How to treat an ankle fracture, how long to walk in a cast? These and other questions about this injury are often asked by patients to the traumatologist. Ankle fractures account for approximately 20% of all lower extremity injuries. There are several types of fractures, so in order to understand what an ankle fracture is, you need to answer several important questions. It is worth understanding what reasons lead to such an injury.
The ankle, or ankle, is the extension of the bone that forms the ankle joint. The most common injury occurs when you fall on your leg or during sports training. In addition, you can break your leg with a strong blow. There are several types of ankle fracture:
The ankle has two main parts, the lateral part is made up of the fibula, and the medial part is made of the tibia.
The easiest fracture is considered to be without displacement. With such an injury, the integrity of the bone is disrupted, but the fragments are not displaced. This injury is considered the least dangerous and has the least complications. Characteristic features are:
However, obvious symptoms of injury without displacement do not always occur; often there is even no pain. Therefore, recognizing this injury is quite difficult. Most often, hematomas are explained by damage to the ligament; in addition, swelling often occurs. Sometimes the injury makes it difficult to see the outline of the bone, most often this happens if the outer malleolus is broken.
However, a telltale sign that a bone is broken is the inability to step on the affected leg. It is worth paying attention if the skin looks stretched and tense. In this case, there is no possibility to bend and straighten the leg; at the slightest movement the person feels acute pain.
As we have already said, a non-displaced fracture is extremely difficult to recognize; if you have such symptoms, you need to contact a traumatologist. The doctor will examine you by palpation and send you for x-rays.
They are treated only with conservative methods. It is very important to ensure immobility of the broken leg; for this, a splint is applied and the bandage is secured with a bandage. The bandage should be applied in such a way that it does not press or tighten the surface of the skin. The bandage is applied from top to bottom. It is very important that it is applied with uniform thickness.
Plaster is necessary because it reliably fixes damaged parts of the leg and ensures rapid healing of the injury. You can walk only after the plaster has hardened. You will have to walk in a cast for about a month and a half. This period is imprecise, since it depends on some factors that affect the speed of healing. An important criterion is the age of the patient: for example, in older people, the leg can take a long time to heal.
After the x-ray shows that the bone has fused, the plaster is removed. It is necessary to undergo a rehabilitation course. Important methods for ankle recovery are massage, performing special exercises, as well as other recommendations of the attending physician. Final recovery occurs after approximately 80 days.
If a displaced fracture is diagnosed, a characteristic symptom is the appearance of sharp pain when trying to stand on the leg. It is worth paying attention: if a hematoma and swelling occurs at the site of the bruise, upon careful examination you can see that the lower leg is in an unnatural position. If you touch the site of the injury, you can feel the movement of fragments in the leg.
There are several possible treatments for this injury. If the doctor chooses plaster casting, then before doing this he carries out manipulations in order to put the bone fragments in place. The bones are fixed using plaster. All manipulations take place under local anesthesia.
Treatment of this injury is complicated by the fact that repeated displacement of bone fragments may occur. In order to monitor the process of fusion of the ankle, the doctor regularly gives orders for x-rays. If plaster does not help, a special device is installed that prevents the bones from moving.
An open fracture is considered the most difficult. In this case, surgery is necessary. During the operation, the doctor restores the correct position of the ankle joint, ligaments, and soft tissues.
This treatment is most effective within a few hours after the injury occurs. Therefore, with such an injury you should go to the traumatology department immediately.
If you wait several hours after a fracture, swelling of the soft tissues will begin to appear. Therefore, doctors will prescribe treatment. It will take several days to eliminate it. It is very important that the leg remains in a stationary position all this time.
After the bones have completely fused, the doctor prescribes a course of rehabilitation procedures. This includes:
How long does it take for an ankle fracture to heal? We have found that there are several types of this injury. Therefore, the healing process will depend on the age of the patient and the degree of injury:
In addition, there are several types of complex fractures that require long-term treatment and rehabilitation. Therefore, the sooner you see a doctor, the faster you will recover.
If the injury is complicated by a broken toe, a posterior plaster splint will be required.
If a non-displaced ankle fracture occurs, when can you step on your foot, every patient wants to know. After all, few people want to lie in bed for a long time or jump on one leg, leaning on crutches. But in order for the limb to heal faster, it is very important to try not to load it ahead of time.
The bones of the lower leg and ankle bear a huge load when a person walks or even just stands. After all, such thin bones (compared to the thigh bone) must support the weight of the entire body. Naturally, you should not stand on your leg for the first time after a fracture, as this can lead to displacement of bone fragments and cause a lot of pain. The bone that is healing is very sensitive to any load and therefore the injured limb must be left at rest for some time.
The ankle is part of the ankle joint; there are two of them in each leg - on the inside of the limb and on the outside (lateral and medial ankles). You can break one of them or even both at the same time by getting into a car accident, falling badly, hitting yourself hard, or twisting your leg. Injury can occur during sports, at home, at work, and in other situations.
Based on the presence of skin injuries, a fracture can be open or closed; injuries without displacement of bone fragments are usually closed. If bones are displaced from their places during injury, sharp fragments tear tissue and skin. After an ankle fracture without displacement of the fragments, the clinical picture may not be clearly expressed; sometimes a person may even get up and move around a little, attributing the symptoms to an ordinary bruise. Such actions lead to complications in the form of secondary displacement.
An internal ankle fracture is less common than an external ankle injury. Both types of damage can occur due to injury or due to age-related changes in the body. Traumatic factors include twisting the foot in any direction or sharply turning the foot. Degenerative factors are changes that occur due to calcium deficiency in older people, cancer, bone tuberculosis, rheumatism, osteomyelitis and other diseases that negatively affect bone strength.
Most often, an ankle fracture can be found in patients who are overweight, have bad habits, or are undernourished. Breastfeeding women are susceptible to injury because they have little calcium in their bodies. Women during pregnancy, although they suffer from brittle bones, when carrying a child, try to walk very carefully, so they do not often encounter fractures.
An undisplaced ankle fracture is a milder type of injury than an injury aggravated by displacement of bone fragments. Its symptoms are as follows:
When the medial ankle is fractured, the leg turns inward. This type of injury is more common than turning the foot outward. Sometimes the ankle breaks on both sides, in which case an unstable fracture occurs, which often involves displacement of the bones and rupture of the skin. In some cases, no symptoms other than bruising and minor pain are observed. And given that when an ankle is broken, blood from damaged vessels flows into the heel area, the victim may not notice this sign of injury.
When an ankle fracture occurs, every victim wants to know how long to walk in a cast. This depends not only on the type of injury and treatment, but also on how timely the person received first aid. If there is at least one sign indicating that the ankle is broken, it is necessary to call an ambulance, which will take the victim to a medical facility. While waiting for doctors, people providing first aid perform the following actions:
If the fracture is open, which is very rare in non-displaced fractures, then first of all the bleeding is stopped by applying a tourniquet to the area above the injury. After the bleeding has stopped, the wound is treated with antiseptic chlorhexidine or hydrogen peroxide and a sterile dry bandage is applied to the wound.
When providing first aid, you should not try to independently set a protruding bone into the wound or compare fragments.
Such actions, performed by non-professionals, lead to displacement, rupture of tissue, damage to blood vessels and nerve processes. Any manipulation of a broken bone must be performed by a doctor using painkillers and, sometimes, surgery.
After the victim is taken to the emergency room or hospital, the doctor will conduct a full examination. Making the correct diagnosis plays a big role in the patient's recovery.
First, the doctor is interested in the details of the injury and records them in the victim’s medical history. Next comes an external examination of the injury site and palpation. The doctor assesses the degree of development of swelling and examines the hematoma. With the help of palpation, the doctor can find out whether there is displacement of the fragments. After the examination, the patient is sent for a more detailed examination using x-rays, which will show the type of fracture and its location.
If it is necessary to examine the vessels, nerve processes, joint capsule and ligaments, the patient undergoes computed tomography or magnetic resonance imaging, as well as ultrasound. After diagnosis, the patient is sent to an inpatient orthopedic or surgical department, where he completes the examination by passing a general blood and urine test. After which the prescribed treatment is completed.
For an ankle fracture, conservative or surgical treatment may be prescribed. With conservative treatment, the doctor performs manual reposition of the fragments and applies a plaster cast. This is followed by taking medications to reduce pain, to prevent the formation of edema, and to resolve the hematoma. If the fracture is aggravated by displacement or when there is a risk that the bones will move out of their places, osteosynthesis surgery is performed. Bone fragments are compared and fastened using special metal structures.
For an ankle fracture, plaster must be applied starting from the popliteal region and in an even layer. After the plaster cast has hardened, the patient is allowed to move carefully on crutches. While wearing the cast, the patient undergoes an X-ray examination several times, during which the attending doctor observes the formation of callus and the fusion of fragments. The patient is also prescribed vitamin complexes and dietary supplements that promote rapid bone healing.
Any patient wants to know whether it is possible to step on the injured limb after surgery has been performed or a cast has been applied. After surgical intervention to reposition bone fragments and the osteosynthesis procedure, the patient is prohibited from standing on the injured limb for a month. However, you can get up and walk with the help of crutches, relying only on your healthy leg, within a day after the operation was performed.
If conservative treatment is carried out without surgery, the patient is given a plaster cast from the heel to the knee. The cast for an ankle fracture is worn for about two to three months and is removed when the bones are completely fused. After the treatment is completed and the plaster cast is removed, the rehabilitation period begins, during which the person will gradually increase the load on the limb. You can fully rely on your leg only four to five months after the injury was sustained.
In order to quickly restore motor activity, it is recommended to begin rehabilitation before the doctor removes the plaster. For this, the patient is prescribed massage, therapeutic exercises with a gradual increase in loads, physiotherapeutic procedures and a special diet rich in calcium and vitamin D. For severe fractures, bed rest may be necessary until the patient recovers completely.
Injuries of the lower extremities in the ankle area account for up to a quarter of cases of the total number of observed injuries to the musculoskeletal system. The increased frequency of violations of the integrity of the ankle is caused by the anatomical features of the joint and the increased load on the area in question. The pathological condition requires urgent treatment at the clinic; refusal of treatment leads to complications, lameness, and - in complex cases, which include a trimalleolar fracture - to disability.
The ankle is a bone formation located in the distal (lower) part of the lower leg. The Latin name of the area is malleolus; synonym: ankle.
The design consists of connections between the heads of tubular elements and the talus. The tendons and muscles attached to them help maintain balance, distribute the load, and ensure the functioning of the joint. The special structure of the ankle allows movement in three planes.
There are 2 types of joints:
The combination of structures forms the “fork” of the joint.
Visually, the ankles look like bone growths of different sizes inside and outside the feet.
Indirect and direct injuries lead to disruption of the integrity of the ankle bones. The first of these types of impacts is more common and is caused by twisting a leg when slipping on an ice-covered (wet) surface, roller skating, walking over rough terrain, or playing sports. The latter is a consequence of road accidents, beatings, and heavy objects falling on the lower limbs.
Additional reasons contributing to the occurrence of fractures of the external and internal ankles are the presence of calcium deficiency and concomitant diseases. So, pathological injuries lead to:
Insufficient intake of chemical elements into the body, which adversely affects the condition of the skeleton, is caused by pregnancy, lactation, women taking oral contraceptives, as well as errors in nutrition, diseases of the gastrointestinal tract, kidneys, and thyroid gland.
In addition to these categories of patients, overweight people, adolescents, and women over 55 years of age are at risk.
Elderly patients are especially susceptible to injury. Fractures of varying severity of the medial and lateral malleolus are a consequence of increased bone fragility; changes in TDA are associated with impaired calcium absorption.
Damage to the ankles of the fair sex occurs due to the onset of menopause. A decrease in the level of female hormones causes disruptions in the process of regulating the exchange of chemical elements.
Young patients are at risk due to intensive skeletal growth and a physiological lack of building material for bones. An important factor is the increased activity of the child.
Teenagers and young people get fractures of the outer and inner ankles due to excessive sports, performing complex exercises, or failure to warm up beforehand.
Violations of the integrity of malleolus are systematized according to several characteristics. The classifications are based on the type of injury, location, presence (absence) of displacement and a number of other factors, which can be learned from the material below.
There are 2 types of pathological conditions: closed (not accompanied by destruction of soft tissues, characterized by the presence of large edema) and open. The latter is accompanied by bleeding, and fragments of joints are visually observed at the site of the rupture.
Taking into account the symptom under consideration, damage is differentiated into two groups:
pain that can be tolerated is not a sign of absence of damage. Self-treatment of injuries affects general well-being, leads to complications, and increases the rehabilitation period.
A fracture of the lateral (medial) ankle without displacement is determined quite simply: when palpating the center of the ankle, unpleasant sensations are localized in the affected area.
Systematization divides the pathologies under consideration into 3 types. The first group includes damage to the external joints, the second - internal ones.
An order of magnitude less common are marginal types of injuries that occur as a result of excessive abduction of the feet. Bimalleolar forms of fractures are differentiated into pronation-abduction and supination-adduction; are among the most dangerous. The double type of changes causes various complications, requires long-term therapy, and increases recovery time.
Damage to the lateral ankle is accompanied by swelling. Most patients report that the injured area does not hurt too much.
A fracture of the medial malleolus can be closed or open.
In accordance with this symptom, traumatologists distinguish 3 forms of pathologies:
There are also isolated injuries to the anterior (rarely - posterior) edge of the tibial tubular element. Damage occurs as a result of forced dorsiflexion (plantar flexion of the feet); characterized by the formation of triangular fragments.
Only a doctor can determine the type of disorder. The final diagnosis is established after the patient undergoes special studies.
Severe pathological conditions include tri-malleolar types of injuries. With such injuries, the fibula, tibia, and talus bones are simultaneously broken. The fork of the joint diverges. Triple changes lead to significant pain and complete loss of motor functions.
The list of complex injuries also includes fractures and dislocations.
The main signs of a fracture of the right (left) ankle are crepitus, swelling, pain, and hematomas.
The crunch appears both as a result of a violation of the bone structure and as a result of damage to ligaments, muscles, and tendons. Pathologies minimize the ability to move the foot.
Discomfort in the ankle area, radiating to the fibular tubular element, can either appear immediately or be delayed. Extensive injuries are accompanied by the development of painful shock. The described symptom may occur with a displaced fracture of the lateral or medial ankle. The dangerous condition is treated with the administration of potent analgesics.
Edema, determined visually, is formed as a result of rupture of the capillaries providing the inflow and outflow of liquid media. Damage to large vessels leads to changes in the size of the entire damaged limb.
Hematomas occur mainly with a displaced fracture of the left or right ankle. Hemorrhages and bruises appear in the heel area and can be the only sign of injury in the absence of divergence of the articulation elements. With fracture-dislocations, an abnormal position of the foot is noted.
Symptoms of an ankle fracture detected in the victim require immediate calling an ambulance. Before the arrival of medical workers, a number of procedures should be carried out, the correct implementation of which will determine the outcome of further therapy.
In the list of actions:
changing the natural position of the bones requires maximum care during first aid.
It is forbidden to touch the modified elements of the articular joint, set damaged joints, or remove bone fragments.
If medical assistance is not available, the victim must be taken to the nearest clinic. Before transportation, it is important to properly immobilize the joint by using available means (boards, skis, branches without cracks, knots). The splint is applied to a limb covered with a cloth, slightly bent at the knee (the foot should be at an angle of 90° in relation to the fibula and tibia). The structure, located on the lateral and opposite surfaces of the leg, is fixed with belts and a bandage.
If you receive an injury and suspect a fracture of the internal or lateral malleolus, either without displacement or with divergence of the components, you must contact a traumatologist or orthopedist. The earlier treatment is carried out, the lower the risk of possible complications.
The attending physician will interview, examine the patient, and prescribe a number of additional instrumental studies. Among them:
It should be remembered that when fusion of elements occurs, a number of studies can be carried out repeatedly to assess the ongoing recovery processes and the consequences of injuries.
Upon completion of the diagnosis, the doctor will issue a sick leave certificate for the patient.
Various techniques are used to treat divergent and nondisplaced ankle fractures. Among them are conservative therapy and surgical intervention. To improve performance, traditional medicine recipes and physiotherapy are used. Keeping the patient at home requires compliance with all medical recommendations.
Indications for prescribing this type of treatment are:
Conservative therapy is used in the presence of chronic illnesses (heart disease, central nervous system, diabetes). The technique is also used in case of a medical ban on the administration of general anesthesia. In a special group are elderly patients: they are indicated for surgical intervention only in severe pathological conditions.
If the bone fragments are adequately repositioned by a traumatologist, treatment of an ankle fracture also does not require surgery.
Taking medications is necessary to prevent the occurrence of infectious diseases, relieve inflammation, and suppress pain. The list of medications used includes antibiotics and analgesics.
Vitamin-mineral complexes and preparations containing collagen and calcium accelerate the healing of injured elements. The listed funds refer to low-cost goods.
The immobilizing limb is made of polymer and a plaster cast (splint) is applied to the foot and back of the leg. Bandaging of the last of these areas is carried out from the bottom up, the first - vice versa. The materials used should not compress the tissue or rub the skin. Quality control of the performed manipulations is carried out using x-rays.
The splint is used for various types of injuries.
After applying the structure, stepping on the injured limb or making sudden movements is prohibited; crutches should be used when moving.
In modern clinics, wearing plaster is replaced by the use of metal and plastic bandages. The devices are removable (fixed with Velcro).
Only a doctor can answer the question of how long you should walk with a bandage. The period of use of the structures depends on the severity of the lesion and the age of the patient. In a child, injury healing occurs within 4 weeks; in an adult, tissue regeneration will take from 1.5 to 2 months or more.
To determine the time of plaster removal, an additional x-ray examination is performed.
When it is permissible to step on a limb when completing treatment after a fracture of the right (left) ankle is given only by experts. It is prohibited to independently calculate the period required for the restoration of a fused bone.
Closed reduction of joint fragments is carried out as follows:
Manual reduction is completed after the clinic staff applies a plaster cast to the victim.
Surgical intervention is used for severe forms of damage and advanced types of changes. Indications for operations are fractures of both (medial, lateral) ankles with displacement, chipping of parts of the bone, extensive injuries, ruptures of large vessels, ligaments, tibiofibular joints.
The main task of manipulation is to restore the integrity of joints and muscles.
The procedure for combining fragments takes a fairly long period of time: the injuries in question, which belong to the group of intra-articular ones, with inadequate therapy can lead to serious complications, including traumatic deforming osteoarthritis.
Types of treatment vary. The most common ones include fastening joints using special bolts and fixing fragments with screws. Osteosynthesis of the internal, lateral ankles is carried out for pronation and supination fractures.
Special plates are widely used in the treatment of isolated injuries. They are installed along the back, outer surface of the bones. The first of the described types of structure location is preferable, but it can lead to increased pain.
Discomfort appears after surgery for displaced ankle fractures. When answering the question of why the syndrome occurs, surgeons point to possible irritation by tendon plates.
Consolidation of the achieved results after removal of the cast is carried out by using alternative medicine recipes. The victim can make infusions and liniments independently.
Decoctions (from pomegranate bark, heather, rose hips) accelerate the regeneration of healing tissues. Ointments, compresses made from fir oil, fresh potatoes, comfrey and black root raw materials are applied to painful areas to relieve discomfort and relieve swelling.
For complicated fractures, injuries to two ankles with displacement, mumiyo and eggshells are used. The listed means are considered the best in the list of used ones; they allow the damage to heal faster. Experts advise a patient who has broken their ankle to start using them before the cast is removed.
Mountain oil is mixed with honey in a small amount, consumed twice a day, 1 tbsp. l. on an empty stomach.
The ground shells of 3 boiled eggs are combined with juice? lemon After infusion for 24 hours, the resulting solution is taken three times a day, 1 tbsp. l.
While undergoing outpatient treatment, the patient must strictly follow the doctor’s recommendations, including:
To speed up recovery during the rehabilitation period, after removing the cast for various types of ankle fractures, you should eat right, wear orthopedic shoes, and do therapeutic exercises developed by experts.
Injuries without displacement heal up to 2.5 months; recovery from bone divergence will have to wait about six months. You should start giving up crutches after 90 days.
A complete resumption of an active lifestyle is a distant prospect. The doctor may allow you to play sports only 2 years after completion of therapy.
Advanced types of ankle fractures and improper fusion of bone tissue will lead to complications, including:
If the operation is performed poorly, the patient's condition can seriously deteriorate as a result of the development of sepsis, thrombophlebitis, and abscesses.
To avoid injury, it is recommended to follow a number of simple rules - do gymnastics daily, lead a moderately active lifestyle, undergo timely medical examination, adhere to a balanced diet, and walk in the fresh air.
It is better for beginner athletes not to perform complex exercises in the absence of a coach; professionals should pay increased attention to warming up and stretching.
An ankle fracture is a dangerous injury that requires medical attention. A favorable prognosis is possible only if you refuse self-medication and contact qualified specialists.
This is the most common type of fracture in the ankle joint. There are two types of fractures of the lateral malleolus: transverse and oblique.
Fractures of the lateral malleolus without displacement of fragments
This is the most common type of fracture in the ankle joint.
There are two types of fractures of the lateral malleolus: transverse and oblique.
Mechanism. A transverse fracture of the lateral malleolus is a pronation fracture. The starting point of its origin is the turning of the foot outward. In this mechanism of injury, the lateral outer surface of the talus presses against the apex of the lateral malleolus and breaks it off. The fracture line in this case runs horizontally (Fig. 15).
In cases where a purely pronation mechanism (turning the foot outward) is combined with abduction (abduction) or external rotation of the foot, an oblique fracture of the lateral malleolus occurs. The fracture line in this case runs in an oblique direction, from the front to the bottom, back and up (Fig. 16).
Rice. 15. Transverse fracture of the lateral malleolus and the mechanism of its occurrence (diagram).
Rice. 16. Oblique fracture of the lateral malleolus and the mechanism of its occurrence (diagram).
Clinic and symptomatology. Immediately after the injury, acute pain occurs at the fracture site, due to which patients cannot stand on their leg. However, there are often cases when patients move independently, relying on the heel of the foot of the injured limb.
Upon examination, moderate swelling is detected in the ankle joint compared to the healthy leg. It is especially clearly visible from the outside, as a result of which the lateral malleolus is not contoured. Flexion and extension at the ankle joint are possible, but limited. The lateral movements of the foot (abduction and adduction) are especially limited, causing severe pain. Palpation reveals pain 3-4 cm above the apex of the outer malleolus (Fig. 17). The symptom of irradiation is clearly expressed, which consists in the fact that when both bones of the leg are compressed in the frontal plane at the level of the middle third of the leg, the patient experiences pain at the fracture site (Fig. 18).
X-ray diagnostics. An anteroposterior radiograph reveals a transverse fracture of the lateral malleolus at the level of the ankle joint or slightly distal to it. The interfibular and articular spaces are preserved.
On a lateral radiograph, the fracture line of the lateral malleolus, passing distal to the joint space, is projected on the trochlea of the talus and is therefore sometimes poorly identified (Fig. 19).
With an oblique fracture of the lateral malleolus, the fracture line is not always determined on an anteroposterior radiograph. On a lateral radiograph, the oblique line of the lateral malleolus fracture is usually clearly visible. It most often has a direction from bottom to top and from front to back (Fig. 20).
Treatment. Treatment begins with anesthesia of the fracture site. The needle is inserted into the fracture site of the lateral malleolus, guided by the radiograph (Fig. 21). 10 - 15 ml of a 2% novocaine solution are injected, after which they begin to apply a plaster cast. The patient sits on the table, the injured limb is bent at a right angle at the knee joint, hanging freely. The foot is placed at a right angle to the shin. A plaster splint is prepared from 8-10 layers of plaster bandage 15 cm wide and 90-120 cm long. The plaster splint can be of two types.
U-shaped splint. A U-shaped splint is applied to the outer surface of the lower leg from the lower border of the knee joint. It covers the anterior-outer and posterior-outer surfaces of the lower leg, then passes to the lateral surface of the ankle joint, covers the rear and middle sections of the foot from its plantar surface and passes to the inner surface of the ankle joint and lower leg (Fig. 22).
Rice. 17. Place of maximum pain in a fracture of the lateral malleolus.
Rice. 18. Position of the hands when examining the symptom of irradiation of pain in a fracture of the lateral malleolus.
Rice. 19. Transverse fracture of the lateral malleolus. X-ray.
Rice. 20. Oblique fracture of the lateral malleolus. X-ray.
Rice. 21. Anesthesia for a fracture of the lateral malleolus.
Rice. 22. Left. The moment of applying a U-shaped plaster splint.
Rice. 23. Right. The U-shaped splint is fixed with plaster rings.
The bandage is modeled according to the shape of the limb and fixed with a soft bandage or plaster rings (Fig. 23). To give a more stable position to the foot when supporting the limb, immediately after applying the plaster, the patient is recommended to step lightly on the heel so that a supporting platform is formed on the bandage. Stepping on the foot is allowed after the plaster has hardened.
Unlined circular splint plaster cast. First, a splint is applied along the back surface of the leg and foot from the popliteal fossa to the tips of the fingers. In the heel area, the lateral edges of the splint are cut with scissors on both sides and the corners of the cut are laid on top of each other. After this, the splint is fixed with circular rounds of plaster bandage. When applying circular tours, it is necessary to ensure that there are no folds, constrictions or pressure on the skin. They start bandaging from top to bottom. The bandage should lie flat, without tension. Each subsequent move of the bandage should cover 2/3 of the previous one. Having reached the fingers, the plaster bandage is wound back in an upward direction. In this case, it is necessary to ensure that the plaster cast at all levels has the same thickness. To avoid constrictions in the area of the anterior surface of the ankle joint, the lower edge of each round of the plaster bandage is cut. The bandage is carefully modeled in the area of the ankles, heel, Achilles tendon and arch of the foot (Fig. 24). After 1-2 days, a metal stirrup is plastered to the bandage (Fig. 25). Support on the leg is allowed after the plaster has hardened.
If there is no stirrup, you can plaster a wooden or plaster heel to the bandage (Fig. 26). The center of the heel should correspond to the vertical projection lowered from the top of the inner ankle (Fig. 27).
Patients with such fractures can usually be treated on an outpatient basis. The plaster cast is removed after 4-5 weeks, depending on the age of the patient. After removing the plaster cast, a control x-ray is taken to assess the degree of consolidation of the fracture.
Rice. 24. Plaster cast “boot”.
Rice. 25. Attaching the stirrup to the plaster cast.
Rice. 26. Plaster cast with heel.
Rice. 27. Place of attachment of the heel to the plaster cast. After removing the plaster cast, the patient is prescribed physical therapy, massage, and baths.
The duration of disability for non-manual workers is 6-7 weeks, for manual workers - 7-8 weeks.
Fractures of the lateral ankle with displacement of fragments
The mechanism of fracture of the lateral malleolus, as in a fracture without displacement, is pronation.
There are two types of fractures - transverse and oblique. Displacement of a broken ankle occurs when a significant force is applied at the time of injury to the pronated or abducted foot. Most often, ankle displacement occurs outward and posteriorly.
Clinical signs and symptomatology of a fracture of the lateral malleolus with displaced fragments are not much different from similar fractures without displacement. However, pain and swelling in the area of the outer ankle are more pronounced.
X-ray diagnostics. An anteroposterior radiograph shows a transverse fracture line of the lateral malleolus at the level of the joint gap or slightly above it. The fragments form an angle, open outward. On a lateral radiograph, the fracture line is superimposed on the contour of the epiphysis of the tibia and is not always clearly visible (Fig. 28).
With an oblique fracture, on an anteroposterior radiograph, the fracture line may be visible as a compacted strip due to the imposition of a shadow. The lateral radiograph shows an oblique fracture line running from front to back and from bottom to top. The distal fragment is displaced posteriorly.
Treatment. The displaced ankle is repositioned under local anesthesia. Using your thumb, press the displaced ankle against the talus. In this position, a longitudinal circular plaster cast is applied from the fingers to the knee joint. After the plaster cast has dried, the stirrup or heel is plastered. Support on the injured limb is allowed from the 2nd day after reposition. The period of plaster immobilization is 5 - 6 weeks.
After removing the bandage, a control x-ray is taken. If consolidation is present, the patient is prescribed warm baths, physical therapy, and massage; he must walk with a cane.
It is recommended to wear the arch support for a year.
Fractures of the inner ankle without displacement of fragments
There are two types of fractures of the medial malleolus: transverse and oblique.
Mechanism. A transverse fracture of the medial malleolus is a pronation fracture.
When the foot rotates excessively outward (pronation), significant tension occurs in the deltoid ligament. The latter in most cases does not tear, but tears off the inner ankle at its base at the level of the joint space or only the top of the ankle (Fig. 29).
According to the mechanism of occurrence, an oblique fracture of the medial malleolus is related to supination fractures. When the foot is excessively turned inwards, the supracalcaneal bone, with its inner lateral surface, rests against the inner ankle and breaks it off. In this case, the fracture line runs vertically or obliquely (Fig. 30).
Clinic and symptomatology. In the area of the inner surface of the ankle joint, acute pain and swelling occur, as a result of which the contours of the ankle are smoothed. In some cases, the patient can move independently, relying on the heel or outer part of the foot.
Movement in the ankle joint is somewhat limited due to pain. On palpation, pain is detected in the area of the inner ankle at the level of its base, which corresponds to 1-1.5 cm proximal to the apex of the ankle.
Rice. 29. Transverse fracture of the inner ankle without displacement and the mechanism of its occurrence (diagram).
Rice. 30. Oblique fracture of the inner ankle without displacement and the mechanism of its occurrence (diagram).
X-ray diagnostics. A direct radiograph (with a non-displaced fracture) shows a transverse fracture line passing through the base of the ankle at the level of the joint space or slightly distal to it.
On a lateral radiograph, the fracture line may not be contoured or may be barely noticeable (Fig. 31).
With an oblique fracture of the inner malleolus, a direct radiograph clearly shows the fracture line running from the articular edge of the base of the inner malleolus, heading upward in an oblique or vertical direction. In this case, the fracture line passes through the metaphysis of the tibia. On the lateral radiograph, the shadow of the avulsed ankle is superimposed on the metaphysis of the tibia (Fig. 32).
Treatment of a non-displaced fracture of the medial malleolus comes down to applying a U-shaped plaster cast or “boot” to the lower leg and foot, to which a stirrup or heel is plastered after 1-2 days. Weight-bearing on the injured leg is allowed after two days. The patient is recommended to walk with the help of crutches. After 2-3 weeks, crutches can be replaced with a cane. The period of plaster immobilization is 6 weeks.
Fractures of the inner ankle without displacement of fragments
The mechanism of these fractures is the same as non-displaced fractures: with a transverse fracture - pronation of the foot, with an oblique fracture - supination of the foot.
Clinic and symptomatology. If there is a displacement of the inner ankle at the level of the transverse fracture, the sharp edge of the tibia at the base of the ankle and the distally displaced ankle are determined by palpation.
With an oblique fracture of the internal malleolus with displacement, it is sometimes possible to determine by palpation a displaced fragment of the tibia.
X-ray diagnosis: with a displaced ankle fracture, a direct radiograph shows a transverse gap between the base of the inner malleolus and the tibia. The lateral radiograph clearly shows the torn medial malleolus, displaced downward and somewhat posteriorly; between the fragments a wedge-shaped gap is identified, often reaching a width of 7-8 mm (Fig. 33).
Treatment of fractures of the medial malleolus with displaced fragments is reduced to reduction and immobilization. For closed reduction, local anesthesia is used. A needle is inserted into the gap between the fragments and 20 ml of a 2% novocaine solution is injected into the hematoma.
Rice. 31. Transverse fracture of the inner malleolus without displacement. X-ray.
Rice. 32. Oblique fracture of the inner malleolus without displacement. X-ray.
With the thumb of one hand, the surgeon presses on the apex of the inner malleolus and moves it proximally. When the ankle is angularly displaced, simultaneously with pressure from the other hand, it produces supination of the foot (Fig. 34).
When performing open reposition of fragments, local infiltration anesthesia with a 0.5% novocaine solution is used. An arcuate skin incision is made, with the convexity facing posteriorly, starting 1-2 cm above the base of the ankle, 6 cm long (Fig. 35). The fracture site is exposed (Fig. 36). Remove the hematoma from the fracture area and from the adjacent ankle joint using gauze pads or a small Volkmann spoon, being careful not to damage the articular cartilage.
Using thin levators, the inner malleolus is placed in place (Fig. 37) and fixed to the tibia with a screw or a thin two-blade nail. The wound is sutured in layers. A control x-ray is taken (Fig. 38). A blind plaster cast is applied to the knee joint. After 2-3 days, a metal stirrup or heel is attached to the plaster cast.
Rice. 33. Displaced transverse fracture of the inner malleolus. X-ray.
Rice. 34. Manual direction of fragments in a transverse fracture of the internal malleolus with displacement (diagram).
Rice. 35. Skin incision during surgery for fixation of the inner ankle.
Rice. 36. Exposure of the fracture site of the inner malleolus.
Rice. 37. Reposition of the inner malleolus using a levator and a single-prong hook.
For non-displaced fractures, the plaster cast is removed after 6 weeks, followed by X-ray monitoring.
For displaced fractures after manual or surgical reduction, the plaster cast is removed after 6-7 weeks. A control x-ray is taken.
If consolidation is present, patients are prescribed physical therapy, massage, and baths. The duration of disability for non-manual workers is 2 weeks, for manual workers - 9-11 weeks.
Rice. 38. The inner ankle is fixed with a screw. X-ray.
Rice. 39. Fracture of both ankles and the mechanism of its occurrence (diagram).
a - pronation-abduction; b - supination-adduction.
Fractures of both ankles without displacement of fragments
Fractures of both ankles without displacement of the fragments are relatively rare. This is especially true for supination-adduction fractures.
Mechanism. The starting point for the occurrence of a pronation-abduction fracture is the abduction of the foot. In this case, a rupture of the deltoid ligament occurs, and more often a fracture of the inner malleolus, usually at the level of the joint space. With continued violence, the outer surface of the supracalcaneal bone, due to its rotation, presses on the inner surface of the outer ankle and breaks it off (Fig. 39, a).
The occurrence of a supination-adduction fracture is characterized by medial rotation of the foot. This mechanism of injury most often occurs when falling from a height onto a supinated foot. Due to extreme stress, the calcaneofibular ligament can rupture. More often, an avulsion fracture of the lateral malleolus occurs at the level of the joint space. With continued violence, the talus rests on the outer surface of the inner malleolus and breaks it off with a small portion of the metaepiphysis of the tibia (Fig. 39, b).
Clinic and symptomatology. Patients complain of pain in the ankle joint and the inability to step on their feet. Active movements in the ankle joint are almost impossible, and passive movements are severely limited and painful.
Upon examination, a moderate (and in case of severe damage to the ligamentous apparatus - significant) swelling in the ankle joint compared to the healthy leg is determined. The ankles are not contoured. The foot is in a position of moderate plantar flexion. When pressing with a finger, the pain is localized 3-4 cm above the apex of the outer ankle or in the area of the apex (when it is torn off) and 1-1.5 cm proximal to the apex of the inner ankle. A positive symptom of “irradiation” is determined.
X-ray diagnostics. With a pronation-abduction fracture of the ankles, a direct radiograph shows a fracture line of the inner malleolus, starting from the edge of the joint space, running transversely or from bottom to top. A fracture is visible in the area of the outer malleolus, and its line runs 1 cm above the joint space (Fig. 40). With a supination-adduction fracture, a direct radiograph reveals a transverse fracture of the lateral malleolus, with the fracture line passing below or at the level of the joint space. The fracture line of the inner malleolus runs in an oblique direction from its base upward and inward, involving the area of the metaepiphysis of the tibia. On a lateral radiograph, upon careful examination, you can see a barely noticeable shadow of the fracture line of the lateral malleolus, which is located slightly below the joint space. The fracture line of the inner ankle is determined against the background of the shadows of the tibia (Fig. 41).
Rice. 40. Pronation-abduction fracture of both ankles without displacement of fragments. X-ray.
Rice. 41. Supination-adduction fracture of both ankles without displacement of fragments. X-ray.
Rice. 42. Cutting a plaster cast with plaster scissors.
Rice. 43. Cutting a plaster cast with a knife using a cord.
Rice. 44. Supination fracture of the ankles with displacement of the inner malleolus.
Rice. 45. The inner ankle is fixed with a screw. X-ray.
Treatment. First, the fracture sites are anesthetized with a 1-2% solution of novocaine in an amount of 20-25 ml. The limb is fixed with a circular plaster cast from the fingertips to the knee joint. If the swelling is slight and there is no tendency to increase, the patient can be treated on an outpatient basis. In this case, it is necessary to recommend to the patient an elevated position of the injured limb and bed rest for 5-6 days. In the first few days, the patient should be under the supervision of a doctor.
If there is significant swelling of the ankle joint area, its increase and the danger of circulatory impairment to the limb, the plaster cast is cut lengthwise along its entire length along its anterior-outer surface, after which it is strengthened with a soft bandage. The frozen plaster cast is cut with special scissors (Fig. 42). You can use another technique. Before applying the plaster, a thin rope cord or a bandage twisted into a tourniquet is placed on the skin of the anterior outer surface of the leg and foot. After applying the bandage, pulling the end of the cord or twisted bandage, cut the plaster cast with a sharp knife (Fig. 43). After the swelling subsides, the plaster cast is changed. The stirrup for walking is plastered. Walking with crutches can be allowed for 1-3 days, and putting weight on the injured limb after 5-6 days. Plaster immobilization lasts at least 6 weeks.
After removing the plaster, an x-ray is taken and baths, massage and therapeutic exercises are prescribed.
The period of incapacity for work for persons engaged in non-manual labor is on average 8-9 weeks, for persons engaged in heavy physical labor - 10-12 weeks.
Fractures of both ankles with displacement of fragments
The mechanism of these fractures is similar to the mechanism of ankle fractures without displacement of the fragments.
Clinic and symptomatology. The clinical picture of such fractures is very similar to that described for fractures without displacement of fragments.
It must be emphasized that depending on the predominance of one or another mechanism (pronation or supination), there may be a displacement of one inner or one outer ankle.
X-ray diagnostics. In case of fractures of both ankles with displacement of one outer ankle, the line of the fracture of the inner ankle and the correct position of the latter are determined on a direct radiograph. The outer ankle is displaced at an angle outward.
On a lateral radiograph, the fracture line of the medial malleolus projecting onto the trochlea of the talus is usually poorly visible.
The fracture line of the lateral malleolus partially overlaps the shadow of the tibia, but is most often quite clearly visible.
When both ankles are fractured with a displacement of the inner malleolus, an anteroposterior radiograph reveals a gap between the fragments of the tibia at the base of the inner malleolus, which is displaced downward and rotated outward.
In the area of the outer ankle there is a barely noticeable gap of its oblique fracture.
The lateral radiograph clearly shows the gap between the base of the ankle and the tibia; The oblique line of the fracture of the lateral malleolus is usually clearly visible in its upper part.
With supination fractures of the ankles, the displacement of the inner malleolus is well determined on the anteroposterior radiograph (Fig. 44). On a lateral radiograph, the fracture line is superimposed on the shadow of the tibia.
Treatment of these fractures is carried out conservatively using the same technique as displaced fractures of one ankle.
In case of a fracture of the inner ankle together with the metaepiphysis of the tibia with displacement of the fragments, the fragments are fixed with a screw, and the latter is inserted not through the top of the ankle, but from the side (Fig. 45).
The period of immobilization for fractures of both ankles with displacement of fragments is 8 weeks.
The ability to work in non-manual workers is restored after 12 weeks, and in manual workers - after 14-15 weeks.