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Fractures

WHAT IS IT?

The ankle joint is a joint in mortise configuration. The lateral side is marked by the fibula; the medial side marked by the medial-most section of the tibia; the articular roof is formed by the tibia. The talus is contained within the ankle mortise.

A break in the continuity of the bone is called a fracture. At ankle level, there are two main reasons for these: torsion and direct impact loading, such as a fall from a height. Torsion causes fractures in the malleoli, taking different names depending on the number of elements affected. Direct impact generates fractures due to compression in the joint cartilage area (tibial pilon fractures). These can imply greater joint damage and can compromise the viability of the cartilage.

CAUSES

The main cause of a fracture is usually trauma. Pathological fractures can occur in places where the bone is weakened by a process or disease.

Repeated and cyclic overloading of a bone can cause what are known as stress fractures. They are found in two types:

• Fractures due to fatigue: The causes are usually strenuous activity or an activity the person is not accustomed to. They commonly affect soldiers, dancers and runners.
• Fractures due to insufficiency: There are a number of causes such as rheumatoid arthritis, osteoporosis, Paget’s disease, osetomalacia or rickets, hyperparathyroidism, renal osteodystrophy, brittle bone disease (osteogenesis imperfecta), fibrose dysplasia and radiation.

Pain, inflammation, haematoma, secondary deformity and displacement.

TREATMENT

The bone is tissue which has the capacity for regeneration. When there is a fracture, a healing process is triggered with an initial phase of inflammation, followed by tissue repair. Finally, via a remodelling process, the bone regains the structure it had prior to the fracture.

The goal of fracture treatment is:

• to maintain correct alignment while the healing process takes place.
• to reduce recovery time.

Immobilisation systems are employed to maintain alignment, be it with orthopedic techniques such as plaster casts or with surgical techniques like the insertion of plaques, pins, endomedullary nails, etc. Correct immobilisation, which permits the transition of stress without the fracture becoming displaced, accelerates the healing process.

Biological treatment using platelet-rich plasma (PRP).

PRP injected in the focus of the fracture eliminates the inflammation phase and enhances the repair phase, thus improving and shortening the healing process.

In conservative treatment of fractures, once reduced and stabilised, the PRP liquid is activated for its injection at the focus of the already-reduced fracture, always under radioscopic control and with maximum asepsis. The volume of PRP injected will depend on the fractured bone. A follow-up of the progress of the fracture will be carried out, and if signs of consolidation slowing are detected, a second injection of PRP liquid will be administered between the fourth and sixth week.