Photo: Outer malleolus fracture

All ankle fractures can be associated with torn ligaments, sprains, and subluxation of the foot (fracture dislocation), but fractures of two and three ankles are the most common. Fractures of the lateral malleolus are characterized by internal subluxation of the foot, while fractures of the medial malleolus are characterized by external subluxation of the foot.

fracture of the ankle

Treatment of this problem is carried out by a neurologist.

The most common injury to the lower limbs is a fracture of the ankle joint. Partial or complete damage to the bony structure limits mobility and affects daily activities, but can also lead to serious complications. In order to avoid adverse consequences and recover as quickly as possible, correct organization of orthopedic treatment and rehabilitation is necessary.

says CMRT specialist

Date published: April 26, 2021 Date checked: January 8, 2023 All facts have been verified by a doctor.

Causes of ankle fractures

The most common cause of ankle instability (approximately 80 %) is a fracture of the lateral malleolus. Injuries to the medial ankle are much rarer.

Immediately after the injury, severe pain occurs at the fracture site, making it impossible to stand on the injured leg. With a simple ankle injury, the injured person can sometimes walk unassisted, leaning on their heel.

Local swelling, hematomas and deformities quickly develop in the ankle area. When palpated, the most painful area is 3-4 cm above the ankle head. Fractures with displaced bone fragments result in extensive crushing of the back of the foot and the sole of the foot. There is a characteristic angle between the tibia and the distal limb, abnormal mobility is present, and a crunch (cracking) of the bone is heard.

An medial ankle fracture is characterized by increased pain in the area of the medial malleolus formed by the tip of the tibia. The clinical manifestations depend on the degree of displacement of bone fragments and ligamentous damage.

ICD-10

Fractures of the tibia account for 10 % of all fractures. The course, extent of the injury and the duration of treatment depend on the severity and extent of the injury and are different for shin fractures of different locations.

Pathanatomy

The tibia is the part of the skeleton that lies between the femur and the foot and consists of two long bones (tibia and fibula). The larger tibia bears the brunt of the load. The condyles (protrusions in the upper part of the tibia) are connected to the femur and form the lower articular surface of the knee joint. The lower part of the tibia connects to the talus bone to form the ankle joint.

The fibula is located on the outside and provides stability and strength to the shinbone. The two tibia bones are connected to each other (above by a common joint, in the middle by an interosseous membrane and below by ligaments). At the lower ends of the two tibia bones there are projections (knuckles) that surround the ankle joint on both sides and provide it with lateral support.

In which phases is the ankle fracture treated with our method?

First stage – The first stage is the closed fixation of the ankle fracture with a plaster or plastic bandage using a special, protected system.

second phase – After applying the bandage, the patient is taught to walk with the injured limb with full support. On the 8th to 14th day after the injury, when the risk of post-traumatic edema is eliminated, the shoe bandage is shortened on the dorsal and sole surfaces of the foot.

If the fracture position is satisfactory, patients are discharged for outpatient treatment. The general appearance of the shoe bandage upon discharge from the hospital is shown in the figure below. The general appearance of the patients upon discharge from the hospital is shown in the figure below.

The general appearance of the patients upon discharge from the hospital is shown in the figure below. Until the first consolidation of the ankle fracture, that is, up to 4-5 weeks after the ankle fracture, the injured ankle joint is freed from a plaster or polymer boot bandage on the dorsal and plantar sides.

Until the expected consolidation of the ankle fracture after 6-8 weeks, depending on the severity of the fracture, the remainder of the plaster or polymer cast is removed. Patients do not have psychological fear of putting weight on the injured limb without a bandage, put on regular shoes and start walking with full weight on the injured limb.

Patient M. 33 years old. Injury as a result of a fall on the street; she twisted her left foot outwards. Diagnosis: Fracture of the medial malleolus, periarticular fracture of the left fibula with posterior dislocation of the foot.

surgical treatment

It is not uncommon for bone fragments to remain in an unsatisfactory position after closed reduction. This fracture is also characterized by secondary displacement of the bone fragments with subluxation of the foot after the swelling subsides.

In these cases, surgical treatment is indicated. The operation should be carried out as soon as possible if the general condition of the patient and the condition of the soft tissues in the area of \u200b\u200bthe fracture allow.

Very often, fractures in the ankle area are complicated by poor blood supply to the periarticular tissue with blistering and sometimes necrosis. Such skin phenomena require special treatment and the operation may be delayed.

Special metal structures, usually plates, screws and spokes, are used to surgically join the bone fragments together in the correct position and correct the subluxation of the foot.

Products that influence the healing process

Of course, it will take longer for bones to heal if a special diet does not stimulate bone healing. So what should you eat to help injured limbs heal faster? One of the most important substances is protein. This is found in cheese, meat, eggs and fish. These foods also contain phosphorus, a trace mineral that is equally important for healing injured bones. Another useful element is calcium. All dairy products are rich in it. You can make your own smoothie with this recipe: add sesame and flax seeds to a glass of kefir. These have an anti-inflammatory effect on the body, promote wound healing and make a broken ankle heal faster. To provide the smoothie with vitamins and to provide variety, fruit and walnuts can be added to the smoothie and the ingredients can be chopped in a blender.

The healing time of a broken ankle in children depends on several factors:

The larger the broken bone and the older the child, the longer it will take to heal. For example, it takes an average of two to three weeks for the toe phalanges to heal and two to three months for the shinbone to heal. In the event of a fracture, e.g. B. a dislocated shinbone, healing can take up to four or five months.

The course of rehabilitation for a child after a fracture does not differ much from that of an adult. It is important that the child regularly performs general physical exercises, does not put too much strain on the injured limb and eats healthily.

Features of recovery after an ankle fracture in the elderly

The fusion of bone fragments is more painful and slower in older people than in younger people, because metabolic processes in the body slow down with age. Bed rest, as a rule, negatively affects the emotional state of elderly patients, and lack of exercise only weakens their body.

When older people break their ankles, a special plaster cast with a metal rod is applied. This means the injured leg can be supported without crutches. If it is a simple fracture and there are no complications, complete healing usually takes two to three months.

The rehabilitation measures are primarily aimed at achieving a normal gait and a normal limp.

Once the cast is removed, it is important not to put any strain on your legs. Traumatologists strongly recommend that older people undergo physical therapy or use the services of a massage therapist after removing the cast.

Peculiarities of recovery in older people

Regeneration of bone fragments is more painful and slower in older people than in younger people because the body's metabolism is slower. Bed rest, as a rule, negatively affects the emotional state of elderly patients, and lack of exercise only weakens their body.

If an ankle is broken, older people are given a special orthosis with a metal splint. This allows the injured leg to be supported without the need for crutches. If it is a simple fracture with no complications, full recovery usually occurs within two to three months.

The rehabilitation measures focus primarily on proper walking and limping.
Once the cast is removed, it is important not to put any strain on your legs. Traumatologists strongly recommend that older people do physical therapy or massage therapy after removing the cast.

The doctor's opinion

If the pain does not subside after immobilizing the broken ankle, the patient should immediately consult a traumatologist. One reason the pain persists may be incorrect diagnosis or treatment. In some cases, pain syndrome may indicate the need for surgical intervention. In other cases, exercises with a therapist to strengthen the muscle corset and cut off the blood supply to the limb can help relieve discomfort.

The recovery time after a bone injury depends on many factors: the type of injury, the age of the injured person, etc. To speed up healing, it is important to consult a doctor in a timely manner, follow his instructions and not neglect the rehabilitation course. An ankle fracture usually leads to a reduction in vitamins, proteins and micronutrients in the body.

A deficiency of these substances leads to pain syndrome and slows down the formation of bone calluses. Typically, pain that lasts for a month is not a serious cause for concern. However, if the pain occurs several months after the injury, a specialist should be consulted for a further examination.

Text Author Yaroslav Filatov Website otravmah .online

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symptoms of an injury

The pathology is very difficult to miss. The injury causes severe pain, making it impossible to walk on the foot. The most common ankle fracture is an open fracture, where the skin is broken and the bone protrudes. With a closed injury, the symptoms are not as obvious, but the signs always point to illness. A double displaced ankle fracture causes the following symptoms:

• severe swelling at the site of injury;
• excessive bleeding due to rupture of the arteries in that area;
• Pain so severe that the injured area cannot even be touched;
• severe bruising due to internal bleeding.

Occasionally there are cases in which the symptoms are quite tolerable. However, they are always associated with fractures without dislocations. They can be difficult to diagnose because signs of injury can easily be confused with bruises, sprains, or strains. An ankle fracture with dislocation always leads to clear symptoms. The diagnosis of such injuries is usually easy to make.

Causes of Double Displaced Ankle Fracture

Musculoskeletal health depends on many factors. When these are compromised, the risk of injury increases dramatically as the bones weaken and their structure is compromised. Causes of a displaced ankle fracture can include:

All causes leading to injury are generally divided into two groups. The first group includes cases of direct impact. These can be bone sprains in traffic accidents or falls with heavy weights on the foot. The second group includes indirect impacts. These can be caused by slipping on ice, an awkward landing after a jump, or a fall. A double ankle fracture with dislocation in this case is caused by rotation of the joint at a greater than permissible angle, which leads to injury. Ligaments and tendons are usually torn, which makes further treatment difficult.

Ankle fractures do not only occur in athletes or people with an active lifestyle, as many people believe. They can also occur in everyday life. But while in the first case trained people provide first aid, in the second case you have to rely on simple and often unknown people. That's why it's important to learn the basics of first aid for these types of injuries. This will help protect the victim from complications.

Which doctor should be consulted?

With such a pathology, the patient has no choice but to go to a medical institution. Immobilization of the injured leg is very important. Adverse movements can lead to complications and serious ruptures of soft tissues and blood vessels. The following specialist should be contacted:

Our specialists

Ankle Fracture Treatment:

Victims with a simple ankle fracture without dislocation are treated on an outpatient basis.

Otherwise, reduction of the ankle fracture and immobilization (cast) is required.

Ideally, according to the canons of the AO (World Association of Osteosynthesis), ALL intra-articular fractures, which include ankle fractures, require anatomical repositioning (elimination of the displacement of the ankle fracture) and absolutely stable immobilization.

In our center, 90 % ankle fractures are operated on. In most cases (especially if the patients come to us in a timely manner) osteosynthesis can be carried out minimally invasively, without large incisions. To fix the fragments, the most modern metal structures from the world's best manufacturers are used.

In most cases, immobilization (casting) is not necessary after ankle fracture surgery. Physical therapy begins the day after the operation with the aim of restoring mobility to the ankle.

In the postoperative period, the patient walks on crutches from the first day after the operation without putting any weight on the operated leg. Weight bearing on the operated leg is allowed after 4-6 weeks. The return to work occurs after 5-6 weeks for external ankle fractures and after 8 weeks for internal ankle fractures.

Clinical examples:

Patient C., 64 years old, type II diabetes, severe course. Closed fracture of the outer medial malleolus. Minimally invasive ankle joint osteosynthesis.

First phase of rehabilitation

After a broken ankle, the leg is put in a cast to ensure the bones heal. A solid cast prevents the fragments from shifting and accelerates healing. However, a long stay in a plaster cast reduces the supply of oxygen, nutrients and bioactive substances to the tissue. To avoid this negative scenario, it is important to carry out comprehensive massage and other physiotherapy treatments. These prevent blood congestion and inflammation and stimulate the growth of new cells.

massage

Rehabilitation after a broken ankle always includes massage treatments. Stroking and rubbing quickly rebuilds the damaged tissue of the ankle joint. Creams with warming, pain-relieving and anti-edema effects can enhance the effect even further. Products with fir oil, phytoextracts of cinquefoil, quinoa, golden beard are particularly useful.

Healing of bone fractures is accelerated by the effect of massage:

• improvement of local blood flow;
• elimination of swelling and congestion;
• Stimulating the regeneration of cartilage tissue;
• increase in muscle tone;
• Increase in amplitude of movement after fractures.

A gentle massage is also performed before the cast is removed, directly over the cast, sometimes with windows cut into the cast. The upper and lower areas of the body are massaged at the same time. At the beginning the movements are gentle, stroking and not uncomfortable for the patient. As the muscles and tendons strengthen, the movements become more intense - tapping, kneading and vibrating are permitted. In this way, before the cast is removed, the ability to move in the injured area is increased and the pain in the ankle quickly subsides.

Massages after an ankle fracture can also be done at home: stroking, kneading and shaking the injured leg, including the ankle and heel area. But professionals can do it better: they know the muscles better and know where to apply more pressure and where they can apply the same pressure more gently.

Second phase of rehabilitation

Patients should not put weight on the injured leg for a long time, as this can lead to weakening of the muscles around the ankle. Physiotherapy and massages are not enough – exercise is required.

On the second day after applying the cast, you need to constantly move the toes of the injured limb by tensing the muscles, turning the leg from side to side and moving it back and forth in bed. In addition, you need to put weight on the healthy leg and do arm and core exercises.

Doctors recommend that patients spend less time in bed. A few days after the fracture, crutches can be used to move around the room and hallway.

However, the most important LFC exercises after an ankle fracture begin in the second phase of rehabilitation. The intensity and range of movement are gradually increased. These exercises prevent muscle weakness and normalize autonomic function, which shortens the recovery time of the limbs. Regular exercise also improves the mental and emotional well-being of those affected after the fracture: They notice that the pain decreases, the muscles become stronger and movements become more confident.

Physiotherapy can be carried out at home. However, to avoid complications after a fracture, it is better to use the services of doctors. At the Tul Grandfather guesthouse, guests with ankle injuries do exercises under the guidance of a rehabilitation therapist. The doctor, taking into account the type of fracture (with or without dislocation), symptoms and the general condition of the body, creates an LFC program and monitors the correct execution of the exercises.

Main causes of injuries.

There are general and local causes that slow down the bone regeneration process. These can include:

• Serious diseases (diabetes, osteoporosis)
• bad habits (smoking, alcohol)
• States of exhaustion of the body
• Older age (over 60 years)
• Multiple broken bones
• Dysmenorrhea in women
• Penetration of infections or foreign bodies into the wound
• Severe soft tissue injuries
• Poor circulation

The diagnosis.

Fractures that heal slowly can be diagnosed

• on the basis of a clinical examination (the doctor determines by bending and applying strong pressure to the site of injury whether the pain persists, whether elasticity and tone appear at the site of the fracture)
• X-ray (can be used 16-22 days after the fracture, it clearly shows the fracture line and the callus formation is indeterminate)

How to improve the leg after a fracture?

To restore the function of the ankle joint, a comprehensive approach is required, in which all procedures and manipulations are carried out regularly and under the advice of a trauma or rehabilitation therapist.

Video: 'Ankle joint recovery after a fracture'.

therapeutic exercises

Therapeutic exercises primarily help to tone muscles, improve mobility, eliminate congestion, and restore mobility to stiff joints. Initially, all exercises should be performed under the supervision of a specialist; Later, the person affected should learn the technique and carry out the exercises independently at home. The load should be adjusted to the rehabilitation period, starting with minimal exercises and ending with more active exercises.

1. Flexion and flexion of the toes.
2. Rotation of the foot in the ankle joint.
3. Extension of the toes to different sides.
4. Raise your feet and bend your knees.

It is recommended to perform each exercise 10 times. If the functionality of the injured joint improves and there are no contraindications to greater stress, the range of exercises can be expanded to include stair running, jumping and water applications. Each patient is guided by a therapist who demonstrates the techniques of the permitted exercises in detail.

massage

If the leg has been in a cast for a long time, swelling, discomfort and dry skin will occur after the cast is removed. Massage treatments can help with this problem. Massage can help tighten damaged tissue, improve blood circulation, and promote the function of ligaments and muscles. The massage should be performed first by a professional masseur and then by the patient or his relatives. The person affected should not feel any pain during treatment.

What are the contraindications for massage and physiotherapy?

Rehabilitation is an important period that affects how quickly a person can return to a normal lifestyle. However, massages and physiotherapy are not always possible. They are not advisable for the following diseases:

Complications that would prolong the rehabilitation period

Complications of an ankle fracture can occur at different stages. Your risk increases if you receive inadequate first aid, do not receive timely treatment, or do not follow medical advice. The most common consequences of the injury are.

• Abscess formation in the surgical wound;
• vascular and soft tissue injuries during surgery;
• postoperative bleeding;
• skin necrosis;
• Embolism;
• fracture healing;
• Incorrect joint formation;
• subluxation of the foot;
• dystrophy of the foot;
• thromboembolic disease.

All of these diseases are serious and can lead to irreversible pathological processes and disability. With timely and adequate treatment and comprehensive rehabilitation, the risk of complications is minimal and the recovery of the joint occurs quite quickly.

• fracture of the lateral malleolus.
• Broken ankle.
• roll the dice.
• The lateral ankle is.
• Closed fracture of the ankle.
• Fracture of the 5th metatarsal.
• Fracture of the lateral condyle.
• Bones of the human ankle.