Ankle fracture
Introduction
Introduction to ankle fracture Fracture fractures (fractureofanklejoint) are more common, both in daily life and on the playing field. According to some statistics, ankle fractures and ankle ligament injury account for 4% to 5% of systemic injuries. Most of the ankle fractures are caused by indirect violence, such as valgus, varus or external rotation. Different types and degrees of fractures occur depending on the size of the violent action, the direction and the position of the foot at the time of injury. The ankle joint is a weight-bearing joint, and the fracture is an intra-articular fracture. If the alignment is not good, it will form traumatic ankle arthritis, scar and pain, and it is difficult to walk and suffer. In addition, such injuries are mostly combined injuries of the bone and ligament, and the same attention and treatment should be dealt with for the fracture and ligament injury. basic knowledge The proportion of sickness: 0.6% Susceptible people: no specific population Mode of infection: non-infectious Complications: ankle cartilage injury
Cause
Causes of ankle fracture
Violent factors (50%)
Fractures occur in areas that are far from violent, and do not occur where violence directly affects. Ankle fractures are caused by violence through conduction, lever or rotation. Therefore, it is caused by indirect violence.
Car accident factor (30%)
Refers to casualties that occur when driving (multi-finger vehicles, etc.). The damage caused can be roughly divided into deceleration injury, impact injury, crushing contusion, crush injury and falling puncture injury, among which deceleration injury and impact injury are more.
Pathogenesis
There are different opinions on the classification of ankle fractures. The classification of the original fractures is relatively simple. For example, according to the shape of the fracture, it can be divided into two types: stability and unstable fracture, or divided into single sputum according to the extent of the fracture. Three fractures and so on.
Prevention
Ankle fracture prevention
Pay attention to details in life, drive, walk and observe the surrounding environment, and do flexible emergency treatment for special incidents to avoid trauma.
Complication
Ankle fracture complications Complications, ankle cartilage injury
There is no complication of this disease.
Symptom
Ankle fracture symptoms Common symptoms Ankle swelling, ankle pain, ankle and foot edema, underarm area, pain, swelling, residual strain, foot and ankle injury
Frightened by sudden accidents, some injured people often can't recall the position and direction of the foot when they were injured.
Symptom
The ankle is severely painful, deformed, and then swollen and subcutaneous congestion, the patient can not walk, severe circulatory disorders in the foot.
2. Signs
Regular physical examination will aggravate the pain, so the doctor should be gentle in the examination, and then the injury is tender and then further aided by the auxiliary examination to confirm the diagnosis.
3. Ashhurst and Bromer classification
According to the cause of the fracture, it is divided into four types: inversion, valgus, external rotation and vertical compression.
(1) varus fracture:
I degree: external malleolus fracture or lateral ligament injury.
II degree: Adding internal hemorrhoid fracture and medial subluxation (double fistula) on the basis of I degree.
III degree: On the basis of the second degree, the posterior malleolus is also fractured (3).
(2) Eversion fracture:
I degree: internal malleolus fracture or medial ligament injury.
II degree: on the basis of I degree, external malleolus fracture, or rupture of the lower ligament, lower jaw or fracture of the lower end of the humerus, medial subluxation (double fistula).
III degree: On the basis of the second degree, the posterior malleolus is also fractured (3).
(3) external rotation fracture:
I degree: external or oblique or spiral fracture.
II degree: add a medial avulsion fracture (double fistula) on the basis of I degree.
III degree: plus a posterior malleolus fracture (3) on the basis of II degree.
(4) Vertical compression type fracture: heel strikes the ground, the anterior humerus fracture of the dorsum of the foot, the anterior talus dislocation, or the humerus and the two comminuted fractures.
4.Danis-Weber classification According to the corresponding position of the radial position of the humerus fracture and the articular surface of the ankle joint, the ankle fracture was divided into A, B, C 3 type. The higher the position of the humeral fracture, the heavier the injury of the patellar ligament.
The greater the risk of instability.
Type A: The humeral fracture line is below the plane of the ankle joint. Most of them are transverse avulsion fractures. There are also avulsion of the lateral collateral ligament. There is no fracture of the medial malleolus, and the posterior margin of the humerus and the humeral ligament are mostly intact.
Type B: A tibiofibular fracture located at the level of the lower ligament ligament, which may be associated with avulsion fracture or deltoid ligament injury; the posterior margin of the tibia may be complete or show a triangular bone avulsion by the posterior iliac ligament.
Type C: tibiofibular fracture in any part between the inferior tibiofibular ligament and the humeral head. The internal malleolus has avulsion fracture or triangular ligament injury; the posterior aspect of the lower end of the humerus has a fracture block; the lower tibiofibular ligament is mostly tear, this type is external The combination of rotational stress and some kind of shock violence, Weber believes that more than one fracture or ligament injury in the ankle is a surgical indication.
5.Lauge-Hansen classification
Lauge-Hansen classifies ankle fractures into five categories through autopsy and clinical practice studies. This classification reflects the position of the foot during injury, the direction of the external force, the association between the ligament injury and the fracture, and at the same time clarifies the fracture. Severity is of great benefit to the guidance of the method, but it is more complicated.
(1) Pre-rotation abduction type: also known as the PA type (pronation-abduction type), the mechanism is that when the foot is in the pronation position, it is caused by abduction violence, which is divided into the following three degrees.
I degree: causing a fracture of the medial malleolus or a laceration of the medial triangular ligament.
II degree: On the basis of the former, the anterior tibiofibular ligament (or other ligament of the lower jaw) is damaged due to the continuous action of the external force, or the abutment is avulsed and fractured.
III degree: on the basis of the second degree plus the external malleolus fracture, this is caused by the continuous action of external forces.
(2) Post-rotation adduction type: also known as SA-type (supination-adduction type), the damage mechanism of this type is mainly caused by the violence of the foot suddenly caught in the revolving position, generally divided into the following 2 degrees .
I degree: external malleolus fracture (rare), or lateral collateral ligament rupture (more common).
II degree: I degree injury plus internal malleolus fracture.
(3) Pre-rotational external rotation type: also known as PER type (pronation-external rotation type), which is caused by the rotation of the foot in the anterior position plus external rotation; it is generally divided into 4 degrees.
I degree: internal malleolus fracture or triangular ligament tear.
II degree: the first degree plus the lower ligament and interosseous ligament rupture.
III degree: second degree plus interosseous tear and spiral fracture below the tibia (6-8 cm above the lateral malleolus).
IV degree: third degree plus posterior avulsion fracture.
(4) Spin-type external rotation type: referred to as SER type (supination-external rotation type), the foot is in the supination position caused by external rotation violence, clinically more common.
(5) Vertical compression type: The compression fracture of the ankle caused by falling from a height is generally divided into two types: simple vertical compression type and composite external force compression type.
1 simple vertical compression type: can be divided into:
A. Back extension type: causes fracture of the anterior inferior border of the tibia.
B. stenosis type: often causes fracture of the posterior inferior border of the humerus, and comminuted fracture of the distal radius, may also be associated with fracture of the lower end of the humerus.
2 composite vertical compression type: due to the combination of rotation, adduction, abduction and other violence to cause compression fractures, the internal and external sputum is also accompanied by different types of fractures.
Examine
Ankle fracture examination
1. Regular X-ray film
Under normal circumstances, the right side of the ankle X-ray film, you can get the correct diagnosis and classification, when taking the positive position, the calf should be rotated 20 °, so that the axis of the ankle joint is parallel with the X-ray. This ankle joint is on the positive position and the normal ankle joint is visible:
(1) The ankle joint gaps are parallel and the spacing is equal.
(2) The "Shenton" line of the ankle joint is smooth and stepless. The so-called "Shenton" line refers to the articular surface of the lower end of the humerus, the contour of the subchondral dense bone, the joint of the lower ligament, the gap, and a small bone protrusion on the inside of the tibia. , into a continuous curved line, small protrusions on the humerus, facing the subchondral bone level of the lower tibial articular surface.
(3) The distal end of the lateral talar articular surface and the distal humerus of the humerus (where the iliac tendon is located) are also continuously curved.
When the ankle is fractured, the X-ray of the 20° internal rotation of the calf can be seen:
1 The ankle joint surfaces are not parallel and the spacing is not equal.
2 The above-mentioned "Shenton" line has a step change and does not connect.
3 The distal end of the lateral talar articular surface and the tibia crypt do not form a continuous arc.
2. Computerized tomography (CT)
CT can distinguish the ankle joints, sagittal fracture lines and some minor fractures that are not easily detected on ordinary X-ray films. If necessary, the choice can be considered.
3. Special inspection
If necessary, under anesthesia, under the stress, take the film under the inversion, valgus, dorsiflexion, flexion stress, orthotopic joint, lateral position, in the pronation-external rotation fracture, high iliac crest can occur Fracture, do not forget to check, if possible, be sure to confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of ankle fracture
X-ray examination should take the ankle joint, the lateral position and the acupoint slice.
It is not difficult to diagnose a fracture based on the history of trauma, pain and swelling of the ankle, and X-ray findings. However, in the case of ankle injury, high fractures of the humeral neck sometimes occur, and should be checked to avoid missed diagnosis. For high lateral or humeral fractures, care should be taken to evaluate the possibility of ankle injury. In addition, it is necessary to check other combined injuries, such as peripheral ligament injury, iliac tendon tendon, Achilles tendon, posterior tendon tendon injury, talus osteochondral injury, nerve and vascular injury.
