A fracture is a painful condition in which the integrity of the bone occurs as a result of injury under the influence of a damaging factor that exceeds the strength of the bone tissue. Fractures are of two types: open and closed, with and without displacement of bone fragments. After an injury, the bones heal until a callus is formed. This process is called fracture consolidation . Accordingly, consolidating is a healing fracture. There are fast and slow consolidations. Rapid consolidation is the complete fusion of bones, in which callus is formed and blood circulation is restored. Delayed consolidation is a failure of bone healing with slow callus formation. As a result, the fracture may heal incorrectly and cause a lot of inconvenience to the patient.
Main causes of injury.
There are general and local reasons due to which the process of bone tissue restoration slows down. These include:
- Serious diseases (diabetes mellitus, osteoporosis)
- Bad habits (smoking, alcohol)
- Exhaustion of the body
- Old age (over 60 years old)
- Numerous fractures
- Dysmenorrhea in women
- Penetration of infection or foreign bodies into the wound
- Serious soft tissue damage
- Circulatory disorders
How is a malunited ankle fracture diagnosed?
The consequences of an improperly healed fracture can be noticed both a short time after the injury and several decades later. Patients suffering from this pathology usually report noticeable impairments in the mobility of the ankle, and for some it becomes painful to step on their foot.
Six months after treatment, patients can often return to their previous foot loads and exercise.
Typical symptoms that occur with an unsuccessful ankle fracture:
- Swelling
- Limitations of foot function
- Blockades during flexion and extension
- Severe pain, reduction in the maximum distance covered when walking
- Long-term instability of the joint, patients often stumble
- Chronic pain
- Limitations of mobility and complaints of foot pain that last more than six months
- Infectious diseases in the affected area
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Treatment.
When bone healing is slow, there are two treatment options – conservative and surgical.
- Conservative treatment is an extension of the period of immobilization of the fracture sufficient for its healing. A non-union fracture is treated by administering drugs that stimulate the process of bone formation; it is possible to inject the patient’s blood into the gap between the fragments, as well as strengthening and tonic injections.
- If the consolidation time increases by more than 1.5-2 months, then the patient is prescribed surgical treatment. In the traumatology department, the patient will undergo one of the necessary operations according to indications: extrafocal compression osteosynthesis, bone grafting, Beck tunneling or sliding graft surgery according to Khakhutov.
Fractures of the tubular bones of the hand (fractures of the metacarpal bones and phalanges of the fingers)
A bone fracture is a complete or partial disruption of the integrity of the bone, which is a consequence of exposure to a load that exceeds the strength of the bone. Fractures of the metacarpal bones and phalanges of the fingers are the most common fractures of the upper limb. There are many types of metacarpal and phalangeal fractures and even more combinations of them.
Fig.1. Various fractures of the tubular bones of the hand
Symptoms:
The most important symptom of any bone fracture is pain. The pain is acute and intensifies when trying to move. Swelling of the injured area increases. Movements in the joints closest to the site of injury become severely limited or impossible. In displaced fractures, there is deformation visible to the naked eye in the area of the fracture.
Diagnostics
Most often, a thorough examination of the nature of the injury and examination of the patient is sufficient to make a diagnosis. The gold standard for diagnosing fractures is an x-ray, which determines the type of fracture, the presence and degree of displacement of fragments. In some cases, additional studies, such as computed tomography and magnetic resonance imaging, are required to clarify the diagnosis and determine further treatment tactics.
Fig.2. X-ray of a patient with multiple metacarpal fractures
Fig.3. X-ray of a patient with a fracture of the main phalanx of the 4th finger
Treatment
Most metacarpal and phalangeal fractures can be treated without surgery. Some fractures still require surgical treatment. The choice of treatment tactics depends on many factors, such as the location of the fracture (intra-articular or not), the type of fracture (oblique, spiral, transverse, comminuted), the presence and type of deformity (angular, rotational, shortening), the nature of the fracture (open or closed), whether there are concomitant injuries to bones and soft tissues and the degree of stability of the fracture. The individual characteristics of the patient (age, level of activity, presence of concomitant systemic pathology, etc.) should also be taken into account.
Conservative treatment:
Fracture without displacement of fragments (crack).
If the fracture is without displacement of the fragments, that is, it is of the type of crack and is classified as a stable fracture, then a rigid bandage of plaster or plastic is applied for 3-6 weeks to fix the joints closest to the fracture while the bone heals. It is necessary to carry out control radiographs 7-10 days after the injury to monitor the correct position of the fragments. It is important that the bandage does not restrict the movements of healthy fingers and elbow joints. After fusion of the bone, a course of rehabilitation treatment is prescribed, which includes physical therapy, paraffin therapy, physiotherapeutic procedures and massage.
Fracture with displacement of fragments:
Any fracture with displaced fragments must be reduced - that is, the displacement must be eliminated.
Closed reduction
fragmentation is one of the most frequently performed procedures in trauma centers and hospital emergency departments. It is most often performed under local anesthesia - an anesthetic injection is given at the site of the fracture. Sometimes other types of anesthesia are used. The traumatologist performs a maneuver, as a result of which the bones fall into place, and a rigid bandage made of plaster or plastic is applied. After which a control x-ray is performed. If a control x-ray confirms that the displacement has been eliminated and there are no indications for surgical intervention (intra-articular fracture, bone fracture, etc.), then treatment can be continued in a rigid bandage for a period of 6-8 weeks. It is necessary to carry out control radiographs 7-10 days after the injury to monitor the correct position of the fragments. It is important that the bandage does not restrict the movements of healthy fingers and elbow joints. After fusion of the bone, a course of rehabilitation treatment is prescribed, which includes physical therapy, paraffin therapy, physiotherapeutic procedures and massage.
Surgery
If conservative treatment is not effective (displacement of fragments remains on control radiographs) or if the type of fracture requires surgical fixation (unstable fracture, oblique, intra-articular, etc.), then this is an indication for surgical intervention.
The purpose of surgery is the anatomical restoration of bone integrity, which is necessary for the complete restoration of the function of the hand and limb as a whole. This is done by holding the fragments in the correct position during the entire period of bone fusion using various metal structures.
Types of operations for fractures of the metacarpal bones and phalanges of the fingers.
There are several types of operations for fractures of the hand bones. The choice of surgical treatment tactics lies with the surgeon and depends on the type of fracture, the requests and needs of the patient. The final decision is made after discussion with the patient.
Closed operation:
Closed reposition of fragments and fixation with pins (under anesthesia, bones are repositioned and fixed using special pins made of medical metal. The operation is performed under fluoroscopic control (a portable X-ray machine is located in the operating room and allows you to take x-rays during surgery and verify the correct position of the bones and metal structures). After the operation, a rigid bandage of plaster or plastic is applied until the bone heals. The metal pins are removed after the fracture heals and rehabilitation treatment is prescribed, which includes physical therapy, paraffin therapy, physiotherapeutic procedures, and massage.
Another type of closed operation is the application of a mini-distraction device (Ilizarov type). The device is applied to the fracture area and stretches the fragments in opposite directions, which leads to tension of the soft tissues and reposition of the fragments. Tension is maintained throughout the healing period of the fracture. The type of anesthesia is selected based on the location and type of fracture; most often it is local anesthesia. The operation is performed under fluoroscopic control (a portable X-ray machine is located in the operating room and allows you to take X-rays during the operation and verify the correct position of the bones and metal structures). After fusion of the bone, the device is removed and rehabilitation treatment is prescribed, which includes physical therapy, paraffin therapy, physiotherapeutic procedures, and massage.
Open surgery:
A skin incision is made at the fracture site and the fragments are compared under visual control. The fragments are fixed with knitting needles, a metal plate or screws. The operation is performed under fluoroscopic control (a portable X-ray machine is located in the operating room and allows you to take X-rays during the operation and verify the correct position of the bones and metal structures). Most often performed under conduction anesthesia (brachial plexus block). After the operation, a rigid bandage made of plaster, plastic, or a removable orthosis is applied. The pins are removed after healing of the fracture, and internal fixators (plate or screws), if they do not cause discomfort, remain in place for life. If stable osteosynthesis (plate or screws) was used, then rehabilitation can begin within a few days after surgery and the recovery time is significantly reduced.
Fig.4-5. Radiographs of a patient with a fracture of the 3rd metacarpal bone before and after fixation with a plate and screws
Rehabilitation.
To speed up the recovery of slowly healing fractures, the following is prescribed:
- Physiotherapy (iontophoresis of calcium salts, UHF, anabolic hormones, quartz irradiation, etc.)
- Physical therapy
- Mud therapy
- Taking calcium supplements in combination with zinc, folic acid, magnesium, vitamins D, C, B.
- Proper nutrition with the obligatory inclusion in the diet of cottage cheese, dairy products, hard cheeses, cod, salmon, beans, liver, and cereals
The treatment process must not be disrupted, as complications may arise. Slowly consolidating bone injuries can lead to additional surgery and a new course of rehabilitation.
What type of doctor performs the operation?
One of the features of the Gelenk Clinic is the trusting relationship between doctors and patients. That is why your attending physician will take care of you from the first examination until the operation itself. He will also monitor your condition after the operation. This way you will have a contact person at the Gelenk-Klinik whom you can contact at any time convenient for you. The specialists at the Gelenk Clinic for the treatment of malunited ankle fractures are Dr. Thomas Schneider and Dr. Martin Rinio. These experienced surgeons are constantly improving their qualifications and are members of the non-profit German Association for Foot and Ankle Surgery (DAF). The Gelenk Clinic Orthopedic Clinic in Germany is a specialized center for the treatment of foot and ankle diseases.
Post-operative care, rehabilitation and aids after ankle surgery
After ankle surgery, only partial weight bearing is allowed. Therefore you will need crutches. In addition, the patient will be given a special orthosis-fixator, which he will need to wear day and night. Gelenk Clinic specialists will make sure that you receive the necessary aids after surgery to correct a fracture.
Therefore, prevention of thrombosis (eg using heparin/enoxaparin) is vital. This will prevent dangerous blood clots from forming. We strongly recommend that you undergo physical therapy and lymphatic drainage after leaving the hospital. This way we can prevent muscle loss and minimize forefoot swelling. The duration of foot swelling depends on the age of the patient.
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What are the conditions of stay at the Gelenk Clinic?
Private ward at the Gelek Clinic in Gundelfingen, Germany.
© joint-surgeon During your stay at the Gelenk Clinic, you are usually in a separate room, which has a shower and toilet. In addition, we provide towels, bathrobes and slippers. You can also use a safe and minibar. All rooms are equipped with TV. You only need to take medications, comfortable clothes and nightwear with you. Patient care is provided around the clock. The medical staff and physiotherapists at Gelenk Clinic will always answer all your questions. Generally, the length of hospital stay after ankle surgery is 3 days. Your relatives can stay at a nearby hotel. Our staff will be happy to take care of your room reservation.
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How can a patient from abroad sign up for treatment of an improperly healed fracture?
To begin with, Gelenk-Klinik specialists will need current MRI and X-ray images to assess the condition of the ankle joint. Email you patient information and cost estimates.
Foreign patients can make an appointment for surgery to correct an ankle fracture in a short time. We will be happy to assist in obtaining a visa after the advance payment indicated in the estimate has been received into our account. If a visa is not issued, the amount received is returned to you in full.
Due to sometimes long flights, we try to keep the time between the first examination and surgery to a minimum. During outpatient and inpatient treatment of the ankle joint, you will be able to use the services of qualified medical personnel who speak several foreign languages (eg English, Russian, Spanish, Portuguese). Payment for a translator (for example, into Arabic) is carried out separately. We also organize transfers, we can book a hotel room, and we will tell you how to spend time in Germany for you and your relatives.
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What type of anesthesia does surgery require?
Foot surgeries are performed under general anesthesia. However, to avoid general anesthesia, we also offer spinal anesthesia if the patient so desires. To do this, the anesthesiologist uses a combination of anesthetics specifically selected for the patient and injects the anesthetic into the spinal canal of the lumbar spine. The patient is fully conscious during the operation. You will decide which type of anesthesia is best for you together with your anesthesiologist.
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