component of the ankle joint, anterior view.

The bones of the lower leg (namely the ankle) cover the talus like a fork, forming the ankle joint. All bone surfaces inside a joint are called articular surfaces. The articular surfaces of the ankle are covered with hyaline cartilage; in the joint cavity the synovial membrane is produced synovial (joint) fluid, its functions:

• intra-articular lubrication,
• prevents “erasure” of articular surfaces,
• nourishes hyaline cartilage,
• provides depreciation of the joint during movement and others.

A. inner surface of the lateral malleolus, connects to the lateral malleolar surface of the talus;
B. lower end of the tibia(arch of the ankle joint);
C. inner surface of the medial malleolus, movements are carried out relative to the medial malleolar surface of the talus;
D. block of the talus, connects to the distal ends of the fibula and tibia;
E. lateral and medial malleolar surfaces of the talus.

Rice. 2. Ankle joint, surfaces of the ankle joint, cut in the frontal plane.

Ligamentous apparatus of the ankle joint

Bunch- This is a dense connective tissue that holds bone, supports the function and integrity of joints, and promotes movement in the joint. Ligaments connect bones and muscle tendons, facilitating the interaction of these structures and the formation of movement.

Tendon- This is a part of skeletal muscle, formed from connective tissue, connecting muscles to bones. With the help of tendons, impulses are transmitted to the bone lever during movements.

Tendon sheath - the sheath of the tendons, which serves the function of isolating each other, protecting the tendons from friction, and lubricating the tendons. Tendon sheaths are located in the ankle and wrist, where a large number of muscle tendons connect.

Articular capsule of the ankle- a kind of joint case, which is formed by ligaments, directly connected to the muscle tendons. The capsule of the ankle joint is attached to the cartilage of the articular surfaces on the sides, in front - to the neck of the talus.

Groups of ligaments of the joint capsule of the ankle (Fig. 3):

1. Medial deltoid group:
   • tibiofavicular ligament
   • anterior and posterior tibiotalar ligaments
   • tibiocalcaneal part
2. Lateral group of ligaments:
   • anterior talofibular ligament
   • calcaneofibular ligament
   • posterior talofibular ligament
3. Anterior and posterior ligaments represent thickenings of the ankle capsule.

• Achilles tendon,
• tibialis anterior tendon,
• tibialis posterior tendon,
• long flexor tendons of the foot,
• extensor tendons of the foot,
• peroneus longus tendon,
• peroneus brevis tendon, etc.

Causes of Ankle Fracture

• Direct trauma (impact), leads to damage to the joints, a fracture of one of the ankles (for example, an accident, an earthquake, heavy objects falling on the leg, etc.).
• Indirect trauma(tucked leg), more common than direct injury, a fracture is accompanied by the formation of fragments of the surfaces of the ankle joint, dislocations and subluxations of the ankle joint and foot outward or inward, rupture or sprain of ligaments. Examples of causes of indirect ankle injury: slipping on ice, slippery floors, skating and roller skating, slipping on steps, playing sports, carelessly walking on uneven surfaces, etc.

1. Physiological calcium deficiency:
   • Childhood and adolescence during intensive growth
   • Elderly age. In old age, women are more likely to suffer from fractures, which is associated with menopause and a lack of female hormones that regulate calcium metabolism in the body.
2. Calcium deficiency:
   • taking female oral contraception,
   • poor diet low in calcium,
   • some diseases of the kidneys and gastrointestinal tract (poor absorption and rapid excretion of calcium),
   • diseases of the thyroid and parathyroid glands, conditions after removal of the thyroid gland,
   • adrenal gland diseases,
   • vitamin D3 deficiency and other conditions.
3. Bone diseases can lead to pathological fractures (as they say, “a fracture out of the blue”):
   • bone malformations (osteopathy),
   • some genetic diseases, chondrodysplasia (Morphan's syndrome, Paget's disease, Volkoff's disease, etc.),
   • specific inflammatory diseases of bones (syphilis, tuberculosis),
   • nonspecific inflammatory bone diseases (osteitis, osteomyelitis, arthritis),
   • bone tumors and other bone diseases.

Types of ankle fractures

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

Types of ankle fractures depending on the mechanism of injury:

Rice. 5. Schematic representation of some types of ankle fractures:

1 – fracture of the lateral malleolus without displacement (oblique and transverse) – pronation.
2 – fracture of the lateral and medial ankles with displacement, outward dislocation of the foot – pronation.
3 – fracture of the medial malleolus, oblique fracture of the tibia without displacement, rupture of the tibiofibular joint, fracture of the fibula and lateral malleolus with displacement, inward dislocation of the foot – supination.
4 – fracture of the tibia in the distal part, avulsion of the lateral malleolus, rupture of the tibiofibular joint, rupture of the medial ligaments, outward subluxation of the foot – supination.
5 – fracture with fragments of the fibula in the distal part, fracture without displacement of the lateral malleolus, oblique fracture of the tibia in the distal part, avulsion of the medial malleolus, rupture of the tibiofibular joint – supination.

Symptoms of an ankle fracture

Diagnosis of an ankle fracture

• straight(mandatory projection), is carried out with the patient lying on his back with the affected leg bent at the knee joint;
• oblique projection carried out with the patient positioned on the healthy side with legs bent, with a pillow placed between the legs and the diseased limb at an angle to the table;
• lateral projection It is carried out in a position on the affected side and with bent limbs, the affected limb is placed anteriorly.

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

X-rays are performed at the beginning to clarify the diagnosis, after surgery, after rehabilitation to assess the effectiveness of the treatment and recovery.

X-ray - signs of ankle fracture:

• Bone fracture line: oblique, longitudinal and spiral. It can be detected on one or more bones, depending on the complexity of the fracture.
• Expansion of the ankle joint gap appears when ligaments are torn. Depending on the group of damaged ligaments, the expansion of the gap is noted in the corresponding part.
• Wedge-shaped ankle joint deformity detected when the foot is subluxated.
• Presence of displacement of bone fragments on radiographs it is determined in the form of various combinations of bone planes.
• Thickening of soft tissues at the fracture site

In difficult cases, behavior is possible other studies of the ankle joint:

• magnetic resonance imaging MRI (will allow you to evaluate not only the condition of bones, but also the condition of ligaments, tendons, muscles, blood vessels and nerves),
• echography (ultrasound) of the ankle joint allows you to assess the condition of the hematoma of soft tissues, ligaments and muscles.

1- fracture line with displacement of the lateral malleolus,
2- fracture line without displacement of the medial malleolus,
3- deformation of the ankle joint, which indicates damage to the ligaments of the lateral and medial groups,
4- displacement of the ankle joint forward,
5- subjective sign of damage to the tibiofibular joint.

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

First aid for suspected ankle fracture

If first aid is provided incorrectly, there may be complications:

• transition of a closed fracture to an open one,
• displacement of bone fragments,
• traumatic or painful shock,
• increased bleeding
• dislocation or subluxation of the foot,
• damage to blood vessels and nerves from bone fragments and others.

1. Firstly, it is necessary calm down and calm down victim!
2. Call emergency medical assistance.

   For such an injury, an ambulance must be called. necessarily and urgently. If the patient is transported incorrectly, complications may arise. But there are places and situations when it is not possible to call an ambulance, then it is necessary to organize a stretcher for the patient from scrap materials and urgently deliver the victim to a trauma center or other medical facility.



3. Do not let the patient become on the injured leg.
4. Release the limb from factors squeezing it: rubble of slabs, fragments of a vehicle and other mechanical objects, remove shoes and tight clothing from the feet (if this is possible without further injuring the foot).

   This must be done very carefully so as not to further injure the ankle joint. Freeing the leg will prevent a possible complication of the fracture and restore blood circulation in the leg. Prolonged compression (more than 20 minutes) and impaired blood supply can lead to necrotization (death) of limb tissue, which subsequently threatens amputation.

5. Give the limb a comfortable position. If a fracture is suspected, the limb must be elevated by forming a soft cushion under the leg. The cushion can be made from fabric, blanket, outerwear, etc. The height of the limb should be comfortable for the victim. This is necessary to relieve stress from the injured limb and reduce the outflow of blood and tissue fluid, which prevents the development of severe edema.
6. If the fracture is open(there is a wound at the site of injury, in which bone fragments can be visualized), then under no circumstances should you touch the wound, try to set the fracture yourself, or pull out even the smallest bone fragments from the wound.
7. If there is bleeding from the wound it is necessary to stop it: put ice or another source of cold around it and, if possible, apply a tourniquet above the damaged vessel. It must be remembered that the tourniquet must be removed every 20 minutes for 20 seconds so as not to lead to tissue necrosis. The tourniquet will be completely removed at a medical facility.
8. Cold should be applied to the limb for any injury to the ankles. This will help relieve the patient’s pain, reduce soft tissue swelling, and stop internal bleeding. Ice, cold water, snow, and, if available, liquid nitrogen can be used to cool the injury site.
9. Tire selection.

   Types of splints for ankle immobilization:

   • an improvised tire made from available materials: plywood, board, long tree branches, broom, shovel, ski, etc.;
   • ladder wire bus;
   • special plywood tire and Dieterichs tire - available only in specialized ambulance teams and medical institutions;
   • pneumatic, plastic, vacuum tires, pneumatic stretchers are also specialized medical tires that are available in specialized ambulance teams.
   • In the absence of special splints or improvised means, you can fix the damaged limb to a healthy one.
10. Transport immobilization of a limb (fixation) is necessary to prevent complications of a fracture, since when the victim “travels” to a medical facility, additional injury to the damaged area is possible.

    Stages of immobilization (splinting):

    • Cover the protruding parts of the shin (ankle) with a soft cloth to prevent chafing from the splint.
    • If there is an open fracture, apply a sterile bandage to the wound.
    • Bring the injured limb to a physiological position: slight flexion at the knee joint and slightly pull the heel so that the foot is at an angle of 90 degrees with respect to the shin.
    • Applying a splint: the splint is bandaged on the outside and inside of the shin with a bandage, belt, cloth or other available means.
11. Administration of painkillers necessary in case of unbearable pain, an open fracture of the leg, impairment or loss of consciousness of the victim (possible onset of traumatic or painful shock), as well as when a limb is compressed by heavy objects, pinched between plates, parts of transport, etc.

    If the pain is severe and the patient remains conscious, you can give a non-narcotic pain reliever, an analgesic, orally (ibuprofen, diclofenac, indomethacin, paracetamol, nimesulide and others).

    In case of compression of a limb or loss of consciousness, it is necessary to use injectable non-narcotic analgesics or, if available, narcotic analgesics (morphine, promedol, etc.).

12. Transportation of the victim to a trauma center or other medical facility.

Treatment of an ankle fracture

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

Conservative treatment of an ankle fracture

1. closed fracture of the ankles without displacement,
2. minor damage to the ankle ligaments,
3. Conservative treatment is possible for a displaced ankle fracture:
   • displacement of the fragments subject to the most effective simultaneous reduction of them by a traumatologist,
   • impossibility of surgical intervention and/or contraindications to general anesthesia (patient refusal, old age, concomitant diseases - severe diabetes mellitus, some heart diseases, central nervous system, etc.).

Plaster application. For an ankle fracture, a cast is applied to the entire back of the leg and foot. The plaster cast is fixed using bandaging from bottom to top, and vice versa in the foot area. To securely fix the splints, several layers of bandage are wound evenly. In this case, the patient should not experience a feeling of squeezing, numbness of the limb, or friction of the skin of the protruding areas of the ankles.

During bone fusion, the patient is strictly contraindicated from standing on the cast leg; walking on crutches is recommended.

After applying the plaster, it is recommended to repeat the radiograph of the ankle joint in order to make sure that during the application of the splint there was no displacement of the fragments or that the fragments were set correctly.

Is it always necessary to apply a cast?

It is always necessary to immobilize the injured part of the leg. Medicine does not stand still and at the moment the pharmacy chain offers us a large assortment of special splints - immobilizer bandages.

Bandages are a frame made of light metals or durable plastic, stretched with dense material, and fixed to the leg with Velcro. This bandage can be adjusted to fit the leg and removed if necessary. But with such immobilization, the doctor is not always sure that the patient does not remove it for a long period, and this can lead to improper bone fusion.

How long is a cast needed?

The period of wearing a plaster splint or bandage is individual and determined by a traumatologist. First of all, it depends on the age of the patient; the younger the age, the faster the fractures heal. If this is a child, then the cast is applied for a period of 1 month, for a young adult - from 6 weeks, and for an elderly person - from 2 months.

Also, the duration of such immobilization depends on the severity of the fracture.

Removal of plaster is carried out after X-ray control when the bone is completely fused.

Complications of improper fusion of bones after an ankle fracture:

• arthrosis of the articular surfaces of the ankle joint,
• formation of a false joint - a joint at the site of fusion of bones, in which there should not be one,
• habitual dislocation or subluxation of the foot,
• deformation of the ankle joint and others.

Surgical treatment of ankle fractures

• open ankle fractures,
• in case of ineffective manual reduction or the impossibility of repositioning due to the complexity of the fracture (displacement in two or more structures, interposition of fragments - complete breaking off of a bone fragment, fragments are easily displaced),
• old fractures (late treatment when the bones began to heal incorrectly),
• fracture of the lower posterior part of the tibia and fibula over more than a third of the surface with displacement in combination with ankle fractures. Such fractures take a very long time to heal and malunion is possible, the formation of arthrosis of the ankle joint,
• fracture of both ankles,
• rupture of the tibiofibular joint and complex ruptures of the ankle ligaments.

• surgical treatment of a wound with an open fracture, stopping bleeding,
• restoration of the anatomical shape of the bone,
• open reduction of bone fragments,
• fixation of bone fragments (osteosynthesis),
• restoration of ankle ligaments, tibiofibular joint,
• and as a result - complete restoration of the integrity and function of the bones, ligaments and muscles of the lower leg, ankle joint and foot.

1. Fastening of the tibiofibular joint(restoration of the fork) – the bolt is secured through the fibula and tibia at an angle from the lateral malleolus, additional fixation with a nail of the medial malleolus.

   All channels are pre-formed with a drill.

   Indications for surgery: fracture of the fibula and medial malleolus (rotation fractures), other fractures with rupture of the tibiofibular joint.

2. Osteosynthesis of the lateral malleolus– a pin is inserted through the ankle along the axis of the fibula, and the medial malleolus is additionally secured with a nail. If the tibiofibular joint ruptures, it is fastened.

   Indications for surgery: pronation fractures.

3. Osteosynthesis of the medial malleolus – the medial malleolus is fixed with a two-blade nail at a right angle to the fracture line. Additionally, the lateral malleolus is also secured with a pin. Additional attachment of fragments with screws is possible.

   Indications for surgery: supination fractures.

4. Osteosynthesis of tibial fragments – fragments of the tibia are connected through the opened ankle joint with a long screw; sometimes an additional screw is required, which is attached along the axis of the bone.

   Indications for surgery: fracture of the tibia along the posterior part of the distal end.

After surgery, the leg is immobilized in a plaster cast. The plaster is applied in such a way that there is access to the postoperative wound for further treatment.

It is mandatory to carry out a control X-ray of the ankle joint immediately after surgery and during recovery.

Rehabilitation after an ankle fracture

Recovery period after surgery

All fixing bolts, nails, screws, pins can be removed after 4-6 months. This is also a surgical intervention. A person can live with metal structures for many years, especially if titanium fasteners were used. But it is advisable to remove the clamps from others.

Full weight bearing on the leg (movement without crutches) can be given after 3-4 months.
Full restoration of ankle joint function occurs after a period of 3 months to 2 years.

Factors on which the speed of joint recovery depends:

• Age, the younger, the faster;
• Absence of concomitant bone diseases (arthrosis, osteoporosis, arthritis, chondrodysplasia, osteopathy and others) and other factors that increase the risk of bone fracture;
• Maintaining bed rest in the postoperative period speeds up recovery;
• The recovery period also directly depends on the complexity of the fracture itself and the extent of the operation performed;
• During recovery, a special diet rich in calcium is required;
• Physiotherapy, massage and therapeutic exercises also affect the speed of complete recovery after a fracture.

The basic principle of such gymnastics is that the load increases gradually. Gymnastics includes flexion and extension of the knee and ankle joint, holding small objects with the toes, and rolling a ball with the foot. Also effective exercises for the ankle joint are walking on your toes and heels, cycling and swimming.

After a fracture, it is advisable to wear shoes with orthopedic insoles.

Swelling of the lower leg can be reduced if you elevate your legs while lying down, and then begin exercising with a load on the ankle joint.

Massage after removing the cast is very effective in restoring the normal functioning of the blood and lymphatic vessels and nerves of the lower leg and foot. During the first massage sessions, you may need to use pain-relieving ointments or gels due to severe pain, but gradually, after developing the muscles and ligaments, the discomfort goes away.

The massage can be carried out independently in the morning and evening - knead, shake, stroke, press in the ankle area.

Physiotherapy for ankle fractures

Preventing Ankle Fractures

But you can prepare your body so that if you get injured, your risk of fracture is reduced.

Measures to prevent bone fractures:

1. Balanced diet, the daily diet should contain foods rich in calcium:
   • dairy products, especially cheese, feta cheese, cottage cheese and other fermented milk products;
   • meat, eggs,
   • cereals: oatmeal, buckwheat, egg;
   • nuts and seeds - almonds, hazelnuts, walnuts, pistachios, sesame seeds, dill, mustard and others;
   • beans: beans, peas, soybeans;
   • fish, especially salted;
   • vegetables: broccoli, spinach, sorrel, cabbage and other green vegetables,
   • syrup,
   • fruits, fruit juices (especially citrus fruits).
2. Sunbathing will allow the skin to produce vitamin D3, which promotes the absorption of calcium in the body. Therefore, it is necessary to walk outdoors every day during the daytime and sunbathe moderately.


3. Gymnastics including exercises for the muscles of the leg, ankle and foot will help to form a frame of strong muscles and ligaments that will protect bones and joints from damage.


4. Timely detection, treatment and prevention chronic and inflammatory diseases of the osteoarticular system.

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.

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

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

There are several causes of ankle injury:

• sudden twisting of the foot when walking quickly;
• a sharp turn of the ankle while moving.

Traumatologists call indirect reasons for an ankle fracture:

• excess body weight;
• fragility of bone tissue as a result of lack of calcium in the body;
• chronic diseases (for example, osteoporosis or arthritis).

Most often, the presence of such injuries is observed in elderly people. This is due to physiological age-related changes, as a result of which the bones of the limbs become fragile - calcium is already poorly absorbed.

Therefore, treatment of fractures in older people is often accompanied by difficulties, and the rehabilitation period, when it is possible to step on the leg, is delayed.
.

As you age, your risk of getting a fracture of this joint increases. For older people, all it takes to damage bones is to stand up incorrectly or fall and land on your shin. Young people most often get this injury after jumping from a high height.

There is a possibility of getting such an injury in a car accident when the ankle bends too much or, on the contrary, extends. The result of this is a fracture of the outer ankle.

Twisting of the joint is another cause of such injury. This can happen when your foot gets stuck in a narrow space while running. In this case, the human body falls in the opposite direction.

Varieties

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.

In traumatology, ankle fractures are considered in the following types:

• Fracture of the medial malleolus (medial);
• Fracture of the outer malleolus (lateral);
• Displaced ankle fracture;
• Non-displaced ankle fracture;
• Closed or open fracture.

It is customary to consider the ankle as a single joint, but in fact, it is composed of two joints: the ankle and the talocalcaneal. The cause of damage can be a sharp or rapid movement of the ankle to the inside or outside.

Very often a fracture accompanies a sprain. Non-displaced ankle fractures are divided into the following types:.

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

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

The direction of the fracture is horizontal. As a rule, the cause of such damage can be a strong outward turning of the foot.

With an oblique fracture of the external malleolus, the rupture line is oriented from bottom to top from the front to the back. Such damage can result from tucking the foot in combination with its abduction (abduction) or when the foot is excessively turned outward.

In a transverse fracture, tension in the deltoid ligament of the foot causes the medial malleolus to be torn off at the base or apex. The cause of this type of injury is a strong inversion of the foot to the outside.

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

Less common in traumatology practice is a fracture of the internal and external ankles (bimalleolar). This fracture occurs when the foot is abducted excessively. Bimalleolar fractures can be of two types:

• pronation-abduction;
• supination-adduction.

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.

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.

Considering the severity of the leg injury, the patient may have symptoms of different types and nature:

1. When the fracture provokes an open form, the victim experiences damage to the soft tissues and skin of the leg in the ankle area. In such a situation, there will clearly be a displacement, and it is thanks to the displaced bones that tissue damage was caused.
2. A closed ankle fracture is quite difficult to diagnose. After this injury, tissue damage occurs internally (under the skin of the leg), and only one symptom in the form of a hematoma can indicate the presence of bone tissue damage. A closed fracture is an external fracture without displacement, which does not provoke a lot of complications and in most cases is completely curable.

In addition to the shape of the fracture, the presence of symptoms can be influenced by both the nature and location of the leg injury:

Such ankle injuries are characterized by several significant symptoms:

1. Crunching in the leg at the site of injury (crunching when moving, which means the bones are broken).
2. Painful sensations (explained by damage to nerve endings as a result of injury).
3. Swelling + hematomas and hemorrhages (are the result of ruptures of blood capillaries, these signs do not begin to appear immediately, but after a couple of hours).

Of course, dysfunction of the ankle joint should also be noted. This pathology will be present because ankle fractures are often accompanied by other injuries:

Because of this, the victim cannot move his foot normally, which allows us to establish a fracture of the outer malleolus without displacement.

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.

The diagnosis of an ankle fracture is made from a combination of interview, examination and diagnostic data.

To determine the presence of a fracture and its nature, it is necessary to conduct diagnostic studies, the first of which is fluoroscopy. X-rays are taken in two projections: lateral and anteroposterior.

Additional methods for examining the joint are sonography (ultrasound), arthrography and arthroscopy.

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, an x-ray must be taken, based on which a rehabilitation course is prescribed.

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.

• 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.

Doctors develop a treatment plan based on the characteristics of the injury a person has received. An ankle fracture must be treated in any case, because it plays a big role in motor function, which is very important for normal life.

Every victim wants to walk fully, so he completely relies on the doctor.

When an ankle is injured, traumatologists can use two treatment methods:

• Conservative treatment;
• Operation.

The first method is suitable for patients with relatively mild forms of fractures, especially those without displacement, because its consequences can be tragic:

• After the swelling is removed, the fragments can move even further;
• Subluxation develops in the ankle joint, with impossible correction during treatment;
• Longer rehabilitation period.

A mild, non-displaced fracture does not always require a cast; in most cases, an elastic orthosis may be suitable. An orthosis on the ankle joint allows you to fix the leg and redistribute the load; it also does not provoke strong compression on the injured ankle and prevents relapses.

An ankle orthosis is a modern orthopedic device that firmly fixes the ankle in case of various types of injuries. In appearance, the orthosis resembles a sock or boot, but the toes remain open when worn.

Modern orthoses are made of fabric, metal and plastic, and are secured with lacing, Velcro or fasteners.

Doctors have developed several types of orthoses that have different degrees of rigidity and have different purposes: preventive, rehabilitative and functional.

The first type of orthosis is used to prevent injuries; the rehabilitation type is worn when a leg is injured for a faster recovery. A functional orthosis can be prescribed for patients with changes in the joint, who must walk with it almost always.

According to the degree of rigidity, orthoses are divided into:

Video demonstrating a rigid ankle orthosis.

Treatment for mild fractures is very similar to that developed for foot sprains, and complete recovery occurs after 1-1.5 months of wearing an immobilizer.

Without displacement of bone fragments, but using a plaster that is adjusted up to the knee (for both internal and external ankle fractures), the treatment period can last up to 1.5 months.

A closed fracture with displacement involves treatment in the form of repositioning of fragments under anesthesia, with further installation of a plaster. Both before and after placing the plaster, an x-ray of the damaged bone is taken. Immobilization lasts from 2 to 2.5 months.

The main method of treating such fractures is the use of conservative techniques.

Traumatologists do not recommend starting self-treatment at home. This is due to the fact that in the course of an incorrectly chosen method of treatment, further recovery of the injured ankle may be delayed and complicate rehabilitation.

Modern methods of treating non-displaced fractures of the lateral malleolus are not varied. There are only two of them:

1. Conservative.
2. Operational.

The first method is used when the fracture is closed without displacement or ligament rupture. To do this, use a plaster splint, which is distributed over the foot (namely its suspended part), followed by fixation with bandages.

The main condition: such fixation should not put excessive pressure on the lower leg to prevent circulatory problems.

A casted limb causes a lot of inconvenience, but the period of wearing a cast can last from six weeks to three months. The timing directly depends on significant factors:

• complexity of bone fracture;
• rapidity of callus formation;
• individual characteristics of the victim’s body.

Only the attending physician can tell the patient when it is possible to step on the leg after such treatment. The standard healing period is two and a half months, but the rehabilitation period sometimes lasts up to a year.

To speed up the healing process, the victim is additionally prescribed maintenance therapy, which includes multivitamin preparations.

The surgical method is used in the following cases:

• the fracture happened a long time ago, the patient was self-medicating incorrectly;
• the injury is accompanied by extensive damage to other parts of the limb;
• There is a complete rupture of the ligaments.

After surgery, a plaster cast is applied, and further treatment is carried out according to the standard regimen. Experts warn: stepping on your foot while wearing a cast is strictly prohibited!

Rehabilitation measures begin after removal of the plaster and control radiography. If everything is fine with the ankle, then the attending physician prescribes a comprehensive treatment, which includes:

• special physical therapy exercises;
• massage;
• health baths.

Experts say that if you strictly follow all the recommendations of your doctor, then after a couple of months the motor functions of your leg will be restored.

When treating an ankle fracture, the doctor adheres to the main idea - restoring the full functionality of the injured limb. There are 2 main methods of treatment:

The type of treatment is selected by a specialist based on the type of injury received. But it is very important that it cannot be postponed. It is necessary to consult a doctor immediately to avoid multiple complications.

If the fracture is displaced or triple, then the conservative method is used only in extreme cases, since it has disadvantages:

• There is no possibility to correct changes that may develop in the ankle (for example, subluxations);
• There is a possibility of displacement appearing after the swelling disappears;
• Finally, after the doctor removes the cast, the recovery will be very long.

First aid

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).

Immediate care should be provided to a patient with such an injury. If it is untimely, then the consequence of a fracture of the ankle without displacement or with displacement may be a transition from a closed injury to an open one. To prevent this from happening, you must:

1. Leave the damaged joint alone. It must not be touched or moved;
2. It is advisable to slightly raise the injured leg by placing a pillow or cushion under it;
3. In case of severe pain, you need to take analgesics;
4. If the fracture is closed, then some cold object should be applied to the sore spot. This method will help relieve pain and swelling;
5. In the case of an open fracture, the leg must be tightly bandaged with a tourniquet over the wound site;
6. Keep the patient away from food or drink. In the event of a serious injury, it is likely that the doctor will administer anesthesia to the patient;
7. Immediately remove shoes and socks. Otherwise, the leg will swell faster, and in the future it will constantly swell;
8. If the fracture of the outer ankle is open, you should prohibit touching the wound. There is no need to remove foreign objects from it. Only the attending physician can do all this.

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.

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.

At different stages of a fracture, complications may develop; an attentive attitude to the patient (or to oneself) will prevent the worsening of the condition or stop it in the early stages:

• suppuration of a postoperative wound;
• injury to blood vessels and soft tissues during surgery;
• formation of arthrosis;
• postoperative bleeding;
• skin necrosis;
• embolism;
• slow consolidation;
• improper healing of the fracture;
• formation of a false joint;
• foot subluxation;
• post-traumatic foot dystrophy;
• thromboembolism.

Complications with proper treatment are rare; much depends on the patient himself: on the accurate implementation of the instructions received from doctors, the correctly structured rehabilitation process and motor regimen.

So, at each stage, a set of rehabilitation measures, provided they are correctly formed, can lead to a faster and more effective recovery of a patient with an ankle fracture.

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.

Ankle fracture is one of the most common types of injuries in traumatology. It occurs as a result of movements of excessive amplitude or non-physiological direction (hyperextension, excessive flexion inward, outward).

A few words about anatomy

The ankles are the distal (lower) ends of the fibula and tibia.

The lateral (lower edge of the fibula) and medial malleolus (lower edge of the tibia) are distinguished; together with the talus, they are components of the ankle joint.

Separately, the distal epiphyses of the fibula and tibia are called the malleolar fork. Together with the tendons and the talus, they form a ring that serves to stabilize the ankle joint.

Clinical picture

During a fracture, the patient feels sharp pain in the ankle joint.

Upon visual examination, the joint is enlarged in volume, deformed, and a hematoma may appear in the soft tissues. With an open fracture, damage to the skin is observed. Almost always a wound is formed in which bone tissue can be visible.

On palpation, acute pain, pathological mobility, and in certain cases crepitus of fragments appear.

Diagnostics

The diagnosis of an ankle fracture is made from a combination of interview, examination and diagnostic data.

To determine the presence of a fracture and its nature, it is necessary to conduct diagnostic studies, the first of which is fluoroscopy. X-rays are taken in two projections: lateral and anteroposterior.

Additional methods for examining the joint are sonography (ultrasound), arthrography and arthroscopy.

Classification of ankle fractures

• by the nature of occurrence: supination and pronation;
• isolated (lateral - outer or medial - inner ankle);
• multiple (bimalleolar, trimalleolar - with separation of the posterior edge of the tibia);
• with concomitant ligament damage;
• by damage to the skin: closed, open;
• by displacement of bone fragments: with displacement, without displacement;
• by violation of the integrity of the ankle ring formed by the ankle fork and ligaments: stable or unstable.

A stable fracture is limited to a single ankle fracture. An unstable fracture is a two- or three-malleolar fracture, or a single ankle fracture with ligament rupture. This type of injury is usually combined with external subluxation of the foot.

Treatment

The main method of treating such fractures is the use of conservative techniques.

Under no circumstances should you trust the reduction of a dislocated back or the manual reposition of fragments to a non-professional; this can lead to many complications.

First of all, all patients undergo pain relief, and further tactics depend on the nature of the fracture.

• If there is an isolated fracture or a fracture without displacement of the fragments, the patient is immobilized.
• If there is a dislocation of the foot accompanying the fracture, it is set while keeping the bone fragments in the correct position.
• Another method of conservative treatment of a fracture is its traction followed by correction.
• If there is displacement of bone fragments, manual reposition or surgical intervention is performed with fixation of the fragments with plates or screws.

Immobilization

For non-displaced ankle fractures, one of two plaster splints is applied to the affected limb:

• U-shaped, running from the upper third of the lower leg along its outer-lateral surface to the ankle joint, then along the plantar part of the foot with a transition to the inner-lateral region of the lower leg to its upper third. The splint is fixed with a bandage or plaster rings.
• Longuet-circular (like a boot) is applied from the upper third of the shin to the tips of the fingers and is carefully modeled according to the patient’s leg.

After applying a plaster cast, a control x-ray examination is performed. It helps to determine whether bone fragments have been displaced during rigid fixation of the tibia.

A few days after applying the bandage, a stirrup or heel is attached to the cast, which helps to properly redistribute the load on the affected limb and relieve the fracture area.

Timing of immobilization:

• one ankle without displacement of fragments: 1 month;
• one ankle with displaced fragments: 6 weeks;
• bimalleolar fracture: 2 months;
• bimalleolar fracture with foot subluxation: 12 weeks;
• trimalleolar fracture: 10 weeks;
• trimalleolar fracture with ligament rupture: 12 weeks.

The patient is disabled for a period of two to four months.

Rehabilitation

While the patient is in a supine position, it is necessary to provide the affected limb with an elevated position to improve the outflow of blood and lymph.

Modern approaches to rehabilitation come down to its earliest possible start (immediately after injury) and completion after complete restoration of limb function. If these conditions are met, the patient can quickly begin his usual everyday and working life.

It must be remembered that a multidisciplinary comprehensive approach to treatment can reduce rehabilitation time and return to the usual rhythm of existence earlier. A combination of drug treatment, physiotherapy, special exercise and massage will relieve inflammation, improve blood circulation, accelerate the resorption of swelling, increase muscle strength, accelerate tissue restoration, strengthen the joint and help avoid possible complications.

Recovery from ankle fractures is carried out in 3 stages.

First stage: immobilization and dosed exercise (10-14 days)

The task at this stage is to prevent possible complications, improve blood circulation in the fracture area and reduce the intensity of pain.

• In case of an isolated fracture of one of the ankles without displacement of bone fragments, dosed loading is allowed after 1 week.
• In case of an isolated fracture of one of the ankles with displacement of bone fragments, dosed loading is allowed after 2 weeks.
• When treating a fracture surgically with fixation of bone fragments with metal structures, loading is possible after 3 weeks.
• For a three-malleolar fracture, dosed loading is allowed after 6-8 weeks.

Exercise therapy

Passive movements are possible immediately after surgery/immobilization.

1-3 days after osteosynthesis, you can perform active movements of the limb and begin walking with the help of crutches without using the injured leg.

At the time indicated above, you can begin to partially load the affected limb.

In any case, the issue of time to expand the motor regime is decided collectively by a surgeon, rehabilitation therapist, physiotherapist, exercise therapy doctor and, if necessary, other specialists.

Physiotherapy

Physiotherapy is prescribed from the first day after the fracture (surgery).

Through a dry plaster cast, treatment can be carried out with UHF electric field, laser therapy and ultraviolet irradiation. Moreover, laser therapy is carried out both in the red spectrum (in this case, windows are cut out in the plaster according to the size of the emitter) and in (contactly through a bandage).

Previously, a contraindication to UHF therapy was the presence of metal structures in the area of ​​the procedure; today there is experience that allows treatment to be carried out even with existing metal parts, provided that the force lines run along them (tangential location of the emitters). When using an external fixation device, the emitters are installed between the external supports and the skin. There are scientific works proving that metal structures do not overheat.

Second stage: limited motor mode

The patient moves with the help of crutches, then without them.

The goal of this stage of rehabilitation is to improve tissue nutrition, accelerate regeneration processes and callus formation.

Exercise therapy

During this time period of rehabilitation, it is necessary to restore the functions of the sedentary ankle joint. For these purposes, in addition to a set of exercises, additional equipment and mechanotherapy should be used: work with the foot resting on a rocking chair, roll a stick, bottle, ball, cylinders, exercise on an exercise bike and a foot-operated sewing machine, and use other techniques. Exercises in the pool are justified: water, by reducing weight, helps to perform movements in a larger volume, strengthen the muscular corset and vascular system.

It is necessary to restore the correct walking pattern; a robotic walking simulator is used for these purposes.
To properly distribute the load when moving, it is recommended to wear individual instep supports, which will be selected by an orthopedist.
At this stage, the full range of motion in the ankle joint should be restored.

Physiotherapy

To improve tissue trophism and accelerate the process of fracture consolidation, magnetic laser therapy, magnetotherapy, infrared irradiation and, if an external fixation device is available, segmental massage are prescribed.

After internal osteosynthesis, in the absence of contraindications, it is advisable to prescribe (pearl, oxygen baths, underwater massage) and thermal procedures (paraffin,).

It is worth noting that traumatologists’ concerns regarding possible overheating of metal structures during thermal therapy procedures with ozokerite and mud are not justified. It has been proven that there is a system of thermoregulation of the body that will allow heat to be redistributed throughout the tissues rather than accumulate in the area of ​​metal parts.

In addition, a UHF electric field in a pulsed mode, high-intensity magnetotherapy (magnetostimulation), and electrical stimulation are used.
If the patient has pain, electrotherapy (DDT, SMT,) can be prescribed.

It is forbidden

In case of metal osteosynthesis, the use of ultrasound therapy and inductothermy is contraindicated, since ultrasonic vibrations create a cavitation effect at the bone-metal interface with the formation of instability. In addition, an alternating high-frequency magnetic field (inductothermy) can cause overheating of metal structures and resorption (absorption) in bone tissue with the formation of instability in the area where the metal adheres to the bone.

Third stage: rehabilitation of residual effects

When the fracture is consolidated, you can expand your motor mode: run on a treadmill in fast walking mode, add jumping jacks to your workouts, and carry out your usual everyday activities. In this case, the ankle joint must be fixed with an elastic bandage or specialized orthoses must be used to unload and hold the joint in a physiological position. It is recommended to put an insole in your shoes to prevent the development of flat feet.

Physiotherapy

During this period, it is prescribed according to indications: thermal procedures (paraffin, ozokerite, mud), CUF, darsonvalization, ultrasound therapy, electrotherapy (including stimulation), baths (including underwater massage), therapeutic massage.

Full weight bearing on the limb is allowed on average after 10 weeks, depending on the type of fracture, the presence of complications and concomitant pathologies.

If the patient has an external fixation device installed, then after removing it, the load on the limb should be reduced by 1/3, followed by a gradual increase over 2-3 weeks. This will ensure smooth adaptation of the injured leg to the load that was usual before the injury without the risk of possible complications.

In case of slow healing of the fracture, extracorporeal shock wave therapy may be used.

Contraindications for massage and physiotherapy

If a patient has the following conditions, physiotherapy should not be prescribed, since there is a possible risk of complications:

• general serious condition of the patient;
• unstable fracture;
• bleeding and tendency to it;
• presence of neoplasms;
• decompensation of chronic diseases;
• acute pathologies;
• mental illnesses that make it difficult to contact the patient;
• blood pathologies;
• purulent process without outflow of contents;
• relative contraindication: pregnancy.

Complications of an ankle fracture

At different stages of a fracture, complications may develop; an attentive attitude to the patient (or to oneself) will prevent the worsening of the condition or stop it in the early stages:

• suppuration of a postoperative wound;
• injury to blood vessels and soft tissues during surgery;
• formation of arthrosis;
• postoperative bleeding;
• skin necrosis;
• embolism;
• slow consolidation;
• improper healing of the fracture;
• formation of a false joint;
• foot subluxation;
• post-traumatic foot dystrophy;
• thromboembolism.

Complications with proper treatment are rare; much depends on the patient himself: on the accurate implementation of the instructions received from doctors, the correctly structured rehabilitation process and motor regimen.

So, at each stage, a set of rehabilitation measures, provided they are correctly formed, can lead to a faster and more effective recovery of a patient with an ankle fracture.

Therapeutic exercises after an ankle fracture:

An injury such as a fracture and/or sprained ankle is considered one of the most common. Accounts for 20% of all bone injuries. This type of injury is characterized by a high risk of complications, which is associated with increased loads on the lower extremities. With excessive physical activity, the joint capsule of the ankle suffers. It is in this part of the lower leg that frequent injuries are observed. With such an injury, cracks occur in the medial and lateral malleolus. Damage to bones is accompanied by joint disorders - dislocations, rupture of the ligamentous apparatus.

The types of damage are determined by the nature of the injury. The classification of ankle fractures involves:

• pronation injury– in this case, a rupture of the tibiofibular joint occurs, cracks and a fracture of the medial malleolus or lateral malleolus appear. An additional component is a rupture of the lateral group of ligaments. One type of pronation injury is Dupuytren's injury. If all the specified components are present, the fracture is considered complete;
• supination injury– implies a fracture of the lateral malleolus with inward subluxation. A displaced ankle fracture cannot be ruled out. Often accompanied by distal;
• rotational injury– with a sharp turn of the foot, an apical fracture of the lateral malleolus develops. Rotational injuries imply dislocation. Rarely accompanied by a splintered wound of the tibia, but rupture of the tibiofibular joint cannot be ruled out. This is one of the severe wounds that leads to repeated injuries.

A fracture of both ankles with posterior displacement of the tibia is called a Pott's fracture. A bimalleolar fracture with dislocation and abduction of the foot is known as a Desto fracture. Pott-Desto injuries are sometimes called trimalleolar fractures. Disorders that cause complex trauma are usually accompanied by ligament rupture. They affect both the left and right ankle. There must be a marginal fracture of the tibia.

A non-displaced ankle fracture is easy to treat. The most severe is considered a trimalleolar fracture with dislocation and displacement. Triple traumatism requires treatment to be carried out extremely delicately.

The group of dangerous injuries includes open fractures. They are not typical for ankle injuries. More often, a closed fracture of the ankle bones occurs with displacement. A displaced fracture of two ankles occurs when a fall from a height or an unsuccessful jump. A non-displaced ankle fracture is a mild injury that does not require serious intervention.

Traumatization of the ankle bones at the edges is accompanied by intra-articular disorders. If there is a displaced fracture of the lateral malleolus and fibula, it is said to be a complex injury. When the posterior lateral surface of the ankle is injured, the heel bone is affected.

Trauma code according to ICD 10

Multiple ankle fractures with possible damage to the leg muscles are encrypted according to ICD 10 code S82.7. The injury code is determined by the position of the damaged bone. The medial bone fracture is designated S82.5, and the lateral bone fracture is designated S82.6.

Causes

The vast majority of injuries occur from direct impact. Especially often such injuries occur during an accident, when heavy objects fall on the leg. Indirect ankle injuries are associated with a twisted ankle. Shoes with heels are a cause of injury in women. Such injuries are accompanied by dislocations and sprains.

Provocateurs of fractures are:

• old age, pregnancy and breastfeeding, a period of intense skeletal growth. These changes are caused by a physiological deficiency of microelements, mainly calcium;
• bone disease– with deforming arthrosis, all joints suffer. A person can break a leg due to osteoporosis and other joint diseases. Bone tumors and genetic pathologies are considered more dangerous;
• endocrine disorders– diseases of the thyroid gland and adrenal glands. In this case, the condition of the skeletal system is of great importance - as a rule, there is a calcium deficiency.

The ankle is part of the musculoskeletal system, and physical activity affects the condition of the lower extremities. Ankle fractures are more common in overweight individuals. With swelling and diabetes, foot movements are limited. Inaccurate turns and bends result in injuries to the ankle joint. If you fall on your side, a closed fracture of the outer (lateral) malleolus occurs.

Symptoms

A characteristic sign of an ankle fracture is a crunching sound. Crepitation occurs with movement and palpation. Symptoms of an ankle fracture include:

• soreness– pain syndrome occurs immediately after injury, rarely has a delayed onset. The pain is acute and intensifies with exercise and movement;
• soft tissue swelling– the leg swells a few minutes or hours after the injury. Swelling of the leg immediately after an ankle fracture signals ruptured capillaries. Sometimes the limb swells so much that the circumference of the ankle area exceeds the circumference of the widest part of the ankle. Swelling when a leg is broken in the ankle is accompanied by pain and a feeling of fullness;
• bruising and bleeding– a hematoma on the leg extends to the heel area, sometimes the entire foot becomes engorged. The leg looks blue. A symptom of an ankle fracture is hemarthrosis, in which bleeding occurs in the joint;
• stiffness– dysfunction of the joint implies not only limited movement, but also abnormal mobility. The position of the foot may be atypical. Why such a pathology occurs is due to damage to the components of the joint. A fracture can be recognized by the displacement of the foot in relation to the lower leg. A turn in one direction or another accompanies a fracture-dislocation.

Symptoms increase with complicated and multiple injuries. The situation is aggravated by damage to ligaments, nerves, and muscle fibers. The pain increases as the tissues swell and the inflammatory process develops.

First aid

In case of an open fracture of the tibia, the wound is treated, then a bandage is applied. If the victim's condition is critical, call emergency services immediately. For severe pain, non-narcotic analgesics are offered: Ketanov, analgin. Cold is applied to the damaged area. This helps to relieve pain in the injured limb, eliminate swelling and prevent the appearance of extensive hematomas.

What to do if there is a fracture of the inner malleolus? The course of action is determined by the nature of the injury. In any case, you need to free your foot from the shoes, and this must be done as delicately as possible to prevent the fragments from moving. The limb is raised and placed on a flat surface, having previously placed a soft cushion under the ankle. This avoids the flow of blood into the affected area in case of internal bleeding. If the injury is displaced, the leg should lie still until doctors arrive. If you have experience with immobilization, then perform dressing.

First aid for arterial bleeding involves applying a tourniquet. It is loosened every 20 minutes and not held for more than 1.5 hours. A double-malleolar fracture without ligament rupture or displacement does not require serious manipulation at the everyday level. Standard treatment is carried out: anesthesia - cooling - immobilization. You can fix the ankle using a bandage or orthosis. In the absence of special devices, a tire is made from scrap materials. The best way to immobilize the ankle is to use a metal frame in the shape of the letter “L”. The leg is wrapped in soft cloth to avoid friction and discomfort, then the splint is fixed. Any load on the injured limb is excluded.

A double open ankle fracture is more difficult to treat and takes longer to heal. Fracture-dislocations are also classified as complicated and require long-term recovery. If the victim received timely help, then the risk of complications is minimal. Bone structures will recover quickly and without consequences. In old age, bones and ligaments are in a less favorable position. They are highly traumatic and take a long time to heal. It may take six months for your ankle to recover.

If the doctor has installed an orthosis or bandage, there is no need to constantly remove or loosen the structure. The immobilizing mechanism is designed to securely fixate the limb. If you frequently remove the bandage, the risk of improper fusion increases.

When can you step on your foot after a broken ankle?

After removing the plaster, they begin to develop the ankle. At the initial stage, the patient feels pain when walking, movements are slow and careful. A cane or crutches may be required; walking without support is only possible if the ankle is completely restored.

When can you start walking after a fracture?? It is absolutely contraindicated to stand on your leg for 4 weeks after the injury. In the future, movement is carried out on crutches. After removing the plaster cast, the leg is fixed with an orthosis or an elastic bandage. From this moment, they begin to gradually load the limb.

The doctor will explain when you can step on your leg after a displaced ankle fracture and select training exercises for effective development. Learning to walk quickly after a serious injury will not work. In the best case, complete recovery takes 3-4 months. In old age and the presence of concomitant diseases of the musculoskeletal system, it takes 1-2 years.

How long to treat and wear a cast

Walking in a cast for a fracture not aggravated by complicating factors is necessary for 1 month in childhood, 6 weeks in adulthood, 2 months in the elderly. How long to walk in a cast for a complicated ankle fracture is determined by the degree of damage to the bone structures and the method of treatment. A plaster cast is applied after surgery for 3 months. After removing the metal structures, fixing bandages are used again - bandages, orthoses.

The fracture heals on average 2-3 months. After this time, the plaster is removed and development begins. If bones take a long time to heal, then drugs are used to compensate for calcium deficiency. It is difficult to say how long to wear a cast in case of malunion. The method of treatment and duration of immobilization are determined by the doctor.

How Long Does Your Leg Hurt and Stiffness After an Ankle Fracture?? When nerve endings, muscles and ligaments are damaged during an injury, the echoes of the injury will persist for a long time. If six months have passed and the pain does not go away, re-diagnosis is necessary.

How long it takes to develop fused bone structures and joints is determined by the age of the patient, the effectiveness of the treatment proposed by the doctor, and rehabilitation measures.

Rehabilitation

Immediately after removing the plaster, development begins. The limb needs to be restored gradually; large loads should not be given. First, they resort to passive methods of rehabilitation, then to active ones. If the ankle is fractured with displacement, the first week after the cast is removed, a light massage is given, then physical therapy begins. Rehabilitation after an ankle fracture should not be forced - the risk of re-injury is too high.

Self-massage, gymnastics, and therapeutic baths are performed at home. The latter are necessary to relieve swelling, relieve inflammation, and relieve pain. Antler baths, which can be done at home, have proven themselves well. Saline solutions have a beneficial effect on the condition of soft tissues. They eliminate swelling and improve tissue metabolism.

Physical therapy is required to restore joint function. It reduces rehabilitation time and helps you quickly return to active life. A set of exercises is selected by a rehabilitation specialist. The rehabilitation period usually lasts 3 months. Only after this period has expired can full weight be given to the foot.

It will not be possible to quickly restore a limb in case of multiple injuries. The patient is offered physiotherapy, diet, balneotherapy, and orthopedic structures.

Physiotherapy

It is best to work out your leg in a physiotherapy room. The doctor will offer hardware recovery methods, herbal medicine, and physical therapy after an ankle fracture. The latter is mandatory for any type of injury. Exercises after an ankle fracture are selected individually. Required elements are:

• flexion and extension of the foot;
• rotational movements;
• walking on toes;
• rolling a ball;
• walking on heels.

Exercise therapy after an ankle fracture involves a gradual increase in load. The patient is offered shoes with an orthopedic insole. Walking times are strictly regulated. Gymnastics for a broken ankle should not be violent. This applies to all flexion and rotation movements. The set of exercises at the first stage involves training the ligamentous apparatus. In the future, physical therapy for an ankle fracture becomes more variable. Training time increases, loads increase.

You should not think that exercise therapy for an ankle fracture includes exercises only for the lower extremities. General strengthening exercises will help disperse the blood and tone the muscles. The duration of therapeutic exercises for an ankle fracture is limited to 4-6 months. In the future, special development of the injured leg after an ankle fracture is not required.

Hardware physiotherapy involves the use of the following methods:

• calcium electrophoresis– provides 10-12 procedures, enhances the healing of bone structures;
• magnetotherapy– prescribed two weeks after applying the plaster. Includes 10 procedures that are performed daily;
• UV irradiation– recommended from the 3rd day after applying the plaster. The method enhances the production of vitamin D, improves regeneration;
• infrared laser therapy– promotes the absorption of calcium, has a beneficial effect on muscle tissue. Includes 8-10 procedures.

Only a doctor will explain how to develop a leg after a fracture. Without the supervision of a specialist, you should not start gymnastics and other types of physical activity - swimming, running, cycling. Physiotherapy, gymnastics and massage will significantly speed up the recovery process.

Massage

To avoid stagnation of blood in the limb, self-massage is performed. Gentle stroking, rubbing and light pinching will help speed up recovery after a broken ankle. With this effect, muscle and bone structures are not involved, but capillary circulation improves. Due to swelling and blood stagnation, rehabilitation may be delayed. Daily self-massage will relieve the negative consequences of injury.

The exposure time should not exceed 15 minutes; an intense massage, in which the muscles are massaged, takes 5 minutes at the beginning of therapy and 10-15 in the future. Immediately after removing the plaster, the massage is entrusted to a specialist, and then done independently at home.

Complications and consequences

If treatment was carried out late or there were errors during reposition, then incorrect fusion is possible. In this case, repositioning is required, which is usually performed surgically.

The main complications that occur after an ankle fracture include:

• contractures– imply limited movement of the joint, pain, inability to fully function;
• calluses after a fracture – occur due to inaccurate reposition. At the junction, growths form that interfere with movements and cause discomfort;
• joint diseases– after any injury, the risk of diseases of the musculoskeletal system increases. Diseases such as arthritis and arthrosis become frequent complications;
• neuritis of the calcaneal branch– occurs if a displaced fracture of the inner or outer ankle is accompanied by damage to the nerve fibers.

Complications such as arthrosis and bursitis are typical for mature and elderly patients. Lameness is considered a characteristic manifestation of malunion.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

The ankle is a process of the shin bone that participates in the formation of the ankle joint. According to statistics, it is this area of ​​the human body that is injured much more often than others. One of the varieties is a non-displaced ankle fracture.

Varieties

It is customary to consider the ankle as a single joint, but in fact, it is composed of two joints: the ankle and the talocalcaneal. The cause of damage can be a sharp or rapid movement of the ankle to the inside or outside. Very often a fracture accompanies a sprain. Non-displaced ankle fractures are divided into the following types:

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

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

The direction of the fracture is horizontal. As a rule, the cause of such damage can be a strong outward turning of the foot. With an oblique fracture of the external malleolus, the rupture line is oriented from bottom to top from the front to the back. Such damage can result from tucking the foot in combination with its abduction (abduction) or when the foot is excessively turned outward.

In a transverse fracture, tension in the deltoid ligament of the foot causes the medial malleolus to be torn off at the base or apex. The cause of this type of injury is a strong inversion of the foot to the outside.

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

Less common in traumatology practice is a fracture of the internal and external ankles (bimalleolar). This fracture occurs when the foot is abducted excessively. Bimalleolar fractures can be of two types:

• pronation-abduction;
• supination-adduction.

Treatment

Symptoms of an ankle fracture are:

1. Crunching when injured;
2. Acute pain in the ankle area, worsening with exercise. They can occur immediately after damage, or after some time. On palpation, sharp pain is also felt in the area of ​​the fibula;
3. Edema or moderate swelling. The ankle increases in size. The swelling is pressed in when you press it and after a while it evens out again;
4. Hemorrhage in the area of ​​injury as a result of vascular damage;
5. Limited functioning of the ankle joint - abduction and adduction of the foot is painful, difficult and accompanied by a crunching sound. The foot involuntarily takes the wrong position.

The diagnosis of an ankle fracture is made in the presence of all of the following symptoms and after an X-ray examination in several projections:

• straight - the patient lies with the leg bent at the knee;
• oblique - the patient is on the healthy side with bent legs, the affected leg is at an angle to the table;
• lateral - on the sore side with bent legs, the sore leg slightly in front.

Depending on the complexity and type of fracture, the line of damage can be transverse, oblique or spiral and determined on one or more photographs. If there is a ligament rupture, then on the image it is displayed as an expanded gap in the ankle joint.

If the gap is deformed and has a wedge shape, this indicates the presence of subluxation of the foot. If it is difficult to diagnose using X-rays, an additional study may be prescribed: tomography or ultrasound of the ankle.

Therapy for non-displaced fractures involves injecting the damaged limb with anesthesia (novocaine solution) and immobilizing it with a plaster cast. The foot is fixed at a right angle to the shin.

Plaster helps to correct the position of the bone and fix it for proper fusion. If the inner ankle is fractured, a plaster “boot” or U-shaped bandage is applied to the lower leg.

The decision to operate is usually made in relation to displaced fractures or old and improperly healed ankle injuries. The indication for surgery in this case may be constant pain at the site of injury.

How long to walk in a cast

If the course of treatment is favorable and all recommendations of the attending physician are followed, the maximum period of wearing a plaster cast for fractures of the external ankle will be 1.5-2 months.

How long does it take to heal?

The healing period for fractures is determined by the individual characteristics of the patient and ranges from 12 to 15 weeks.

Rehabilitation and recovery after plaster removal

The recovery period lasts from 1 to 2 months and includes special procedures and exercises, by performing which the patient can completely restore the mobility of the limb in a short time. The rehabilitation period includes:

1. Massage treatments;
2. Physiotherapy;
3. Orthopedic shoes and insoles.

Timely rehabilitation will help prevent muscle atrophy, eliminate circulatory disorders, improve the functioning of the lymphatic system, and also strengthen the ligaments and return the leg to its former mobility.

When can you walk

You can rest on the injured limb in a couple of days. Use crutches for walking, replace them with a cane after 3 weeks.

How long does your leg hurt after breaking your ankle?

Pain after an ankle injury does not go away immediately and may accompany the patient for a long time. In order to reduce pain and discomfort, it is necessary to begin developing the joint as early as possible, preferably under the guidance of a rehabilitation physician.

If rehabilitation is over, and the leg still continues to hurt, the doctor will prescribe a bandage or orthosis that will gently fix the foot, reducing the stress exerted when walking. If after walking the patient is often bothered by pain in the heel, then a control X-ray should be taken to make sure that the bone has healed correctly.

If there are no repeated injuries, it is recommended to maintain a protective regime for the injured limb: keep the leg elevated and continue the prescribed treatment. If misdiagnosed or untreated, non-displaced ankle fractures can lead to the development of diseases such as arthrosis and ankle arthritis.

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