Update: December 2018
Ankle injury up to 70% of all injuries.
ankle joint and is relevant because it leads to
long-term disability Surgical intervention on
ankle constitute 60% of all trauma manipulations.
Ankle – distal (distant) part of the minor and tibial
bones голени. Outer and inner ankles are part of
ankle, form a “fork” of this joint and are responsible for its
stabilization. Visually, the ankles are defined as small and large.
elevation of the foot.
Causes of ankle fracture
|Traumatic causes:||Pathological causes:||Physiological causes:|
- Ankle fracture with or without displacement of the bone
- Ankle fracture with dislocation, subluxation or without dislocation
- Open or closed fractures.
- Fracture of the external ankle, internal or a combination thereof.
Very severe pain occurs at the time of injury and lasts for
for several hours, after which, subject to immobilization
limbs, slightly subsides. Sometimes pain syndrome is not
arises at the very beginning, and begins some time later. it
due to a large release of the hormone adrenal glands – adrenaline.
Such a manifestation is characteristic of small fractures without bias.
отломков bones и значительного повреждения сухожильно-мышечного
аппарата ankle joint Severe pain occurs on palpation.
damaged area or trying to rest on injured leg.
Crepitus of bone fragments (crunch) in case of injury is
reliable sign of fracture. Palpation produces a sound
like a crunch of snow. As a rule, the sound is combined with a pronounced
болевым синдромом и смещением fragments. Crunch никогда не возникнет
при переломе лодыжки без смещения fragments.
Violation of flexion and rotational functions of the joint
Impaired ankle function is manifested by complete absence
flexion and rotational movements in the joint, pathological
положением feet. it связано как с самим переломом, так и с полным
sprains, augmented by damage to the ligaments (see the difference between dislocation
from fracture, stretching).
Hematoma is a permanent sign of ankle fracture.
It is especially pronounced in the distal part of the leg and ankle.
The appearance of cyanotic coloring is due to damage to small vessels,
located in the muscles and tendons. In case of damage to larger
vascular trunks may appear hemorrhage, which
значительно усугубляет заживление bones и приводит к
Edema при переломах лодыжки или другого компонента голеностопного
joint arises almost immediately after injury, aggravating with
this pain due to the displacement of so damaged nerve trunks and
vessels. Edema является закономерным ответом на травму и имеет
двоякую природу: воспаление и выход жидbones из капилляров в
Loss of sensation
Sometimes the leg after a fracture may lose sensitivity in
distal parts, which is explained as the damage to the nerve
trunks, and their compression by hematoma or swollen tissue.
If the first medical aid was not provided in time, then
more than half of the victims after a few hours begins
develop traumatic shock. It is characterized by a decrease
reactivity of the body to injury, a decrease / decrease in arterial
pressure and centralization of blood circulation (almost all blood enters
in the liver, heart and lungs). This condition is in most cases
develops in victims after ankle fracture on both sides and
complete dislocation of the foot (Dupuytren’s fracture).
- Inspection: visual and clinical assessment of the damaged segment
limbs indicated above.
- X-ray: a standard method for the diagnosis of fractures of any
type and localization, for correct damage assessment is performed with
gripping the distal and proximal joints from the site
damage; – снимок bones выполняется в переднем и боковой
projections; – проводится на каждом этапе лечения (после перелома,
a few weeks after casting or casting
and after a few months to assess consolidation processes).
- MRI: does not bear radiation load and can be performed many times;
– позволяет более детально оценить fracture site; – is contraindicated
after metallic osteosynthesis.
- CT scan: the most informative method for the diagnosis of fractures; –
allows you to layer-by-layer examine the fracture area and reveal any
bone system pathology; – несет сильную лучевую нагрузку и
produced according to strict indications.
- X-ray densitometry: allows you to determine the mineral
bone density and is the standard in the diagnosis of osteoporosis; –
indicated for frequent fractures.
- Ultrasound: is an additional method and allows you to evaluate
cavity and joint structures.
- Eliminate the impact of a traumatic agent, for example,
release the ankle from squeezing it during an accident.
- Soothe the victim and, if possible, enter
- Call for help or ambulance.
- Avoid rough movements and do not let the victim stand on
an injured leg, which may contribute to even greater displacement,
damage to nerves and blood vessels.
- Fix the injured limb with improvised means,
and if possible, special transport tires (hold
immobilization). This can be done with the help of boards, fittings, etc.,
bandaged with bandages or a long cloth.
- With an open fracture, apply a sterile dressing to
prevent further infection in the wound.
- If there is arterial bleeding, what can happen if
fracture of the inner ankle (throbbing and quickly flowing scarlet
blood) apply a tourniquet with improvised means above the wound, preferably on
hip, since putting it on your shin cannot guarantee
- In the presence of venous bleeding (dark-colored blood, without
pulsations) apply a pressure bandage.
- With closed ankle fractures and, if possible, apply cold
to the fracture site, the latter will not only reduce swelling, but also reduce
- If possible, give the injured lower limb
exalted position. This is achieved by using a roller from
- Independently, you can not “reset” anything, it does when
necessary only by a traumatologist after x-rays.
There are two fundamentally different approaches to fracture treatment.
ankles: conservative and operative. Indications for
conservative measures (the imposition of a plaster splint) include:
- Closed fracture of one or two ankles without displacing bone
fragments and without breaking the ligamentous apparatus;
- With adequate reposition traumatology fragments;
- The inability to perform surgery (severe
concomitant pathology, failure of the victim from the operation).
The plaster splint is applied on the back of the shin and on
the whole plantar part of the foot, after which it is securely fixed by the usual
bandage. Such a longget should not squeeze the lower leg too much, since
this can lead to acute circulatory disorders in
damaged limb. After casting plaster splint
you must perform a re-x-ray to exclude
displacement of bone fragments.
It is important to understand that the withdrawal of gypsum occurs only after 6-12
weeks and it depends on the degree of consolidation of the bone, the complexity
fracture and bone spur that periodically
evaluated by x-ray control. That is to
The question is how much in a cast should be with ankle pearl, the answer is from 1.5 to
2,5 месяцев. While wearing a plaster splint in no
In this case, you cannot step on your foot, as this may cause
re-displacement of all the same fragments and carrying out operational
Recovery after a fracture can last from 2 to 12 months.
It depends on the general condition, age, metabolism of vitamins and
micro / macronutrients, as well as the complexity of the fracture itself.
Frequent complications after gypsum and not normal fusion
- False joint in the specified anatomical region;
- Irreversible joint changes (arthrosis);
- Habitual dislocation of the ankle;
- Deformation of the normal ratio of the minor and tibial
- Ankle Contracture.
Indications for the treatment of ankle fracture with surgery
- Complete rupture of the ankles;
- Complete dislocation of the foot, combined with the displacement of fragments;
- Open fracture;
- Various complex fractures (old, repeated, margin
between the tibial articulation, Dupuytren fractures);
- Active bleeding;
- The formation of an extensive hematoma.
All types of surgical interventions for ankle fractures are divided
External MOS (metal osteosynthesis) Submersible MOS, which
in turn, is subdivided into the fixation of the ankle fragments with
- The fixing metal design which fastens on
наружной поверхности bones;
- Внутри bones;
- Through the bone.
If necessary, this type of surgery can
be complemented by restoring the integrity of the connective apparatus
ankle joint After successful completion of surgery
the wound is compulsory drained using PVC
tubes to prevent re-bleeding or
infection in it and on top of it a plaster cast is applied.
Complications after surgery MOS and their treatment
Among the frequent complications postoperative period is observed
the addition of infection and the formation of a purulent focus. Arises as
in the wound itself, and in the seam projection. The essence of the treatment is
disclosure of the wound, its revision and treatment with antiseptic substances
with the subsequent repeated drainage (for sanitation during
Bleeding recurrence is one of the frequent complications and may
due to damage during surgery
trunks, insolvency ligatures on the vessel and purulent
melting of the artery or vein wall. This complication requires
emergency surgery to conduct an audit,
identify and eliminate the source of bleeding.
Также часто случается и остеомиелит bones на которой было
surgery was performed. The latter represents
расплавление внутренней части bones с выходом образовавшихся
necrotic masses out with a fistula. Such a complication may
arise as a variant of rejection of alien material by bone (in
In this case, the metal plate). Osteomyelitis also requires
reoperation, the essence of which is
opening a sequester, removing and draining it.
Recently, new methods are increasingly being used.
treatment of complications. The latter can be attributed apparatus
ultrasound cavitation allowing using this physical
эффекта очищать гнойно-некротические очаги в ране и bones без их
injuries, as well as the VAC system, which reduces the number of
dressings on the operated limb by creating a complete
vacuum, resulting in the death of all microorganisms.
Conservative treatment of the postoperative period
- Preventing the addition of infection: the appointment of antibiotics and
regular wound dressings.
- Pain relief: pain relief and comfort for further
- Treatment сопутствующей патологии.
Rehabilitation and prognosis
Ankle fracture requires the start of this event.
already a few weeks after casting or performing
operations, because how long rehabilitation will last depends on
general condition of the victim and his efforts. Also she must
carried out after the gypsum, especially if it was in excess of
6 weeks. This is due to minor atrophy of the muscles of the lower leg and
deterioration of tissue microcirculation under gypsum.
Gymnastics после перелома лодыжек является одним из основных
rehabilitation activities and includes a set of exercises:
Early period after injury (1-2 month):
- Flexion and extension of the toes (cyclically 20 times in 3-4
- Flexion, extension and rotation of the foot (10-20 times 3-4
- Mahi straight injured leg to the side, while fixing
hand behind the back of a chair or wall;
- Flexion and extension of the injured leg in the knee joint
Late period after injury (6 months-1 year):
- Walking on the toes, and then on the heels;
- Jumping rope at an average pace of 30 seconds;
- Running a step-by-step, also at a moderately intense pace;
- Squatting on socks.
It should be noted that gymnastic exercises in the late and
early period should be held only after fixing the ankle
elastic bandage in the form of a cruciform bandage.
- The first 10 days after limb fixation, UHF-therapy,
magnetic therapy and interference currents reduce tissue swelling and
reduce pain due to the acceleration of microcirculation.
Magnetic therapy is contraindicated in MOS. Read more about indications and
contraindications of magnetic therapy.
- 10-45 day ultraviolet irradiation of the limb (sub-erythematous
and erythemal doses) to improve bone regeneration and
sufficient production of vitamin D.
- 45-90 day interference currents with frequency up to 100 Hz for
enhance local metabolism.
Forecast после перелома лодыжек в 70-80% благоприятный и уже
after 2-3 months, the performance is fully restored,
20-30%, respectively, there is a persistent dysfunction of all
ankle joint, approximately 6-8 months, this leads to
long rehabilitation and further complications from