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Abstract: In this article, the patient fell accidentally while tumbling over the wall, resulting in ankle fracture. The entire lower leg and foot and ankle were significantly swollen and deformed, and the patient was in great pain. After consultation, the patient was examined and clearly identified as a triple ankle fracture, and priority was given to the patient for root bone traction and medication to reduce swelling. After the swelling of the patient’s ankle had subsided, the patient was given an incisional surgery to reset the internal fixation.
Basic information】Male, 43 years old
Disease Type】Three ankle fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】September 2021
Treatment plan】Heel traction + medication to reduce swelling (loxoprofen sodium capsule) + fracture incision and internal fixation surgery
Treatment period】2 weeks of hospitalization and 1 year of outpatient follow-up
Treatment effect】The fracture healed and the walking returned to normal
I. Initial consultation
A 43-year-old male patient fell from a wall and fractured his ankle. The patient contacted the 120 emergency ambulance urgently after the injury, and was then transferred to the emergency room. At the initial consultation, it was evident that the calf and ankle were temporarily immobilized in a splint, and there was significant swelling and deformity throughout the calf and ankle. The patient was in great pain and the family was anxious. Based on the patient’s injury, the ankle fracture was first considered and admitted to the hospital.
II. Treatment process
After admission, the first step was to take a film to clarify the patient’s injury. It could be seen that there were fractures in the inner, outer and posterior ankle joints, and the patient was finally diagnosed with a triple ankle fracture. In addition to the fracture, the soft tissue contusion at the moment of injury and the bleeding from the fracture end also caused the patient’s ankle joint to swell severely. In this case, although the patient was eager for surgery, he could not be operated immediately, otherwise the surgery would further aggravate the soft tissue swelling and lead to difficulty in closing the incision and even tissue and skin necrosis. Therefore, the patient was first given heel traction to maintain the stability of the fracture end by continuous traction, while the patient was given loxoprofen sodium capsule to reduce swelling and relieve pain. After 1 week, the swelling was obviously relieved, and the fracture incision and internal fixation surgery was completed after the skin folds appeared.
III. Treatment results
The patient’s stitches were successfully removed two 2 weeks after surgery, and the patient’s skin healed smoothly without necrosis or infection, and the patient was given discharge. At the time of discharge, the patient was able to move the ankle normally in a passive state; 3 weeks after surgery, the patient could leave the bed and gradually start to walk on the ground with the help of double crutches, but the ankle joint could not be put on the ground to bear weight; 3 months after surgery, the patient gradually changed to a single crutch, gradually landed on the ground and practiced weight bearing without pain; 6 months after surgery, the patient gradually abandoned the crutches and strove to restore normal walking gait; 1 year after surgery, the patient’s fracture was found to be healed and the internal fixation was removed during the review. The internal fixation will be removed when the patient’s fracture is found to be healed at the postoperative review one year later.
IV. Notes
We are glad that the patient gradually recovered from the fracture of the third ankle, but we still suggest that the patient should not be careless after discharge from the hospital, and should avoid long-term weight-bearing walking on the ankle joint and strenuous exercise during the follow-up time of discharge and recuperation. In the early stage, passive exercises are the main focus, that is, the family members help to do flexion and extension activities, after that, you can actively flex and extend the joint by yourself, and later you can do stirrup exercises. Through these exercises, joint stiffness can be effectively avoided without affecting the healing of the fracture.
V. Personal insight
A triple ankle fracture is an intra-articular fracture, which means that the fracture destroys the integrity of the articular surface, and it is difficult to achieve a good alignment with closed reduction of this fracture, so surgery is recommended. Usually, as in this patient, the fracture can be significantly relieved by surgical treatment, and the surgery can restore the joint surface flatness under direct vision and minimize the possibility of postoperative arthritis in the long term. However, because the fracture itself damages the articular cartilage, the possibility of postoperative traumatic arthritis still exists, even if the surgical repositioning is good. In addition, it is important to gradually start functional exercises after ankle fracture according to the doctor’s advice to avoid joint stiffness.