How to distinguish a fracture from an ankle sprain

A break, a bruise, a sprain or even a torn ligament has many differences. In general, however, any injury is uncomfortable and can produce similar painful sensations. That is why it is important to consult a specialist to clarify the diagnosis - he will determine exactly what the patient has suffered.

Achilles tendon injury symptoms

An Achilles tendon injury is a relatively common sports injury. It is important to know the symptoms of this injury in order to be able to treat the situation quickly and correctly. Achilles tendon tendinopathy causes pain when the calf muscles are overworked, when the ankle is subjected to prolonged force, or when the foot is subjected to a single but excessive load. The pain doesn't have to be severe, it can also be a slight pulling or discomfort in the ankle area. Signs of damage usually appear in the morning when one takes the first few steps after waking up. This is because most of the night the feet are held in a certain position - the toes are down, the fingers are 'hanging down' and the heel is sort of pulled up. As a result, the ankle muscles feel stiff and sluggish in the morning. Some patients experience pain when walking up and down stairs for a long time.

The pathology clinic depends on the severity of the tendon injury:

• Contusion - closed soft tissue injury, the tendon remains intact.
• Tear (partial tear or sprain) – the tendon is microtraumatized, but the fibers remain partially intact;
• Tear – anatomical disruption of tendon continuity

Main symptoms of a tendon strain

With an Achilles tendon strain, the pain may only be felt on impact. You may have little or no discomfort afterwards, such as: B. Discomfort when walking, jumping or running and possible bruising and slight swelling at the bruised area.

Minor cuts and minor sprains are unlikely to cause pain. More severe tears can be painful anywhere in the tendon, and symptoms vary by location:

• Stiffness or pain in the ankle region appears in the morning after waking up or after sitting for a long time, then the pain subsides, but with intense and prolonged movement the pain returns;
• Above the heel, near the insertion of the Achilles tendon, there may be swelling and puffiness due to an enlargement of the fibers;
• On palpation, the tendon may be thickened and painful in places;
• Tension of the calf muscles up to cramps;
• The pain increases with pressure, e.g. B. climbing; then the pain is localized, more inward, outward, or back in the middle of the heel;
• The heel may become larger, hotter than surrounding tissue, and hyperemic;
• The flexion and extension of the foot is impaired;
• There may be a crunch when walking:
• limp, and sometimes it is almost impossible to walk or stand, and it may be necessary to use crutches;
• In the case of chronic sprains caused by improper or untimely treatment, even slight exertion, e.g. B. when walking faster occur.

injuries

The most common injuries to the musculoskeletal system are contusions, dislocations and fractures.

These injuries are caused by external mechanical factors acting as a trauma factor. These mechanical impacts can take the form of an impact, a fall on the spot or a fall from a height (more than 2 m). The force of these impacts exceeds the limits of tissue strength. Depending on the location of the damaging effect and the type of injury, a distinction is made between:

bruises – Soft tissue injuries with no (or minimal damage) to the integrity of the skin. Contusions most commonly occur where soft tissue (muscles, subcutaneous tissue) is pressed sharply against an underlying bone. Small blood vessels (capillaries) are damaged and bleed into the tissue space.

strain – This term refers to the ligaments of the joint. Although the term 'sprain' is a misleading representation of the nature of the injury. The essence of the injury is that the ligaments are not stretched, but are torn (fully or partially). What is mistaken for a sprain is actually a tear in the ligament fibers.

fractures – Structural injuries of the skeletal apparatus. Depending on the integrity of the skin, they are divided into open and closed fractures, and according to their shape, into simple, oblique, helical, punctured and comminuted fractures.

Other common types of injuries are. contortionsIn these cases, the congruence (anatomical alignment) of the joint surfaces is disturbed.

Symptoms of fractures, bruises and dislocations

• Pain – the level of pain depends on the type of injury. With bruises, the pain is minor, while with fractures, it is severe.
• Swelling of the subcutaneous tissue at the site of the injury.
• Bleeding (hematoma) also occurs.
• Deformation of the bone (in the case of fractures) and the joint (in the case of dislocations)
• Difficulty or inability to move at the injury site
• With open fractures – external bleeding. Extensive injuries with profuse bleeding cause shock.

• Immobilization with special aids - splints, plaster splints, immobilization bandages
• Pain relief with narcotic and non-narcotic analgesics
• Cold in the first hours after the injury
• Stop bleeding (if any).

Treatment

The injured knee should first be immobilized so as not to aggravate the pain. Once the diagnosis is made, the bone and its fragments (if any) are repositioned. This can be done closed or surgically. After repositioning, the fracture site is fixed until it heals. This can take several weeks or even months. It is important that rehabilitation after bone repair is done correctly in order to restore normal function of the leg and return to a normal lifestyle.

In any case, a knee injury requires special attention, since only a specialist can determine its severity, and delayed treatment can lead to tragic consequences. Enjoy life, not knee pain.

What is needed in prehospital care

To properly treat a sprain, you should have a bandage and compression bandage, pain relievers, and a cool bag, which can be replaced with the following items

• thermal cooler bag;
• ice cubes from the freezer packed in a bag;
• finely chopped frozen vegetables;
• snow pack;
• a heating pad filled with cold water.

Ideally, the coolant should be easy to mold into any shape to better conform to the injured area. An elastic and simple bandage and a cold pack should always be in your home, office or car first aid kit to provide first aid for sprains in case of need. Sterile bandages should be available for open wounds. Splints may also be required to immobilize the injured limb, which can be substituted with any elongated object that is handy.

stages of supply

Before we delve into the steps of prehospital first aid for sprains, it is useful to point out what absolutely must not be done. After a punch, the first reflex movement is to rub the bruised area. It's best not to do this, because rubbing stimulates blood circulation, and if the blood vessels are damaged, bleeding into the surrounding tissue will increase, leading to a growing hematoma.

The same goes for warming the injured area. In the first two days you should not warm the injured area, do not take hot baths or showers, and do not make warm compresses. This can only be done after 48 hours, when the threat of bleeding from the injured vessels has passed.

First aid for a sprain is to rest, cool, and apply pressure to the injured joint. Painkillers are also used if necessary. We have already briefly discussed the first aid measures for a sprain, but now we will consider them in detail.

Quiet

The first step in treating muscle and tendon sprains is to immobilize the injured joint. This has two goals: to stop the pathological processes caused by the injury and to reduce pain.

The injured person should be placed in a position that minimizes pain in the joint. Ideally, the injured area should be above heart level. This reduces blood flow to the injured area.
If there is a suspicion of a broken or torn ligament, it is advisable to immobilize the limb with splints. However, this must be done after a period of elastic bandaging and cooling.

The splints are placed on either side of the injured area and secured to the limb with bandages. A soft tissue should be placed under the splints to avoid injuring the skin.

compression

The next step in providing first aid to an injured person with a sprained muscle or ligament is to apply a compression bandage to fix the joint while compressing blood vessels and minimizing internal bleeding. A compression bandage is best, but if one is not available, a tight bandage can be made from ordinary bandages or strips of clear fabric. If there are wounds on the skin, they should be covered with several layers of sterile bandages before a tight bandage is applied.
The bandage should be applied tightly, but not too tightly, so as not to impair blood flow to the limb, since in the event of a dislocation, the casualty's condition before hospitalization should improve, not worsen. If the skin of the limb turns blue or pale after applying a tight bandage, the bandage should be loosened.

restrictions

X-rays are not recommended for infants younger than three months who can have ultrasounds. Doctors also advise against X-rays of the pelvic area of infants as it can lead to infertility, blood disorders and cancer in the future. Children are examined strictly on an as-needed and ration basis, at most once every six months.

X-ray examinations are not performed on pregnant women in order to avoid negative effects on the fetus. X-ray examinations are also contraindicated in people with metal prostheses or implants in the area being examined and in people with schizophrenia (and other mental disorders) who are unable to keep still. Other people, including the elderly, can be screened.

What an x-ray of the ankle shows

The ankle is often affected because the foot is most heavily used when walking upright. Radiographs of this joint are usually taken in three projections, with or without loading: lateral, oblique, and calcaneal radiographs. Computed tomography (CT) or magnetic resonance imaging (MRI) is sometimes also ordered to clarify the diagnosis and evaluate the soft tissues.

• injuries;
• arthrosis of the ankle;
• arthritis, synovitis, gout;
• Congenital anatomical abnormalities;
• osteophytes – heel spurs;
• flat feet;
• metabolic disorders, etc.

X-rays are a good indicator of the bone condition of the foot

Symptoms of a bruise

The impact site is quickly swollen and bruised. There is usually severe pain at the site of impact. The person has difficulty walking or holding objects in their hands. This depends on where the bruise formed. The pain itself can get worse as the day goes on. Sometimes over several days. The pain is caused by the damaged soft tissues. Trying to touch the bruise will also cause pain.

There are only four grades. The first degree does not require medical treatment. The bruise is minor and causes little discomfort. In the second degree, the pain is quite severe. The bruise increases and the soft tissue is injured. In the third stage there is a tendon injury. This is very painful and causes a lot of bruising and swelling. swelling. In the fourth stage it can lead to a fracture of Bone. The pain is unbearable. huge hematoma, swelling.

In stage four, the person has difficulty moving parts of the body, or moving at all (if the area of the breasts, abdomen, Move). At the second stage, it is advisable to consult a doctor Physician. The third and fourth stage is an immediate drive into hospital to determine the state of the organs as soon as possible. Treatment must be urgent, otherwise complications and disabilities may occur (in cases of severe e.g fractures).

Difference between a fracture and a bruise

The symptoms in these two situations are quite similar. There can be very severe pain, a hematoma of enormous size, a large one swellingbleeding, difficulty controlling the limbs/body. The only difference between the two cases is the timing of the pain. In the bruise the pain subsides within two to three hours. At fracture two possibilities: 1) the pain remains; 2) it strengthens. If a fracture is suspected fractureyou should immediately go to Go to the doctor..

First of all, it is advisable to have a Association with a special soothing ointment. Association Apply a bandage Association in place. The bandage is best taken up with a self-tightening bandage. If the point of impact is leaking bloodIt is advisable to bandage the area and cover it with an antibacterial plaster.

Abrasions should also be treated to prevent infection. A cold pack or ice should be applied to abrasions on the leg. Painkillers can also be used. If there is one bruise EyeIf the eye is injured, it may need rest. In addition, cold should be applied.

First aid for broken bones

How do you tell if a person has a fracture or dislocation of the foot? To do this, ask the patient about their symptoms. This information can be used to determine what first aid measures are required in this case. In the case of an ankle fracture, the following measures are recommended:

1. Remove the casualty's shoes and assess the situation.
2. Apply ice to closed fractures until ambulance arrives.
3. For open fractures, try to stop the bleeding if it is heavy. This can be done by applying a bandage over the injury site.
4. The injured should be able to rest. It is also advisable to administer an analgesic.

It is also important to completely fix the limb. This is to ensure that the injured bone is not displaced, as this can significantly aggravate the situation.

diagnosis

After the injured person is taken to a medical facility, a distinction must be made between a fracture and a dislocation. How to do this? It is advisable to see a trauma surgeon who will collect information about the symptoms and the situation in which the injury occurred. X-rays should be taken after examining and palpating the injured limb. These are made in two projections: lateral and direct. In some cases, computed tomography may also be needed. Based on the information obtained from the diagnosis, the appropriate treatment is prescribed.

How do you distinguish a fracture from an ankle sprain? This is done with the help of an X-ray. After all diagnostic measures have been carried out, treatment is prescribed. In the case of a fracture, treatment consists of the following measures:

Immobilization of the injured ankle by wearing a plaster cast for up to 1 month.

Pressure should not be applied to the injured limb while wearing the cast, as dislocation of the bone may occur.

What is a dislocation?

Ligaments are tight bundles of connective tissue that hold bones together and hold the joint in place. They strengthen the joints of the bones and direct movement in the joints. In this way, the ligaments provide both mobility and fixation, preventing the joint from moving in the 'wrong' direction.

If When ligaments are tense When a ligament is strained, the connective tissue is partially torn or fully stretched. Normally contortions most commonly occur in the ankle and hand when twisted or dropped. sprains of the ligaments Knee and elbow ligament sprains are less common. The shoulder joint is injured by a sudden jerk or swing of the outstretched arm.

Signs and symptoms of dislocations

The ligaments are criss-crossed with many nerve endings and blood vessels, so that contortionsTherefore, sprains and even torn ligaments cause severe pain and swelling in the injured joint. Typically, acute pain of varying degrees of severity joins contortions usually immediately after the injury or shortly thereafter. Other symptoms can also appear within a short time. contortionsThese include hematoma at the site of injury, swelling, reddening of the skin, significant impairment of joint function, and pain on palpation. Depending on the severity of the contortion Depending on the severity of the sprain, there may be an increase in temperature (almost always a local increase in temperature), congestion and visible bleeding from the soft tissues.

Sometimes the injured person hardly feels any pain immediately after the injury and can move the injured joint. This situation is confusing and contributes to sprain of the ligamentsThis is deceptive, because movement in the injured joint leads to further damage to the ligament. After a short time (minutes to one to two hours after the injury), swelling and pain in the damaged ligaments increase and the function of the joint becomes impaired.

In addition to Besides the contortionsJoint injuries can also occur, such as B. a torn ligament or a rupture. sprains A strained ligament differs from a torn ligament not only in the pain but also in the mobility of the injured area: while a sprain usually has limited mobility, a tear can have an extremely high amplitude.

sprains of ligaments must be distinguished from other joint injuries such as dislocations or fractures. When a dislocation occurs, the ligaments are usually torn, one of the bones is misaligned, and the joint surfaces of the bones no longer come into full contact (complete dislocation) or only partially (subluxation). This usually changes the appearance of the joint and prevents movement of the joint. Dislocations and fractures are much more serious than one sprain. They require urgent and qualified medical attention. Painful conditions and symptoms in severe sprains sprains and Z. B. closed fractures are very similar, so that a definitive diagnosis can only be made after a radiological examination.

What happens if a tendon injury is left untreated?

The consequences of a tendon rupture can be extremely unpleasant:

• Persistent pain that occurs against a background of 'knots'. These structures form when the tendon does not heal properly. Tumors increase friction and cause chronic inflammation;
• damaged nerves cause numbness and tingling in the limbs;
• An abnormally healed tendon can tear with the slightest strain. Achilles tendon injuries are particularly dangerous. There is no guarantee that the patient will be able to regain their previous mobility.

Therefore, limb tendon injuries must be treated as soon as they are discovered.

How are tendon injuries treated?

Incomplete tendon tears can be treated conservatively with a plaster cast. Unfortunately, this method is not always effective. A scar may form at the anastomosis site.

Ladistein tendon tears are treated using modern microsurgical techniques. Surgery is the only option if the tendon is completely torn. It then does not heal by itself. The adjacent nerves and blood vessels are often also damaged. The trauma surgeons sew up all structures under anesthesia and immobilize the limb with a plaster cast until it has healed. In some cases, tendon plastic surgery or lengthening is required.

How long does it take for the tendon to heal after the operationThe duration depends on the severity of the injury and age. On average, full recovery can take anywhere from 1.5 to 4 months.

Rehabilitation for a tendon rupture The rehabilitation of a torn tendon in the fingers, toes or arm involves additional measures. These include physiotherapy, massage, physiotherapy. Ladisten offers a whole complex of procedures using modern equipment and under the supervision of qualified doctors.

1. Unzhakov VV, Bersnev VP, Kokin GS, Orlov AY, and Izvekova TO. 'Repeat surgeries in patients with sequelae from combined nerve and tendon injuries' Acta Biomedica Scientifica, no. 6, 2006, pp. 98-100.
2. Popov GI Biomechanics of motor activity: a textbook for students of higher professional schools / GI Popov, AV Samsonova. – Moscow: Publishing Center 'Akademie', 2011. 320 pp. (Undergraduate series).
3. Khoroshkov, YA. Ultrastructural foundations of muscle-tendon junction force / Yu. A. Khoroshkov // Mechanics of polymers, 1975 – Vyp. 4 – P. 626-628

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