(1) Non-displaced single and double ankle fractures generally only need to be fixed with a small splint, or the ankle joint is fixed in a neutral position with tubular plaster. After 4 weeks, take out the external fixation and start walking and functional exercise, generally without leaving sequelae.
(2) Under local anesthesia, fractures with unilateral or bilateral ankle displacement were fixed with manual reduction and small splint or leg tubular plaster. Different reduction methods are adopted according to fracture types, and the basic principle is to reduce in the opposite direction of violence.
1. Eversion fracture: Two assistants hold the injured foot and calf respectively and pull them in opposite directions. The surgeon holds the medial malleolus with one hand, squeezes the lateral malleolus and lateral foot with the other hand, and puts the ankle joint in the varus position. If the lower tibiofibular ligament is broken at the same time, the talus is displaced laterally. The operator can squeeze two ankles with two palms to make them make do. In case of external rotation fracture, internal rotation manipulation should be added during reduction.
2. varus fracture: under traction, the operator holds the lateral ankle with one hand, squeezes the medial ankle and the medial foot with the other hand, and puts the ankle joint in the valgus position. If the talus dislocates backward, the heel should be pushed forward first, and then eversion will hurt the foot, keeping the foot in eversion and dorsiflexion.
No matter whether it is an eversion fracture or an eversion fracture, the X-ray film after reduction shows that the broken ends of the medial malleolus are not arranged correctly, especially the lateral film shows that the broken ends of the medial malleolus are separated, indicating that there is periosteum or ligament compression between them, so the compressed soft tissue should be pried open or open for reduction. Nonunion of medial malleolus can cause pain.
(3) Reduction of trimalleolar fracture
Manually reset the medial and lateral malleolus first, and then reset the posterior malleolus. When repairing the posterior ankle, the foot should be slightly bent to prevent the talus from pressing the articular surface at the lower end of tibia due to the traction of achilles tendon, then push the heel forward forcibly to correct the backward movement of talus, then extend the ankle joint backward, and pull down the posterior ankle with a tight posterior joint capsule until it is flush with the articular surface at the lower end of tibia, so as to repair the fracture block of the posterior ankle.
(4) Open reduction and internal fixation
(a) reset loser manually.
(2) Multiple fractures of ankle joint with separation of tibia and fibula.
(3) Patients with ankle nerve and blood vessel injury or open injury need debridement or exploratory repair.
Surgical methods: After surgical reduction, the medial malleolus, lateral malleolus or posterior malleolus were fixed with screws, and plaster was applied externally for 8 ~ 10 weeks.