A trimalleolar fracture is a violation of the integrity of the ankle joint, in which both ankles and the extreme part of the tibia are injured. Among all pathologies of this type, a trimalleolar fracture is considered by doctors to be the injury with the greatest severity. The results of treatment in this case are very important, as they determine the further functioning of the ankle joint.
What is a trimalleolar fracture
A displaced trimalleolar fracture is an injury to three components: the outer malleolus (fibula), the inner malleolus (tibia), and the posterior edge of the tibia. The combination of anatomical structures listed above constitutes the ankle joint.
When a fracture occurs, bone fragments are displaced and disrupt the relationship of the articular surfaces. At the first signs of a fracture, it is important to consult a specialist in time and eliminate the pathology. If this is not done, the patient will develop severe deforming osteoarthritis of the ankle joint.
People at risk for this injury include:
- Elderly people (over 60 years old);
- Motorcyclists, drivers and passengers of cars who do not wear a seat belt;
- Builders, climbers and patients whose profession involves working at a height of more than two meters;
- Patients suffering from osteoporosis;
- People who skateboard or ski;
- Professional speed skaters or figure skaters.
Injuries are caused by excessive twisting, flexion and extension of the joint, turning the foot inward or outward, falling from a height, and road accidents.
Symptoms
The clinical picture largely depends on the nature of the damage. Doctors identify a number of common symptoms by which pathology can be recognized:
- Deformation of the ankle joint, due to which the foot noticeably changes its shape.
- Paleness of the skin in the affected area.
- Severe pain when touching or walking.
- Numbness of the foot or entire limb (noted when nerve fibers are damaged or blood vessels are damaged).
- Tension of the skin over the area where the fracture is located. When the fragments are displaced, the skin is injured and may even tear.
- Decreased or loss of motor abilities. In some cases, the patient cannot even move his fingers.
- Formation of hematomas - accumulations of blood in places where blood vessels rupture. If left untreated, the symptom worsens, causing the hematoma to affect the toes.
Patients suffering from a trimalleolar fracture complain of severe swelling. The leg becomes deformed and swells. This occurs due to injury to the ligaments and joint capsule. Synovial fluid and blood accumulate in the affected area, which leads to the formation of edema.
Even with the listed symptoms, the pathology can be mistaken for a sprain. To clarify the diagnosis, the patient is sent for an X-ray examination.
Diagnostics
| Diagnosis of a fracture | |
Clinical data:
| Posterior subluxation of the foot is visually determined |
| X-ray data. |
|
First aid
Self-treatment of a fracture at home is unacceptable. Trying to change the position of the leg or realign a bone can aggravate the condition and make the person disabled. At the first signs of the disease, it is recommended to immediately consult a traumatologist. Before the ambulance arrives, you can provide first aid to the person:
- To prevent severe swelling, apply ice to the affected area. This must be done carefully and always over clothing. A medical ice pack is applied for 25 minutes. After this, you need to take a break for 15 minutes and apply a cold compress again. If you keep ice continuously, a side effect will occur - tissue hypothermia.
- Give the person pain medication. To relieve pain, the patient can be given tablets from the group of non-steroidal anti-inflammatory drugs. These include Ibuprofen, Nurofen, Ketanov or Nise. Before giving the patient a pill, read the list of contraindications and ask the patient if he has one of the listed diseases. Consider the presence of allergic reactions and intolerance to components.
- Pay attention to the symptoms that occur as a result of the fracture. If you are providing first aid to a person with a chronic illness, ask about their condition. If necessary, give him medications that the patient must take regularly.
It is not recommended to feed or water the victim until the ambulance arrives.
When doctors arrive, inform them about the care provided and the general condition of the patient. If you have information about the nature of the injury and the conditions under which the fracture occurred, share this with specialists. This will help them choose treatment tactics.
Fracture treatment
If the patient is diagnosed with a non-displaced ankle fracture, it is enough to apply a plaster cast to the affected area. The cast fixes the foot in a horizontal position, holds the bones in the correct position and sets the fragments until a callus forms.
The bandage is applied at the beginning of the tibia and extended to the knee. 2-3 days after fixation, a special stirrup is attached to the patient, which helps the patient when walking. The duration of wearing the bandage is from 6 weeks to three months.
Bone reduction
If a dislocation is diagnosed during an x-ray examination, the patient undergoes reduction. The procedure involves returning the bones to the place from which they were displaced. Reposition is prescribed to patients in cases where displacement has occurred by more than a third of the bone diameter.
Reposition is divided into closed and open. In the first case, we are talking about a traditional method of treatment without surgery. Open reduction is a surgical procedure.
Closed reduction
Closed reduction is prescribed in cases where the skin remains intact and completely hides the fracture site. For minor or transverse fractures, the surgeon and his assistant perform the procedure manually. This process is carried out as follows:
- The initial process of reduction is called traction. It involves stretching a limb. The task of the trauma surgeon is to align the axis of the broken bone. To do this, the doctor and his assistant move the bone fragments around the axis until the required distance is formed between them.
- While the doctor works with the fragments, his assistant holds the limb in the joint above the area in which the fracture is located. This is necessary in order to create the effect of stretching the limb.
- Once the doctor achieves diastasis (the required distance between bone fragments), the next step is to rotate the limb along the axis. This is done by palpation (palpation). By palpating, the trauma surgeon compares the fragments and achieves maximum correspondence between the fragments and the bone, due to which the displacement is completely eliminated.
The disadvantage of closed reduction is the lack of fixators and the likelihood that the fragments will not fit together accurately. In this case, repeated reposition is often prescribed, which is performed surgically.
Open reduction
This procedure is prescribed for open fractures or multiple injuries that can no longer be reduced. With a large number of fragments, it is no longer possible to make a correct comparison using palpation. Comparison of fragments is possible only with exposure of bone tissue and visual inspection of the affected area.
The advantage of open reduction is the ability to securely anchor the bone. To fix the bone, the doctor installs one of the following elements:
- Kirschner wires;
- Metal plates;
- Special screws.
Doctors consider the Ilizarov apparatus to be the most popular and reliable method of bone fixation.
The bone is secured using 4 external fixation rings. The latter are attached to special knitting needles, which are installed and pass through the fragments, allowing them to be held in one position.
Other advantages of the operation are reliable fixation, the ability to move joints and walk already on the 3rd day after surgery. This gives the patient the opportunity not to interrupt his usual lifestyle and go to work, but physical activity must be limited during the first month after surgery. The disadvantage of this method is that the metal completely penetrates the bone and can cause osteomyelitis, an infection of the bones.
Important Tips
Physical therapy will be more beneficial if you take care of auxiliary recovery techniques. Let's consider the main ones:
- Go for a massage to a specialist or do it yourself twice a day. Stroke, squeeze, knead and shake your leg. Repeat each technique 10 times, but do it in such a way that it does not hurt.
- Before going to bed, run a warm bath on the injured limb. In the water, move your feet in different directions.
- Go for magnetic therapy, ozokerite and electrophoresis.
- Move more, but within your capabilities. During movements, your foot should bend at different angles. Therefore, it would be optimal to walk up the stairs and exercise your legs on an exercise bike (or on the pedals of a sewing machine).
- Take vitamins and calcium.
By combining all these techniques, you will completely restore your leg and be able to live a full life. But it is important to say that any Therapeutic Physical Culture classes should be carried out under the supervision of an experienced doctor or instructor. This is especially true for very complex injuries.
Recovery period
Depending on the severity of the fracture and the type of surgery, the recovery period takes from 6 weeks to 2.5-3 months. To restore full function of the joints, the patient is referred to the following procedures:
- Exercise therapy (physical therapy). The patient is prescribed simple exercises aimed at warming up the joint and gradually restoring motor functions.
- UHF (ultra high frequency therapy). This is a physiotherapeutic procedure during which the body is exposed to a high-frequency electromagnetic field. This helps create a warming effect, increase blood circulation and speed up recovery.
- Electrophoresis with novocaine. Aimed at relieving pain.
Additionally, vitamins and microelements are prescribed to improve metabolic processes and nervous regulation.
Rehabilitation after plaster removal
To completely eliminate the consequences of a trimalleolar fracture, exercise therapy is prescribed after the cast is removed and involves completely different exercises.
Unlike the previous ones, they are aimed at restoring the range of motion of the ankle and developing atrophied muscles. By performing them, you can quickly normalize motor functions and forget about the injury you suffered.
Consider these exercises (do them from a lying position, combining them with deep breaths):
- Tighten your thigh muscles, then relax. Perform the exercise slowly, repeating it 20-30 times.
- Gently bend and then straighten your foot. Repeat 10-20 times.
- Bend and straighten your toes. Do this 10-20 times, also very slowly.
- Rest for 1-2 minutes and do exercise No. 3 again.
- Perform circular movements of the foot in the joint. Do these rotations 10 times in each direction. The pace of gymnastics can be accelerated a little.
- Bend your foot as far forward as possible and then back. Repeat the exercise 10-20 times.
- Bend your leg towards your stomach, extending your toes towards you. Lower your leg. Repeat the movement 10 times.
- Move your toe as far as possible to the side, turning not the foot, but the entire leg from the hip. Return the limb to its original position. Perform the technique 10 times.
- Raise your leg at a right angle, trying not to bend it and pull your toe towards you, then lower it. Repeat the exercise 10 times.
- Do exercise #1.
- Raise your leg up again, but this time bend and straighten your toes and foot at the same time. Repeat the exercise 10 times.
- Raise both legs perpendicular to the floor and lie in this position for 5-10 minutes.
In addition to the exercises listed, gymnastics with additional equipment is of great benefit. You can do it with a rolling pin, ball, bottle or any other cylindrical object. Some of these exercises are demonstrated in a video of exercise therapy for a trimalleolar fracture.