For the ankle to function properly after an ankle fracture, not only the necessary treatment is considered important, but also proper rehabilitation, which speeds up recovery and prevents possible complications.
The rehabilitation stage after an ankle fracture consists of a set of measures that are necessary from the first days after the injury until the final restoration of the functionality of the joint.
An ankle restoration plan is developed by a traumatologist or rehabilitation specialist individually for each patient. Before considering the main methods of the rehabilitation period, it is important to familiarize yourself with the causes and types of injury itself.
Anatomical features
According to its structure, the ankle joint is a trochlear joint: between a kind of “fork” of two ankles, a block of the articular surface of the talus is inserted. Stability is provided by numerous ligaments: they are arranged in several layers, powerful and durable.
Fig.1. Ankle structure
Freedom of movement is somewhat limited: the joint allows the foot to flex and extend with good amplitude only in one plane.
The ability to move the foot to the right and left is small, but the supporting ability allows it to cope with loads reaching ten times the body weight. True, sometimes even such a safety margin is not enough.
Diagnostics
The doctor will discuss with the patient the medical history (how long the pain has been, what happened before the injury) and symptoms. He will also ask how the injury occurred and examine the affected area. If your trauma surgeon thinks you may have broken your ankle, he or she will order a series of tests to more fully understand the injury.
X-rays : X-rays can show whether the ankle bone has been broken and how many pieces of broken bone are there. They can also determine if there is displacement (a gap between broken bones). The doctor may also take X-rays of other parts of the leg or foot to make sure nothing was damaged as a result of the injury.
Stress test : A stress test is performed to determine whether surgical procedures are necessary to heal the injury. The doctor will apply some pressure to the ankle and take a special x-ray to determine the severity of the injury.
CT scan (computed tomography): If the fracture extends beyond the ankle, a CT scan may be needed to further examine the injury. A CT scan allows you to obtain a series of images in different planes, from which the doctor can determine the severity of the injury. Source: Comprehensive diagnosis of ankle joint injuries. Kim L.I., Dyachkova G.V. Genius of Orthopedics, 2013. p.20-24.
MRI (Magnetic Resonance Imaging) Scan: If your doctor suspects ligament damage has occurred, he or she may order an MRI scan to get a better look at the affected area. MRI can look deeper into bones, soft tissues, and ligaments to create higher-resolution images than most other tests.
Mechanism of injury
Fractures of the ankle joints occur under the influence of multidirectional forces:
- Axial force perpendicular to the sole (causing wedging of the talus between the ankles).
- Excessive bending (flexion) and extension (extension).
- Turning inward (supination) and turning outward (pronation).
- Rotation of the foot inward (inversion) and outward (eversion).
If a sufficiently large amount of energy is applied in any of these directions, the joint structure may fail and break.
Varieties and types
The classification of ankle fractures is quite complex. Separately classified:
- Fractures of the fibula (outer malleolus).
- Tibial (inner malleolus).
- Damage to the tibiofibular syndesmosis.
- Talus.
Each of these categories has sub-items. In case of injuries, they are combined and rarely occur in isolation. Knowing all the nuances of each type of fracture and understanding the mechanism of injury allows you to eliminate the damage as completely and effectively as possible.
Usually, ankles break off: external (lateral, - the process of the fibula) or internal (medial - part of the tibia). Both can break at once.
Rice. 2. a. displaced fracture of both ankles; b. fracture of the ankles and posterior edge of the tibia.
The peculiarity of such fractures is that sometimes the ankles seem to be torn off from the bones of the leg: when the leg is twisted, strong ligaments may not break, but pull the ankle along with them, tearing it off completely, or causing a breakage and displacement of a small fragment of the bone.
Severe high-energy injuries may not be limited to the ankles and are accompanied by fracture of the articular surface of the tibia.
The talus fractures noticeably less frequently. But if it is damaged, intra-articular fragments may occur. They do not always produce pronounced symptoms and often end in the development of false joints.
We have to deal with fracture-dislocations: when one or both ankles of the leg are broken off, they lose the ability to fix the block, the talus dislocates and shifts, complicating treatment.
Fig3. A. fracture of the outer malleolus, rupture of the syndesmosis and deltoid ligament, subluxation of the foot outward. b. fracture of the talus.
Such injuries are dangerous due to disruption of the blood supply to bone tissue, which causes aseptic necrosis (talus bone) and greatly complicates the work of doctors.
A frequent complication is rupture of the external and deep ligaments and displacement of bone fragments.
Treatment for an ankle fracture
Treatment for an ankle fracture without displacement and with minor tissue swelling is carried out in an outpatient setting. Plaster immobilization is carried out for 3-6 weeks. In the future, therapeutic exercises, massage, various sets of physiotherapeutic procedures, special shoes and orthopedic insoles are prescribed.
In all other cases, with a fractured ankle, hospitalization of the patient is mandatory . To avoid the development of post-traumatic arthrosis in the ankle joint, which is under heavy loads, it is necessary to correctly restore the exact distance between the tibia and fibula and the length of the fibula.
If, after closed reduction of an ankle fracture, the displacement remains, then urgent surgical restoration of the exact relationships between the elements in the joint is necessary. Surgery - osteosynthesis of bone fragments is used to restore the anatomy of the ankle joint. Today, our center uses advanced technologies, materials, and new surgical techniques in the surgical treatment of ankle fractures. This is necessary in order to achieve a good functional result and prevent human disability and the formation of deforming arthrosis of the ankle joint in the future.
Photo - removal of metal structures after an ankle fracture
- X-ray of the leg with installed metal structures
- performing epidural anesthesia before surgery
- head department Pavel Zhadan treats the leg
- laser scalpel provides a bloodless cut
- removal of metal structures after a fracture
- application of a cosmetic suture with minimal tissue trauma
Symptoms
Certain aspects of external manifestations depend on the type and extent of injury. Attention should be paid to the following symptoms:
- Pain in the injured joint.
- Swelling in one or both ankles.
- Atypical foot orientation.
- Joint deformity.
The tricky part is the risk of low-symptomatic variants. You may encounter a break-off of a small fragment of bone, which does not lead to gross external manifestations, which means there is a delay in seeking medical attention after a fracture and, accordingly, treatment.
Derotation boot: dimensions
The dimensions of the derotational boot are determined by the length of the foot. Since the derotational boot is not closed in the toe, one boot corresponds to 2-3 adjacent shoe sizes. Dimensions for derotation boots may vary from manufacturer to manufacturer. Some manufacturers may have letter designations for sizes S/M, L/XL, others in the form of numbers.
For example, derotational boot dimensions for model F-215:
No. 3 Shoe size 34-37;
No. 4 Shoe size 37-40;
No. 5 Shoe size 40-43;
№6 Shoe size 43-46
Diagnostic measures
Questioning and inspection cannot provide the necessary information. The key role is played by x-ray methods. As a rule, a radiograph of the injured limb is required in two projections.
Moreover, for better visualization of individual parts of the joint, different techniques are used (displacement, rotation, tilt of the foot). When necessary, a photo of the healthy leg is taken for comparison. There may be a need for CT or MRI.
Fractures of the talus require a more careful choice of diagnostic technique, as they are more complex in terms of treatment.
Fig4. A. CT scan shows a fracture of the talus and tibia, b. MRI revealed a fracture of the talus
Therapeutic measures
Uncomplicated ankle fractures without significant displacement allow conservative treatment. Manual closed reduction is performed, the details of which depend on the type of injury.
The basic principles are:
- Carrying out the most accurate reposition before applying a plaster immobilization bandage.
- Rehabilitation after removal of the cast, restoration of movement and joint function.
After this, a plaster-based fabric bandage is applied: immobilization is necessary, its duration depends on the degree of the defect and ranges from 4 weeks.
We will help you restore bone integrity, joint function and return to your usual active lifestyle. We have an individual approach to each patient.
Surgical measures
If it is obvious that closed reduction will not be effective, plaster is not used: they resort to open osteosynthesis surgery and installation of metal structures directly on the bone tissue.
Violations of the integrity of the talus are preferable to be treated surgically due to the risk of aseptic necrosis. Reduction and reposition of her fracture-dislocations must be carried out by repeating the mechanism of injury in the opposite direction.
Fig.5 a. osteosynthesis of the talus and calcaneus with screws, b. fracture of both ankles; osteosynthesis with plate and screws.
Factors influencing fusion time
The duration of ankle recovery depends entirely on the following factors:
- type of fracture (open, closed ankle fracture);
- nature of the damage (displaced, without displacement, splintered, multi-splintered);
- prescribed treatment;
- the stage at which the victim went to the hospital;
- the age of the victim and his general health.
The lifestyle of the victim is also very important. Bone heals much faster in those who watch their diet, do not smoke, do not drink alcoholic beverages, follow all the recommendations of the attending physician and spend a lot of time in the fresh air.
If you neglect treatment measures, put stress on the injured limb and eat unhealthy food, which prevents the supply of beneficial vitamins and minerals to the damaged area, the healing period of bone tissue will be long and will bring a lot of inconvenience to the victim.
Consequences
If you do not consult a doctor in time, even a simple ankle fracture can complicate your future life.
A common consequence of delayed treatment is ankle pseudarthrosis, fusion in the wrong position, post-traumatic arthrosis.
Insufficiently thought-out treatment leads to impaired ankle stability and deformation. In old cases, eliminating such consequences is not easy.
Gross defects are much more dangerous:
- Persistent impairment of the supporting function of the foot.
- Due to blood supply disorders, aseptic necrosis of bones occurs.
- Infectious complications in the affected area.
The loss of physiological gait affects the entire human skeleton, primarily the spine. In some cases, ankle replacement may be required. .
First aid
X-ray images
Most often, there are no special devices at hand to fix the injured limb, so any means that are nearby will do. It is important to choose dense material that will not crack or deform during transportation of the victim.
There are very important points when providing first aid. When applying cold to the affected limb, it should be wrapped in a cloth, for example, a towel or rag. Contact of cold with skin should not exceed half an hour. Otherwise you may get frostbite. Between cold compresses you need to take a break of about half an hour and only then repeat the manipulation.
What to do if there are wounds on the damaged area of the skin? First of all, you need to not panic. A clean cloth must be applied to the wound and secured well. A scarf or bandage is perfect for this. If bleeding occurs, you will have to apply a tourniquet. You must remember that in summer it overlaps by 2 hours, and in winter by a maximum of 1.5. It is important not to forget to mark the time when the tourniquet was fixed. If you don’t have paper on hand to write on, you can leave the inscription on the leather, as long as the number is not erased during transportation.
If you receive an injury such as a fracture or dislocation of the ankle, under no circumstances should you reset the joint yourself. This can cause serious complications. It is better to leave these manipulations to specialists.
