Fracture of ankle with displacement: surgery with plate, massage, therapeutic gymnastics

click fraud protection


  • 1Fracture of ankle with displacement - rehabilitation and recovery
    • 1.1How is an ankle fractured?
    • 1.2Clinical manifestations of trauma with displacement
    • 1.3Watch the video on this topic
    • 1.4Confirmation of X-ray fracture
    • 1.5First Aid
    • 1.6Operation and other types of treatment
    • 1.7Conservative way of therapy
    • 1.8Application of skeletal traction
    • 1.9Operative way of treatment
  • 2Surgery with a plate with a shank fracture with displacement: rehabilitation
    • 2.1Anesthesia during surgery
    • 2.2How to choose a plate
    • 2.3Operation with the plate with a fracture of the tibia with displacement is carried out in several stages: the development of metalloesteosynthesis
    • 2.4Post-operative care
    • 2.5Plate removal
    • 2.6After what time is the plate removed?
    • 2.7When is the plate removed?
    • 2.8Rehabilitation after removal of the plate
  • 3Rehabilitation after ankle fracture
    • 3.1A few words about anatomy
    • 3.2Clinical picture
    • 3.3Diagnostics
    • 3.4Classification of ankle fractures
    • 3.5Treatment
    • 3.6Immobilization
    • instagram viewer
    • 3.7Rehabilitation
    • 3.8The first stage: immobilization and dosed load (10-14 days)
    • 3.9Exercise therapy
    • 3.10Physiotherapy
    • 3.11The second stage: limited motor mode
    • 3.12Exercise therapy
    • 3.13Physiotherapy
    • 3.14You can not
    • 3.15The third stage: rehabilitation of residual phenomena
    • 3.16Physiotherapy
    • 3.17Contraindications for massage and physiotherapy
    • 3.18Complications of ankle fracture
  • 4Fracture of ankle with displacement - operation with fixing plate
    • 4.1Pattern of fracture and plate mounting
    • 4.2Symptoms of fracture with displacement
    • 4.3Types of Ankle Fractures
    • 4.4Using a titanium plate
    • 4.5Methods of osteosynthesis are:
    • 4.6Recovery period

Fracture of ankle with displacement - rehabilitation and recovery

In the structure of fractures of the lower leg bones, an ankle fracture with displacement is most often observed - these injuries account for 60% of cases.

Fracture with bias requires surgical treatment, and without shifting the application of gypsum.

Rehabilitation should begin during treatment, while a plaster bandage is applied on the leg or a skeletal traction is performed. It is important to maintain the physiological circulation of blood and lymph in the damaged limb.

Key recommendations:

  1. This is ensured by the appointment of minimal loads on the foot. Such loads with a fracture with displacement are allowed two weeks after the start of treatment. The methods of therapeutic physical training, massage of the open part of the limb and healthy legs are used.
  2. In addition, physiotherapy methods are used - laser therapy, UHF, magnet therapy. A month later the load is given to a greater extent - walking with support and without. Methods of exercise therapy and physiotherapy are also used. If there was a fracture of both ankles, the terms of rehabilitation slightly increase.
  3. After the end of treatment, rehabilitation exercises are prescribed. Gymnastic exercises begin with a minimal load with a gradual increase. The goal of curative gymnastics is to restore the elasticity of the ligaments and muscles of the limb. Of the original methods used by the legs to the sides, the rotation of the foot in the ankle. Gradually, the load increases and dosed walking is assigned, then running on the treadmill.
  4. In parallel with medical gymnastics, physiotherapy is also carried out, also aimed at restoring ligaments and muscles by improving blood supply in the damaged area.
  5. Rehabilitation after a fracture also consists in proper nutrition. The diet includes meat and dairy food - rich in protein and calcium, substances necessary for the speedy recovery of bone tissue.

How is an ankle fractured?

A straight blow to the ankle rarely leads to a fracture, mainly this is observed with excessive rotation of the foot or when landing on it from a high altitude. Here, two subspecies are distinguished: the pronation mechanism of injury and the supination mechanism.

With a pronation fracture, the foot turns outward. And in this case, the following damage occurs:

  • transverse tearing of the ankle;
  • fracture of the external ankle in an oblique direction - this variant is characterized by displacement of fragments;
  • the rupture of all ligaments of the ankle joint - in this case, a dislocation of the foot joins the fracture of the ankle.

Supination fracture occurs when the foot is turned inwards.

In this case, the following can happen:

  • transverse tearing of the external ankle;
  • oblique fracture of internal ankle with displacement;
  • rupture of ligaments and dislocation of the foot.

Clinical manifestations of trauma with displacement

  1. The initial symptom in the fracture will be a pronounced painful attack in the ankle.
  2. Rapidly builds up edema at the site of the fracture.
  3. With a fracture of the external ankle, the foot deviates outward. Here you can notice a pronounced skin tension and palpate or see displaced bone fragments.
  4. Fracture of the inner ankle, respectively, leads to the deviation of the foot inside. There will also be skin tension and bone fragments. If a dislocation joins the fractures of the ankle, the foot will still bend downward. Any movement in the area of ​​the fracture causes increased pain.
  5. If the vessels are damaged, a rapidly increasing hematoma can occur in the area of ​​the injury.
  6. Massive hemorrhage in this case does not happen, but mixed shock can develop - both hemodynamic and painful.
  7. In this case, there will be a drop in blood pressure, a quickening of the pulse, a pallor of the skin. More often it is observed at a fracture of both ankles at once.

Watch the video on this topic

Confirmation of X-ray fracture

Find out the exact localization of the fracture, the presence or absence of bias, the free fall of the fragments allows X-ray study. It is necessary to take a picture from several sides - in anteroposterior and lateral projections.

A transverse fracture is usually not accompanied by an offset, but with an oblique fracture, it is possible to detect displacement of the fragments relative to each other.

First Aid

Help a person with a fracture should be immediately after the injury:

  1. To prevent further displacement of fragments, immobilization of the injured limb is ensured.
  2. To do this, a tire is placed on the foot from the foot to the knee joint - wooden, wire or pneumatic.
  3. In case of severe contamination of the fracture site, it is necessary to wash the leg, preferably with an antiseptic solution. This is done before applying the bus.
  4. In case of severe bleeding, a tourniquet is applied to the lower leg for no more than two hours.
  5. Anesthesia is done only by taking medications inside. Analgesics in injections are not recommended in connection with possible infection of the fracture site.
  6. In cases of shock, support of cardiac activity and infusion therapy is necessary. Naturally, these activities are performed by medical personnel directly at the site of the injury.

Operation and other types of treatment

Fracture of the ankle with displacement is treated only in a hospital. In addition to direct treatment of the fracture, the whole body needs support. To this end, prescribed painkillers, funds to improve microcirculation, vitamins.

After removing the gypsum, a course of calcium-containing preparations is needed to strengthen the bone tissue.

Conservative way of therapy

Conservatively it is possible to treat a simple fracture of the ankle with displacement. To do this, reposition of the fragments by hand is used, after which a plaster bandage is applied.

Periodically, X-ray control of fracture fusion is performed. Loading of the leg is usually permitted after a month of treatment. Complete restoration of limb function and fusion of the fracture is observed after 4 months.

Application of skeletal traction

In complex fractures, skeletal traction is used. After a month of treatment with a skeletal extension, a gypsum is applied to the leg and lasts for about two months.

Periodically, the fracture growth should be monitored. Restoration of bone integrity is observed in terms of 4 to 5 months.

Operative way of treatment

It is prescribed in the case when the reposition of displaced bone fragments can not be performed either manually or by skeletal traction. The essence of the operation with the plate is the comparison of fragments by the open method and the imposition of a metal plate on them.

It is fixed to the bone with screws. The plate acts as an ankle retainer in the correct position. In the postoperative period, a plaster cast is applied to the limb for a period of 4 weeks.

A source:

Surgery with a plate with a shank fracture with displacement: rehabilitation

Metalloesteosynthesis of shin fracture by plate

Fracture of the lower leg is a common trauma, which can be caused by a car accident, a fall, a sports injury.

Injury of the tibia is sometimes complicated by displacement, debris, damage to the skin (open fracture), and fracture of the fibula.

Depending on the type of fracture (with or without bias, with fragments or without fragments), one of the methods of treatment is the insertion of the plate with a shin fracture.

The fibula, most often, is not subject to targeted treatment, since the supporting bone is the tibia of the tibia. After repositioning, the tibial fibular bones are leveled and fixed with gypsum after surgery on the tibia.

Anesthesia during surgery

Fracture of lower leg with displacement

Before the surgery for the metalloesteosynthesis of the leg, it is recommended to hold the victim for a few days on a skeletal tract.

The construction of the skeletal traction is the holding of the Ilizarov's needle through the heel bone, a weight of several kilograms is attached to it on the line.

Such an extension is performed under local anesthesia and allows the fracture to gradually be broken.

You will be interested in:Exercises for pain in the lower back and neck

Skeletal traction with a shank fracture with displacement

The operation itself is performed under general anesthesia or with the help of spinal anesthesia. The choice of type of anesthesia depends on the complexity of the operation, its estimated duration, on the overall health of the patient.

How to choose a plate

What plates are put in fractures of the shin? Metal implants, used for metalosteosynthesis in traumatology, are made of titanium, which does not cause allergic reactions. Very rarely there may be an allergy, the process of rejection of the implant begins to develop, and it must be removed.

On bone already has time to build up a small bone callus, which holds the place of fracture. Further treatment should be carried out in the cast before the full consolidation (fusion) of the fracture.

Synthesis of a shank and knee joint fracture by a plate

When choosing a plate on the shin for fracture, the traumatologist takes into account the localization of the fracture.

This will determine the thickness of the plate, its shape and length.

If the fracture of the tibia is in the middle third, then the plate can be taken thick and straight.

The fracture that enters the joint part of the tibia involves choosing a plate with one wide end. In this case, the thickness of the plate is a little thinner, so that it is possible to adjust its shape for a close fit to the bone.

Operation with the plate with a fracture of the tibia with displacement is carried out in several stages:Carrying out metalloesteosynthesis

  • hiding the place of fracture;
  • cleaning of the fracture site from blood clots, soft tissues and bone fragments, which interfere with the bones;
  • metallosteosynthesis (plate mounting and fixation by screws);
  • X-ray for monitoring;
  • layer wound suturing;
  • superposition of plaster langet.

During the operation, the operating field is washed several times so that the infection does not get into the open tissue.

Along the plate is laid rubber or tubular drainage, which allows you to remove the wound from the accumulated blood (preventing the formation of bruises).

On the surgical wound, a sterile bandage is applied.

Metalloesteosynthesis of the tibia plate

The price of the operation depends on the complexity of the fracture, on the selected anesthesia, and also on the type of plate that will be used.

Post-operative care

The first dressing is recommended to be done the day after the operation. Within a few (3-5) days the patient should be in a supine position, the leg should be on a hill.

But the leg should not be permanently immobilized, so pressure ulcers can form - the leg can be slightly rotated and its position changed.

A small turn in the ankle allows you to get rid of the contracture.

While the patient lies, from the first day is prescribed respiratory gymnastics, so that pneumonia does not develop.

From 2-3 days the masseur conducts general strengthening massage and development of the joints of a healthy limb, as well as gentle development of the joints of the operated limb.

With a normal uncomplicated course of the healing process, you can get up for 2-3 days, but you can not load a limb.

Sutures are removed on the 12-14 days after the operation. Moving is allowed only with the help of crutches.

For the speedy restoration of muscle tone and the efficiency of the limb, development of the limb in the basin is appointed for 4-5 weeks after the operation.

This helps to restore blood flow and lymph flow in the operated limb, as well as in a gentle mode increase the amplitude of movements in the joints (instructions for physiotherapy are individual for each patient).

If the fracture consolidation is stable, you can walk without crutches, but you can not heavily burden your leg. Complete restoration of the limb comes in 10-12 months.

Plate removal

Even a titanium hypoallergenic design is still considered a foreign body. A foreign bodies are subject to removal. As soon as a strong callus was formed at the site of the fracture, the traumatologist assigns a planned operation to remove the plate in case of shin fractures.

After what time is the plate removed?

When to remove the plate after a shin fracture?

In the normal course of healing remove the plate after a fracture of the tibia is recommended approximately year after its installation, but there are certain nuances that force to remove metalwork before:

  • The rejection of the metal from which the plate is made;
  • formation of a false joint;
  • improper fracture fusion;
  • bone callus is not formed;
  • fracture of the plate or screw;
  • suppuration of the fracture site;
  • Migration of screws;
  • unreliable fixation.

These reasons are not only an indication for surgery to remove the plate. Also, if suppuration occurs, a prolonged course of treatment of damaged soft tissues or even bones is suggested.

The photo shows how the plate has grown into bone:

Removal of the plate after a shin fracture

When is the plate removed?

In the event that more than 3 years have elapsed since the insertion of the plate, and the patient has not consulted a traumatologist, there are options for leaving the plate in the shin:

  • too deep ingrowth of metal in the thickness of the bone;
  • the patient's age (after 80 years, repeated operations are not recommended);
  • close placement of the neurovascular bundle to the site of the fracture.

The latter reason can do more harm than good. If the doctor accidentally damages this bundle, it can lead to profuse bleeding and a loss of sensitivity in the limb.

Rehabilitation after removal of the plate

Removal of the plate after fracture of the lower leg is less traumatic than its installation. But it's still an operation, during which the bone (bone cleansing of the place where the plate and screws are fastened) can also be damaged. So, the place of the fracture is again weakened.

Rehabilitation after a shin fracture

Gypsum is not needed, but it is recommended to reduce physical stress on the aching leg. Renew the usual load on the leg should be gradually. For example, you do not need to run a 10 km cross at once.

A source:

Rehabilitation after ankle fracture

Fracture of the ankle is one of the most common types of injuries in traumatology. It arises as a consequence of movements of excessive amplitude or nonphysiological direction (overextension, excessive bending inward, outward).

A few words about anatomy

The ankle is the distal (lower) end of the fibular and tibia.

Isolate the lateral (the lower edge of the fibula) and the medial malleolus (the lower edge of the tibia), together with the talus bone, they are integral parts of the ankle joint.

Separately, the distal epiphyses of the peroneal and tibial bones are called the ankle fork. Together with the tendons and the talus bone they form a ring that performs the function of stabilizing the ankle joint.

Clinical picture

Fracture of the ankle is accompanied by pain in the ankle and violation of its function.

During the fracture, the patient feels a sharp pain in the ankle.

At visual inspection the joint is enlarged in volume, deformed, in soft tissues there can be a hematoma. When the fracture is open, damage to the skin is observed. Almost always there is a wound in which bone tissue can be seen.

When palpation appears acute soreness, pathological mobility, and in certain cases, crepitation of fragments.


The diagnosis of an ankle fracture is made from a combination of survey data, examination and diagnosis.

To determine the presence of a fracture and its nature, it is necessary to conduct diagnostic studies, the first of which is fluoroscopy. The X-ray is performed in two projections: the lateral and antero-posterior.

Additional methods of joint research are sonography (ultrasound), arthrography and arthroscopy.

Classification of ankle fractures

  • on the nature of occurrence: supination and pronation;
  • Isolated (lateral - external or medial - inner ankle);
  • multiple (dvuhladyzhechny, trehkladyzhechny - with detachment of the posterior edge of the tibia);
  • with concomitant ligament damage;
  • for damage to the skin: closed, open;
  • on the displacement of bone fragments: with displacement, without displacement;
  • on the violation of the integrity of the ankle ring, formed by the ankle and the ligaments: stable or unstable.

Stable fracture is limited to a fracture of one ankle. An unstable fracture is a two- or three-fold fracture, as well as a fracture of one ankle with a rupture of ligaments. This type of damage is usually combined with an external subluxation of the foot.


The main method of treating such fractures is the use of conservative techniques.

In no case should you trust the direction of dislocation of the back or manual reposition of fragments to a layman, this can lead to many complications.

First of all, all patients are anesthetized, and further tactics depend on the nature of the fracture.

  • In the presence of an isolated fracture or fracture without displacement of the fragments, the patient is immobilized.
  • With a concomitant fracture of the dislocated foot, it is corrected with simultaneous retention of the bone fragments in the correct position.
  • Another method of conservative treatment of the fracture is its extension with subsequent correction.
  • If there is a displacement of the bone fragments, manual repositioning or surgical intervention is performed with fixation of the fragments with plates or screws.


In fractures of the ankles without bias, one of the two plaster lingettes is superimposed on the affected limb:

  • U-shaped, going from the upper third of the shin along its outer-lateral surface to the ankle joint, then - on the plantar part of the foot with the transition to the inner-lateral region of the shin to its upper third. Longuet is fixed with a bandage or gypsum rings.
  • Long-circular (according to the type of boot) is superimposed from the upper third of the shin to the fingertips and carefully modeled on the patient's leg.
You will be interested in:Fracture of ankle without bias

After applying a cast bandage, a control X-ray examination is performed. It helps to determine whether the displacement of bone fragments occurred during the rigid fixation of the tibia.

A few days after the dressing is applied to the gypsum, a stirrup or heel is attached, which helps to correctly distribute the load to the affected limb and to unload the fracture area.

Terms of immobilization:

  • one ankle without displacement of fragments: 1 month;
  • one ankle with displacement of fragments: 6 weeks;
  • double-fracture fracture: 2 months;
  • double-fracture fracture with subluxation of the foot: 12 weeks;
  • three-fold fracture: 10 weeks;
  • three-fold fracture with ligament rupture: 12 weeks.

The patient is incapacitated for a period of two to four months.


While the patient is lying in a lying position, it is necessary to provide the affected limb with an elevated position to improve the outflow of blood and lymph.

Modern approaches to rehabilitation are reduced to the earliest possible onset (immediately after the injury) and the end after complete restoration of the function of the limb. If these conditions are met, the patient can start the usual everyday and work life for him quickly enough.

It is necessary to remember that the multidisciplinary comprehensive approach to treatment allows to shorten the terms of rehabilitation and earlier to return to the usual rhythm of existence.

The combination of medical treatment, physiotherapy, special physical training and massage will remove the inflammatory phenomena, improve blood circulation, accelerate the resorption of edema, increase muscle strength, accelerate tissue repair, strengthen the joint and help avoid possible complications.

Recovery after fractures of the ankles is carried out in 3 stages.

The first stage: immobilization and dosed load (10-14 days)

The task at this stage is to prevent possible complications, improve blood circulation in the fracture region and reduce the intensity of the pain syndrome.

  • With an isolated fracture of one of the ankles without displacement of bone fragments, the dosed load is allowed after 1 week.
  • With an isolated fracture of one of the ankles with displacement of bone fragments, the dosed load is allowed after 2 weeks.
  • In the treatment of fracture by surgical method with fixation of bone fragments by metal structures, loading is possible after 3 weeks.
  • With a three-ligament fracture, the dosed load is resolved after 6-8 weeks.

Exercise therapy

Passive movements are possible immediately after the operation / immobilization.

1-3 days after osteosynthesis, you can perform active limb movements and begin walking with crutches without using an injured leg.

In the terms indicated above, you can begin to partially load the affected limb.

In any case, the issue of the time for the expansion of the motor regime is decided collectively by a surgeon, a rehabilitator, a physiotherapist, a physician of the exercise therapy department and, if necessary, other specialists.


Physiotherapy is prescribed from the first day after the fracture (operation).

Through a dry gypsum dressing, it is possible to treat with an electric field of UHF, magnetic therapy, laser therapy and ultraviolet irradiation.

And laser therapy is carried out both in the red spectrum (while in the gypsum the windows are cut to the size of the radiator), and in the infrared range (contact through the bandage).

Earlier, the contraindication to UHF therapy was the presence of metal structures in the field of procedure, today there is experience that allows to treat and with the existing metal parts, with the condition that the lines of force pass along them (tangential location emitters). When using the external fixation device, the radiators are installed between the external supports and the skin. There are scientific works proving that overheating of metal structures does not occur.

The second stage: limited motor mode

The patient moves with crutches, then without them.

The task of this stage of rehabilitation is to improve the nutrition of tissues, to accelerate the processes of regeneration and the formation of bone callus.

Exercise therapy

At this time interval of rehabilitation, it is necessary to restore the functions of a slow-moving ankle joint.

For these purposes, in addition to the complex of exercises, additional equipment and mechanotherapy should be used: to work with the foot rest on a rocking chair, rolling a stick, a bottle, a ball, cylinders, practicing on an exercise bike and a foot sewing machine, using other techniques.

The exercises in the pool are justified: water, reducing weight, helps to carry out movements in a larger volume, strengthen the muscular corset and the vascular system.

It is necessary to restore the correct pacing stereotype, for these purposes a robotic walking simulator is used. For correct distribution of the load during movement, it is recommended to wear individual insteps that the orthopedist will pick up.

At this stage, the total amplitude of movements in the ankle joint should be restored.


To improve the trophism of tissues and accelerate the process of consolidation of the fracture, magnetolaser therapy is prescribed, magnetotherapy, infrared irradiation and massage, with external fixation apparatus - segmental massage.

After internal osteosynthesis in the absence of contraindications, it is advisable to prescribe hydrotherapy (pearl, oxygen baths, underwater massage) and thermal procedures (paraffin, ozocerite).

It is worth noting that the fears of traumatologists regarding the possible overheating of metal structures during the thermal therapy with paraffin, ozocerite and mud are not justified. It is proved that there is a system of thermoregulation of the organism, which will allow the heat to be redistributed in the tissues, and not accumulate in the field of metal parts.

In addition, the UHF electric field is applied in the pulsed mode, high-intensity magnetotherapy (magnetic stimulation), electrical stimulation.
If the patient has a pain syndrome, electrotherapy (DDT, CMT, electrophoresis) can be prescribed.

You can not

In metalloesteosynthesis, the appointment of ultrasound therapy and inductothermy is contra-indicated, Ultrasonic vibrations create a cavitation effect on the medium-metal interface with the formation of instability.

In addition, an alternating magnetic field of high frequency (inductothermy) can cause overheating metal structures and resorption (absorption) in bone tissue with the formation of instability in the area adherence of metal to bone.

The third stage: rehabilitation of residual phenomena

When the fracture is consolidated, it is possible to expand the motor mode: to engage on a treadmill in fast walking mode, to add jumps to training and to conduct usual household activity.

The ankle joint should be fixed with an elastic bandage or use specialized orthoses to unload and hold the joint in a physiological position.

In shoes, it is recommended to put insole-supinator to prevent the development of flat feet.


At this period is appointed according to the indications: thermal procedures (paraffin, ozocerite, mud), KUF, darsonvalization, ultrasound therapy, laser therapy, electrotherapy (including stimulation), baths (including underwater massage), massotherapy.

Full load on the limb is allowed on average after 10 weeks, depending on the type of fracture, the presence of complications and concomitant pathologies.

If the patient has an external fixation device, then after lifting it, the load on the limb should be reduced by 1/3, followed by a gradual increase in it within 2-3 weeks. This will ensure a smooth adaptation of the injured leg to the usual load before injury without the risk of possible complications.

In the case of slow fracture fusion, extracorporeal shock wave therapy is possible.

Contraindications for massage and physiotherapy

If the patient has the following conditions, physiotherapy should not be prescribed, since there is a risk of complications:

  • the general severe condition of the patient;
  • unstable fracture;
  • bleeding and addiction to them;
  • the presence of neoplasms;
  • decompensation of chronic diseases;
  • acute pathology;
  • mental illness that makes contact with the patient difficult;
  • blood pathology;
  • purulent process without outflow of contents;
  • relative contraindication: pregnancy.

Complications of ankle fracture

At different stages of the fracture, the development of complications is possible, a careful attitude towards the patient (or to himself) will help prevent the worsening of the condition or be quenched in the early stages:

  • suppuration of a postoperative wound;
  • trauma during surgery of vessels, soft tissues;
  • formation of arthrosis;
  • postoperative hemorrhages;
  • necrosis of the skin;
  • embolism;
  • delayed consolidation;
  • improper fracture fusion;
  • formation of a false joint;
  • subluxation of the foot;
  • posttraumatic foot dystrophy;
  • thromboembolism.

Complications with proper treatment are infrequent, much depends on the patient: from the exact implementation of instructions received from doctors, properly built rehabilitation process and motor mode.

So, at each stage, a complex of rehabilitation measures, provided it is correctly formed, can lead to a faster and more efficient recovery of the patient with an ankle fracture.

A source:

Fracture of ankle with displacement - operation with fixing plate

The ankle is the most fragile part of a person's legs. Slips of slender girls and an elegant structure of bones are especially susceptible to injuries of various kinds.

Fractures can result in a jump from a height with an unsuccessful landing, a sharp turn of the foot, an unexpected turn of the joint, a sharp blow. Given the traction of the ends of several bones, fractures often result in a displacement of the damaged bone.

Therefore, the operation is performed using a titanium plate, to which the surgeon fixes the connected parts of the bones.

Pattern of fracture and plate mounting

Fracture of ankle with displacement

The processes of the lower tibia bones enter the internal structure of the ankle group. Outside, they are attached to the fibula, from the inside - to the tibia, thus forming an "ankle" fork, on both sides limiting and protecting it.

You will be interested in:Paraparesis of the lower extremities: what is it?

The medial joint plays a significant protective role, it is also the triple burden - from the weight of a person, from the dynamics of movements, from prolonged stress.

Therefore, trauma causes a double fracture of the ankle with an offset, which leads to the need for a fairly complex operation.

A fracture in the ankle is a serious matter. Joints of bones and tendons fuse together long, painfully. The doctor decides to handle the injured leg.

The installation of a metal plate is recommended during an operation on an ankle fracture. If the deformation of the ankle joint is accompanied by the displacement of the bones, then during the operation the surgeons apply a titanium plate to join the bone debris.

This is an obligatory operating element, a real bone installation, if from the inside there is a detachment from the top of the ankle. The patient walks with the plate for several weeks, months, until the bone is fully coalesced, as seen in the control X-rays.

After that, the plate is removed, and the second period of rehabilitation begins.

How long is the hospital after the operation at the fracture of the ankle with displacement, first the doctor who prolongs the sick leave, then - the medical advisory commission that establishes the degree incapacity for work.

Symptoms of fracture with displacement

Closed fracture with displacement

Characteristic symptoms are manifested directly in the minute of injury. They are very expressive: unbearable pain in the limbs, loss of control of movements, lack of support on the foot, visible deformation of bones.

Palpation at the site of injury causes an audible crunch of bone fragments. It is impossible not to step on foot, but simply to control its movement. Such symptoms allow the doctor to make a preliminary diagnosis: a fracture with a shift.

If the ligaments are damaged, the fracture is accompanied by a dislocation, and noticeably the displacement of the foot, its pivot inward or outward turning.

The activities of the person who provides first aid should be well-trained and clear. The victim is urgently required to provide first aid in case of trauma, to inject an anesthetic medication, to wipe whiskey with ammonia, half diluted with water.

Diagnostics includes X-ray examination, in which images are taken in several projections. This helps to visualize all the bone fragments, their location, the direction of the shift.

The modern types of examination - CT, MRI, ultrasonic three-dimensional scanning - clearly and precisely show the fracture pattern.

A detailed examination is required to select the procedure of the operation, to solve together with the osteosynthesis, plastic alignment of the damaged ligaments.

To help the doctor stop in choosing a certain technique of the operation, a comprehensive examination and monitoring of the general condition of the patient helps.

After a double fracture of the ankle with displacement, the operation is performed in accordance with the complexity of the patient's condition, based on this, anesthesia is chosen, either general or spinal.

Regardless of the general condition of the patient, treatment and the postoperative period is carried out in the hospital for a long time - the patient needs to lie as much as the attending physician will say, before the bones are joined.

Types of Ankle Fractures

A variety of ankle injuries give fractures that are classified according to specific signs:

  • closed, with the preservation of skin;
  • open, with damage to the skin.

Both types of fractures occur both on the external and internal ankle, or a bilateral fracture is diagnosed.

Injuries are classified according to the type of damage:

  • with fragmentation of bone;
  • occurred in a helical direction;
  • with fragments;
  • torn;
  • fractures combined with dislocation and subluxation of the foot, with damage to the ligaments.

All types of fractures are gross injuries, accompanied by visible external changes in the ankles, severe pain. It requires the help of a surgeon who will compare bone fragments, if necessary, perform osteosynthesis.

Using a titanium plate

A greater number of fractures in the ankle area occur with the displacement of fragments, trauma of ligaments and tendons.

The task of the surgeon is to conduct effective surgical treatment, restore the anatomy of the bones, the sites of their articulation.

For this, the doctor reliably fixes the joint fragments by osteosynthesis, that is, restores the integrity of the bones with the installation of a titanium plate to help the bones to fuse properly.

Methods of osteosynthesis are:

  • closed, extra-focal;
  • open.

A closed method involves the use of metal spokes. They must be installed without opening the site of damage, above and below the injury.

Then, the spokes go to the staples of Ilizarov's apparatus, intended for long-term fixation of fragments of bones. The device is adjusted with screws, bolts, after the surgeon moves the fragments of bones under the X-ray.

The device must be worn until the bones coalesce, which is shown by X-ray images of the formation of bone calluses at the site of injury.

Osteosynthesis of an open type is much more common, when a surgeon compares fragments, removes debris, releases clamped soft tissues.

Remove bone fragments carefully, without leaving the slightest - this is a prerequisite for carrying out the operation by any method. Combined bones doctor rigidly fixes a plate, equipped with several holes and screws.

The time of healing of a bone depends on how accurately the surgeon produces a combination of broken fragments.

The price of the operation is determined by the use of the fixation device: if Ilizarov's apparatus it is used repeatedly, only the consumable material changes - spokes; then titanium plates are used only once. The cost of the entire operational complex includes the sum of the prices only for consumables.

With a double fracture, the intramedullary method is used, when a metal pin is inserted directly into the bony canal.

Over time, the practice of traumatology introduces the latest techniques for osteosynthesis. Intra-articular lesions are combined during the operation using the method of arthroscopy.

With it, joints are not opened, and small incisions are made to insert a probe with a video camera and special tools.

Through the incisions, small fragments are removed, the chamber illuminates the places of infringement of soft tissues for their release, the fragments are fixed. All the surgeon's actions are accurate, accurate, correct.

Old bone fractures in the ankles after their incorrect fusion are accompanied by the development of irreversible deformities of the ankle joint.

Develops arthrosis, contracture, there is a complete immovability of the ankles.

Any changes in the structure of the bony joint of the ankle are accompanied by severe pain.

In this case, patients are offered surgical intervention aimed at returning the mobility and physiological structure of the ankle.

An operation is performed - arthrodesis of the ankle, where the joint must first be broken, then closed, completely immobilizing it.

The recovery should begin immediately after the operation, even when the plate is installed.

Recovery period

Ankle replacement

Rehabilitation after an ankle fracture with displacement after surgery lasts individually, the period depends on the ability of the body to recover from the age of the victim, and continues after removal plate.

Fixation of the ankle when inserting the plate on an ankle fracture with displacement is performed for a long time, for, -3 months. Therefore movements are activated in the knee and hip joint. This is necessary so that the circulation of lymph and physiological fluid does not stagnate.

Exercises are carried out lying and sitting, it is important to dispense with crutches, not leaning on the operated leg.

It is necessary to perform a complex of respiratory gymnastics, which activates blood circulation and oxygen supply of cells. Hip massage is connected with the same purpose - to improve the flow of blood to all parts of the leg.

It is necessary to carefully and conscientiously do everything that the attending physician will appoint to achieve an effective result of rehabilitation.

When the plaster cast is removed, the development of the ankle joint begins with a gradual increase in the load. Physiotherapeutic procedures are carried out - ozocerite, baths, acupuncture.

After the doctor will allow to step on the operated leg, it is necessary to use orthopedic insoles for damping the load on the joint.

Connects exercise, only under the supervision of an experienced coach, so that gradually the patient could fearlessly stand on a sore leg. The number of repetitions of physical exercises is gradually increasing.

Complex professional treatment after surgery at ankle fractures with displacement leads to restoration of the functions of articulation of the ankle, prevents complications and repeated traumas. After completion of rehabilitation, the doctor appoints the day of plate removal.

The home recovery period includes continuation of treatment, implementation of the recommendations of the physical education so that the affected leg can safely heal in good conditions of care and rehabilitation activities.

Injuries of the ankle become more frequent due to the fact that there are many new wonder-devices - rollers with a low boot, skateboards with moving fastening boards, snowboards, longboards, fribords, hoverboards, gyroskutery, scooters... Rotary movements to control such a mobile device increase the possibility of injury ankle.

A source: