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Abstract: The ankle joint, commonly referred to as the neck of the foot, includes the articular surfaces of the lower tibia and fibula and the talar talus. Since the articular surface of the talar talus is wide in the front and narrow in the back and has a special shape, the ankle joint will be in a relaxed state when the foot is in a plantarflexed position, that is, with the toe pointing downward, such as walking downhill or descending stairs, when the ankle joint is prone to sprain and a serious sprain can result in a fracture. In this case, the patient fell and caused a fracture of the external ankle, which was fixed in a cast as soon as possible and the prognosis is good.
Basic information】Male, 42 years old
Disease Type】External ankle fracture, ankle ligament strain
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan】Plaster braking + swelling treatment (horse chestnut seed extract tablets) + anti-osteoporosis treatment (calcium carbonate, vitamin D)
Treatment Period】Regular outpatient follow up
Effectiveness】The fracture healed and the walking returned to normal
I. Initial consultation
The winter in Northeast China is very cold, and after the snow falls, the snow on the road is difficult to melt even in the daytime, and it often forms a smooth ice surface after the car crushes it, so pedestrians will slip and fall if they are not careful. This patient slipped and sprained her ankle while getting out of the car and was sent to the emergency room by 120. At the initial consultation, we could see that the ankle joint was temporarily fixed in a splint and the whole foot and ankle were obviously swollen with subcutaneous petechiae formation and mild deformity. After ankle sprain, we must be alert to fracture, so we first took a film to clarify the injury. Based on the imaging performance, the patient was finally diagnosed with external ankle fracture.
II. Treatment history
The patient’s fracture line was superior and therefore could also be considered a fracture of the lower end of the fibula with a spiral fracture line, suggesting the presence of torsional violence at the time of injury. In addition, the normal alignment of the ankle joint was abnormal, so it is likely that the moment of injury also led to a strain of the joint ligaments. After seeing the film, the patient also realized that he had a fracture, so does this fracture require surgery? In fact, most simple external ankle fractures can be treated conservatively. After the manual repositioning, the patient went home to recuperate with a cast on his lower leg. The patient was instructed to observe the degree of swelling and skin color and temperature of the limb after returning home, to take oral anti-swelling medication (horse chestnut seed extract tablets), and to take calcium supplements to combat osteoporosis (calcium carbonate, vitamin D) during the period of immobilization. Regular review at the outpatient clinic.
III. Treatment effect
Basically, the patient visited the outpatient clinic for review every 1-2 weeks. About 5 days after putting on the cast, the patient’s ankle pain was significantly relieved, and the swelling basically subsided in about 10 days, and there was no obvious discomfort in the ankle joint after 1 month. In 2 months after fixation, the patient gradually started to perform stirrups in bed, and gradually started to practice walking with weight on the ground. 6 months after the fracture, the fracture had reached clinical healing.
IV. Precautions
After the cast is applied, it does not mean that you can rest easy, there are still many precautions. First, the degree of swelling of the limb should be observed. In the early stage of the fracture, the cast tightness often needs to be adjusted according to the swelling of the limb. Second, to pay attention to the skin color changes, if the limb blood flow is poor, the affected limb appears numbness, pain, dark color, etc., need to promptly remove the cast to release the compression. Third, pay attention to joint exercises, because the cast usually takes 3-4 months, during this time if you do not pay attention to joint exercises, it is easy to form joint stiffness. Fourth, remember to review regularly.
The patient has a simple closed fracture of the external ankle, which is not very serious and the fracture end can be restored to stability after repositioning by manipulation, so the fracture can be healed by conservative treatment, and I am grateful for this point, which has not yet reached the point of surgery.
V. Personal insight
The specific treatment of external ankle fracture also depends on the condition of the fracture. If the fracture is significantly misaligned and the stability of the ankle joint is affected, surgery may be required. The ankle joint is the weight-bearing joint of the human body. If the ankle fracture is poorly repositioned, it may cause continuous pain and limited movement in the later stage.
Plastering is the most basic and common form of conservative treatment after a fracture. Before plastering, I will perform manual repositioning according to the characteristics of the patient’s fracture and try to fix it in the best position.
In addition, I remind the patient to be careful when the road is slippery in cold weather and to prevent falling. If you accidentally fracture your ankle again, you must seek medical treatment as soon as possible to avoid deterioration.