Open reduction and internal fixation of ankle fractures

Ankle fractures include single hernia, double hernia, three ankle fractures, supracondylar fractures and anterior border fractures of the inferior tibial joint. These fractures can be combined with internal and lateral collateral ligaments, sacral ligament rupture, and combined with subtalar joint separation, or talus dislocation. In addition to the supracondylar fracture, the ankle joint fracture has intra-articular fractures. In addition, the articular surface of the ankle joint is smaller than the hip joint and the knee joint, but the weight is greater than the hip and knee joint. Therefore, ankle fractures, if not treated properly, can easily cause arthritis of the injury. For the above reasons, the treatment of ankle fractures requires anatomical reduction as much as possible, and functional exercise as early as possible, so that the fracture site can be often molded by the talus, and the fracture can heal more in line with the requirements of joint activity. Therefore, manual reduction and small splint fixation can meet the above requirements, and can be used as the first choice for the treatment of ankle fractures. However, surgical failure and old fractures still require surgery. Treatment of diseases: ankle fractures Indication 1. Internal malleolus fracture, there is soft tissue embedding between the two fracture ends. 2. The mandibular fracture failed to reset. 3. Single or double ankle fracture combined with subtalar joint separation, closed reduction was unsuccessful. 4. Three-ankle fracture, in which the posterior malleolar fracture exceeds 1/3 of the sub-femoral articular surface. 5. Old fractures with displacement. Preoperative preparation 1. If there is obvious swelling in the fracture site, the affected limb should be raised to promote swelling. 2. If there is abrasion or blisters in the fracture site, the blisters should be twitched with a syringe. The wound should be completely healed, the blisters dry up, and the epidermis can be removed before surgery. 3. The ankle joint fracture is usually fixed with screws for internal fixation. The appropriate length and length of the screw should be selected according to the x-ray film before operation. Surgical procedure a) internal malleolus fracture 1. Position: supine position, external rotation of the affected limb; or lateral lying on the affected side, the knees are padded with a soft pillow, the feet are separated, so that the injured side is upward. 2. Incision, revealed: an arc-shaped incision along the anterior aspect of the medial malleolus, about 4 to 5 cm long, and descending backwards through the medial malleolus. When cutting the subcutaneous tissue, be careful not to damage the saphenous vein and the saphenous nerve. When the flap is turned back, the fracture can be revealed and the distal end of the fracture is often displaced forward. When separating the posterior aspect of the medial malleolus, be careful not to injure the posterior tibial muscle and its tendon sheath. 3. Reset: Before resetting, first use the towel clamp to clamp the fracture block and slightly pull, expose the joint cavity, remove the intraoperative hematoma and broken bone fragments, and carefully explore whether there is soft tissue embedding between the fracture ends. If there is soft tissue embedding, it should be separated. Remove afterwards. At the time of resetting, the assistant pulls, and the surgeon clamps the fracture block with a towel clamp to help reset, and longitudinally clamps both ends of the fracture to maintain the reset. 4. Internal fixation: The larger fracture block is mostly fixed with screws, and the small fracture block can only be fixed with Kirschner wire. A hole is drilled in the center of the fracture block and then at an angle of 45° to the longitudinal axis of the humerus. An oblique fracture of the opposite side and screwing of the screw (or a Kirschner wire) should be performed as a bone nail to promote healing. (2) External ankle fracture Along the leading edge of the lower part of the humerus, the lower end of the lateral malleolus is made to make an arc-shaped incision. The length depends on the height of the fracture. Be careful not to injure the tendon tendon and its tendon sheath. After the fracture block is revealed, it is reset and internalized according to the surgical procedure of the internal malleolus fracture. (three) posterior malleolar fracture Take the prone position, pad the sandbag in front of the calf, in order to activate the ankle joint during the operation. According to the position of the fracture block, the internal or external incision of the Achilles tendon is about 6-8 cm long. Pull the Achilles tendon to one side, cut the iliac crest and bend The adipose tissue between the long muscles pulls the muscles to the sides (the external posterior flexor tendon should pay attention to protect the posterior tibial vessels and nerves located inside), and the posterior talus and the talus can be revealed. Then, the fracture block is reset with a towel clamp, and then pressure is applied to the back of the fracture block so that the two folded faces are in close contact and fixed by screws. The larger posterior malleolar fracture block can be reinforced with 2 screws. complication joint pain.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.