The EMC Center for Traumatology and Orthopedics performs the diagnosis and treatment of injuries and injuries to the musculoskeletal system, including ankle fractures, one of the most common intra-articular fractures that occur with excessive supination (turning the sole of the foot inward), pronation (lowering of the arch of the foot), adduction (bringing towards the central axis of the body) or abduction (withdrawal from the central axis of the body).
Classification of fractures
The most widely used classification of AO (Arbeitsgemeinschaft fur Osteosynthesefragen from German - Osteosynthesis Association), according to which the following types of ankle fractures are distinguished:
Damage in the area below syndesmosis:
- isolated damage;
- with a medial ankle fracture; with a fracture of the posteromedial margin.
Fibula injuries at the syndesmosis level:
- isolated fracture;
- with medial injuries; with medial injuries and a fracture of the posterolateral margin.
Lesions in the area above syndesmosis:
- diaphyseal simple fibular fracture;
- diaphyseal comminuted fracture of the fibula; proximal fracture of the fibula.
There is also a distinction between open and closed ankle fractures.
Diagnosis of ankle fracture
A preliminary diagnosis can be made based on the symptoms of ankle fractures, which include pain, deformity of the foot in the ankle joint and discoloration of the skin. To confirm the diagnosis, it is necessary to undergo a clinical examination, including palpation of the proximal tibio-fibular joint, as well as the bones of the lower leg along the entire length, and the ligamentous apparatus of the ankle joint.
In order to determine the type of fracture and the degree of ligament damage, it is necessary to undergo an X-ray examination, which is performed in lateral and antero-posterior projections. Note that X-rays of the entire tibia can reveal a fracture in the proximal tibia or dislocations in the proximal tibia-fibula joint.
In the case of an isolated fracture of the inner ankle, an isolated fracture of the posterior edge of the tibia, or a rupture of syndesmosis, damage to the interosseous membrane may occur, as well as a fracture of the upper third of the fibula.
Sonography and arthrography are performed to assess the condition of soft tissues.
Conservative treatment of ankle fractures
Target conservative treatment is the accurate anatomical restoration of the disturbed proportions of the elements of the ankle joint, as well as their reliable fixation and healing of damaged ligaments. Conservative treatment is indicated for ankle fractures without displacement, as well as for severe concomitant diseases or poor soft tissue condition, when surgery is contraindicated. Conservative treatment of dislocated ankle fractures is possible if the general condition or local changes do not allow surgical treatment.
Single-stage closed ankle fracture reposition is used most often. During reduction, it is extremely important to know exactly the location of the fragments. The anteroposterior and lateral projections of the X-ray image give the most accurate picture of the position of the fragments and the foot, according to which the fracture is corrected. The reduction takes place under local anesthesia. In more severe cases, intraosseous anesthesia and/or intubation anesthesia with relaxants are used.
After the fracture is repaired and a plaster cast is applied, control radiographs must be taken in the anteroposterior and lateral projections.
Surgical treatment of ankle fractures
The most favorable time for osteosynthesis is the first 6-8 hours after injury, before the formation of large edema. Otherwise, the operation will be performed after the edema subsides - 4-6 days after the fracture. Before surgery, the fracture should be fixed with a dissected plaster cast or with skeletal traction.
Treatment of open ankle fractures is carried out in accordance with the general rules for the treatment of open fractures. Internal osteosynthesis is performed after healing of soft tissue wounds.
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