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Abstract: Most elderly people have osteoporosis and are prone to ankle fractures when the ankle is sprained, with internal ankle fractures being the most common, which can have clinical symptoms such as severe ankle swelling, pain, and limited movement. This 68-year-old female sprained her ankle while going downstairs, and radiographs were taken to confirm the fracture of the right inner ankle combined with the fracture of the outer ankle.
Basic information】Female, 68 years old
Type of disease】Right internal ankle fracture combined with external ankle fracture
Hospital】Harbin First Hospital
Date of consultation】November 2021
Treatment plan】Ankle fracture incision and internal fixation + brace fixation + cold compresses + elevation of the affected limb + rehabilitation training + medication supplementation (calcium carbonate tablets)
Treatment period】7 days of inpatient treatment, 3 months of outpatient follow-up
Results】Fracture repositioned and fixed, pain relieved, ankle joint activity resumed
I. Initial consultation
The right ankle joint was immediately painful and swollen, and she did not dare to touch the ground. The pain gradually worsened over time, so the patient came to the hospital. After examination, it was found that the patient had medial and lateral pressure pain in the right ankle joint with obvious local deformity and palpable bone rubbing sensation, and radiographs were taken to confirm the right medial ankle combined with the external ankle fracture. Considering the patient’s relatively high demand for ankle joint function in order to maintain the body’s daily activities, the first consideration was to restore the stability of the joint and the flatness of the joint surface through surgical internal fixation to prevent traumatic arthritis. After communicating with the patient about his condition and treatment method, the patient chose ankle fracture incision and internal fixation.
II. Treatment history
During the operation, it was found that the broken end of the inner ankle fracture was obviously displaced and there was soft tissue embedded between the broken ends of the fracture, which affected the repositioning, so the soft tissue was removed, and after the broken ends of the fracture were repositioned, internal fixation screws were used to fix them, and the fracture site of the outer ankle was fixed at the same time. Since the patient had fractures in both the inner and outer ankle, the cartilage of the ankle joint surface was damaged, and the joint surface flatness was restored as much as possible under arthroscopic surveillance to prevent joint dysfunction due to traumatic arthritis. After the surgery, the patient was immobilized with a brace and cold compresses and elevation of the affected limb. After the pain was relieved, the patient started rehabilitation training, such as ankle flexion and extension exercises, to avoid joint stiffness.
Treatment effect
After the ankle fracture dissection and internal fixation, the patient’s pain symptoms improved rapidly after 3 days; about 1 week after the operation, he could move the ankle joint on his own initiative and walk with the aid of double crutches out of bed, without serious pain symptoms. After the doctor’s examination, the patient was discharged from the hospital 7 days after the operation, and was instructed to follow up for 3 months on an outpatient basis.
IV. Notes
We are glad that the patient’s fracture was reset and her condition improved after the relevant treatment. During the recovery process, the patient needs to adhere to daily ankle exercises to ensure the function of the ankle joint as well as to prevent the manifestation of muscle weakness in the lower limbs. However, it is noted that strenuous exercise in the short term is not suitable for the patient, which may cause the internal fixation to break and may easily cause adverse effects on the already damaged joint and bone. In addition, since elderly women mostly have severe osteoporosis, it is recommended that patients take daily calcium supplements such as calcium carbonate tablets, which can enhance bone strength and prevent fractures from reoccurring.
V. Personal insight
When ankle fractures occur, most of the fractures occur in the outer ankle, not in the inner ankle. However, in this case, the patient was injured because the action was to turn the ankle joint outward, and the inner ankle was under excessive local stress, resulting in the inner ankle fracture. The patient’s fracture injury was relatively serious, so if conservative treatment was adopted, it would not be conducive to ankle function recovery, but might cause serious traumatic arthritis, while active surgical treatment could accurately reset the fracture end and firmly fix it, so that the patient could move the ankle joint early after surgery and avoid ankle function disorder.