Non-displaced fracture of the lateral malleolus, complete recovery. Displaced ankle fracture. Physiological causes of injuries. Ankle fracture with and without displacement: symptoms, treatment, prognosis Fractured ankle

Ankle fractures are serious injuries to the lower extremities that impair their functionality, cause pain and discomfort, and require immediate treatment. This type of injury has a number of varieties.

How to distinguish an ankle fracture without displacement from an injury with displacement of bone fragments on your own, what treatment is necessary in each specific case, and how long can the rehabilitation period last for various types of ankle fractures? We will answer these questions below.

Classification

This type of injury can occur in an open or closed form. The latter is a mild form and occurs under the cover of soft tissue. An open ankle fracture is a bleeding wound with torn skin from which broken bones may protrude.

In addition, there is a classification of ankle fractures depending on the specific site of injury (inner or outer ankle), as well as depending on the direction in which the injury occurred. According to the direction, damage occurs (the components of the fracture will be described through the line, i.e. those parts that can be subject to injury, both individually and all together):

• Pronation type - dislocation or subluxation of the left or right (depending on the leg that was injured) of the foot occurs outward and a fracture of the inner ankle, as well as the outer one. In this case, the injury is usually accompanied by a rupture of the deltoid ligament. The lower part of the fibula may also be broken and the tibiofibular syndesmosis may be torn.
• Supination – the foot is “turned” inward. A fracture of the outer ankle occurs or the ligaments of the ankle joint are torn. The inner part of the tibia is also broken along an oblique line. If all components are damaged simultaneously, then the fracture is considered complete.
• Rotational – the foot dislocates forward or towards the back. Accompanied by a fracture (possibly comminuted) of the tibia, including its distal part. There is a rotational fracture of the fibula.

Both a lateral malleolus (external) and a medial malleolus (internal) fracture can occur with or without displacement.

It is even possible to fracture both ankles (bimalleolar fracture) or three (trimalleolar fracture).

Causes

The injury may result from receiving a blow to the joint area. You can also get this injury when you twist your foot. In addition, the greatest chance of getting a fracture is:

• in pregnant women and nursing mothers, who usually do not have enough calcium in the body;
• for those who practically do not consume foods rich in calcium;
• in people with thyroid diseases;
• in older people;
• in children;
• those who suffer from diseases of the adrenal glands and kidneys;
• in those who have bone diseases.

Symptoms

When you fracture your ankle, the following symptoms may occur:

• the occurrence of sharp, acute or aching pain in the damaged area;
• the appearance of hematomas and small bruises under the skin;
• When an ankle is fractured, deformation of the foot may occur;
• rupture of the skin, bleeding from the wound and protrusion of broken bones;
• presence of edema;
• inability to stand on one's feet;
• the leg may become numb;
• feeling of chills;
• swelling of the foot.

Depending on the type of damage, all of these fracture symptoms may be more or less pronounced.

Diagnostics

Regardless of the symptoms, which may clearly indicate the presence of a fracture, the doctor is obliged to conduct an X-ray examination in the direct projection, which is mandatory, as well as in the lateral and oblique projections.

At the same time, in different projections, the patient occupies different positions:

• when performing an x-ray in a direct projection, the patient takes a supine position so that the knee joint is bent;
• the lateral projection also implies a lying position, but on the side on which the leg was fractured; the patient bends his knees, but moves the affected leg forward;
• the oblique projection is similar to the lateral projection, only you have to lie on your healthy side, a pillow is placed between your legs, and the broken ankle is tilted towards the table.

First aid

Treatment of a fractured ankle is successful only when the injured person has been provided with competent first aid. If any of the above signs of an ankle fracture are present, the first thing a person should do is call an ambulance and get medical attention. To do this, you first need to ensure that it is stationary. In this case, the injured leg should be placed at a small height from the floor or ground, for this purpose something like a bolster should be constructed from available clothing. Shoes must be removed from the foot immediately, as it will be difficult to do this if it swells further.

It is strictly forbidden to touch a joint that has been fractured with your hands, so as not to displace any fragments, if any. If this is a closed fracture of the ankle, if the injured leg is handled incorrectly, it can become open, because probably more severe displacement of bone fragments, which can tear the skin.

Think about ways to relieve swelling in your leg. Any cold is suitable for relieving puffiness - it can be frozen from the refrigerator, wrapped in a cloth. The cold will also help relieve pain from the damaged area.

If the ankle fracture is open, the bleeding must first be stopped. To do this, you can make a tourniquet from any things available nearby. Apply such a bandage above the open wound. Only then can cold compresses be applied near the wound to stop the bleeding faster. Also, such actions will help relieve swelling at least a little.

You should not try to return the protruding bones to the wound or connect them together, since such an intervention can provoke further ruptures of the soft tissues and the spread of fragments further along them. If a person's pain is unbearable, he can be given painkillers and wait for the doctors to arrive.

Treatment

How to quickly cure an ankle fracture and not worsen the situation - to do this, you need to accurately determine the location of the fracture, its type, and identify the presence or absence of fragments. The doctor also questions the patient in detail about what caused the injury.

After an ankle fracture, swelling may occur. And if the injury is accompanied by the splitting of bones into fragments, a conservative type of treatment cannot be used. Since when swelling decreases, the broken parts of the bones can move significantly. Also, a cast applied in this case can lead to subluxation of the foot, which can no longer be corrected. In this case, surgical intervention is necessary. Specialists will connect all the broken fragments to their natural position using surgical steel fasteners, set the displaced bones in their place, and only then fix the injured lower leg using a plaster orthosis. It is applied for a period of up to 1.5 months.

If a leg fracture in the ankle occurs without displacement and has a closed form, only a special orthosis is used to treat it, limiting the motor function of the ankle. This type of injury heals the fastest – 8 weeks is enough. At the end of this time, the patient can gradually step on the leg, transferring full weight to it only over time.

If, but it is closed (the integrity of the skin is not compromised), the patient is restored to the natural position of the bones under anesthesia, and then casting is performed for a period of 8 to 12 weeks. During this time, complete healing of the bones should occur. Skeletal traction can be used to reduce the risks of further or repeated displacement of the fragments to zero. A knitting needle is threaded through the heel and a kettlebell counterweight with a load of 12 kg is suspended from it.

If soft tissue is torn, surgery is also required. After an ankle fracture, the foot swells - this is the reason that the intervention is carried out only 4-5 days after the patient was injured. Then the swelling and subcutaneous hemorrhages present should decrease. Surgeons tighten the torn blood vessels during surgery, attach screws and metal plates to the bones, and then sew up the torn muscles and skin before placing a cast on the leg, which secures the leg from the foot to the knee. With such an injury, the shin should heal within 8-10 weeks.

There are situations when unpleasant consequences are possible after a broken ankle. Sometimes a broken bone heals incorrectly and then surgeons have to perform additional intervention. During the reoperation, the fused bones are again crushed and connected to their natural position again.

Rehabilitation

How long the patient will have to walk in a cast and the period of complete recovery depends on the type of injury received and the physiological characteristics of the body. The faster the bones heal, the faster the attending physician will remove the plaster.

Many people are interested in the question “when can you step on your leg after an ankle fracture without displacement and with it?” It is impossible to give an unambiguous answer to this due to differing factors in the presence of damage, the patient’s age and other factors. But you can rely on averages and understand when you can start walking. The doctor gives permission after an x-ray is taken and a completely healed fracture is visible. If the bones heal quickly enough, it is possible that a specialist will be able to free the injured shin from the plaster within 6 weeks.

Both during the recovery period and after removing the plaster cast, the patient is recommended to attend the following procedures:

• Exercise therapy is aimed at fully restoring the motor activity of the joint.
• Massage is aimed at restoring muscles that have been atrophied due to prolonged wearing of a plaster cast.
• Physiotherapeutic procedures - electrophoresis and magnetic therapy, aimed at accelerating the restoration and healing of bones.

Is it possible to step on the leg after removing the cast, and how to attend these procedures?

You definitely need to go for the procedures, no matter how difficult it may be. When you can step on your injured leg completely, you will definitely feel it. Well, first, start to lean lightly on your leg when walking, without putting a heavy load on it. The sooner after removing the immobilizing bandage you begin to develop the affected joint and the leg muscles that are in long-term isolation, the sooner you will restore full motor activity. But don’t rush too much - do everything according to your feelings. At first, any movements may cause pain, but you need to hold on until the end and, overcoming it, restore the motor functions of the leg.

According to traumatologists, an ankle fracture is one of the most common bone injuries. Usually the injury is recorded in winter in those areas where the fight against ice and snow is not given due attention. Also at risk are athletes, children and women who prefer 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.

In an open ankle fracture, 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 (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. The type of x-ray is shown in the photo.

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

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, an x-ray must be taken, 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.

Rehabilitation consists of:

• In a balanced and proper diet, enriched with calcium, potassium, phosphorus and other components that take part in the formation of bone tissue. Taking vitamins is also important.
• In carrying out a massage, during which muscles atrophied after the orthosis are developed. How many sessions are needed for recovery is determined by the attending physician. During such procedures, the use of warming ointments is recommended.
• In carrying out physiotherapeutic procedures that are possible while the cast is still on the limb. Traumatologists strongly recommend them, because they believe that when they are performed, the injury heals faster.
• In performing physical therapy. How many and what exercises need to be performed is determined only by a specialist. At first, physical education should be gentle, and then gradually the load should be increased.

For complete recovery, it is important to tune in psychologically. After all, many are initially afraid to step on an injured leg. However, ankle development is an important and integral part of recovery. Otherwise, you will not be able to recover completely.

An ankle fracture is the most common injury to the musculoskeletal system; this problem is found in the majority of patients complaining of severe pain in the leg. Damage is typical for teenagers, athletes and women wearing high-heeled shoes. The frequent occurrence of injuries is explained by the structural features of this part of the musculoskeletal system. It is not always possible to completely restore the functions of the joint; in 10% of cases, the consequences of damage become irreversible.

Based on the nature of damage to bone and soft tissue, the following types of injuries are distinguished:

1. A closed ankle fracture is a complete or partial destruction of the bone while maintaining the integrity of the surrounding soft tissue. Excessive loads on the leg, intense pressure on the bone, or the effects of decreased mineral density contribute to the occurrence of such damage. With proper first aid, treatment and rehabilitation, the chances of recovery are close to 100%.
2. An open ankle fracture is an injury in which bone fragments come out through a soft tissue defect. The wound is formed by the sharp edges of the bone. Such a fracture is considered a severe injury, often leading to bleeding, painful shock and infectious complications. It occurs under intense mechanical stress, such as a car accident, a fall from a great height, or a bullet wound.

External malleolus is diagnosed in 30% of cases. Most often, such an injury is diagnosed in elderly and senile people, which is associated with a decrease in bone density, impaired coordination of movements and a deterioration in the general condition of the body. It is easier to get a fracture of the lateral malleolus in winter when moving on ice.

Damage of this nature has the following development mechanisms:

1. Rotary. When the ankle joint is twisted, a fracture occurs on the outer part of the ankle. The bone fracture runs from bottom to top, heading outward. With prolonged exposure to a traumatic factor, the tibiofibular ligaments are stretched and torn. With a rotational fracture, damage to the deltoid ligament is observed, which immobilizes the ankle joint for a long time.
2. Supination-adduction. When the foot rolls inward, the calcaneotibial ligament is pulled, causing separation of the outer malleolus. If the influence of the provoking factor continues, an oblique fracture of the inner part of the ankle occurs.

An apical fracture of the lateral malleolus is a marginal injury to the upper part of the bone, characterized by the presence of pain of varying severity.

The inside of the joint is most often damaged at the base. The fracture line is uneven, and no displacement of the talus is observed. A separate category includes avulsion injury associated with structural features of the ankle. The deltoid ligament is attached to the talus, calcaneus and navicular bones. When exposed to a traumatic factor, the tissues withstand the load, the tendon is torn off along with part of the inner bone. If not treated correctly, a fracture of the medial malleolus causes irreversible dysfunction of the joint.

Displaced ankle fracture

A displaced fracture of the medial malleolus is a complex bone injury. At the time of injury, bone fragments move relative to each other. Strong pressure contributes to bone damage. The clinical picture is complemented by signs of violation of the integrity of soft tissues. Swelling is more pronounced; to clarify the diagnosis, the use of hardware research methods is required. In this case, the victim requires emergency surgery.

Non-displaced ankle fracture

A non-displaced fracture of the lateral malleolus is the simplest type of injury that is treated with conservative methods. In this case, no displacement of bone fragments occurs. The injury occurs when the foot rolls outward. The first sign is severe pain that interferes with the use of the leg as a support. A fracture can be diagnosed without x-ray examination.

Causes of fracture

The main causes of ankle injury are mechanical impacts, which are:

1. Direct (squeezing a joint, heavy objects falling on the leg, road accidents).
2. Indirect (twisting of the foot). They are more common than straight ones. A fracture that occurs for this reason is accompanied by a sprain or tear of the ligaments. Indirect injury occurs when skiing, walking on many surfaces, or playing sports.

Provoking factors include:

• calcium deficiency in the body;
• period of intensive growth in children;
• disruption of the production of female hormones during menopause;
• pregnancy and breastfeeding;
• taking hormonal contraceptives;
• poor nutrition;
• diseases of the digestive system that interfere with the absorption of vitamins and minerals;
• pathologies of the thyroid and parathyroid glands;
• consequences of removal of the thyroid organ;
• dysfunction of the adrenal glands;
• vitamin D3 deficiency.

A fracture of both ankles is most often pathological in nature; it occurs in the presence of the following diseases:

• osteoporosis (decreased bone mineral density);
• deforming osteoarthritis (destruction of cartilage, accompanied by joint deformation);
• bone abnormalities;
• genetic pathologies characterized by impaired development of bone and cartilage tissue (Marfan syndrome, Volkoff disease);
• infectious bone lesions (tuberculosis, syphilis);
• non-infectious inflammatory processes (arthritis, osteitis);
• benign and malignant bone tumors.

Symptoms of an ankle fracture

An ankle fracture causes the following symptoms:

1. Crunching at the time of injury.
2. Pain in the affected area. It occurs immediately after bone damage, but can appear after a few hours. The pain syndrome is acute and intensifies when using the leg as a support. On palpation, the unpleasant sensations become sharp, the pain spreads along the fibula. The appearance of this symptom is explained by a rupture of the periosteum, which is supplied with a large number of nerve endings.
3. Pain shock. Characteristic of severe injuries accompanied by displacement of bone fragments. This life-threatening syndrome requires the administration of powerful pain medications.
4. Swelling of surrounding tissues. The ankle increases in size and the contours of the ankle change. The symptom occurs 3-10 hours after injury. When you press on the skin, a dimple is formed, which takes a few seconds to disappear. The development of edema is facilitated by disruption of the integrity of small vessels. In complex fractures, swelling covers the entire lower leg.
5. Subcutaneous hemorrhage. The skin of the affected area becomes bluish and the area becomes hematoma. The cause of hemorrhage is the rupture of small vessels, in which blood permeates the soft tissue. Hematomas are most typical for displaced injuries.
6. Limitation of joint mobility. It manifests itself as an inability to perform normal movements, a violation of the position of the foot. This is due to the destruction of bone and soft tissue.

First aid

The scheme for providing first aid for a fractured ankle includes:

1. Elimination of loads on the injured limb.
2. Removing compressive objects (concrete slabs, vehicle parts, tight shoes). This is done carefully, trying not to aggravate the severity of the damage.
3. Giving the leg the correct position. The limb is raised and a soft cushion is placed under the foot.
4. Elimination of bleeding. For closed injuries, apply cold compresses; for open ones, apply a tourniquet, which must be loosened every 10 minutes.
5. Splinting. The device can be built from scrap materials: boards, branches, plywood. Immobilization of the limb prevents the development of complications that may arise when delivering the patient to a medical facility. Before applying the splint, the affected limb is bent at the knee. The boards installed on both sides of the shin are fixed with a bandage.
6. Anesthesia. The administration of drugs is indicated for complex fractures, with severe compression of the leg.
7. Delivery of the patient to the trauma department.

Treatment after an ankle fracture

Treatment and rehabilitation tactics are determined by the type and complexity of the injury. Both conservative and surgical methods are used.

Conservative treatment

Conservative therapy is indicated:

• when closed;
• when ligaments are torn;
• in old age;
• with decompensated diabetes mellitus;
• in acute heart failure.

For ankle joint injuries, the following techniques are used:

1. Manual reposition (reduction of bone fragments). Performed under local anesthesia. The leg is bent at the knee joint, the thigh is held with the hands. The doctor rotates the foot until the joint reaches its physiological position, and then applies a plaster cast.
2. Plaster application. After the bandage is formed, the person should not experience a feeling of squeezing or friction. During the healing period, do not put any weight on the affected leg.

Surgical treatment

Surgery for a displaced ankle fracture is aimed at:

• to cleanse the wound, stop blood circulation;
• to restore bone structure;
• for the reduction of bone fragments;
• to restore the functionality of the joint.

Types of surgical interventions:

1. Restoration of the tibiofibular joint. The bolt is passed through the tibia and fibula, and then attached with a nail to the inner malleolus. Channels are created in advance. The operation is indicated for injuries caused by rotation of the joint.
2. Osteosynthesis. For ankle fractures, plates are installed parallel to the fibula, and the middle part of the ankle is fixed with a pin.
3. Combination of fragments of the tibia. A long screw is inserted through the open ankle to secure the pieces of the tibia together. The operation is indicated for injuries accompanied by the formation of large parts

Rehabilitation

During the recovery period, it is recommended to carry out the following activities:

1. Using crutches. Any stress on the injured leg is excluded for 4-6 weeks after surgery. It takes at least a year to fully restore joint function with a double ankle fracture.
2. Wearing a tight bandage. The cast is worn for 2-3 months, after which it is replaced with an elastic bandage. The fixing devices are removed after six months.
3. Performing special exercises. Exercises are necessary to restore joint mobility. Training begins 2 weeks after removal of the plaster cast. The complex is selected by a physical therapy instructor. The load on the affected leg is increased gradually.
4. Wearing orthopedic insoles.
5. Massage. After removing the tight bandage, it helps restore the flow of blood and lymph. The first procedures are carried out using anesthetic gels. After developing the joint, the discomfort disappears. Massage is performed 2 times a day. The leg is rubbed, stroked, shaken.

Complications after an ankle fracture

Early complications of ankle injuries include:

• decreased sensitivity of the limb;
• subluxations;
• thrombosis;
• shortening of the fibula;
• bacterial infections;
• soft tissue necrosis.

Consequences

In patients who do not follow the doctor’s recommendations, several years after the injury, arthrosis develops, a false joint forms, and problems with ankle mobility appear. If the bones do not heal properly, the gait changes and constant aching pain in the legs occurs.

Injuries to the musculoskeletal system not only complicate a person’s life and deprive him of his ability to work, but can also cause various complications. One of the most common types of human injury is a broken ankle.

Causes

Untimely or incorrect provision of this type of assistance can cause the following situations:

• Destruction of integumentary tissue by bone fragments.
• Interposition of tissues, formation of displacement.
• Development of shock due to excessive pain.
• The appearance of bleeding or its intensification.
• Formation of ankle dislocation.
• Injury by bone fragments of nerves.

To prevent this from happening, those around you should do the following:

1. Create rest for your feet.
2. Contact the ambulance service.
3. Free the ankle from any compressive influences; shoes must be removed without changing the position of the limb.
4. Raise the fracture area and place it on a soft cushion.
5. Apply a cold source to the injury site.
6. It is recommended to immobilize the damaged area using available means.
7. Give the victim a pain reliever - an analgesic or non-steroidal anti-inflammatory drug.

When the victim is taken to a hospital or emergency room, the doctor will assess the condition of the limb and choose a method of therapy - reposition or surgery.

Conservative

Both medial and lateral localization of the fracture can be treated conservatively (without surgery). However, for this to happen certain conditions must be present:

• The fracture must be closed.
• There should be no offset.
• The ankle ligaments are not damaged or slightly sprained.
• If there was a displacement, the doctor eliminated it with a one-step reduction.
• If there is displacement, concomitant pathology does not allow surgical treatment.

Conservative treatment is carried out as follows:

1. The site of injury is numbed. Sometimes you have to resort to general anesthesia.
2. The traumatologist resets the fragments back to the mechanism of injury.
3. After reduction, a plaster cast is applied to the foot and lower leg.
4. Standing on an injured leg is strictly prohibited. Moving is only possible with crutches.
5. After treatment, a control radiograph is taken.

Modern orthopedics makes it possible to treat a fracture conservatively without applying a plaster. It is being replaced with special ones. These devices are more convenient and reliable than plaster. The disadvantage is the high cost of the products.

Immobilization is indicated for 4–8 weeks. The bandage or bandage is removed after examination by a doctor and a control x-ray.

Operational

Unfortunately, sometimes it is impossible to do without surgical intervention. Surgery is resorted to in the following cases:

• With an open limb injury.
• If manual reduction cannot be performed effectively.
• If an old ankle fracture is detected.
• Fracture of the ankles on both sides with simultaneous damage to the diaphysis of the lower leg bones.
• ankle joint.

The listed conditions require surgical treatment. It can be produced in the following ways:

1. Fixation of the tibiofibular joint with a nail.
2. Osteosynthesis of the medial or lateral malleolus with nails and pins.
3. Osteosynthesis of shin bone fragments using a screw along the axis.

During the operation, the following goals are achieved:

• Treating the wound and stopping bleeding.
• Recreating the correct shape of bones.
• Reposition of fragments in an open way.
• Osteosynthesis – fixation of fragments.
• Ligament restoration.

After the operation it is also necessary to apply a plaster cast. In this case, the splint is fixed in such a way that the wound remains accessible for dressings and treatments.

Rehabilitation

Whatever treatment of the fracture is performed, the patient is required to undergo a course of rehabilitation. It includes activities that help restore support function and range of possible movements.

The following methods are used for recovery:

1. Physical therapy is indicated for all patients and has no contraindications. The load on the limb is gradually increased and the optimal set of exercises is selected together with a physical therapy doctor.
2. After a fracture, it is recommended to wear special shoes. This helps reduce the risk of re-injury.
3. Massage and self-massage procedures are recommended. Manual therapy methods help tone the muscles and restore effective blood circulation in the ankle area.
4. Physiotherapy is also widely used in the rehabilitation period. The best effect is achieved by electrophoresis, magnetotherapy, UV and UHF, laser therapy, and shock wave treatment.

It is better to combine rehabilitation methods with each other. Recovery takes place especially organically in rehabilitation centers or sanatoriums. Indications for sanatorium treatment are determined by the attending physician.

Prevention

Once occurring, a fracture can occur again. To prevent this from happening, it is necessary to apply secondary prevention measures. It is sometimes impossible to avoid accidents, but the risk factors for fracture can be adjusted:

1. You need to eat right. The diet should be complete in terms of protein and calorie content. The diet should be rich in calcium and phosphorus; for this, consume more dairy products, cereals, nuts and beans, vegetables and fruits.
2. Vitamin D helps absorb calcium. This substance is produced in the body with sufficient exposure to the sun. It is not the tan that is important, but the length of time spent in the fresh air. Slow regular walks are recommended, especially in the summer.
3. Gymnastics that support the muscles of the lower limb create the correct corset for the bones. Exercises are performed regularly in the morning and evening, this helps to avoid injuries.
4. It is necessary to compensate for chronic inflammatory diseases and eliminate foci of infection. It also reduces the risk of unwanted damage to bones and joints.

It is possible to prevent a fracture, but if it does occur, you should consult a doctor as soon as possible to receive full help.

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

General information

The ankle, or ankle, refers to the lower protruding part of the lower leg. It consists of two bone growths, which are located respectively near the outer and inner parts of the foot. Doctors distinguish two sections in the ankle:

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

Both sections form the ankle fork.

note

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

Causes

An ankle fracture can be caused by direct or indirect trauma. In the first case, a blow is struck to the bone, for example, as a result of an accident, a fight, or an object falling on a limb. In the second, it’s all due to the “twisting” of the leg, which violated the integrity of the bone. Most often this happens on a flat, slippery surface - on ice, tiles. Injuries also occur while skating or running in uncomfortable shoes.

Some diseases and pathological conditions aggravate the situation:

• lack of calcium caused by poor diet, intake, vitamin D3 deficiency;
• diseases of the adrenal glands, kidneys, acromegaly, disorders of the digestive tract, thyroid gland, which impair the process of calcium absorption;
• old age and adolescence, pregnancy and lactation, which become the causes of physiological calcium deficiency;
• diseases of the skeletal system or diseases that affect the skeletal system - bone neoplasms, chondrodysplasia, .

Symptoms of an ankle fracture

When ankle fractures occur:

The severity of symptoms directly depends on the severity of the condition. The following factors are important: the presence of displacement, sprained ligaments, and bone fracture zone.

Kinds

Depending on the location of the damage, doctors distinguish:

• fracture of the medial malleolus;
• lateral fracture.

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

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

• pronation fracture - when the foot turned outward;
• supination - when the foot is turned inward;
• rotational - when the shin rotates around an axis with the foot stationary.

Ankle fracture with and without displacement, other types

In medical practice, the most common diagnoses are:

• fracture of the outer ankle;
• inner ankle;
• displaced ankle fracture;
• non-displaced ankle fracture.

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

note

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

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

• Direct fracture, or pronation, when the foot turns outward and the deltoid ligament is stretched.
• Oblique– supination of the foot is also observed, and a piece of the inner ankle breaks off above the heel bone.

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

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

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

First aid for a broken ankle

Any sign of an ankle fracture is a reason to see a doctor immediately. Before this, it is recommended that the victim receive first aid.

note

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

First aid for a broken ankle includes:

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

Possible complications:

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

Diagnostics

As a rule, a preliminary diagnosis is possible after examining and interviewing the patient. Meanwhile, the doctor additionally recommends taking x-rays in three projections:

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

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

If necessary, other diagnostic methods are possible:

• ankle;

Treatment for an ankle fracture

Treatment for an ankle fracture can be conservative or surgical. Everything is determined by the severity of the situation.

Conservative treatment

Conservative treatment methods are possible when diagnosed:

• closed fracture without displacement;
• minimal ligament damage;
• a displaced fracture, in which simultaneous closed reduction is possible.

note

Conservative treatment is also indicated in cases where the patient has contraindications to surgery, be it diabetes, old age, heart disease or nervous system disease.

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

It is worth noting that such a bandage is not always applied for ankle fractures. In some cases, it can be replaced with plastic or metal immobilizer bandages. The period of wearing the bandage depends on the severity of the condition and ranges from 4 to 8 weeks. It is removed only after a control photograph has been taken.

If there has been a displaced fracture, before applying the plaster, a closed manual reduction is performed - the fragments are compared. Before the manipulations, anesthesia or anesthesia is given. Then the leg is bent at the knee and hip at a right angle. With one hand, the surgeon takes the heel and ankle in front, and with the other, the lower leg, behind and on the sides, resulting in countertraction.

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

Surgical intervention

Operations are performed when:

• fractures of both ankles;
• open fractures;
• complex injuries;
• fracture of the tibia and fibula by more than a third;
• complex ligament ruptures;
• old fractures.

Surgical intervention allows:

The type of surgery depends on the nature of the damage. The surgeon can:

• fasten the tibiofibular joint if there have been fractures of the medial malleolus and fibula. In this case, a bolt is fixed through the fibula and tibia at an angle from the lateral malleolus. Using a drill, channels are made for inserting devices.
• Perform osteosynthesis of the medial malleolus if supination fractures are diagnosed. In this case, a two-bladed nail is inserted at a right angle to fix the medial malleolus. The lateral one is secured with a pin, and the fragments are secured with screws.
• Perform osteosynthesis of the lateral malleolus for pronation fractures. In such cases, a pin is passed along the axis of the fibula through the lateral malleolus, and the medial one is fixed with a nail.
• Perform osteosynthesis of fragments of the tibia if there are fractures along the posterior part of the lower end. A long screw is used for fastening.

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

Rehabilitation after an ankle fracture

• calcium diet;
• massage;
• physical therapy;
• UV irradiation, warm baths, mud applications, magnetic therapy, electrophoresis with calcium preparations and other physiotherapeutic procedures.

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

note

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

A week after the cast is removed, the patient is sent to therapeutic exercises to develop the joint. The first classes are carried out using a warm bath with sea salt, as it relieves the swelling caused by wearing a cast.

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

Massage helps restore the functioning of nerves and blood vessels. When performing this procedure, the specialist may use pain-relieving gels to eliminate discomfort. Physiotherapeutic procedures speed up the rehabilitation process.

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