Ankle arthroscopy: preparation for surgery

Last Updated on 07/06/2017 by Perelomanet

The ankles are the lower end sections of the tibia bones of the leg, which are part of the ankle joint. One of them is external, it belongs to the fibula, and the other is internal and is the end of the tibia. The limiter of the ankle joint is the so-called “fork”, consisting of two ankles. Since the ankle bears the main load of the whole body, injuries involving it often occur, especially in people whose age exceeds 60 years.

Kinds

A displaced ankle fracture can be open or closed. Regardless of this, there is a fracture of the outer ankle and an inner one, or a fracture of two ankles at once. There are also different forms of injury:

• tear-off;
• splintered;
• helical;
• rotary;
• fragmented;
• fracture with dislocation.

Such fractures are considered severe. They are accompanied by severe pain, changes in the shape and appearance of the damaged limb.

Causes of ankle fractures

As a rule, people who have reached retirement age most often undergo such fractures, since their bones have weakened and at the slightest overload the joint cannot withstand and damage occurs. Also reasons may be:

• an unfortunate incident while performing physical exercises;
• sloppiness;
• extreme sport;
• ice

During a displaced ankle fracture, there is a risk that the bone will crumble and bone fragments will move in different directions.

There are cases when, when damaged, small parts of the bone are formed, which over time fall into the soft tissues and, accordingly, provoke their ruptures (open fracture).

Rehabilitation

The minimally invasive nature of the procedure allows you to quickly return to your normal life. This is facilitated by therapeutic physical education. Exercise helps strengthen muscles and restore blood flow. The rehabilitation plan is purely individual, it is drawn up by the attending physician, giving a gradual load on the joint and prescribing the necessary medications.

It is possible to return to full-fledged sports after 3-6 months, and any risks of relapse can be eliminated only after a year. You yourself can contribute to effective recovery by regularly consulting with a specialist and practicing at home.

Symptoms and diagnosis

Symptoms of a displaced fracture appear immediately and therefore, at the slightest manifestation, you must immediately seek help from a specialist who will conduct an examination and prescribe the necessary treatment.

Doctors strongly recommend not to delay going to the hospital, because if you do not get treatment in a timely manner, then damage to blood vessels and nerve endings is possible, which will subsequently lead to complications and a simple fracture will develop into chronic paralysis.

Symptoms:

• acute pain at the site of injury;
• limb deformity;
• swelling and swelling;
• traumatic shock;
• bruising;
• body temperature exceeds normal.

Once you go to the hospital, the doctor will need to give you an accurate diagnosis and prescribe specific treatment. Before this, he must carefully examine the site of the damage and carry out all the necessary examination methods. To find out what the nature of the damage is and in which direction the displacement is directed, it is necessary to use precise diagnostic instruments - CT, MRI, ultrasound, X-ray, etc.

Possible complications

Complications can occur in very rare cases, and even more so due to an incorrect diagnosis or very late and poor-quality treatment. For example, if for some reason the stitches come apart, creating an open wound. An infection can easily get into the wound and cause an inflammatory process. But in order for this to happen, you probably need to escape from the hospital on the day of the operation.

One of the real threats is improper fusion of the ankle. This leads to the development of arthrosis and joint deformation. The process is accompanied by regular swelling, as blood circulation is impaired and, as a result, lameness appears. Another scenario: hemorrhages into the joint cavity, sprained ligaments and the effects of anesthesia (nausea, dizziness). All sensations should be reported to the doctor.

Complications occur in 0.1% of cases out of a hundred. But the most important thing to remember is that the tendons, nerves and blood vessels remain intact. And it is very easy to avoid any complications: you need to strictly follow the recommendations of your doctor, especially in the first weeks of rehabilitation.

Treatment for a fracture

The severity of the ankle injury determines what treatment your doctor will prescribe for you - external or surgical. For both treatments, the first step is to correct the bone displacement. Otherwise, the bone may simply not heal, not return to its previous appearance and not restore its functionality.

Conservative treatment has many disadvantages, since it does not provide full access to the injury; with this type of treatment, it is impossible to adjust the subluxation and much more time for rehabilitation will be required.

In addition, treatment without surgery is notorious for its pain. On the first attempt, it may not be possible to correct the displacement and you will have to go through the bone realignment procedure again, which, as we know, brings quite unpleasant sensations. If conservative treatment is incomplete or incorrect, a simple fracture can lead to various complications and cause deforming arthrosis of the ankle joint. This type of treatment is prescribed when surgery is not possible due to the patient’s health problems and his low chance of being able to undergo surgery.

X-ray of the ankle after osteosynthesis

Often, ankle fractures occur in conjunction with ligament rupture and divergence of the ankle joint, and a complete restoration of the anatomical integrity of the tibia is required, but with external therapy this is simply impossible (fixation with osteosynthesis is required). The doctor selects the type of osteosynthesis individually for each person; the choice depends on the severity of the injury. There is an open and closed method of osteosynthesis.

When closed, the fracture site is not exposed. Metal spokes, placed above and below the fracture, are connected to the clamps of the compression-distraction apparatus. The device, adjusted with screws, moves the fragments in the desired direction.

The open type of osteosynthesis is mainly used. This type includes open comparison of bone fragments, their removal and interposition between soft tissue fragments. After this, the bones are fixed using screws and a plate with holes.

The main thing in this method is the correct modeling of the plate and fixation so that the screws do not penetrate into the joints.

When is arthroscopy prescribed?

Ankle arthroscopy is prescribed for severe injuries, failure of conservative treatment, or lack of effect from taping or elastic bandages for a long time. The procedure is prescribed by the surgeon. The reason for the operation may be:

• development of deforming arthrosis of the joint or its chronic, advanced stage;
• damage to cartilage tissue, its detachment;
• unstable joint condition;
• pain of unknown etiology;
• synovitis of various nature;
• chondromatosis;
• arthritis;
• impingement syndrome.

The procedure can be both a diagnostic method and a therapeutic one. Diagnostics using an arthroscope allows you to assess the condition of the joint and its structures, determine existing pathologies and the state of their development, take tissue samples for analysis, and clarify the existing conclusion.

Surgical intervention is necessary to excise individual fragments, remove adhesions, tissue or bone growths, synovial membrane (full or partial), replace damaged areas, and compare pieces of destroyed bones.

Treatment of a fracture with a plate

The purpose of plate surgery for a displaced ankle fracture is to:

• connection of bone fragments;
• realign displaced ankle bones;
• restore the integrity of the ligaments;
• repairing the resulting damage.

The operation is performed under anesthesia. Experts compare the ankle and its fragments with a pin or screw. If the deltoid ligament is torn, it is sutured along its entire length.

Titanium plates for fractures are used if the examination revealed a separation from the top of the inner malleolus. Such a plate is fixed on a specific bone fragment.

The time for using the plate depends on the severity of the injury and ranges from 1.5 to 3 months. After complete restoration of the bone, the plate must be removed, since it is a foreign body and the human body will reject it. After completion of treatment, unpleasant rehabilitation will be required, which is also an important component of the effectiveness of the results obtained from therapy.

How is the operation performed?

Ankle arthroscopy is performed under either local or general anesthesia, depending on how large the area being operated on is and how complex the problem is. The operation time also depends on this – from 30 minutes to 3 hours.

The shin is secured with a stand at the required height and several access incisions are made to insert instruments. Just as during shoulder surgery, a saline solution is injected to improve the visibility of the device. The surgeon's assistant stretches the joint space in the ankle so that the doctor can insert the arthroscope.

The image from the device is broadcast on a large screen, allowing you to examine the joint and periarticular space in detail.

At the end of the operation, the joint cavity is cleared of excess fluid introduced initially and filled with a healing solution. The incisions are closed with sutures and a sterile dressing.

Postoperative rehabilitation

• Rehabilitation after an ankle fracture

After plate surgery has been performed for a displaced ankle fracture, the person should be fully rehabilitated. The outcome of treatment and the restoration of functionality of the ankle joint depend on the quality of the rehabilitation period.

The wounds will take the first couple of weeks to heal. During their healing period, dressings need to be done from time to time. In some cases, in order to provide rest to the bruised limb, a cast is applied. This will make it impossible for the patient to move around and may require the use of crutches to increase comfort.

From three to eight weeks after surgery, incomplete recovery occurs. During this time, the use of crutches is stopped, but stress on the affected joint is undesirable. It is recommended during the recovery period - exercise therapy. Rehabilitation therapeutic exercises are an excellent way to get rid of inconvenience and the risk of complications; it is an opportunity to fully recover in the shortest possible time.

Your health depends only on you. If you approach the problem of a fracture seriously and in a timely manner, you can avoid long-term and improper healing, and also significantly reduce the risk of unpleasant complications.

Preparation for surgery and contraindications

The first consultation is given by an orthopedic surgeon. He examines the sore spot and prescribes additional diagnostics: X-rays, MRI, ECG, fluorography. There are contraindications for ankle arthroscopy, so it is important for your doctor to know everything about your health.

Contraindications are divided into two groups: relative and absolute. Relative contraindications imply pre-treatment. For example, hidden damage to the ligaments and joint capsule or hemorrhage into the joint cavity. This group also includes somatic disorders. For women there is an additional point - the operation is not possible during menstruation.

List of absolute contraindications:

• intolerance to anesthesia;
• cavity fusion;
• purulent infection;
• infectious skin diseases;
• pathologies of the cardiovascular system, diabetes mellitus;
• progressive dystrophic pathology of cartilage tissue;
• HIV, hepatitis;
• herpes;
• colds.

To detect contraindications, you need to consult a general practitioner, who will make a conclusion based on a general and biochemical analysis of blood, urine, a test for the presence of hepatitis and HIV, and the testimony of an anesthesiologist. People who have had a heart attack or stroke need to visit a neurologist or cardiologist.

You will have to prepare for the operation not only mentally, but also physically. A light diet is recommended a few days before surgery, abstinence from alcohol for 10-15 days and complete absence of food 12 hours before the introduction of anesthesia. You need to take care of crutches in advance, because in the first postoperative days, stress on the sore joint is excluded.