Clinical picture of bruise, code according to ICD-10
In accordance with the International Classification of Diseases (ICD), tenth revision, a bruise of the ankle joint is coded S90.0 and denotes an injury caused by a blow or a fall.
The disease is characterized by the presence of:
- damage to the skin and underlying layers (muscle fibers and subcutaneous tissue);
- bruises and hematomas resulting from damage to nerves and blood vessels;
- swelling and swelling, bruises in the injured area;
- pain in the ankle area;
- tissue necrosis (in case of neglect, severe development).
Accompanying injury to the ankle joint are superficial skin injuries, bruised fingers (damage to the nail plate, fracture of the phalanges), and ankles.
In severe cases, hemarthrosis develops (collections of blood in the joint cavity).
Ankle: injuries, treatment, orthopedics
The ankle joint plays an important role in the static-dynamic balance of a person, concentrating on itself the entire weight of the body’s support.
The ankle is a movable joint of three bones: the tibia, fibula and talus. This structurally complex joint takes on a significant load, so pain and injuries associated with the ankle are common. Most often, ankle problems occur in people of working age and athletes. According to the International Olympic Committee, ankle joint injuries account for one fifth of all sports injuries of the lower limb and rank third in frequency among athletes, along with injuries to the shoulder and lower leg.
You can injure your ankle while playing sports, or simply by slipping on ice, tripping, or unsuccessfully leaning on your leg. Injuries, dislocations, and repeated subluxations can lead to the formation of chronic instability of the ankle joint, which significantly reduces a person’s quality of life. Traumatologists, physiotherapists and rehabilitation specialists from all over the world pay great attention to the problem of treating injuries to the ankle joint.
Types of Ankle Injuries
The ankle joint is surrounded by a complex system of ligaments and tendons. Their function is to stabilize the ankle joint, as well as to direct movement in it.
You can damage your ankle ligaments if you exercise too intensely. Such injuries often accompany athletes (football players, basketball players), paratroopers (at the moment of landing), and dancers. In everyday life, you can damage your ankle when you place your foot poorly, fall, or get hit. Ankle sprains can occur, for example, due to frequent walking in high heels. In this case, excessive supination of the foot occurs - overstrain of the muscles of the foot and lower leg due to a shift in the center of gravity.
The ligaments of the ankle joint have low elasticity and during an injury there is not stretching, but rather tearing of their fibers to varying degrees, up to complete rupture. The diagnosis of ankle joint injuries is made based on the nature and mechanism of the injury, the clinical picture, and a mandatory x-ray.
Three degrees of ligament damage:
Damage I degree
Stretching (microscopic tears) of the ligament, causing local pain and minimal swelling; joint mobility in this type of injury is slightly impaired, stability is preserved. In this case, the load with body weight is bearable, and there are no deviations from the norm on radiographs.
Damage II degree
A severe sprain and partial tear of the ligament that causes significant tenderness, moderate swelling and pain with exercise, and loss of stability and mobility of the joint. Radiographs in standard projections are not very informative. However, when the position of the foot changes, a loss of ligament function is detected, which is determined by the abnormal position of the talus in the joint.
Damage III degree
Complete ligament rupture. The patient is unable to bear weight; There is pronounced swelling, which causes joint contracture and severe instability in the first hours after injury. Severe pain or loss of nerve function. Standard radiographs reveal a violation of the relationship of the talus in the articular fork.
Rehabilitation
For the treatment of ankle pathologies, two types of treatment are used: conservative and surgical treatment. The most commonly used is so-called conservative treatment.
Treatment consists of three phases:
Acute phase (protection)
In this phase, inflammation, swelling and pain are observed. Therapeutic measures are: control of edema, inflammation, pain, hardware physiotherapy, immobilization (plaster, orthosis), passive movements and massage (subject to restrictions for this type of injury), static muscle tension.
Movement recovery phase
Inflammation and pain are reduced. For rehabilitation, they carry out: control of edema, hardware physiotherapy, functional orthotics, development of range of motion, transverse massage, muscle retraining, balance and coordination training, activation of local muscles of the foot, strengthening and increasing endurance of key muscles.
Functional phase
There is no inflammation, pain is present only at the end of the range of motion. To complete the treatment, the following is carried out: control of swelling after exercise, muscle stretching, functional orthotics during exercise, physical therapy exercises, exercises.
Types of ankle orthoses
Fixation of the ankle joint is an essential part of rehabilitation therapy. To support the damaged joint in the correct position, special products are used - orthoses.
There are orthoses with light, medium and high degrees of fixation. Light fixation orthoses are used for mild injuries, when returning to sports after surgery, as well as for preventive purposes. Orthoses with a high degree of fixation are used for combined and severe trauma, or after complex operations, including suture of the Achilles tendon. Medium fixation orthoses are universal and suitable for most situations where protection of the capsular-ligamentous structures of the joint is required.
Orthoses are divided according to the degree of fixation:
Easy fixation
Orthoses made of special elastic fabric without stiffeners or inserts. Similar bandages are used for bruises, sprains, dislocations, and they are also used in sports to reduce the load on the joint. The elastic bandage is invisible under clothing, does not require changing shoes and can be worn around the clock, including by children.
Medium fixation
Products made of elastic material with stiffening ribs. They are used by people with chronic ankle instability, for moderate injuries and during the rehabilitation period after surgery. In addition to moderate stabilization, such orthoses will have massage and compression (warming) effects, which contribute to the restoration of the joint.
Semi-rigid fixation
An elastic and durable product with stiffening ribs and additional fixing inserts. Fixation is adjusted depending on individual parameters and can change during the rehabilitation period. For this, lacing or Velcro fasteners are used. Semi-rigid ankle orthoses are used for injuries, severe ankle instability, flaccid foot paralysis and other pathologies.
Rigid fixation
Provides complete immobilization of the foot. For this degree of fixation, a rigid base made of medical plastic, rigid inserts, and a lining (in the form of a boot) are used. The basis of such orthoses is carefully thought out. The design contains recesses that help adjust the orthosis to the user and create additional air exchange.
The linings are made of soft materials with good breathability, so that the user feels comfortable even when wearing the orthosis for a long time. The covers are removable - easy to put on and convenient to clean.
Thanks to the presence of a hinge, you can set the flexion-extension angle at the ankle joint in a selected range. The rubber outsole provides stability and anti-slip protection.
Providing first aid
First aid measures for a bruised ankle include:
- fixing the joint with a bandage (use a regular or elastic bandage; bandage it so as to avoid squeezing the blood vessels);
- applying cold to reduce pain and swelling (withstand no more than an hour);
- raise the sore leg above the level of the body and fix it;
- Riciniol (an emulsion that has an analgesic effect) can be applied to the bruised area;
- for severe pain, take Analgin, Diclofenac, Ketonol, and perform intramuscular injections of an anesthetic drug.
Publications in the media
Joint contracture is a persistent limitation of mobility in a joint.
Classification • By origin: •• Congenital •• Acquired • By etiology: •• Arthrogenic - with pathology of the articular surfaces of the articulating bones, ligaments and joint capsule •• Painful (antalgic) - reflex limitation of movements in the joint with painful movements •• Dermatogenous - with extensive cicatricial changes in the skin •• Desmogenic – with cicatricial changes in connective tissue formations (fascia, aponeuroses, etc.) •• Myogenic – with muscle shortening as a result of injury, inflammatory or dystrophic processes •• Neurogenic – with innervation disorders •• Paralytic – with muscle paralysis or muscle groups •• Post-amputation contracture is a complication of limb amputation in the form of contracture of the joint closest to the stump; develops due to incorrect surgical technique or errors in postoperative management •• Professional - contracture due to chronic trauma or overstrain of certain muscle groups in connection with professional activities •• Psychogenic (hysterical) - neurogenic contracture during hysteria •• Reflex - contracture due to prolonged irritation of the nerve leading to to the emergence of a persistent reflex in the form of an increase in the tone of a muscle or muscle group •• Cicatricial - contracture with gross scar tissue changes •• Spastic - contracture with central paralysis (paresis) •• Tendon (tendogenic) - contracture with shortening of the tendon •• Functional-adaptive ( compensatory) - a contracture that develops to compensate for an anatomical defect, for example, flexion contracture of the joints of one leg when the other is shortened • By nature: •• Extensor - contracture with limited flexion in the joint •• Flexion - contracture with limited extension in the joint.
Treatment • Early and comprehensive • Treatment of the underlying disease • Exercise therapy, physiotherapy (electrophoresis with lidase, ronidase, phonophoresis with hydrocortisone, disodium salt of ethylenediaminetetraacetic acid), massage • For arthrogenic contractures - intra-articular hydraulic novocaine blockades • If conservative treatment is unsuccessful - surgical (arthrolysis, plastic surgery, etc.).
Prevention - passive and active early therapeutic exercises for diseases leading to the formation of contractures.
ICD-10 • M24.5 Joint contracture.
Application. Arthrogryposis is a congenital multiple contracture due to underdevelopment of the muscles of the limbs. There are several genetic varieties, in particular autosomal dominant forms (*108110; 108120 [9p22–9q22.3, AMCD1 gene defect] - arthrogryposis multiple congenita, distal, type 1; 108130; 108140; 108145; 108200), autosomal recessive ( *208080; 208081; 208100 [5q35, AMCN1 gene defect]; 208110; 208150; 208200) and X-linked (*301820; 301830 [Xp11.3–Xq11.2, AMCD gene defect] - arthrogryposis multiplex congenita, distal) " Amyoplasia congenital « Arthromyodysplasia congenital. ICD-10 • Q74.3 Congenital arthrogryposis multiplex
Treatment
Basic treatment techniques are prescribed by a specialist and carried out after the patient arrives at the medical facility.
Conservative therapy
Includes:
- local injection of Novocaine solution into the ankle joint;
- applying plaster (it is worn for two to three weeks);
- if there is severe damage, use a splint (up to 10 days).
For 6 weeks after removing the plaster cast, do not overload the affected leg.
Surgical method
Surgery for a bruised ankle joint is indicated if the ligaments have ruptured. In this case, stitching is practiced without the presence of an external seam. After the operation, the leg is fixed in a plaster cast, which is worn until the wound is completely healed (about 8 weeks).
ethnoscience
Effective for ankle bruises:
- Onion compress: the vegetable is ground into a paste, applied to gauze, and applied to the sore spot overnight.
- Aloe, cabbage: the leaves are washed and cut, bandaged to the injured joint. The procedure is carried out daily for seven days.
- Milk: it is heated, cotton wool or a bandage is soaked in it, which is then placed on the bruised area on the left and right sides and bandaged.
Traditional recipes will be a good addition to the main therapy and will help eliminate pain and swelling. Their use must be agreed with your doctor.
Prevention
Includes:
- avoidance of traumatic situations;
- compliance with safety regulations;
- wearing comfortable, practical low-heeled shoes, sportswear and sneakers during training and competitions;
- regular gymnastics and physical exercises: they strengthen muscles and ligaments, contribute to the health of the body;
- proper rest and balanced nutrition, giving up bad habits.
Ankle bruise is a common injury that should not be ignored. A minor injury to the lower leg can lead to serious consequences if prompt treatment is not provided.