Fratture

Fractures of bones about the foot and ankle

Fractures which do not involve joints

In a generally healthy human foot, fractures which do not involve the joint will heal spontaneously. Help and comfort is often achieved by means of a cast or a splint.

However, the axis of the bone must be preserved thus preserving the normal weight-bearing patterns of the foot. For this reason, fractures of the “long” bones within the foot, the metatarsals, must often be operated on to restore alignment.

Fractures which involve the joints

If a fracture involves a joint, the joint surface and its cartilage layer may be displaced. If this is the case, the joint will not work properly anymore (even after the fracture has healed!) and it is quite likely that the joint will degenerate prematurely, becoming painful and impairing function.

The foot has 28 bones and more than 30 joints and therefore fractures about the foot very often involve joints. Fortunately, not all of these joints are essential for proper function and therefore exact repair is necessary only for certain bone fractures.

Ankle fractures

The fractures are always articular fractures and must be analysed carefully with x-rays. A large majority of these fractures must be operated on, by means of precise, minute repositioning of the fracture fragments and then they need to be fixed with implants such as plates and screws to achieve a good final result (“internal fixation”).

Precise and meticulous repair of the joint surfaces also allows active mobility of the joint very soon after such repair while avoiding the premature degeneration mentioned above.

In our practice, so-called malleolar fractures, if seen within the first hours after the accident, can be treated and operations performed on an out-patient basis.

 

Fractures of the talus

This bone is situated just below the tibia and thus is involved in malleolar fractures.

If fractured itself, this bone should be repaired by means of an operation in all cases, regardless of the location of the fracture.

Talo 1
Talo 2

Fractures of the calcaneus

This bone is located just below the talus and is the bone of the heel. In our opinion, if a fracture of this bone involves one of its 3 joint surfaces, only an internal fixation can provide a solid and functional reconstruction.

The same holds true even in cases of intact joints because the axis and outer shape of the bone is severely altered through the fracture.

Calcagno1

Combined talus and calcaneus fractures should always be treated by open reduction and internal fixation.

Calcagno2

Fractures of the navicular

This bone is located just in front of the talus and is part of the most important joint of the foot.

If this bone is fractured, which is rare, an internal fixation will optimize the final result in most cases.

os1
os2

Fractures of the cuboid

This bone is located on the external side of the foot, just in front of the calcaneus. As a small “cuboid” bone, it links the lateral metatarsals (for the 4th and 5th toe) to the calcaneus.

If this bony link undergoes deformation due to a fracture, the whole foot is at risk of deformation. In these cases, the fracture is best treated by internal fixation.

Fracture-dislocations of the tarso-metatarsal joints

These lesions are at least as complex as their name. Known also as “Lisfranc’s” dislocations they are always partly dislocation and partly fracture. What is fractured is basically the “basis” of the metatarsals, especially the second one, which correspond to the axis or the “roof” of the foot.

As we humans have 5 rays which end with 5 digits or toes, these lesions may end in converging or diverging dislocated rays. Thorough early diagnosis is mandatory since mild dislocations might be overlooked.

These fracture-dislocations must be treated by operative minute re-orientation of the metatarsal rays thus achieving an anatomical alignment of all five metatarsal heads.

Fractures of the toes

The bones of the toes are numerous and in cases of fracture do not need systematic internal fixation.

However, if there seems to be a high risk that the toe will not touch the ground after bone healing, it may need some operative alignment.

Fractures of bones about the hip and pelvis

Fractures which do not involve the hip joint

The pelvis is the biggest bone within the human body. In fact, it is formed from two symmetrical bones which are linked by a cartilage, the symphysis pubis. Each one of these “hemi-pelvises” is built up of three bones which consolidate at the age of 12 – 14 years: the ilium, the ischium and the pubis.

The pelvis is the mechanical link between the spinal column and the lower limbs. The articulation to the spine is called the sacro-iliac joint and the articulation to the thigh is called the hip joint.

Although fractures in this region are exceptional in children, they are common fractures in the elderly, mainly due to osteoporosis. The severity of these fractures goes together with displacement of the fragments which causes harm to the soft tissues, blood vessels, nerves etc.

Complex pelvic fractures are life-threatening conditions which need immediate surgical care.

Hip fractures

These fractures do not involve the joint surface, or cartilage, of the hip joint. Hip fractures are very frequent and represent an important socio-economic factor in view of our ever-increasing elderly population.

Depending on the localization of the fracture, the hip joint is either replaced by prosthetic implants or the fracture is fixed and splinted by an osteosynthetic device.

The ever present aim in fracture care remains fast recovery of the ability of the injured to walk.

Fractures which involve the joints

If a fracture involves a joint, the joint surface and its cartilage layer may be displaced, producing a step.

If this is the case, the joint will not work properly anymore (even after the fracture has healed!) and it is quite likely that the joint will degenerate prematurely, becoming painful and impairing function.

In the pelvis, fractures which involve the hip joint are called acetabular fractures. The acetabulum is the “cup” which accomodates the upper extremity of the bone of the thigh: the femur. As acetabular fractures per se do not require immediate surgical care, they are best repositioned anatomically and fixed operatively to allow early mobilization of the joint and walking.

In the femur, fractures which involve the hip joint surface (femoral head fractures) are rare. These fractures are difficult to treat and sometimes have a poor prognosis due to the disturbed blood supply of the femoral head.

We do not inherit the earth from our ancestors, we borrow it from our children (Antoine de Saint-Exupéry)