Bones of the human ankle

After the operation, the patient receives a special plaster splint that fixes the ankle in an overcorrected position. The specialist sends the patient for a follow-up x-ray to ensure that the bone and joint are in the correct position. To relieve the pain associated with this type of injury, specialists continually administer painkillers. To speed up bone healing, patients are recommended to visit a physical therapy clinic.

Ankle fracture in a child

An ankle fracture is an injury in which the integrity of one or more bones that stabilize the ankle joint is compromised. This pathology requires accurate diagnosis and comprehensive treatment to maximize the recovery of joint function. The experienced children's traumatologists at the SM-Clinic in Moscow examine and X-ray a child with suspected ankle fracture and, if necessary, perform a closed reduction and a plaster cast. If the injury requires surgical treatment, the patient is transferred to a specialized hospital.

The ankle is a fairly complex joint. It is formed by the contact surfaces of the talus and the tibia and is stabilized on the sides by two ankles. These bony outgrowths of the fibula and tibia are located on the sides of the joint. When walking, running, jumping and playing sports, the ankle joint is exposed to daily stress. A common cause of injury is misalignment of the foot and turning the foot in or out.

Classification: Types of ankle fractures in children

Like any other fracture, an ankle injury in a child can be open or closed (with or without skin separation), with or without dislocation, and uncomplicated or complicated by damage to adjacent structures.

The main classification of injuries is based on the location of the injury. The most important classification is the isolated external or internal ankle fracture, the double ankle fracture (both ankles are injured) and the triple ankle fracture. In the latter case, in addition to the ankle fracture, the edge of the shinbone is also affected.

ankle fracture

If the ankle fracture is not displaced, a cast is required. If It is a displaced fracture.He must be immobilized with a metal frame. At the L-Clinic we perform osteosynthesis with spikes through a small incision in the skin without using plates.

Duration of the intervention: 30 minutes to 1 hour.
Length of stay in the clinic: 4-6 hours.
Anesthesia: Intravenously (the operation is painless for the patient while he is asleep).
Rehabilitation: Stepping on the foot without major strain after a month, full recovery after 2 to 5 months.

It can be tempting to mistake a foot or ankle injury for simply a sprain. Fractures and sprains of the foot and ankle have similar signs and symptoms, including:

Types of ankle fractures

An ankle fracture is a complex injury due to the complexity of the ankle joint. The type of injury depends on whether the fracture occurred during pronation (flexion) or supination (plantar flexion) of the foot. A traumatic impact to the pronated foot results in damage to the outside of the ankle and to the supinated foot results in damage to the inside of the ankle.

Ankle fractures are classified according to the type of displacement as follows:

• External rotation - caused by a torsional (spiral) force, damaging the medial malleolus and causing the joint to move outward or backward; this injury often occurs in traffic accidents;
• Abduction eversion – the foot is pronated and twisted outward at the ankle joint; Fibula fracture due to strong lateral abduction;
• Adduction eversion – the foot becomes supinated and rolls inward at the ankle joint, the calcaneus bone is rotated inward; often occurs with inward rotation of the foot;
• Pott fracture – the foot becomes supinated and twists outward at the ankle joint; the back part of the ankle joint is broken laterally.

A fall from a height results in a vertical ankle fracture with forward displacement of the foot. Fractures that involve displacement and damage to the ankle joint are classified as major fractures.

• A closed fracture occurs when the bone does not damage the soft tissue;
• An open fracture occurs when the integrity of the skin is compromised, an open wound exists, and bone tissue leaks. This can lead to the development of inflammation.

Closed (simple) fractures are most commonly diagnosed. A distinction is made between displaced and non-displaced fractures. Displaced fractures result in rotation and deformation of the joint and foot. All types of fractures have common symptoms.

Symptoms of an ankle fracture

The main symptoms of an ankle fracture are as follows

• Severe, stabbing, burning pain in open fractures and dull, aching pain in closed fractures, which increases when attempting to move the foot;
• Rapid onset swelling that gradually increases and is pronounced;
• Marked deformation of the ankle joint;
• Restriction in the range of motion of the joint;
• Inability to bear axial load (inability to stand on the foot with the foot resting on the foot);
• In some cases, hematomas (bleeding) and an increase in local and general body temperature occur.

Types of ankle fractures

Modern medicine classifies ankle fractures as follows:

1. Compound fracture. This injury can result from any mechanical impact on the ankle area.
2. Pronation-abduction fracture. The patient suffers this injury as a result of an unnatural rotation of the foot. This injury can result in ligament rupture and the formation of a subluxation.
3. Rotation fracture. This injury can occur when the foot is forcibly turned outward.
4. Supination-adduction fracture. This injury can be caused by excessive inward rotation of the foot.
5. Isolated flexion or extension fracture. This type of injury can be caused by any mechanical impact on the ankle area, as well as excessive flexion of the foot.

diagnosis

After an injury to the lower limbs, the injured person must be taken to a medical facility where they will receive emergency care. After admission to the hospital, the trauma surgeon will examine the patient, probe the injury site, and arrange for a hardware examination. X-rays are used to confirm the initial diagnosis made by the specialist. Using the image of the damaged ankle joint (in several projections), the doctor can determine the type of fracture, the degree of displacement of bone fragments, etc. If this examination does not give a complete picture of the disease, the patient is referred for a CT scan of the joint or an MRI scan of muscle tissue.

Before being taken to a hospital, the injured person should be given rest, secured with handrails if possible, and taken to the nearest medical facility as quickly as possible.

No fracture, if:

• the leg is supported;
• the legs are the same length
• the axis of the leg is normal and not bent;
• there is no abnormal mobility (ie, no movement of the ankle).

If you find that you have a serious ankle injury and no one is around, try not to move the leg, do not stand on the injured leg, and ice it if possible. Call emergency services.

If you wear jewelry on your ankle or fingers, take it off. Take non-steroidal anti-inflammatory medications from your first aid kit.

diagnosis diagnosis and treatment

An ankle fracture is diagnosed with the help of X-rays, CT or MRI scans. The main treatment option is surgery.

The ankle joint carries the load of the entire body, but is extremely delicate and prone to fractures. In the case of displaced fractures, osteosynthesis (stiffening) of the ankle joint is required. This procedure maximizes recovery and eliminates the risk of limping and persistent leg pain after treatment.

Ankle osteosynthesis can be done open or closed. Open osteosynthesis is a more aggressive procedure and is used in complex cases. Open ankle osteosynthesis involves making an incision around the ankle, with the surgeon performing all procedures manually. During closed osteosynthesis of the ankle joint, special spokes are inserted without making an incision. These spokes, along with the Ilizarov apparatus, return the bone fragments back into place over time, ensuring proper stiffening of the bone.

What to do if you have an ankle fracture?

Try not to put any strain on your leg. Ask a friend or relative to take you to the nearest trauma center or call an ambulance. During transport to the car, an assistant should support you on the side of the injured leg while you move the other leg. While you wait for medical attention, you should cool your injured leg with ice wrapped in a cloth (such as a towel) and keep it elevated.

You can take over-the-counter painkillers to relieve the pain. Ibuprofen or paracetamol are good choices. If there is an open fracture, an ambulance should be called.

Treating a broken ankle with your doctor

Your doctor must provide you with reliable pain relief. This is done through injections of painkillers, less often through a medication drip or inhalation anesthesia.

X-rays of the injured leg are required to confirm the fracture and select appropriate treatment. If the bones in the area of the fracture are displaced, the doctor performs closed repositioning, which means he tries to bring the bone fragments into their correct position by aligning them with each other without operating. You should not feel any pain during the procedure as the doctor will administer general anesthesia. Simple fractures without dislocation do not require repositioning. Repositioning the bone helps control pain and swelling in the ankle and reduces the risk of complications from the fracture.

After the bone has been repositioned, you will be placed in a cast or splint. You will not be allowed to lean on your broken ankle, so you will need crutches to walk. At the trauma center you will be given painkillers and told when and where you can have an examination. The broken ankle is then treated by a trauma surgeon.

Ankle fractures usually heal within six to eight weeks, during which time you will need to wear a cast. After four weeks, you can put some weight on the injured leg or replace the cast with special shoes that can be removed. Until the bone has healed, you should see your doctor regularly for x-rays.

For more severe fractures, surgery is often required to realign the bone. The operation usually requires general anesthesia (where the patient is put to sleep).

The surgeon makes an incision in the skin around the ankle and returns the bones to their normal position. Metal plates, screws, pins, and other tools are used to repair the fracture. The wound is then stitched up. This procedure is called open repositioning with metal (internal fixation of the fracture). Typically, the metal structures are only removed if they are causing problems.

method

The suction massage is used initially after the injury. Its main purpose is to eliminate swelling, prevent congestion and improve lymph flow. The main effect is on the thigh. The lower leg area is only stroked if it is not painful for the patient.

When the period of immobilization in the cast is over, a more in-depth massage treatment is carried out. It mainly consists of spreading and kneading techniques. The upper and lower leg are massaged.

Only 2 weeks after removal of the plaster cast and radiological confirmation of successful callus formation. Stroking and spiral rubbing techniques are used. During the same period, the hip massage is stopped. Instead, a deep massage of the shinbone is performed.

Not only manual but also mechanical massage is used. The main mode of action is vibration.

The role of massage in the patient's recovery process

Massage of the ankle joint after an ankle fracture plays a supportive role in the treatment of the patient. This is evidenced by the obvious fact that without this treatment, the bones will heal successfully, and with the right treatment approach the person will fully recover. At the same time, massage alone, without other treatment options (complete repositioning of the fracture, immobilization or surgery), will not lead to anything good.

But it is not only the result of the treatment that is important, but also the patient's feeling, the functionality of his limb after treatment and the healing rate. It is precisely to influence these indicators that ankle massage is performed after an ankle fracture. Applying the procedure 3 days after permanent immobilization or in the early postoperative period helps to reduce swelling and pain, create good conditions for the formation of bone callus and protect muscle tissue from atrophic changes.

Massage is also performed in the late rehabilitation period. It is carried out after the cast has been removed, some time has passed and the patient has been able to put maximum weight on the limb. Therapeutic exercises are at the forefront of the patient's recovery. This allows the joint to develop and the muscles to strengthen. Massage, on the other hand, helps to increase the effectiveness of exercises by improving microcirculation and preparing the muscles for the upcoming load or, conversely, relaxing them after training.

Diseases that cause swelling

Ankle swelling can be caused by both external and internal factors, the most common of which are:

• Gout is a chronic, progressive disease in which joints become inflamed due to excessive buildup of uric acid salts in soft tissue. In most cases, the disease is accompanied by tissue swelling and acute pain when walking.
• Arthritis is the collective term for a range of joint pathologies (lesions) that are of both inflammatory and immunological origin. As a result of this disease, the cartilage tissue begins to degenerate and ossify (due to the rubbing of the deformed outgrowths against each other), resulting in an edema clinic. It occurs most often in older people.
• Bursitis is an inflammatory disease of the joint capsules in which excessive exudate accumulates in the capsule cavities.
• Psoriatic arthritis is always accompanied by a skin disease called psoriasis. In this case, arthritis of the fingers causes slight swelling of the ankle joint.
• Rheumatoid arthritis is a systemic connective tissue disease caused by an autoimmune reaction. This pathology is dominated by small joints in a type of erosive-destructive polyarthritis.
• Plantar fasciitis is an inflammation of the thick band of connective tissue on the lower leg.
• Soft tissue infections that may be associated with viruses and bacteria (brucellosis, Reiter's syndrome, pseudotuberculosis, tick-borne Lyme disease).
• Peripheral edema due to microcirculation disorders.
• Overweight (fourth degree obesity).
• Disorders of the lymphatic system (elephantiasis).
• Septic arthritis – in case of infection, after traumatic penetration of bacteria into the joint cavity.

Various injuries can also lead to the development of edema in the ankle joint:

Edema of the lower limbs

Swelling of the legs is just a symptom, although it can be a sign of both harmless, temporary disorders in the body (for example, if the person has drunk too much water), but also very dangerous and serious diseases. Yusupov Hospital specialists diagnose leg swelling using modern, innovative equipment and can very quickly determine the cause of its occurrence.

If you have this problem, it is best to first visit the family doctor at the Yusupov Hospital, who will call in other specialists if necessary. Most often, this symptom is accompanied by other symptoms that indicate a dysfunction of an organ. The following additional symptoms may be of concern to the patient:

• It is noticeable that the swelling of the lower extremities decreases during sleep and then increases again in the evening, with additional constipation and shortness of breath. With this symptom, the patient should be referred to the cardiologist of Yusupov Hospital. Swelling in the legs is one of the main symptoms of heart failure as it impairs the heart's pumping function and makes it difficult to pump blood from the lower limbs to the upper body;
• The appearance of signs of varicose veins. Pain occurs, the calf muscles can cramp at night, and the legs tire quickly when walking. In this situation, it is necessary to visit a qualified phlebologist at Yusupov Hospital;
• Leg swelling can also occur with kidney and liver diseases (usually cirrhosis) and with impaired kidney function.

Treatment of chronic diseases is possible with folk remedies, but only after mandatory consultation with a specialist.

The specialist will determine all diagnostic measures on an individual basis. If necessary, the patient can be referred for the following examinations:

1. X-rays;
2. electrocardiogram (ECG);
3. Ultrasound examination (ultrasound);
4. Hemostasiogram (coagulation diagram);
5. Ultrasound duplex vascular examination (USDS).

Ankle fractures: How to recognize them and what to look out for

The term 'ankle' refers to the bony elements that make up the ankle joint. Most of these fractures are diagnosed in winter. During this time, ice forms on the sidewalks and pedestrians fall on them. This leads to serious injuries.

Such an injury causes acute pain in the injured leg, and the ankle swells quickly. The person is unable to walk on the injured leg. Depending on the type of tissue damage, a distinction is made between open and closed fractures. Bone fragments may be displaced from their original position or remain in place. The ligaments of the ankle joint and the joint capsule are often torn in combination with a fracture. A simultaneous fracture of the ankle joint and a dislocation of the ankle joint are considered complicated.

How is the injury diagnosed?

The initial diagnosis is made on the basis of an external examination. The doctor examines the circumstances of the injury and researches the mechanism of the injury. The final diagnosis can only be made by a trauma surgeon who examines x-rays.

• For a fracture without bone displacement, conservative treatment in an outpatient setting is acceptable. The duration of treatment is up to one and a half months. A shoe bandage is applied to immobilize the injured leg.
• A slightly displaced fracture can also be treated using the conservative method described above. The only difference is that surgery (closed repositioning) is performed beforehand to put the bony fragments back in place.
• Complex fractures of the ankle joint, in which there is a significant displacement of bone fragments, tibial plateau and other factors, require surgery. The operation restores the ankle joint's anatomical integrity. Osteosynthesis is carried out, i.e. stiffening of the fractures with screws or orthopedic spokes. Only then can a plaster cast be applied. Treatment takes place in hospital and lasts up to 6-10 weeks.

To achieve complete recovery of the ankle after a fracture, special attention should be paid to the rehabilitation period.

Traumatologist Maxim Banetsky explains more about ankle fractures, flat feet and valgus deformity in the program 'Symptoms' on Doctor TV:

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