ankle fractures

A broken ankle bone can involve breaking one or more bones, as well as causing injury to the surrounding connective tissue (ligament).

Anatomy of my ankle

The top of the ankle consists of three bones:
• The shinbone (tibia),
• The other bone of the lower leg, the shin bone (fibula),
• Ankle bone (talus).

The foot bones sit in a scoop around the top of the ankle joint. This allows the foot to bend up and down. In the lower right part of the ankle joint, another joint that connects the ankle bones to the heel bone (calcaneus) is the subtalar joint. The joint allows the foot to swing back and forth. Three ligaments of fibrous tissue connect the bones and provide stability to both joints. The rounded protrusions you can feel on either side of the ankle are the last points of the bones of the lower leg. The protrusion on the outside of the ankle (lateral malleolus) is part of the shin bone (fibula); The smaller protuberance (medial malleolus) on the inside of the ankle is part of the shinbone (tibia).

Fracture Symptoms

Any of the three bones that make up the ankle joint can be broken as a result of a fall, a traffic accident, or other trauma to the ankle. A severe ankle sprain masks the signs of a broken ankle, so any ankle sprain should have the ankle examined by a doctor.

• Severe pain,
• Inflatable,
• Bruising,
• Sensitivity by touch,
• Inability to step on one’s foot,
• Ankle deformity, especially if there is a dislocation of the joint (bone dislocation), as well as a fracture.

Such symptoms may indicate a fracture in the ankle. In a broken ankle, the ligaments can also be destroyed. Your doctor will order your X-rays to find the exact location of the fracture. Sometimes a computed tomography (CT) scan or bone scan may also be required.

Treatment and Rehabilitation

If the fracture is stable (not separated) (no ligament damage or joint death), it can be treated with a leg cast or support device. In the end, a broken ankle takes six weeks to heal, and it may take many months for you to return to exercise at previously competitive levels. Your doctor will likely order X-rays during recovery to make sure of any changes in your ankle or pressures that are causing changes in the bones.

If the ligaments are also torn, or if the fracture is a detached fracture, surgery may be needed to fix the bones together so that the bones can heal properly. The surgeon may use a plate, metal, or absorbable screws, wires, or tension bands to hold the bones in place. The range of motion exercises are important, but it is more important not to put any weight on the foot and not to step on the foot until the specified time.

A child with a broken ankle should be monitored regularly for more than two years to ensure that growth is progressing smoothly without the development of deformity or uneven foot length.

TALUS FRACTURE

The talus is a small bone located between the heel bone (calcaneus) and the two large bones of the lower leg, the tibia and fibula. Where the talus meets the foot bones, it forms the subtalar joint, which is very important in walking on uneven places. The talus is a very important connecting bone that helps transfer weights and pressures between the foot, leg and body to the middle of the ankle joint.

Although most talus injuries result from motor vehicle accidents, falling from a height can also injure the talus. These injuries are often associated with lower leg injuries.

Signs and Symptoms

The most common symptoms of talar fractures are:

• Difficulty putting weight on the foot
• acute pain
• Significant swelling and tenderness

The risk of infection increases in talar fractures (open fractures) that protrude through the skin. Injuries by snowboarders can be mistakenly confused with talar fractures due to the tenderness and excessive bruising of the outer side of the ankle caused by a sprained ankle.

Diagnosis

Your doctor will ask you to manually examine your foot and describe what the injury was like. He or she will take X-rays of your feet and ankles. In some cases, a computed tomography (CT) scan may be needed. These examinations will show the exact location of the fracture. These tests will also show that the bones are still, regularly, in place (nondeplaced fracture) or displaced (displaced fracture). In the detachment of a tiny piece of bone, the fracture must be identified, as the fragment must be removed.

Your doctor will check the function of the nerves of the foot to make sure there is no damage. At the same time, he or she will want to make sure there is enough blood flowing to the toes and that there is no pressure building up in the foot muscles (compartment syndrome).

Treatment

A talar fracture that is left untreated or does not heal properly will create problems for you in the future. Your foot functions will be weakened, you may develop arthritis or persistent pain, or bone collapse may occur.

In talar joint fractures; A well-padded splint should be applied, covering the foot and leg from the toe to the top of the calf. Raise your foot above heart level and apply ice every hour for 20 minutes or until you see a doctor. Never put any weight on the foot.

In rare cases, if x-rays show that the bones are not displaced and the bone alignment is intact, talar fracture; can be treated without surgery. To treat your fracture, your foot and leg will be placed in a cast for six to eight weeks. During this time, you should not step on your feet. Afterward, your doctor will give you some exercises to restore the range of motion and strengthen your foot and ankle. Most talus fractures require surgery to minimize late complications. Your orthopedist will realign the bones and use metal screws to hold the pieces together. If small pieces of bone are detached, it may be necessary to use bone grafts to remove these broken pieces and restore the structural integrity of the joint.

After surgery, your foot will be placed in a cast for six to eight weeks and you will not step on your feet until the end of three months. Once the bones begin to heal, your orthopedist may order Magnetic Resonance (MRI) to see the amount of blood returning to the bone. If the blood supply is impaired, the bone tissue may die and the condition defined as Avascular Necrosis or Osteonecrosis will occur. This causes the bone to collapse. Even if the bone is healing properly, you may still be living with arthritis years later. Most talus bones are covered with articular cartilage, which allows the bones to move flat against each other. If the cartilage is destroyed, the bones will rub against each other bone; pain and stiffness will occur. Treatments of arthritis; activity changes include ankle-foot orthoses, joint fusion, bone grafting, and ankle joint replacement.

HEEL FRACTURES

The heel bone (calcaneus) is not easy to break. Because although it requires a lot of strength, such as in severe motor vehicle accidents or falling from a height, heel fractures can also occur in other injuries such as rear-side injuries.

Signs and Symptoms

• Difficulty putting weight on the foot
• Pain

The pain may be focused within the heel tissue, especially when you step on your foot. Or it may be localized on the outside of the ankle, just below the fibula, which is one of the lower leg bones. Your foot may develop swelling. Contact your orthopedist immediately, because if the bone heals improperly, serious problems can occur in the future.

Diagnosing a Heel Fracture

Your doctor will pinpoint the exact area of ​​pain and tenderness. X-rays of the ankle areas will also be taken. In addition, sometimes a computed tomography (CT) scan may be required. If you are also experiencing pain in the back of the heel, your doctor may also order an X-ray of the lower leg to see if there is a fracture.

The nerves that bring sensation and movement to the foot pass very close to the heel bone. Your doctor will check the function of the nerves to ensure there is no damage to the nerves. The doctor will also want to make sure that there is enough blood flowing to the fingers and that there is no pressure building up in the foot muscles (compartment syndrome).

Treating Heel Fractures

If the pieces of the broken bone have not slipped out of place, surgery is not needed.

• It is important to raise your foot above the level of your heart so that it does not swell, and to wrap it with a huge compress so that the bones do not move.
• Ice packs are applied every one or two hours for 20 minutes to reduce pain and swelling.
• Your doctor may apply a splint for one to three weeks until the swelling goes away. Next, the doctor may give a removable splint and describe some exercises to maintain flexibility and mobility.

You should not put any weight on your feet until your bone heals completely (6-8 weeks).

Surgical Treatment and After

If the bones are displaced outward (displaced fracture), you will most likely need surgery. Bone graft can be used to heal the bone. A metal plate and small screws are used to hold the bones in place. The surgical site will be bandaged and a splint will be applied until it heals. You will then begin using a removable splint so that you can begin your ankle exercises. You should not put any weight on your feet until approximately 10 weeks after the operation. You may need to wear a special cane and special boots when you start walking. Full recovery may take up to a year after the injury. Depending on the type of job you do, you may not be able to return to the same type of job. Even if your healing is smooth, your heel may never be the same as it was before the injury because of the amount of force required to break the heel bone. Your heel may continue to be stiff, so you can use a heel lifter that raises the heel, or you may need special shoes, such as a cup with an extra-deep section for the toes.

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