DAMAGE TO THE

LOWER LEG, ANKLE

AND FOOT. SPRAINS
OF THE FOOT BONES
Damage to the tibia

Among the damaged leg bones should

distinguish between intra-articular fractures of the
proximal tibia, isolated damage to one of diaphyseal
fractures of both diaphyseal and total damage
department shin bones. Each of these groups has its
own characteristics injury diagnosis and treatment.
Most fractures of the tibia is located in close
proximity to the skin, so the displacement of the
fragments with a rough or irregular shifting
transporting the patient could lead to perforation of the
skin and the formation of secondary open fracture. In
this connection special importance is the provision of
first aid.
Dislocation of the fibular head

This damage or rupture of the proximal tibiofibular joint -

uncommon and can occur as a result of both direct and indirect
injury mechanism. It may be damaged and the peroneal nerve, fibula
enveloping her neck.
 Diagnostics.

In the area of deformation is determined by the

proximal tibiofibular joint. The head of the fibula
displaced anteriorly or posteriorly, palpation and easily
reduce a newly shifted. Pressing on the head or the
closing pressure on the shin bone causing increased
pain in dislocation. Radiography allows you to specify
the diagnosis. With concomitant damage to the
peroneal nerve is marked plantar foot overhang.
Treatment.
Conservative treatment of dislocation is usually the effect does
not hold due to the difficulty of the head of state reduction.
Therefore, surgery is used: the head is fixed to the tibial condyle
transosseous sutures or bone pin. After operation for 4 weeks
impose a plaster bandage from the toes to mid-thigh. Walk,
loading the leg in a bandage, it permitted 2 weeks after surgery.
After removal of the cast spend the development of joint
movement, prescribe physiotherapy. When combined injuries of
the peroneal nerve treatment depends on the nature of his injury .
• Isolated fracture of diaphysis of fibula

Damage is usually the result of a direct mechanism of injury - a

blow to the outer surface of the tibia.

Diagnostics. Damage to the diaphysis of the fibula to recognize

difficult due to the following reasons. Fibula does not bear the
load of the body, the upper and lower ends of its firmly fixed to
the tibia. Therefore, any significant displacement of the
fragments does not occur and the ability to support the lower
leg suffers slightly. In some cases, patients may even walk,
noting, however, increased pain at the fracture site. Finally,
the fibula is surrounded on all sides of the muscles, so there
is no deformation of the lower leg caused by a fracture.
Palpate the fragments to determine their mobility is not
possible. Persistent symptoms are pain at the fracture site,
and local tenderness.
 Treatment.

In isolated fractures of the fibula is not

difficult and can be done on an outpatient
basis. Impose posterior plaster splint to
mid-thigh for 3 - 4 weeks. After 10 days are
allowed to go to the dressing, using a stick.
Employability is restored after 5 - 6 weeks
Diaphyseal fractures
of shin bones Options
Immediate reposition the
lower leg bone fracture on
the traction unit
Osteosynthesis of fractures
of the tibial shaft
Plaster bandages for the
functional treatment of tibia
fractures
Ankle Injuries

Damage to the ankle joint - frequent

type of injury, which can reach up to
"traumatic epidemic" size during the ice.
The mechanism of injury is usually
indirect - tucking the foot when the axial
load. Less damage can occur at another,
including direct, mechanism of injury.
Damage to the ankle ligaments

Damage to the ligament apparatus - the most

common injury of the ankle area. Usually the
damage is observed when tucking foot inside,
when it forced supination and adduction. At the
same time there is a partial or complete damage
to the fibers break external lateral ligaments of the
ankle joint. The first to suffer talo-fibular ligament.
A full break her anklebone, and then reduce a
sprained spontaneously under the influence of the
peroneal muscles.
 Diagnostics.

There is pain in the ball of the foot in the area

of ​the outer ankle, aggravated by movement,
especially the reduction and supination of the foot.
In the area of ​the joint swelling is observed more
pronounced in the outer ankle. On palpation
tenderness is maximal at the lower edge of the outer
ankle and in front of her. However, palpation ankle
at 1 to 1.5 cm above the top of it, and on the falling
edge of little painful. This symptom is helpful in the
differential diagnosis, allowing to exclude fracture of
lateral malleolus.
X-rays of the ankle in two projections avoids
bone fracture.
 Treatment.

Partial rupture of the ankle ligament fiber

treatment is carried out by immobilizing the
joint vosmiobraznoy bandage on 5 - 14 days or
bandage of elastic bandage. Before applying
the dressing is appropriate to introduce in the
hematoma 10 ml of a 1% solution of
novocaine. The dressing is better to impose a
wet bandage, lifting the outer edge of the foot.
Drying up, the bandage shrinks, improving joint
fixation. On 3 - 4 days prescribed thermal
treatments.
 Ankle fracture

Fractures of the ankle up to 60% of all

fractures of the shin bone. This damage is
rarely found in the direct mechanism of
injury. The immediate impact usually results
in a fracture of one ankle or, very heavy
damage to the joint. In the indirect
mechanism of joint damage injuries occur as
a result of the forced turning of the foot,
abduction or bring it to vertical load.
 The most common ankle fracture occurs
by exposing the foot outwards. This stop
is in the position of pronation, abduction
(abduction) and Equinus (plantar
flexion). However, the main elements of
the mechanism of injury is pronation.
Therefore, this type of damage is called
pronation fractures.
Pronation fractures
Forced tucking foot sole inwards leads to the so-called supination
fracture - damaged, reverse mechanism pronation fracture.

supination ankle fractures

Deformation foot fracture
dislocation of the ankle
 Treatment. Patients with a fracture of one or
even two ankles without bias is usually treated on an
outpatient basis. However, patients with open or
"complex" fractured ankles with displacement,
dislocation of the foot and the vast area of ​the joint
swelling in need of hospital treatment.

Immediate reposition followed by the imposition

gypsum bandage is the main conservative treatment
of fractures of the ankle with an offset. Closed
reposition "complex" fracture in the ankle, especially in
the later stages, is carried out under general
anesthesia.
 Skeletal traction for
fractures of the posterior
edge of the tibial posterior
dislocation of the foot
(Kaplan).
Types of operations for
fractures of the ankle
 Subtalar dislocation of the foot

Dislocation occurs in the heel and

ladevidrom joints in cases of indirect
mechanism of injury. When subtalar
dislocation of the foot often displaced
medially or posteriorly and medially -
internal and posteromedial dislocation.
 Diagnostics.

Expressed deformation subtalar area. When

an internal dislocation stop abruptly shifted
inwards, it is in the equinus, supination and
varus. At the rear of the foot clearly palpable
head of the talus. Medially from it is determined
to shift the navicular bone. When posterior-
internal dislocation, in addition, there is a
shortening of the forefoot and heel extension.
The function of the foot completely broken.
 Treatment.

When subtalar dislocation is reduced to possible

earlier reposition it under anesthesia, immobilization plaster
cast up to the knee in the 3 - 4 weeks and the subsequent
functional treatment. When posteromedial dislocation
reduction is carried out as follows. Shin bend the knee to 90
°. The stack is fixed by the heel and the front office, giving
it a position of extreme reduction, supination and equinus.
Then produce traction and direct pressing from the inside
outward at the foot pronation and abduction. Assistant
provides counter, fixing the lower shin department. When
failure of closed reduction shown urgent surgical reduction.
A full load on the foot is allowed after 6 - 8 weeks.
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