Ankle fracture

Inflamation

Case Mike - Anatomy presentation

Haemostasis- Blood vessels contract (vasoconstriction) resulting to clot formation to stop bleeding

-Rise in exudate levels which means blood vessels dilate to allow essential cells, antibodies, white blood cells (neutrophils), growth factors eg cytokines, enzymes and nutrients to the damaged area.

-Signs of inflammation-maceration (softening or wetness), erythema (redness), heat, oedema and pain

-Phagocytosis-Autolysing (breakdown) of devitalised (deprived tissues) tissue by macrophages and neutrophils which transport through blood vessels then to interstitial tissues to inflammation site.

Tissue repair

IMPROVING PATIENTS CONDITION

Tissue damage/ destruction-triggers the process of regeneration and repair which is a healing response

Regeneration -complete restitution of lost or damaged tissue

Repair -may restore some original features but involves combination of collagen deposition and scar formation

3 Phases- Inflamation

-Proliferation

-Maturation

Ankle fracture and skin lesion

Ankle elevation:- By limiting the swelling of mikes ankle, I would advise mike to elevate his leg up. This will reduce further swelling

- Medication:- Using analgesic drugs other than aspirin or medicines containing aspirin can be used by Mike to relieve pain

- Psychological analgesic: - Listening to a patient worries and believing a patient can be very therapeutic in pain management. Mike would need some assurance that all be well with his leg

- Wound care: - Mikes wound should be dressed according to the doctor’s orders and the splint be put on at all times. It should be kept dry and clean.

- Teaching crutch use for safe movement

Fractura bimalleolaris lateralis

Weber C, unstable, always requires an operation

WHAT'S DONE

Proliferation

-Begins 4-5 days after injury

- Fragments are repositioned into their normal alignment

- They are held together with special screws and metal plates while they heal

- Mike will wear a splint well-padded posterior splint after the surgical procedure to help him not bear weight on the ankle.

-Rebuilding of damage with new granulation tissue comprising of collagen and extracellular matrix

-Involves development of new blood vessels (angiogenesis), since healthy granulation is dependent on fibroblasts receiving sufficient nutrients and oxygen.

-Color and condition of granulation may indicate whether it is healthy granulation, eg dark color may indicate ischemia, infection and poor perfusion while a health one is pink or red with uneven texture

Ankle Structure

Rehabilitation

-Epithelialization-covering of the wound surface with epithelial tissue which is a specialized tissue formed to cover internal and external body surfaces to provide structural support.

Physiotherapy will begin once the brace or cast is removed

Ankle Structure

-The wound begins to contract

Passive joint

mobilization

Mariia Guskova

Mathew Meli

Essi Meisalmi

Judith Ouma

Decrease

pain

Massage

Maturation

References

-Occurs when the wound is closed

-Involves remodeling of collagen from type III to type I

(formation of new collagen)

-May take 2-3 years

-scar tissue is only 80% as strong as original tissue.

-Scar formation is the final healing process.

1. Holma S, 2012. Pain Management. Preoperative Nursing Lecture. Jamk University of applied Sciences. Jyvaskyla. Finland.

2. 1. NIH. 2002, Patient education: Post-Op Instructions: Taking care of yourself after surgery

http://www.cc.nih.gov/ccc/patient_education/pepubs/postop.pdf

3. Foot Physicians.2015. Americal college of foot & ankle surgeons.http://www.medscape.com/viewarticle/405699_6

4.CliniMed.2013. Phases of wound healing. http://www.clinimed.co.uk/Wound-Care/Education/Wound-Essentials/Phases-of-Wound-Healing.aspx

5. Summit Medical Group. 2014. Ankle Fracture Exercises. http://www.summitmedicalgroup.com/library/adult_health/aha-ankle_fracture_exercises/

6. Physiopedia. Ankle and Foot Fractures. http://www.physio-pedia.com/Ankle_and_Foot_Fractures#Clinically_Relevant_Anatomy

7. Advantage physiotherapy. 2009. http://www.advantagephysiotherapy.com/Injuries-Conditions/Ankle/Ankle-Issues/Adult-Lower-Leg-Fractures/a~3266/article.html#sec343038

Bone tissue healing process

-Inflammation

-Bone production-clotted blood from inflammation is replaced

by fibrous tissue and cartilage (formation called ‘soft callus)-

visible in x-rays weeks after fracture

-Bone remodeling- may take several months,

bone continues to form and become compact and

blood circulations in the area improves.

Image by Tom Mooring