Splint a broken leg or ankle: First Aid, Material, Techniques & Types
Broken Leg: Symptoms, Causes, Diagnosis, Treatment
What Is a Broken Leg?
A broken leg is when you break one of the bones in your leg. It can happen lots of ways, like falling or getting into a car accident.
Your leg has four bones (the femur, the patella, the tibia, and the fibula). If there’s an accident, any one of these bones may break (fracture) into two or more pieces.
- Femur. This is the bone in your thigh. It’s the longest and strongest bone in your body. The upper part of the femur fits into the pelvis (the bone that supports your spinal column) to form the hip joint. At this joint, it can move frontward, backward, sideways, and even rotate in and out. When people speak of a “broken hip,” it’s this upper part of the femur that’s broken. The lower end of the femur rests on top of the tibia, forming the knee joint. At the knee, the leg can swing frontward, backward, and even rotate slightly.
- Patella. The kneecap (patella) glides back and forth in front of the knee joint. The kneecap connects your thigh muscle to the tibia. It also helps protect your knee.
- Tibia. This is the shinbone. It supports your body’s weight.
- Fibula. The bone runs alongside the tibia below your knee. It’s on the outside part of the leg and is smaller than the tibia.
The ankle is made up of the bottom ends of the tibia and fibula, the connecting foot bones, and the ligaments and tendons. Serious twisting injuries to the ankle can result in fractures of the tibia or fibula near or within the ankle joint.
Types of Leg Breaks
There are many types of breaks. What type you have depends on the force it takes to break and the way it breaks.
Types of breaks include:
- Comminuted, when the bone breaks in three or more pieces and there are fragments where the bone broke
- Compression, when the bone is crushed
- Greenstick, when the broken bone isn’t completely separated (an incomplete fracture)
- Oblique, when the bone break is diagonal
- Segmental, when the bone is broken in two pieces (meaning there’s a “floating” part of bone)
- Spiral, when the bone break is spiraled, usually because of a twisting injury
If you can see the bone when it’s broken — either because there’s a cut over the fracture or the bone is sticking out through the skin — it’s called an open fracture. This is sometimes called a compound fracture.
Broken Leg Symptoms
Breaking your femur takes a lot of force, so it’ll probably be obvious if you break it. The major symptoms of a broken leg are pain, swelling, and deformity. Less obvious breaks might need an X-ray to diagnose.
Signs you might have a broken leg are:
- Not being able to walk
- Serious pain that gets worse when you move and gets better when you’re still
- A change in the form of your leg
If a leg is broken, it can change form in the following ways:
- Rotation: The leg below the break is twisted.
- Angulation: The leg bends at the break instead of at the joint.
- Shortening: The broken leg appears shorter than the unaffected leg.
If you think your child or toddler might have a broken leg, they might cry or stop walking on it without saying why.
When to seek medical care
Some parts of your leg may be broken and still seem like a bad strain. This happens a lot with injuries around the ankle, or sometimes with the fibula, the little bone next to the shinbone.
Call your doctor if:
- You can’t walk without being in a lot of pain
- It hurts when you push on the bony parts of the leg
- You’re worried you might have a broken leg, even if you’re unsure
If you think you or someone else has a broken leg, go to an emergency room for further evaluation. If you can’t walk, you should call 911 for an ambulance.
If you’ve recently had surgery, or had a splint or cast placed already, return to the hospital fight away if you have these problems:
- Loss of muscle strength or numbness in the leg or foot. Some loss of strength is common because of the pain of the fracture, but if you notice you’re quickly losing strength, having numbness, or suddenly have a lot of pain that doesn’t go away with your pain medication, it could be a sign of a “compartment syndrome.” Compartment syndrome happens when swelling gets so serious in your leg that it cuts off blood flow to it. This can cause damage to the muscles and nerves in your leg.
- Redness, fever, lots of swelling or pain, and pus draining from a surgical cut are all signs of possible wound infection.
Broken Leg Causes
It usually takes quite a bit of force to break bones in your leg. If your bones have been weakened somehow, they can be broken more easily. If the amount of force put on a bone is greater than the amount it can handle, the bone will break.
Some of the ways your leg may break include:
- Car or motorcycle accidents. You can break the bones in your leg when your knee hits the dashboard during a car crash. It’s possible to break all three of the bones in your leg when you get into an accident.
- Falls. Falling, especially from somewhere high, can break one or both of the bones in your lower leg, but falling usually won’t break your thighbone (femur).
- Overuse. It’s possible to get stress fractures — tiny cracks in your bones — when you put pressure on them often, like with long-distance running. Stress fractures can also happen with activities like ballet and basketball.
- Sports injuries. Getting hit during contact sports, like martial arts or football, can cause broken bones, too. So can hyperextending your leg.
In children, child abuse can break leg bones. If a child can’t walk and has a broken leg, that could be a sign of child abuse.
An injury can also cause a bone to break if your bones are weakened by diseases or conditions, including:
Broken Leg Diagnosis
The doctor will check your leg for signs of a break (fracture). If the doctor thinks a bone has been broken, they’ll order X-rays.
The doctor also will look for signs that an artery or nerve was damaged or injured. To do this, they’ll feel for pulses and test your strength and sense of touch below the injury.
If the doctor suspects some other medical condition has weakened the bone, leading to the fracture, other lab tests may be ordered.
It’s often tough to diagnose stress fractures, and special studies beyond X-rays may be needed.
Broken Leg Treatment
If you have a broken leg, you’ll need to take care of it right away when you’re at home.
Treating a broken leg at home
If an injury happens and you suspect a break, remember the following:
- Keep your leg as still as possible until help arrives.
- Rest. Try to keep from making the injury worse.
- Put an ice pack wrapped in a pillowcase or towel on your leg to ease swelling.
- If possible, keep your leg raised with pillows or cushions to reduce swelling.
- Often with a broken leg, surgery is necessary. For this reason, don’t let someone with a broken leg eat or drink anything until seen by the doctor. Always ask the doctor if it would be OK to eat before doing so.
Medical treatment for a broken leg
The type and location of a break in a leg bone will determine what treatment is needed.
- If the bones have become displaced or out of alignment, they’ll need to be put back into alignment. This procedure is called “reduction.” To do this, you’ll be given medications for pain before the procedure.
- An emergency doctor will be able to treat many types of fractures with a temporary brace or plaster splint and will tell you to follow up with an orthopedic doctor (bone specialist). Fractures of the thigh bone or the shinbone typically will need further care by an orthopedist right away. This may mean a cast or even an operation.
- Your bones will be kept from moving so they can heal using several methods:
- Setting your leg: When you first get diagnosed, a doctor will keep your leg still with a splint. Your doctor might keep the splint on for a day to let the swelling go down.
- Immobilization: Next, your doctor might use a splint or cast to stop your bones from moving around. You might also need crutches or a cane to get around easier. If that’s the case, you’ll probably use your crutches or cane for about 6-8 weeks.
- Medications and treatment: Your doctor might suggest you take over-the-counter pain medication (like acetaminophen or ibuprofen) to help with the pain and swelling. But if your pain is severe, they might give you stronger painkillers.
- Therapy: Once your leg heals and the doctor takes off your cast or splint, you’ll probably need some sort of therapy. Therapy will help your leg get back to normal, since your muscles will have weakened. It can take a few months or longer for your leg to heal completely.
- Surgery: Although a cast or splint is usually all most broken bones need, you could need surgery, depending on your break. If you need surgery, pins, screws, and metal plates or wires are usually used to hold together the broken ends of a bone. For fractures in the middle part of the thigh bone (femur) or the shinbone (tibia), a metal rod sometimes is placed down through the center of the bone. This is done in the operating room.
Broken Leg Complications
Although not everyone will have other problems that stem from breaking their leg, some complications are possible, including:
- Arthritis. Your break can cause arthritis to pop up years later.
- Blood vessel or nerve damage. When you break your leg, you could also damage the blood vessels or nerves that are nearby.
- Bone infection (osteomyelitis). If you had an open fracture, that means the bone was exposed to the outside air, including germs and fungi. Those could give you an infection in your bone.
- Compartment syndrome. Swelling, pain, and sometimes disability in the muscle near the break can happen with this rare condition. It’s more common with car accidents because it’s considered a “high-impact” injury.
- Delayed or poor healing. A serious broken leg might not heal quickly. It also might never fully heal, depending on the break. This is more common if you have an open fracture involving your tibia, since there’s less blood flow to the bone.
- Legs that are different sizes. If your child breaks a leg, one leg could end up shorter than the other. This is because children’s bones are still growing. But this is rare, especially with the right treatment
- Pain in your ankle or knee. Your ankles or knees could hurt because of your break.
From the emergency department, you will usually need to follow up with an orthopedic doctor. This bone specialist will guide you in further appointments and rehabilitation as necessary.
Broken Leg Prevention
To lessen your risk of injury from a car accident, use a seat belt. For children, use a safety seat appropriate for the child’s age and weight.
- If you play sports that involve high speeds or heights, play only at your experience level and use the right protective gear.
- Use assistance, like a walker or cane, as instructed by your doctor, if you are at risk for falling or have an unsteady walk.
- Talk to your doctor about screening for diseases that may weaken bones.
Broken Leg Recovery
If treated promptly and properly, a broken leg usually will regain normal function. How severe the injury is and your age will play roles in how you recover. For instance, an elderly person with a hip fracture may have a hard time getting their strength and mobility back.
Orthopedic Injuries in the Wilderness
Increasing numbers of adventurers are seeking the solace and beauty of the backcountry either on skis, mountain biking or on foot. There is a degree of risk involved in venturing into the wild where cell phones don’t work and professional medical resources are nonexistent. In a remote setting, what should a buddy do to help an injured friend and not exacerbate the injury? A basic understanding of first aid and creative use of available natural resources can impact the outcome of a bad situation.
NIH data confirms that 70% of non-fatal injuries in the wilderness are broken limbs or sprains. Turning an ankle on a steep trail is one of the most common injuries. Ankle injuries account for 53% of all injury evacuations during the National Outdoor Leadership School courses. As a lay-responder, diagnosing a strain, sprain, ligament tear, dislocation, or fracture is nearly impossible. The first step is to implement the RICE method: rest, ice, compression, and elevation. Reduce the swelling by icing the area with snow or a t-shirt soaked in a mountain stream. Compress the joint with an ace bandage or bandana, but don’t cut off circulation. Elevate the injury above the heart. RICE for 20 minutes. Now is the injured friend able to walk? If so, it may be necessary to create a splint for a leg or ankle injury and use a hiking pole or wooden stick to bear some of the weight and help with balance. During the walk back to civilization, stop to rest every two hours and RICE again. If there is doubt about the seriousness of an injury, treat it as a fracture. Signs that an injury is indeed a fracture include a limited range of motion, tenderness and bruising, pain in the injured area, possible deformity, inability to bear weight, and a grating sensation when moved. During the accident, he or she may have heard or felt a pop or break. After the RICE treatment to relieve pain and reduce swelling, build a splint with available resources to prevent movement and protect the injured part from further damage.
To create a splint in the wilderness:
- Cutaway clothing if it cannot be removed without moving the injured body part.
- Stop any bleeding by applying gentle pressure. Cover open wounds with a clean dressing before splinting.
- Pad the injured joint with jackets, sleeping bags or clothing.
- Include the joint above and below the injury in the splint.
- Make a splint with two straight objects, ski or hiking poles, tree branches, canoe paddle, etc., and position them around the fracture.
- Tighten the splint using a belt or ropes or whatever is available.
- Keep the injured limb tied tightly to begin the long, slow hike out.
- Check the splint ties frequently to be sure they do not hinder circulation.
Shoulder, clavicle, upper arm, elbow, forearm, wrist, and hand can be stabilized with a sling and swathe around the chest splint:
Shoulder fractures: Sling immobilization.
Upper arm fractures: Immobilize in a splint and swathe arm against the body.
Hand fractures: Immobilize with buddy taping and hand splint.
If a fractured hip is suspected, the injured person must be carried out on a sled or in a helicopter. Contact Search and Rescue as soon as a phone has service. Whether walking out or transporting a friend on a makeshift sled, the injured person needs definitive care immediately. For orthopedic injuries, the best immediate care option is Direct Orthopedic Care. Open seven days a week to diagnose and treat any musculoskeletal injuries that happen in the wild.
Splint Care Tips | Michigan Medicine
A splint protects a broken bone or other injury. If you have a removable splint, follow your doctor’s instructions and only remove the splint if your doctor says it’s okay.
Most splints can be adjusted. Your doctor will show you how to do this and will tell you when you might need to adjust the splint. A splint is sometimes called a brace. You may also hear it called an immobilizer. An immobilizer, such as a splint or cast, keeps you from moving the injured area.
You may get a splint that’s already factory-made. Or your doctor might make your splint from plaster or fiberglass. Some splints have a built-in air cushion. Air pads are inflated to hold the injured area in place.
- Follow your doctor’s instructions on how much weight you can put on your injured limb.
- If the fingers or toes on the limb with the splint were not injured, wiggle them every now and then. This helps move the blood and fluids in the injured limb.
- Prop up the injured limb on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.
- Put ice or cold packs on the limb for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Be careful not to get the splint wet. Put a thin cloth between the ice and your skin. If your splint is removable, ask your doctor if you can take it off when you use ice.
- If you have an adjustable splint that feels too tight, loosen it slightly.
- Keep up your muscle strength and tone as much as you can while protecting your injured limb. Your doctor may want you to tense and relax the muscles protected by the splint. Check with your doctor or your physical or occupational therapist for instructions.
Splint and skin care
- If your splint is not to be removed, try blowing cool air from a hair dryer or fan into the splint to help relieve itching. Never stick items under your splint to scratch the skin.
- Do not use oils or lotions near your splint. If the skin becomes red or sore around the edge of the splint, you may pad the edges with a soft material, such as moleskin, or use tape to cover the edges.
- If you’re allowed to take your splint off, be sure your skin is dry before you put it back on. Be careful not to put the splint on too tightly.
- Check the skin under the splint every day. If you can’t remove the splint, check the skin around the edges. Tell your doctor if you see redness or sores.
Water and your splint
- Keep your splint dry. Moisture can collect under the splint and cause skin irritation and itching. If you have a wound or have had surgery, moisture under the splint can increase the risk of infection.
- Tape a sheet of plastic to cover your splint when you take a shower or bath, unless your doctor said you can take it off while bathing.
- If you can take the splint off when you bathe, pat the area dry after bathing and put the splint back on.
- If your splint gets a little wet, you can dry it with a hair dryer. Use a “cool” setting.
When to call for help
Call your doctor now or seek immediate medical care if:
- You have increased or severe pain.
- You feel a warm or painful spot under the splint.
- You have problems with your splint. For example:
- The skin under the splint is burning or stinging.
- The splint feels too tight.
- There is a lot of swelling near the splint. (Some swelling is normal.)
- You have a new fever.
- There is drainage or a bad smell coming from the splint.
- Your limb turns cold or changes color.
- You have trouble moving your fingers or toes.
- You have symptoms of a blood clot in your arm or leg (called a deep vein thrombosis). These may include:
- Pain in the arm, calf, back of the knee, thigh, or groin.
- Redness and swelling in the arm, leg, or groin.
Watch closely for changes in your health, and be sure to contact your doctor if:
- The splint is breaking apart or losing its shape.
- You are not getting better as expected.
Current as of:
November 16, 2020
Author: Healthwise Staff
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Current as of: November 16, 2020
Ankle Sprain & Fracture Treatments
In the case of an ankle sprain, rehabilitation is crucial and starts early. A Rothman foot and ankle surgeon may recommend one or more of the following treatment options:
*Immobilization- Depending on the severity of the injury, a short-leg cast, walking boot, or brace will keep the ankle from moving. Crutches may also be needed.
*Early Physical Therapy- A doctor will start a rehabilitation program as soon as possible to promote healing and increase range of motion and strength.
*Medications- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be needed to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
*Ice- Applying ice to the injured area several times a day until the pain and swelling resolves is advised. Do not put ice directly on the skin.
*Compression Wraps- To prevent further swelling, keep the ankle wrapped in an elastic bandage or stocking.
*Elevation and ice- In most patients, swelling is often seen following an ankle fracture. An important part of proper treatment is to reduce this swelling. By limiting the amount of swelling, the pain from the ankle fracture will be decreased as well as preventing further damage to the surrounding tissue.
*X-rays- A majority of ankle fracture patients are treated in an emergency room or a doctor’s office. The initial procedure is to obtain an X-ray of the damaged ankle to determine what the fracture looks like, how separated the bones are, and to find out the condition of the bone itself. The X-ray of the damaged ankle will help determine the proper course of treatment.
*Splint- Applying a splint to an ankle fracture is most commonly performed in the emergency room. The splint usually remains on the leg for a few days before applying a cast. In the case of continued swelling, a splint allows for more room than a cast. If the damaged ankle is not extremely displaced, the splint may be applied immediately without moving the broken ankle. However, if there is bone separation, a “reduction” should be performed. In this case, the patient will be given anesthesia while the ankle fracture is set or aligned. Resetting the ankle bone will improve the alignment of the broken bones.
*Cast- After a few days, a cast will be placed on the ankle area. However, if the swelling is minimal, it may be applied sooner. The cast is made of either fiberglass or plaster. If it is determined that the cast is needed to hold the broken bone in a specific location, then a plaster cast is usually applied since plaster molds to the skin better. A fiberglass cast is most often used if some healing has taken place or if the fracture is not unstable.
*Crutches – Since most types of ankle fractures require some degree of immobilization and rest following the injury, crutches play an important part in recovery. In many cases, a patient will not be able to place any weight on the ankle for several days, weeks, or even months. Crutches will be provided to aid in mobility while injured.
You have an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken. This often causes pain, swelling, and bruising.
A fracture is treated with a splint, cast, or special boot. It will take about 4 to 6 weeks for the fracture to heal. Surgery may be needed to fix severe injuries.
You will be given a splint, cast, or boot to prevent movement at the ankle joint. Unless you were told otherwise, use crutches or a walker. Don’t put weight on the injured leg until cleared by your healthcare provider to do so. Crutches and walkers can be rented at many pharmacies and surgical or orthopedic supply stores. Don’t put weight on a splint. It will break.
Keep your leg raised to reduce pain and swelling. When sleeping, place a pillow under the injured leg. When sitting, support the injured leg so it is often. This is very important during the first 48 hours.
Apply an ice pack over the injured area for no more than 15 to 20 minutes. Do this every 3 to 6 hours for the first 24 to 48 hours. Keep using ice packs 3 to 4 times a day for the next 2 to 3 days, then as needed to ease pain and swelling. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. You can place the ice pack directly over the cast or splint. As the ice melts, be careful that the cast or splint doesn’t get wet.
Keep the cast, splint, or boot completely dry at all times. Bathe with your cast, splint, or boot out of the water, protected with 2 large plastic bags. Place 1 bag outside of the other. Tape each bag with duct tape at the top end or use rubber bands. Water can still leak in. So it’s best to keep the cast, splint, or boot away from water. If a boot or fiberglass cast or splint gets wet, dry it with a hair dryer on a cool setting.
You may use over-the-counter pain medicine to control pain, unless another pain medicine was prescribed. Talk with your provider before using these medicines if you have chronic liver or kidney disease or ever had a stomach ulcer or GI (gastrointestinal) bleeding.
Follow up with your healthcare provider in 1 week, or as advised. This is to be sure the bone is healing correctly. If you were given a splint, it may be changed to a cast or boot at your follow-up visit.
If X-rays were taken, you will be told of any new findings that may affect your care.
When to seek medical advice
Call your healthcare provider right away if any of these occur:
The plaster cast or splint becomes wet or soft
The fiberglass cast or splint stays wet for more than 24 hours
There is increased tightness, sore areas, or pain under the cast or splint
Your toes become swollen, cold, blue, numb, or tingly
The cast or splint becomes loose
The cast or splint has a bad smell
The cast or splint develops cracks or breaks
Ankle Fractures (Broken Ankle)
What Causes an Ankle Fracture?
Fractures of the ankle, also called a broken ankle are commonly the result of an inversion ankle rotational or rolling injury; much like how the ankle rolls when it’s sprained. A high impact injury, as in a car accident or fall, can also result in an ankle fracture. A fracture is a partial or complete break in a bone. In the ankle, fractures involve the far or distal ends of the tibia, the fibula, or both bones. The tibia is the shinbone and is located on the inner, or medial, side of the leg. The fibula is located on the outer, or lateral, side of the leg. The distal ends of the tibia and fibula bones are also known as the medial and lateral malleoli, respectively.
Some distal tibia fractures can involve the rear or posterior part of the bone, which are also known as posterior malleolar fractures. Ankle fractures can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe, shattering-type breaks. Some fractures may also involve injuries to important ankle ligaments that keep the ankle in its normal position. Ankle fractures are commonly caused by the ankle twisting inward or outward.
Brief Overview of Treatments for an Ankle Fracture
Treatment options for a broken ankle differ depending on the severity of the injury. If the broken bones are not out of place and the ankle is stable, the injury can usually be treated without surgery. These treatment options include: walking boot, cast or removable brace and the use of crutches or a knee roller/scooter.
However, if the ankle is unstable, broken in more than one place, or the fracture is out of place, surgery may be required align the joint in the correct position and prevent future problems associated with an ankle fracture that doesn’t heal properly which can lead to several long terms issues including instability, chronic pain, residual deformity and the development of debilitating arthritis of the ankle joint.
Symptoms an Ankle Fracture
One or all of these signs and symptoms may accompany an ankle fracture:
- Pain: Typically located at the site of the fracture, but can radiate from the foot to the knee.
- Swelling and Bruising: May occur along the length of the leg or be more localized at the ankle. Swelling can be so severe a times that the skin may even blister. Blisters may occur over the fractured area.
- Inability Place Weight on Foot/Ankle: It is possible to walk or bear weight upon the ankle with less severe fractures. Never rely on walking as a test of whether the ankle is fractured.
- Deformity and Dislocation: Following an ankle fracture, the foot may be turned in an awkward position. This is an indication that there has been a severe injury to the bones leading to stability. This is considered an emergency. Please make sure you go to either your foot and ankle specialist or to the emergency room in order to obtain a rapid diagnosis and reduction. The longer an ankle is out of position, the more likely there will be an adverse effect on the potential healing as the vascularity to the ankle can also be disrupted. In extreme cases, the fractured bones may protrude through the skin. This condition is known as an open ankle fracture. These types of ankle fractures require immediate treatment to avoid problems like infection.
How are Ankle Fractures Diagnosed?
Most patients with ankle fractures are treated in an emergency room or a doctor’s office. An X-ray of the damaged ankle may be taken to determine what the fracture looks like, which bones are broken, how separated or displaced the bones are, and to find out the condition of the bone itself. The X-ray will help determine the proper course of treatment. In some cases, a CT scan may be helpful to help determine the extent of the fracture, especially if there are more than two fractures on to diagnose a fracture that extends into the ankle joint.
Ankle Fracture Treatments
Ankle fractures that don’t have gapping or angulations/rotation at the fracture site are usually treated with cast and if indicated, physical therapy. These usually do not require surgery.
- Elevation and Ice: Swelling is often seen after an ankle fracture. By limiting the amount of swelling, the pain from the ankle fracture can be decreased and further damage to the surrounding soft tissue may be prevented. Elevating the ankle and icing the affected area can help to limit swelling.
- Splint: A splint may need to be placed to support the broken ankle. The splint usually remains for several days. A splint allows for room to accommodate swelling. If the damaged ankle is not displaced, the splint may be applied immediately without moving the broken ankle. However, if the bones are displaced and/or the ankle joint is dislocated, a closed reduction is performed while the splint is placed. This treatment involves setting the tibia and/or fibula bones and ankle joint to improve the position and pain at the ankle. This treatment may require some type of anesthesia.
- Rest/No Weight Bearing: Most patients require some period of rest with no weight being put upon the ankle. Crutches, walkers, knee rollers and wheelchairs allow patients to keep weight off of the ankle. Many factors can determine which is the best choice for an individual patient. The type of ankle fracture will determine when patients can start to stand and walk on their injured ankle. In many cases, a patient will not be able to place any weight on the ankle for several days, weeks or even months. This is a determination that must be made by your foot and ankle specialist.
- Cast/Fracture Boot Immobilization: Some ankle fractures can be treated without surgery. These are usually injuries where one bone is minimally displaced. Such fractures can be treated simply with a period of immobilization. Once the initial swelling improves over the first several days, either a cast or a fracture boot can be applied to the ankle to properly protect and immobilize it. Both a cast and a boot can provide adequate protection to the ankle. A cast cannot get wet or be removed without special tools. A boot can be removed for bathing and sleeping. The type of fracture and the physician’s judgment will determine the best type of immobilization. The cast or boot is worn until the fracture is fully healed, which usually takes two to three months.
Ankle fractures often require surgery to replace the fractured pieces to normal anatomic alignment and put the ankle joint in the correct position. The surgical treatment is known as an open reduction and internal fixation or ORIF. This is usually accomplished with the help of specially designed plates and screws. There are several reasons why an ankle fracture will require surgery. If the fracture is displaced or angulated, and the ankle joint is no longer aligned, surgery is required to realign the ankle joint. It is essential to align the ankle fracture to within 2 millimeters of original position for optimal long-term results. Ankle fractures involving joint cartilage can lead to arthritis in the joint. It is especially important that ankle fractures are reduced to return the anatomy to its normal position and alignment.
Ankle fractures will also require surgery if the ankle is broken in several places (called a bi-malleolar or tri-malleolar fracture). These types of ankle fractures are very unstable, and will require surgery to stabilize the joint. If these injuries are not stabilized with surgery, the bones will likely shift, causing a malalignment of the joint, which may lead to post-traumatic arthritis in the ankle.
As the ankle heals after surgery, the joint is protected with restricted activity and a cast or fracture boot. The cast or boot is worn until the fracture is fully healed, which usually takes two to three months.
How to Splint a Fracture of the Lower Leg: 13 Steps
About This Article
Medically reviewed by:
Board Certified Critical Care Surgeon
This article was medically reviewed by Jonas DeMuro, MD. Dr. DeMuro is a board certified Pediatric Critical Care Surgeon in New York. He received his MD from Stony Brook University School of Medicine in 1996. He completed his fellowship in Surgical Critical Care at North Shore-Long Island Jewish Health System and was a previous American College of Surgeons (ACS) Fellow. This article has been viewed 38,621 times.
Updated: April 30, 2020
If you or someone you’re with has fractured a leg, call emergency services or go to the emergency room right away. While you’re waiting for help, use scissors or a knife to cut off the pants leg or any other clothing covering the fracture. If the fracture site is bleeding, apply pressure with a clean cloth until the bleeding stops and elevate the leg above heart level. You should also put an ice pack on the affected area to reduce swelling. Don’t try to set the fracture yourself, since this could cause more damage. Once you’ve provided first aid, wrap the leg with a soft material such as foam padding or a blanket. Then, place something hard along the side of the leg from knee to ankle, such as a piece of hard cardboard or a tent pole. Secure the splint with a strip of cloth or some packaging tape, making sure to cover the joints above and below the ends of the splint. Finally, check under the splint for a pulse to make sure it’s not tight enough to cut of the circulation, and loosen it if necessary. For more advice from our Medical co-author, including how to prevent and treat shock, keep reading!
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Plaster of paris versus conventional plaster – innovations in traumatology
Doctors also have complaints about traditional plaster. Classic gypsum material almost does not transmit X-rays, the image is indistinct. It is difficult for a specialist to assess how correctly the bones are fused under the bandage.
In addition, when wearing plaster for a long time on the damaged area, blood circulation is often impaired. Tendons, joints and muscles do not work much, which can lead to lameness or reduced joint mobility after the cast is removed.
Alternative to conventional plaster
However, the fracture site must first of all be fixed and immobilized, that is, immobilized. In trauma centers and hospitals, the classic plaster is offered in the old fashioned way, in the absence of other alternatives. In the medical center “Medassist” doctors use materials of a new generation – polymer immobilizing bandages, they are also called “plastic plaster”.
Plastic gypsum is a bandage impregnated with a special polymer compound.
Plastic plaster is used not only in case of a broken arm or leg. With its help, feet, elbows, knees, dislocated shoulder or ankle are fixed, and also used for stretching muscles or ligaments.
However, in order to apply or remove polymer plaster, the doctor must have special knowledge, tools and materials. Medical center “Medassisst” is one of the few in the city where doctors can apply modern orthopedic dressings made of plastic.
Advantages of artificial plaster
Unlike classic plaster, plastic plaster weighs several times less and does not interfere with movement. At the same time, the material is very durable, which guarantees the correct healing of broken bones.
Modern plaster made of plastic is not afraid of water, you can safely swim with it both in the bathtub and in the sea, and in case of contamination, simply wipe it with a damp cloth.
The porous structure of the material allows oxygen to pass freely, so that the patient does not experience itching, irritation or other skin reactions.In addition, polymer fixatives are non-toxic and hypoallergenic.
Due to the elastic material, the gypsum adheres tightly to the site of injury, and at the same time allows you to simulate any shape with complex fractures.
During the X-ray, the plastic plaster does not need to be removed, it does not trap X-rays. The doctor can see all the details in the image, which means there will be no difficulties in assessing the bone fusion.
Plaster made of plastic looks neat even after long wearing, and the patient feels it like a regular bandage and does not feel discomfort like wearing a regular plaster.
Such a retainer is removed using a special saw and, due to the smooth texture, does not injure the skin and hair. This compares favorably with the classic plaster, which, when worn for a long time, almost grows together with the skin.
What are the types of artificial plaster
There are several types of polymer gypsum. The most famous are scotchkast, softcast and turbocast.
Scotchkast – polymer gypsum, strong and rigid, due to which it reliably immobilizes the fracture.The lightest of all artificial bandages. A special lining stocking is put under it so as not to injure the skin. Scotchkast comes in different colors, which will appeal to children and lovers of bright colors.
Softcast allows you to create dressings of varying rigidity. After hardening, the material remains semi-rigid, which allows maintaining muscle mobility in the damaged area. At the same time, the material is flexible, but not stretchable, which helps to maintain its original shape. It is used not only for fractures, but also for sprains of the limbs.
Turbocast is the most famous polymer gypsum made from thermoplastic. It makes it possible to give the dressing any shape, which makes it indispensable for the most complex fractures, including in children and adolescents. The special design allows the patient to independently remove and put on the bandage (with the permission of the doctor).
Consult a doctor
Each type of polymer gypsum is indicated for certain injuries and fractures. Only the attending physician can determine which one is right for you.
The plastic bandage does not cancel visits to the doctor and does not accelerate the fusion of broken bones, but it makes the treatment as comfortable as possible.
In the medical center “Medassist” the doctor-traumatologist-orthopedist Sokolenko Natalya Vladimirovna (link to the doctor) will help to determine the type of polymer gypsum that suits you.
You can find out more detailed information or make an appointment by phone. +7 (4712) 46-03-03.
Published on April 17, 2020.
Complete recovery from ankle fracture in 28 days
This is the story of how I got injured, if you are interested in recovery, you can skip directly to this item
I broke my ankle on the trampolines. As usual, I went to Sunday evening class with my friends. After 55 minutes of jumping, I was about to leave, but finally decided to do a clean back somersault on the net. Bounce. Somersault. Landing. All perfectly. After a somersault, already in a jump, I decide to turn 180 degrees, but something went wrong and I land on one leg.This is what they say on the very first busy “Never land on one foot! At all. Never! Better to fall on your back or side. Any of these outcomes would be better. Well, in general, the result was on the face: upon landing, my leg turned inward. I heard a loud crunch inside, and felt a sharp pain. Hot, sharp pain as from a burn. I fell onto the net. I couldn’t feel my ankle from the shock. The coach asked, “Is everything okay?” I answered “No and took off my sock.” The coach saw a leg swelling in front of my eyes and quickly ran after the freeze and ice.The leg swelled and became simply huge, I did not feel it, there was only aching pain. In order not to lie on the net, I crawled to the side and then slightly touched the side with my foot. Again a sharp burning pain pierced the brain. I realized that things were bad. The coach was already running with a freeze spray and ice packs.
The leg was already of decent size and the coach stated that it was at least a ligament rupture. He said that this is the most common injury here, they say, do not worry, okay) it happens to everyone. At that time, I was not particularly worried, I thought maybe in a week everything would heal.But my ankle had other plans.
I am writing to my girlfriend that I will be “a little late” 🙂
An ambulance was called for me, as I could not walk at all. Any movement of the leg is a sharp pain. Somehow, with the help of my friends, I jumped to the locker room, changed my clothes and went out to the reception. An ambulance team was already waiting for me there (they arrived very quickly, in about 10 minutes). They looked at me, laughed, said that they come here 3 times a week to pick up such lucky ones like me.
Funny moment: when the doctors picked me up and we headed for the exit, a group of girls opened the door to the trampoline center.They looked at me, then one of them turned to her friend and said, “Listen, Ir, maybe well, fuck him? Will not go?”. The doctors and I laughed and jumped to the ambulance.
There I lay down on the couch that smiled at me all the way
Paramedics asked a couple of questions about my age, what I do, and so on. Along the way, they asked if I refuse to take an injection of anesthetic. I said, “It would be nice.” To which the doctor writes down and says loudly, “Refuses the pain reliever!” 🙂 Then I realized that with any drug substance they have to sign a bunch of papers and no one wants to do this, but oh well, my leg did not hurt much, it was tolerable.
We drove about 20 minutes to the emergency room of the nearest hospital. There the brigade handed me over to the surgeon and said goodbye. The surgeon looked at my leg, said “stomp for an x-ray” I appreciated the joke, considering that they brought me in a wheelchair. A nurse picked me up and took me to the x-ray room. I climbed into the rookery of this gigantic and dumb car. An elderly radiologist came up and began to admire my socks: “Oh, what cool socks you have! It’s not from AliExpress by any chance ?! I want to take the same to my son? What is your size? Are they kind of dimensionless? What wonderful socks, I will definitely take it! ” I was a little embarrassed, they don’t fire you every day that you wear things from Aliexpress 🙂 He said that probably not, they just look alike.I got it as a gift. I lied. It’s a shame.
X-rays were taken in two projections, the nurse took me back in a wheelchair and left me waiting in the corridor. I saw my picture only on the screen of the surgeon, who was behind the glass and from a distance of 4 meters. But I saw how he twisted the parameters there, highlighted, changed the contrast, peered at something. After 10 minutes he came out to me and took me into the examination room.
The leg has already swelled to this size
Lord! How huge it is !!!!
The surgeon said that I have a closed two-malleolar fracture and damage to the capsule-ligamentous apparatus.“Those times have arrived” I thought, sounds serious, but then I did not attach much importance to this. I asked “How much to walk and how much to run?” The doctor replied that 3-4 weeks in a cast, then an orthosis, then recovery and after 2 months it will be possible to run. PPC 2 months…. It’s the same to guard for how long. But still 3 weeks in a cast before that…. It’s necessary to lie down.
– Will you put in the hospital? – I asked
– Why? Here you can lie down at home, I’ll make you a plaster cast and let you go – the surgeon replied. “Just listen to the recommendations” Keep on a hill and it’s cold for 3-4 days! ”
– Got it, I say, it will be done! -Fuh, well, at least you don’t need to lie in the hospital, and that’s good.
– Your current swell is too much, but it happens when you are young, do not worry, now we will do everything.
In 5 minutes I am already walking with my foot forward (not two, but one 🙂 to the dressing room, where the doctor applies a warm cast to me. Quite pleasant sensation from warm wet dressings. I put it on and said to lie down. 20 minutes and the plaster will harden. I’m lying.
After 20 minutes, he comes back and shows which orthosis I need to buy. He also gives me a certificate stating that I really have a “Closed two-malleolar fracture with damage to the capsule-ligamentous apparatus”.
Says “That’s it, you can go!”
Once again I appreciated his joke or maybe it was faith in my strength 🙂 He asked, “Is there anyone to take?” “No, I say, I’ll try to call a taxi”, he is like “o_O Well, okay, be careful!”
I order an Uber, I say that I am in traumatology, that I need to drive as close as possible, otherwise I will not get there. The driver said that he understood everything and after 5 minutes he was there,
Now imagine: I have a sports bag in my hand, a shoe in the other hand, I am on one leg.Trying to jump to the exit. It turns out so-so. And outside, winter, slippery and cold. I understand that I cannot get to the taxi, because I will probably fall 10 times before that 🙂 I decide to call a man standing next to me for help. He enthusiastically agrees and helps me out of the emergency room safe and sound. A taxi drove up, the two of them are trying to put me in, somehow climbed in. It is very difficult to climb with one leg. Because you feel very insecure, there is no balance and there is a fear of accidentally stepping on a sore foot.
They sat down. Let’s go. I’m home in 50 minutes. The girl was not very happy with my adventure 🙂
But nothing can be done 🙂 I called my parents and asked them to buy an orthosis and crutches to get around somehow.
It was in the evening we ate and went to bed. I put my foot on a cushion-shaped hill as the doctor advised. However, I could not sleep that night. The pain was terrible. Feeling as if someone is constantly tugging at the nerve endings. I was sniffling, moaning and sweating a lot, the girl could not sleep that night either.I didn’t buy an anesthetic because I didn’t think there would be such severe pain. And the doctor forgot something. Somehow survived this night. Determined to get the pain reliever today.
At 10 am I remembered that I had not asked for a sick leave. Damn it, why do that. I call the local clinic, explain the situation, say “Come” after 2 hours to the traumatologist, we will do it! ” I ask my parents to help with the transportation of my young but mortal body 🙂 They say “Ok, we will be there soon! And we’ll give you a lift to the pain reliever! ”
Super! It’s time to get out of bed and go for breakfast.I get up on one leg, lower my leg with a plaster cast and then BAM! I feel like blood begins to rush into my sore leg with a frenzied force! It swells, the pressure in the cast builds up, the hellish pain becomes even stronger, I can’t help screaming. Painfully! Highly! After a while, it lets go. I start jumping around the apartment here and there, then into the bathroom, then into the kitchen. Then comes the understanding that the resources of my healthy leg are not unlimited. After 5-10 jumps, she begins, as athletes say, “to hammer”. Muscles begin to ache and it is already difficult to make even one jump.I had to constantly cling to the nearest objects: a table, a chair, a curbstone, a wardrobe, a door. Such a pitstop, before the next throw. It was hard. I realized very quickly that my healthy leg would get a lot of stress in the next 3 weeks if I didn’t get crutches. I called my parents again and reminded them that we should have churches today.
Parents arrived: Complaints, reproaches, bewilderment: “But how could it be ?!” “What were you thinking?!” “What did the doctor say?!” “Why did you go there at all ?!” 🙂 I said: “Well, why should I say this now? Will it help somehow? ” The reproaches stopped.They brought crutches, an orthosis, some food and ointment. I thanked them for all this goodness and we drove to the clinic. There I took a ticket to a traumatologist and jumped to him on crutches.
I went to the traumatologist, handed over the certificate that was given yesterday. He looked at her and said, “Come on? A fracture? ” Bent over to the cast and pressed the front of the ankle. I screamed. He says, “Indeed, fracture.” I’m so O_o, what kind of diagnostic methods does he have? I sent it to the x-ray. Since he said that in half of the cases, two-malleolar fractures need to be operated on: put pins and so on.It became dumb. X-ray I made
Here is a snapshot
On it, the traumatologist saw a marginal fracture of the inner ankle and something from the outer (I called a Latin word, I can’t remember now) The operation is not needed, everything is more or less good .. He said 6 weeks in a cast. I objected that the previous doctor told me to put on the orthosis in 3 weeks. There is already a doctor and a nurse in unison “What an orthosis, what are you doing, it won’t hold your ankle!”. The hospital was discharged for 2 weeks, they said you will come every week, we will renew it.”OK! Thank you “
Went home time 15:00
What does everyone do as soon as they get injured and get a diagnosis?
That’s right, they google pictures of fractures :)) Well, in general, they study the issue in every possible way. I spent the whole day studying the question “Ankle fracture. How. What. Why ”
I read dozens of articles, watched a bunch of vidos, reviewed hundreds of pictures. And I got an idea.
Conduct an experiment. Recover much faster than doctors predict.
Well, here’s my recovery story.
Recovery after fracture
I want to warn anyone who wants to apply the advice in this article. I am not a doctor, and not even a nurse . My competence is not enough to give advice even with a cold. But, I conducted this experiment on myself to prove that human resources are much greater than doctors think. Every fracture and person is unique, so these tips can both help and harm.Think with your own head, assess the situation and the state of your body. Use the tips in this article if you are confident in your abilities. This is your health and your risk. I took a chance and do not regret it. Good luck!
A bit of theory
In most of the videos I watched, people, two months after the fracture, could barely move their legs and did super simple exercises. Fear gripped me. And this is 2 months later? What about running and all that? After watching other videos, I realized that people started running after such injuries after 3 months, and some only after six months! His mother cannot run for six months.What kind of HELL?!?! But in fairness, I can say that these were people with a three-ankle fracture with displacement, who underwent surgery. In my case, everything is much simpler.
But then I came across this video:
If it still would have been without a religious connotation …. After watching it, doubts stuck in my head: can doctors really be so wrong? Is it really possible to recover so quickly? Isn’t he lying for an hour? What if he doesn’t have such a fracture for me?
In general, this video was the beginning of my search and a guide to action.I wrote to Yuri on the same day. I asked for advice, asked when he took off the plaster himself.
Yura said what any doctor would say: Remove edema. Then I thought that well, yes, it would be nice to apply ice, but I did not fully realize the importance of this process. Now I understand that this was the most important reason for the success of a quick recovery.
Therefore, we will derive the golden rule for ankle fracture
The main thing is to quickly remove edema
I have a theory: any reaction of our body is developed by evolution for a reason.And if the body reacts to the fracture by swelling of the tissues, then this is how it should be. But I could not admit the thought that our body is not perfect in this regard. To be more precise, this is his “universal” reaction, which means that whether it is a fracture, bruise or dislocation, the reaction is one. Edema. Versatility cannot be perfect. Therefore, it was decided to “help the body to react correctly”
But why is it so important to remove edema? How does it promote healing?
Now let’s write out the second rule in gold
New blood is the key to tissue healing.The greater the inflow of new blood, the sooner the recovery
I’m not a doctor, but purely logically everything is clear here: new blood carries nutrients, lecocytes, and other useful things that help heal damaged areas of bone, muscles and ligaments.
In general, with such a fracture, damage or complete rupture of the ligaments almost always occurs. If this has not happened for you, you are very lucky. Because the main reason for a long recovery is damaged ligaments.
Ligaments are not restored, we have heard this many times. The ligaments are scarred like scars on the skin. Therefore, it is very important to stretch this “scar” in time. Because if you do not do this from the very beginning, then you will never return the previous joint mobility. Okay, okay, but it will take months and years, not weeks.
Very accessible about ligaments and ankle injury can be found in this playlist. There are 13 videos of 2 minutes each, I advise you to watch them all 🙂
Well, the theory seems to be clear, but what is in practice?
24 hours after the injury, the constant pain subsided and felt better.I kept my leg in a canopy almost all the time when I lowered it – I felt how everything was swelling and bursting with plaster from the inside, unpleasant sensations, but bearable. putting your leg in a cast on the floor – it hurts, very much! Any touch on the leg in a cast is pain!
I was jumping on one leg and felt how much my back was straining, later this will come back to haunt me with a trip to a chiropractor and sessions to relieve muscle spasms of the back and cervical spine. Therefore, immediately one more piece of advice
Tap the back
Buy the tapes yourself or go to a doctor who will competently apply them to you, but do it!
And cervical spine
I did this only after 2 weeks and got a lot of problems, so if I do it on the first day, then everything will be fine with my back.The fact is that in case of any imbalance during walking, the spine takes over the entire load. The balance during your jumps on one leg is provided by excessive tension of the back muscles, and they are strained only from the side of the sore leg, which leads to spasms of the muscles of the lumbar and cervical spine. And we don’t need this. Therefore, do not delay taping, the faster you do it, the better. By the way, the sensations are very cool, as if you are walking in an exoskeleton, muscles are less tense and it is somehow easier to even walk and jump 🙂
I didn’t do anything special that day.I did not remove the swelling, as I was afraid to remove the cast. I thought that I still need to wait some time, otherwise the bone will not grow together. I watched vidos with exercises, read recovery stories, studied materiel about ligaments, bone mazoli, and so on. Enlightened as best he could. This day was spent on crutches.
I decided that on this day it was worth removing the cast, since the blue fingers sticking out from under the cast did not give me rest, I thought that my leg was dying 🙂 The cast was not removable, so I understood that if I now cut it and something then it goes wrong, then I will have no one to impose a new one and nothing.It was dumb, very. But I decided that if anything, I would fix the leg with the purchased Orthosis, some kind of fixation. I started cutting plaster
I treated it with a piece of ice and tightened it with an orthosis, so I still sat at the computer for 2 hours
I spent the night in Orthez and in the morning I took it off and did not wear it again.
When I took off the orthosis and put my leg down on the floor, I felt a hell of a pain. Still, when blood rushes to damaged tissues, it hurts. I can say that this hellish pain continued for another 5 days.I will not hide, I screamed in pain. To understand, imagine that your leg is numb, so numb that you hardly feel it. Now release the bloodstream. Beginning to pinch, pull, and something akin to a cramp passes through the entire leg. It is unpleasant for you and may even be a little painful. Now multiply this sensation 50 times. This is the kind of pain you will feel. Unpleasant 🙂
I started doing creo procedures 3-5 times a day. I took a piece of ice and led it along my leg for 7-15 minutes. I tried to do everything as Yuri said, slowly, little by little.
On the same day I began to do the very first exercises: to move the toe back and forth. Important:
In the first 6 days after the fracture, it is better not to move the toe left and right, because in this case the joint will move, which can displace your fracture. The forward and backward movement of the toe is safe and can be done 6-7 days after the fracture. Once again: I am not a doctor, this is my subjective opinion.
Why can’t you move left to right?
It is advisable to move the foot to the left and to the right after the formation of primary callus.It will fix your fracture and protect you from complications.
What is bone callus?
The structure formed during the regeneration of bone tissue after a bone fracture during the normal course of the fracture healing process; it is the connective tissue that forms at the site of the fracture.
When is it formed?
By the end of the first week, primary callus is formed. Callus rebuilds into normal bone in about one year.
Let’s go back to the exercises.Does it hurt to do them?
Imagine stretching your muscles while exercising. Let’s say sit on a twine or stretch to the toes with straight legs. If you do everything right, then at a certain point, you will get hurt. This is the limit for stretching your ligaments and muscles. Then you need to stretch a little bit through the pain so that the ligaments become more plastic.
A rupture of the ligaments is equivalent to the fact that you no longer have stretch marks, even the most basic one. At all. No. Any movement, the amplitude of which is more than 1-2 cm, is given through pain.Therefore, it is difficult to move the toe back and forth at least 2-3 cm. Painfully. Here the most important thing to remember about the rules of stretching: Do not try to regain your previous mobility at a time. Your ligaments have a long way to recover by increasing your range of motion every day. We do everything in moderation, but it should be a little painful.
After 10-15 minutes of this light exercise, you should probably be sweating. For during pain, the muscles of your whole body will tense.
I tried to do the exercises often: 5-10 times a day, for 5-20 minutes.
The rest of the time it is important to keep your foot on a hill. All day I sat at the computer and put my foot on the table. He dropped it only if it was necessary to move somewhere.
Why on a hill?
Remember rule 2 about the flow of new blood? So the leg must be above the level of the heart, so that the circulation is faster. If the leg is down, the blood stagnates, it is more difficult for the heart to “pump out” the old blood and fill in the new one, so the leg turns blue and swells.
Let’s write out in gold
The first 20 days – step up the hill!
I don’t remember what I did that day 🙂 Most likely cryo procedures and exercises)
I started to step on my bad leg.Learn to walk again.
Again, it was scary, you don’t know if you are doing it right or maybe this experiment will leave you crippled for life. But the body told me that he was ready. The feeling when you step on a sore leg is tantamount to the feeling of walking with a completely numb leg. It feels like you have not a leg but a wooden prosthesis 🙂 The leg does not feel the balance, it hurts to step, but bearable. There is a huge fear of rearranging the healthy leg, as I am not sure if the leg will support the weight of the whole body for this short period of time.But with a slight limp, I still manage to walk, albeit awkwardly
From that day on, I began to massage my leg, all the way down to the knee. It hurts to touch at first. The massage should be started very smoothly, stroking the damaged areas along the blood outflow, from bottom to top. Gradually increase the pressure with your fingers and flex the ligaments and muscles. We massage everything. The inside of the foot, toes, the calf muscle, the Achilles tendon and most importantly the front of the ankle.For now, just iron the left and right sides, any pressure will cause pain.
I did massage 3 times a day.
The most important thing is to do a massage in the morning, if you put your foot on the floor without massage, then a sharp and severe pain is guaranteed to you. If you do a massage, the pain will be, but not severe.
Remember the first rule about new blood flow? So, massage helps new blood to reach deep areas of damaged tissue. Plus, massage accelerates blood flow.And this is exactly what we need 🙂 Therefore
Massage the foot and lower leg
I no longer walk on crutches, I walk with a limp, work out my leg
Started doing contrast baths according to the recommendations from this video
Scheduled visit to the surgeon. I put on an orthosis, took crutches so that my parents would not see that I was already walking. Well, you know, I don’t want to hear lectures about “WHAT ARE YOU THINKING ABOUT?!?!” Etc. It will be calmer for them to know that I follow all the doctors’ advice 🙂 When they arrived and saw that I was wearing an orthosis, the question “Where is the gypsum ?!” I said that the swelling was asleep and the cast fell apart and was no longer holding anything, so I decided to fix the leg at least with a cut.It seems that this answer calmed them down) I skillfully walked on crutches, they did not even suspect that I practically did not use them 🙂
We came to the Surgeon, he again pressed hard on the front of the ankle – I groaned. Ascertained the formation of primary callus O_o. How do you do it as a magician and a wizard? What could you even feel there through the orthosis? Well, okay, I didn’t send it for x-rays, he said, there is still nothing to be seen, it is necessary to do it in a week. Let me go home.
By the way, remember how the same surgeon said that current is needed in the orthosis 4 weeks after the cast? The fact that I came today wearing an orthosis did not bother him at all 🙂 Such a specialist!
In general, my parents took me home, where I already took off the orthosis, threw away the crutches and continued to pursue my recovery program
In the evening, as usual, made Baths
First time going down and up the stairs. An interesting observation, when you descend, you cannot lower your sore leg first, it’s scary and painful.You always put your good leg first and then pull up the sick one. I also struggled with this with the bench exercises described in day 15.
Thoughts aloud and a story about the previous days of restoration 🙂
PAIN WHEN LOWERING THE LEG IS GONE !!! URAAAAA! No more groans in the morning! In honor of this
On Day 14, there was an unpleasant sensation in the heel, as if the joint was not in place and was about to “crunch” to “stand up” back.A block that restricts movement. But it did not crunch and cause discomfort with lateral movements of the ankle. The pain is sharp, hellish, penetrating the whole body. I was about to start to panic that something was going wrong. No matter how hard I tried to “insert” a joint or bone into place with the help of exercises, it was all in vain.
In the morning, as soon as I got up on my foot, I felt this block, intuitively I got on the toe and began to lower my foot to the heel, and then the long-awaited “Crunch” occurred and all the pain was released and it seemed to me that the joint was given greater mobility.It was the most pleasant crunch in my whole life :)))
Subsequently, the leg constantly “crunched” in this place up to 60 days.
What is this crunch?
I am not an expert, but I think this is the result of breaking the callus that enveloped the joint.
On the 15th day I had to go to the doctor again, this time I didn’t bother anyone but went to the doctor myself, on foot 🙂 It was not far away, about 1 km, but I walked for a long time, since you can imagine what Moscow is in winter? Sidewalks covered with snow, slippery and dumb) I walked, checking every step so as not to wrap myself up.
Came to the hospital and went for an x-ray. I go into the office together with the last picture and say “I am the same, in two projections” The radiologist looks at me, at the picture, again at me, then dialogue
—How long has it been since the fracture?
—Who allowed me to walk ?!
– Surgeon. – I lied 🙂
– Strange … .. Okay, lie down.
X-rayed, taken to the surgeon.
He looked at the picture and said
“I don’t see any fracture here anymore.” You have a bone failure here, but it’s not even a fracture, it occurs in old people, nothing will grow with time.Would you like to extend your sick leave?
– No, I want to work, I already walk normally
– Well, then you need to do exercises every day and go to the pool!
“Exercises must be done”, I have been doing them since the 5th day, and you told me in general 6 weeks in a cast. Where is the logic? )) Okay, I think it’s good that I didn’t scold, for the fact that I removed the plaster early and that’s good. “Thank you all kindly”
That evening I went to the pool. There I did exercises in the water for about 20 minutes, worked out my leg, and then swam for another 20 minutes.The pain was, but small, sometimes sharp, but bearable, here the joint itself was already aching, since its mobility was not fully restored and when the amplitude was more than necessary, there was a sharp pain. But after 40 minutes of swimming, the pain went away completely. At the end, I jumped a little on my foot in the water. You have to start somewhere short-term loads.
In this video I say that I recovered by 90%. Now I understand that this figure is exaggerated and at that time the recovery was about 75%))) Youthful maximalism and the desire to prove that I was so cool excited my ego! ))
I went to work.The first day when I walked for a long time. I took a yoga mat (foam) with me to work to do the exercises and … .. slippers. I don’t care how I look when it comes to recovery, so I walked around barefoot and in slippers to work to maximize the flow of new blood. Shoes, on the other hand, squeeze the shin and block the blood.
I immediately said that I would need to do the exercises, so don’t let my colleagues be embarrassed.
At work we had a rubber ball, a polythene roll and a small bench for feet.This became my little rehab center for the next 2 weeks. I did the exercises 3-4 times a day for 15 minutes every day. In addition to the standard set, I also rolled the ball with my foot, stood on a polyethylene roller and rolled it back and forth. There is also a lot of exercise with a small bench: I went up and down. Put the sore leg first when descending and ascending. Then I tried to get up and lower my leg on the toe (as it naturally happens) It turned out badly)
It is very difficult to learn to walk again.It seems that you are doing everything wrong, that it is not natural and that you will never learn to walk normally again. The brain realizes that something is wrong, but at the same time it cannot tell what needs to be done to start walking correctly. This is terribly infuriating. I was sometimes overwhelmed by the feeling that I would not be able to walk as before and would always limp.
What to do?
Never mind, continue walking, sooner or later you will return to your old and natural gait, I had it on the 20th day.
After a whole day of walking, in the evening, there was a big bruise on the calf, most likely this is due to the fact that after a long break the leg received an unusual load and the calf muscle ached from the inside.
Day 16 – 27
These days I continued to go to work and to the pool, do exercises and contrast baths. The pain gradually disappeared and the mobility of the foot became better and better.
I am a vegetarian, so during the fracture I did not eat the recommended “jellied meat” “fish” “meat”. Instead, I took calcium D3 and Omega 6. I don’t know if this affected the bone fusion, but nonetheless. At the same time, I ate quite a lot of dairy products: cottage cheese, yoghurts, curds.My diet hasn’t changed much.
Today I swam 1 km and ran 6 km
Trampolines I’m back!
Conclusion. Day 60
Now I feel great, my leg does not hurt in the morning and I can fully exercise, run and jump without any pain or discomfort. There is still a small mass on the outside of the ankle, in the form of bone mazol, but it should dissolve within the next 4 months (according to medical articles and textbooks)
I am grateful to everyone who supported me during this period of time.And those who twisted their fingers to their temples when they heard that I removed the plaster on the 3rd day are not grateful 🙂
I am grateful to Yuri for a series of videos that he made. It was they who prompted me to carry out this experiment.
I would like to wish everyone who has faced this trauma of patience, fortitude and will. You can do everything, the main thing is the attitude. I wish you all a speedy recovery, write in the comments how you got through this period.
Good luck to everyone and all the best!
Extraction of tips from article:
- The main thing is to quickly remove the swelling. Do Cryo procedures from the first day
- Keep your foot high. This will keep the blood from stagnating
- Tap the back immediately after the fracture
- New blood – the key to a quick recovery
- Ligaments are not restored, they scar. The main thing is to stretch this scar in a timely manner
- In the early days of exercise, forward and backward movements of the toe
- Do self-massage in the morning, afternoon and evening
- How to remove swelling – do contrast baths
- Exercise 5-10 times a day.This will help your ligaments quickly return to shape
- It should be painful to exercise, but bearable. If you can’t stand the pain, wait 1-2 days and try again
- Do not overdo it and listen to your body
- A positive attitude is the key to a successful and quick recovery 🙂
Chatik in a telegram with those who had ankle fracture
The ankle is a fragile joint, almost unprotected by muscles.It can be damaged while playing sports, slipping on the ice, or simply accidentally tripping over and unsuccessfully leaning on your foot. The bandage for fixing the ankle joint is used both for the treatment of injuries received and for their prevention.
What is the difference between a bandage and plaster?
A bandage is a device that helps to fix a part of the body. For minor injuries, it is made of dense fabric, for more serious ones, it may contain plastic or metal inserts.The ankle brace is similar in appearance to a sock: it is put on the foot, leaving the toes open, securely fixing the heel and ankle.
Although plaster can be quite compact, the bandage is more comfortable
The main difference from plaster and splints is, of course, convenience. The bandage takes up little space, you can wear shoes on it, and soft fabric options are almost invisible under clothes. In addition, you can purchase a ready-made version at a pharmacy with preliminary fitting, or order via the Internet.
Ankle braces are available as ready-made and universal (some types can be resized by lacing), and on personal order. To choose a brace, first of all, completely measure your leg: you need the girth of the lower leg, the length of the ankle and the exact size of the leg. Knowing these dimensions, you can easily select a finished device. If you have a non-standard shape or foot size, it would be more correct to apply for the manufacture of a bandage according to your own parameters.
Injuries requiring a bandage for fixation
There are a lot of options for injuries in which a bandage is used.It helps with sprains, arthrosis, dislocation, fracture and recovery from surgery. The tightness of the dressing depends only on the severity of the injury.
For minor sprains, bruises and arthrosis in remission, your doctor will prescribe a soft elastic bandage. It is made of elastic dense fabric, so it does not rigidly fix the foot – with minor injuries, this does not make sense.
A tighter version of fixing the ankle with a bandage is required in case of rupture of ligaments, severe bruises and loose joints.Such a bandage differs from a soft one by the presence of plastic or silicone elements, as well as fasteners and lacing, which allow the device to be adjusted to the size of the leg. It may be recommended to you if you have used the mild option before, and it did not bring the expected effect.
This is what a hard ankle brace looks like.
Rigid bandage consists of metal and plastic inserts. Only it provides complete immobility of the ankle joint, and therefore is used for the most severe injuries: fractures, arthritis, extensive ligament ruptures and serious dislocations.These are the most expensive models, but only they will provide complete immobility of the diseased joint and allow the bones and ligaments to recover in the shortest possible time.
Are there any contraindications?
This fixing option is not suitable for everyone. The main contraindication: diseases of the skin and veins of the lower extremities. An open fracture or serious wounds at the site of the joint injury do not allow wearing a tight bandage. Various skin problems such as rashes, allergies, ulcers (including diabetes mellitus) also prevent the use of the bandage.Since the bandage will be tightly pressed to the skin for a long time, the disease may worsen.
Contraindications for venous disease include thrombosis, venous ulcers and arterial occlusion. In severe vascular diseases, it is contraindicated to pull the limb and disrupt blood circulation in the affected area. The bandage is too tight around the leg, and it will be dangerous for damaged veins and arteries.
Rules of use and care
The bandage should be put on in a sitting position, on a thick cotton sock.In the early days, wear it for no more than an hour so that the leg gets used to its new position. You can gradually increase the wearing time, but remember to remove the bandage regularly to check the condition of your skin. If there is no redness or irritation on it, you can increase the load on your legs.
Remove the fixation every 6 hours to rest your feet and treat the skin with an antiseptic.
Only a doctor can prescribe the wearing of a bandage. Without the advice of a specialist, you are unlikely to be able to choose the right model and level of fixation.
The bandage itself also requires maintenance. Clean it regularly from dirt, soft dressings can be washed in warm water and soap. Then dry them away from batteries and hot air.
Bandage for prevention and training
Soft elastic bandage can be used not only for treatment, but also for the prevention of injuries. This is especially important for lovers of an active lifestyle: in some sports, you simply cannot do without it. You can choose special sports models, or you can pay attention to medical, soft and medium hardness.
If you play football, basketball or volleyball, the brace will protect your ankles from possible sprains and sprains. It will also help with dancing, gymnastics or running – in other words, in all sports where the ankle has a high load and there is a risk of dangerous incorrect positioning of the legs.
During power loads, a tight bandage on the joints is used both as a prophylaxis of injuries and to increase the load. Plus, a medium-hard brace is essential if you’ve recently recovered from an ankle injury and want to get back to training as soon as possible.
If you are engaged in manual labor or like to walk in heels, a soft bandage will also be useful for you. It will help prevent injury, strengthen tendons and reduce fatigue after a long day on your feet. The main thing is to choose the right device together with the doctor, choose the right size, and the bandage will significantly improve your well-being and health in general.
90,000 Fracture: plaster cast or surgery?
The program “Trauma center” is on air. Today I, Yana Fedulova and Maksim Bessarab, an orthopedic traumatologist, are leading it. The topic of today’s program is “Fracture, plaster cast or surgery.”
I want to start by saying that, for example, I am walking down the street. I looked – a man was playing basketball, fell sharply and broke his arm. Open fracture, my actions?
Of course, any normal person wants to help another person who is in a difficult life situation.In this case, I think that you do not immediately diagnose an open fracture or a closed one. Usually, a person falls and suddenly grabs onto an injured limb, be it an arm or a leg, or another part of the body, experiences severe pain. If this is a leg, then it usually lies on the ground, if a hand, then he holds on to it, tries to bring it closer to the body so that the mobility in this segment is as little as possible. Anyone should know how to provide first aid for fractures.
In general, the main idea of first aid for fractures, if you suspect that a person has one, is the so-called immobilization.Immobilization, translated into Russian, means immobilization. You, as a person passing by, or the person himself, should create peace for the limb as best as possible. If it is a leg, then usually, often in films, you may have seen someone fall in the mountains, breaking a leg; they take a ski, break it, tie it to the leg, or a branch, a stick, that is, they do it so that the leg does not move, it is tied to the tire. If this is a hand, then usually it is hung on a kerchief, you can also make an impromptu splint so that the hand does not move.As soon as the arm or leg stops moving, the person’s pain syndrome immediately decreases; pain decreases, rest of the injured limb is created. In modern conditions, even cardboard tires are often made. You can just take a piece of thick cardboard, packaging from a TV or refrigerator, a box, wrap your leg with it, wrap it with tape and in this position the leg is immobilized. As soon as movement in the injured limb decreases, the person’s pain immediately decreases.
Here you can roughly say about the symptoms of a fracture.Usually, with a closed fracture, in addition to severe pain, a person immediately develops swelling. Open fractures are much less common. And completely open fractures so that the bones stick out from under the skin – this very rarely happens.
If it happens, and I, as a girl, understand that I definitely won’t be able to put a splint on him, tie a ski to his leg, probably I’ll just call an ambulance and that’s it?
I think you will call an ambulance in any case, but you have to help him in some way when she arrives.If this is, for example, an open fracture, as you insist, although I repeat that such fractures are much less common. Of course, if there is a wound, then first aid, first of all, you must stop the bleeding. If it is heavy bleeding, a tourniquet is applied. Almost everyone knows what it is. Or a special harness is taken, which is sold in the pharmacy, a rubber band, or some improvised means – a belt, for example, or something like a belt. The belt is almost always found. A tourniquet is applied if there is heavy bleeding.The tourniquet must be correctly applied, not applied to bare skin, there must be a lining. The time must be noted, the time when the tourniquet was applied. Because if a limb is squeezed for a long time and blood does not flow to the lower sections under the tourniquet, then, perhaps, if expressed in everyday language, the tissues will begin to die and disintegrate. Therefore, it is not necessary for the tourniquet to be very long. In a city situation, of course, an ambulance will arrive and be taken to the hospital. There, the wound will be treated surgically, the bleeding will be stopped, the surgical treatment will be performed, the fracture will be stabilized by some method of fixation – an operation will be performed.
Is the operation done only for open fractures?
No, not only when open, but also when closed. With open fractures, it is definitely done. Let’s get back, after all, to first aid.
So, a tourniquet is being applied, the hand is immobilized. If the wound is open, then an aseptic dressing must be applied, the open wound should not be in the air. Usually they take sterile gauze and bandage the injury site.If there is a pill on hand, a pain reliever – of course, it is better to give a person. Usually women carry head pain relievers in their purses. You can give medicine to such a person. If these are upper limbs, a fracture of fingers or forearms, then they either call an ambulance, or you can transport a person himself, on some kind of transport, if this is not a serious injury, not a pronounced deformation, you can transport him to an emergency room. Or call an ambulance, an ambulance will come and take him to the hospital or, again, to the emergency room.
How to understand if it is a fracture or a bruise? The symptoms are the same.
In fact, it is better for a layman not to find out anything. There is severe pain, there is an injury, which means that he needs to seek medical help. The doctor in the emergency room, or in the hospital, or in the clinic will figure out whether it is a fracture or a bruise. How do you understand that this is a bruise? It often happens with us that a person has fallen, his leg or arm hurts; everyone has a different pain syndrome, someone screams from a bruise, and someone may have a fracture without displacement, but the pain is not so pronounced.He walks on this leg for 3-4 days, or uses this hand for several days. His arm hurts more and more, he seeks medical help after 5 days, we take an X-ray and find a fracture there. Therefore, it is not necessary to self-medicate in these cases.
You go to the clinic, to the emergency room and we, the doctors, decide whether it is a fracture or not. In addition to fractures and bruises, there are various ruptures of ligaments, tendons, muscles. These are also things that can, one might say, come out sideways in life.These situations also need to be treated, and in order to treat them, you need, again, to seek qualified help. Of course, we can most often distinguish large fractures from bruises if we touch on this situation. Usually, with fractures, severe deformity. Roughly speaking, your hand is straight, forearm or finger. You break it, and it deforms. That is, an unnatural deformation of this segment, plus a strong violation. Of course, if you have broken the humerus, then it is unlikely that you will be able to straighten the elbow, the movements are immediately disrupted.This is done by doctors in hospitals.
Your main first aid is to immobilize the patient, I repeat again; if there is a wound, bandage; if there is severe bleeding, apply a hemostatic tourniquet on the limb, and transport the person to a hospital as soon as possible. If it is a village, then to the regional center to the hospital, if it is a city – call an ambulance or take it to the nearest emergency room, if the ambulance is traveling for a long time and there is no way to wait.
An ordinary person should not try to determine the type of injury – fracture, bruise or rupture of ligaments
If a person has a painful shock? In general, tell us about it. He probably does not feel pain, although the fracture is obvious.
At first, a person with a fracture, I can tell from myself. I personally had a broken leg. This is a pretty serious fracture when the tibia and fibula breaks. These are the main bones on which, in fact, a person walks. I had an injury, I twisted my leg, it twisted and broke from the fall.The fracture usually does not come from a direct blow. For example, if it is a leg, lower leg, often on skates. You are skating, your skate has stopped, but your body continues to rotate, twisting occurs in a certain segment and the bone breaks. It seems to break from twisting, not just hitting it like a stick, and it broke, but from twisting. Most often, such fractures occur in humans. I fell and suffered the first, very bad fracture. Severe trauma and, indeed, it is very painful. But at first, certain hormones are secreted in the body, including adrenaline, I don’t even want to dwell on this.
At first, a person does not feel pain, there is some kind of sensation, not very pleasant, but then every movement, all the time that I was traveling by ambulance to the hospital, felt literally every bump. True, in case of severe injury, so that a person does not develop a certain cascade of life-threatening situations, life-threatening processes in the body, it is imperative to anesthetize the person well. If you provide first aid to a fallen person, you can give him a pill, ketonal, movalis – whatever you have.These are non-steroidal anti-inflammatory drugs, they may not be as effective. The ambulance is usually anesthetized with narcotic drugs, this pain relief is more effective, feels a little less pain and quite well, then you are taken by ambulance to the hospital. I was also taken to the hospital and operated on.
How long have you been recovering?
In general, there are a lot of approaches to fracture treatment.In traumatology, we can treat a fracture in different ways. The most ancient method is gypsum, one of the most ancient methods, I would say so. A plaster cast is modeled on the injured limb. What is the meaning of plaster cast? Gypsum, when solidified, can take the form that you ask it, so it is used in sculpture. We, for example, have a fracture of an arm or a leg, apply a plaster cast using the so-called reduction – this is a medical term. We take, stretch the bones, give them the correct shape.
Is Repositioning Essentially Recovery?
No, reduction is the restoration of the previous shape of the bone, an approach to restoration. You have a shoulder, the humerus is straight, suppose when you broke it, it was bent. When we apply a plaster cast, we use a special method, this is a whole technique, it is taught by traumatologists, we pull on this segment, for example, by the hand, press in a special way at the correct points, make this bone even again, bring the fragments closer and we put them at the right angle.
Plaster cast – no, this is not an operation. This treatment is conservative, non-surgical. The gypsum hardens, it hardens and, accordingly, the corrected bone also hardened in this cast, took the shape of an arm or a leg. The person walks for a while; for example, the humerus, maybe two or three months, grows together, the person removes the cast, the arm grows together. The main thing is that the fracture healed, it must be immobilized. If an arm is broken, we walk, we chat to it, then it will not grow together, almost never.
How can we talk with a broken arm?
Pain goes away after some time. I’m presumably saying that if the fracture is not treated, leave it and walk like that. There are asocial people who drink, use drugs, and do not pay attention to fractures and continue to carry on their asocial activities, they do not heal such fractures. Hence, one of the methods of treatment is plaster cast. We put it on and the person in this cast walks until the fractures heal.This method has its pros and cons, just like any. Plus, of course, this is that we do not introduce any invasion to the body, we do not cut the skin, do not separate muscles, do not twist, do not give anesthesia. This treatment is non-surgical and conservative.
But pain relief, nevertheless, is given, because in case of dislocation, I know that often they do not give pain relief, but simply adjust and that’s it.
Dislocation is a completely different situation, it has nothing to do with it.Yes, of course, when we reposition the bones, pull them out, put them in place at the right angle with the help of a manual one – this, of course, is very painful, therefore, before this manipulation, we anesthetize the fracture site and anesthetize the person himself, the whole body, so that it does not hurt so much. … In general, this is not very pleasant, I would say so.
The undoubted plus of this method is that there is no invasion of the body. There is no risk from the operation, and there is always some risk during the operation, albeit a small one. But, there are also disadvantages: a person needs to walk in a cast for a long time.If it concerns large bones, then it is three to four months, and before that people walked in a cast. Accordingly, if your arm or leg does not move for four months or three, then all the muscles there will atrophy, the joints will no longer bend well. Because if you do not bend the joint even for two or three weeks, it will only move poorly afterwards. Yes, the fracture will heal, but then the hand cannot even always return to its function, which was before the fracture, because the joints will not move well, they used to call it “gypsum disease”, they said so.Therefore, science went further, and decided that it is better to treat fractures not conservatively, but promptly. But there is also an intermediate method in the so-called stretching, maybe you have seen in films, hanging with weights. Often in comedies, these weights hang, indeed, in this way.
Is gypsum now different from the gypsum that was, say, 10 years ago?
Gypsum itself, as it was gypsum, what its chemical formula was, so the gypsum remained.Gypsum is a material that has been and remains. The only thing that has appeared more modern methods of fixation like plaster is polymer gypsum, sometimes they say in everyday life “plastic plaster”. This is a polymer material that is really light, you can wash in it, you cannot wash your hand in ordinary plaster, it will immediately disintegrate. The polymer material is applied to the injured limb, it can also be modeled as needed, that is, repositioned, it hardens. It is plastic until it dries, like ordinary gypsum.Within a few minutes it is plastic, we can shape it and it will solidify in that shape. Modern materials, of course, are more expensive, were invented in the West. This is a plastic material that is applied to the hand, also dries up, but you can wash in it. It is like plastic in the end, when it dries, in order to remove it, it is almost necessary to cut it, real plastic. These are the ways.
There was also a method of conservative treatment – the method of skeletal traction, which is also used. When I was studying to be a trauma surgeon, he was constantly used, but now less often.Recall that conservative treatment is treatment without surgery, this does not apply only to traumatology, this applies to any branch of medicine. Treatment without surgery is called conservative treatment. In addition to conservative treatment of fractures, such as plaster cast, skeletal traction, there is surgical treatment. Surgical treatment, like any method of treatment in medicine, has its pros and cons. The main disadvantage of the operation is invasion into the body. To get to the broken bones, we have to cut the skin, muscles.
The main disadvantage of surgical treatment is invasion into the body
But it also exists, doesn’t it, a minimally invasive operation?
If we talk about the fracture – indeed, they exist, but still, this is an invasion. Although minimally invasive, we still give a person anesthesia or do local anesthesia, and there can always be risks of complications, especially in the elderly.As often happens, older people suffer from fractures, who, in addition to a fracture, have a large number of concomitant diseases: heart, lungs, kidneys, liver and the whole body. Sometimes the burden of concomitant diseases is extremely large and it is very dangerous to have an operation, but they do it anyway, because there is no choice.
The plus of operations, plus the surgical method of treatment in traumatology, is that we can more accurately match the bones during the operation. Still, the cast does not allow us to very accurately compose the bones and, unfortunately, many fractures cannot be treated in a cast, due to the fact that it is impossible to achieve a good position of the fragment.This is especially true for fractures inside the joints. With a fracture inside the joint, the articular surfaces of the articulating bones are damaged, they can be placed exactly only operatively. If we do not perform the operation, then they grow together in an irregular shape, the person completely loses the function of this joint. Another rather big plus of the surgical method of treatment is that when we fix fractures correctly, literally, in a few days we can give the function of this limb. The person can move the hand.Pieces, fragments are very firmly connected with plates, screws, nails – whatever, a person can immediately start moving an arm or a leg, respectively, the muscles do not atrophy. Rehabilitation takes place, literally, immediately after the operation. After a few days, almost even the next day, a person can begin to engage in rehabilitation. His joints do not stagnate, contracture stiffness does not develop, muscles do not atrophy; he, one might say, immediately returns to his usual life.
It turns out that the operable way, after all, has much more advantages in it than in the conservative one?
Medicine is evidence-based science. A comparison was made between people with conservative and surgical treatment. Yes, there are complications with surgery, but it turns out that there are more complications with conservative treatment. Plus, we can more quickly return a person to work, which is beneficial for the state as well. Indeed, why should a person pay for sick leave for many months, and then he will become, for example, a disabled person, he will continue to pay his disability pension for life if he can be operated on quickly.Yes, maybe it will be more expensive to carry out the operation. But, most importantly, human health is saved, and the state will not have to deal with disabilities, all sorts of benefits and everything else. Take a person, quickly heal and put him back in line.
In fact, the main disadvantages of risk are anesthesia, how a person responds to anesthesia, and a scar, but a scar is not a problem. As a last resort, he will go to a plastic surgeon.
No, the scar is not a complication at all. A scar is such a thing for medicine, it, in general, has little value.
But I am speaking from the point of view of a person who, perhaps, wants to be always perfect.
Of the complications, first of all, the risk of anesthesia, of course, exists. This is a life-threatening condition from which you can even die. But this is very rare, literally, a fraction of a percent.I have, perhaps, seen several times in my entire life. Literally, recently, a patient in a plastic surgery clinic, for example, died, she underwent blepharoplasty. No one is to blame here. When a person goes to an operation, he signs a paper, a standard form. It says that a person is still a little-known organism, whatever you want can happen to him; we, as doctors, do everything that is needed at this level of development of medicine, but anything can happen to him, he is warned in everything, in all methods of treatment: conservative, operational, and he clearly, in his right mind, understands what he agrees.Almost all the responsibility is assumed. That’s right, that’s the way it is. This is true. This is not a car in which a spare part can be changed and it will go further. This is a man, indeed, he has not yet been very well known.
Someone may have a wound that festers, fractures do not heal, a blood clot comes off and he will die on the operating table or after. But this, again I say, is a very small percentage. Most people tolerate surgery well. Of course, there is definite discomfort: this operation is not very pleasant, and morally, and maybe the first days are not very pleasant pain in the operation area, but, in the end, he gets better.World science has calculated that a person after surgery is much better, and he recovers much better, and the function of the limb improves than without surgery, conservatively, not only economically, but also in health.
Please tell us more about rehabilitation after surgery. What types of rehabilitation are there? Baths, maybe in a special solution.
Bath in a special solution? This is from some fantastic films.
I read it on the Internet.
On the Internet? Read the Internet less. There you can read a lot of unnecessary things
In fact, I am not a rehabilitator or a physiotherapist, I’m unlikely to tell you in great detail about rehabilitation. Indeed, rehabilitation in many operations, especially in sports injuries, in case of damage to the ligaments, shoulder, knee joints, plays an extremely important role.Sometimes it even depends more on rehabilitation than on the operation itself, including for fractures. I can tell you that for most fractures, especially if it does not affect the joint area, for many people, maybe rehabilitation is important, but not 100% directly. It is more important here how this fracture was operated on, how correctly the metal structure was installed, what the position of the bones was. Many people, unfortunately, because of their perhaps closeness, do not attach much importance to this, but in some situations, rehabilitation is really important.
What can we say about rehabilitation? First of all, we tone the muscles around the fracture, because it is very important that the limb functions well; so that the muscles and ligaments in the area of the joints are in good tone, not hypotrophied, the joints move – this is what rehabilitation is about. There is also the so-called physiotherapy, this is probably more about baths, when a magnet, laser, hydrocortisone are used, which is just not done. It is such an effect on the body that improves blood flow, reduces inflammation, and reduces swelling.This is rehabilitation. Abroad, this is generally put on stream, after all the operations, the program carried out, the instructor works with patients, with each patient individually, and for a very long time. Indeed, you can quickly put a person on his feet. Plus, pain, edema syndrome disappears faster; all sorts of pluses. This is a whole science, very rapidly developing in the West.
Unfortunately, we are lagging behind a little in this matter, even in Moscow, but we are slowly catching up with our Western colleagues.We have already learned how to operate, as in the West, almost everyone, if we talk about traumatology and orthopedics, practically, the level of surgery is the same for joints and in sports medicine. But rehabilitation is slightly behind. Probably, there are federal centers, special medical centers are paid. This is also at a very high level. But, for everyone, I would say that it probably still needs some work. In the regions, I think, in general.
You have casually touched upon the topic of complications after surgery, can you give more details?
The biggest, the most unpleasant for us, doctors, complications, if we take it immediately after the operation, is the suppuration of the postoperative wound. These are some of the most formidable and unpleasant complications. You were operated on, a fracture or a large tubular bone was collected for you, or, worst of all, in the area of the joint, several days pass – the wound turns red, swells and pus appears from there.
What causes suppuration?
There are a lot of reasons. An open fracture is already initially contaminated, provoked, there is already an infection, it got there from the street or where the injury occurred. We cannot completely treat the wound so as to remove all the infection from there. Plus, internal problems in the body.
For example, if we do a planned endoprosthetics operation, then we sanitize up to the point that even the oral cavity needs to be sanitized, because caries can also cause complications. There is also an infection.Therefore, for example, a person for a planned major operation, large, joint arthroplasty, in principle, should (not always, maybe, it is performed in modern conditions, but, in theory, should) be with a sanitized oral cavity, there should be no caries, he must have an infection. Of course, when a person comes, he has caries everywhere instead of teeth, there will be a couple of rotten teeth in which there is definitely an infection. If he undergoes a major operation, then there is always a risk that from there the infection will enter the operation area, even despite our antibiotic prophylaxis.And in the body, the wound for some reason can fester.
In medicine, everything is done to prevent this from happening: a person is given antibiotics, prophylaxis is carried out, the operation takes place in sterile conditions, sterile instruments, everyone is dressed in sterile gloves, in sterile clothes, in the operating room almost the air is sterilized. But there is always a risk that suppuration will occur. This may depend, of course, on the introduction of an infection, for example, during an operation, there is some kind of infection in the air of the operating room, but, most often, this is due to internal, the infection is, roughly speaking, already inside the person from the very beginning.Plus, there are severe concomitant injuries, where the risk is simply infectious. When several segments are broken, a serious injury: a person fell from a motorcycle, his legs and arms are broken, he is in intensive care, he has pneumonia. Already initially there are certain ones, it will take a long time to talk about it. In general, the risk in such patients – infection and postoperative complications in the form of wound suppuration – is much higher in severe, concomitant injuries. Then this pus begins to flow, we begin to treat it, in general, the whole story. This is a very unpleasant complication.Fortunately, this is rare.
But fixable, all the same?
Not always fixable. Sometimes, as patients say, begins to “rot the bone”, the infection enters the bone, called osteomyelitis. The bone festers for a very long time, fistulas form, the patient walks. Although rare, it happens, and every person who undergoes surgery on bones should know about it approximately that it happens.
How can he avoid it? Or not at all, if it was originally?
There is no way to avoid it. This is a long-term special treatment, we will not even talk about it. This is a lot of repeated operations.
Not yet a very pleasant complication is non-union of the fracture, unfortunately, for some reason. In some people, fractures heal worse than others. Trite, lack of calcium. A person eats poorly, for example.I, of course, cannot say with numbers, for sure. In medicine, everything must be evidence-based. I think maybe in vegetarians who don’t eat meat or animal proteins. Their fracture will probably heal worse, because there is no building material. People who do not eat well at all, or they have diseases that interfere with the healing of fractures. Sometimes there are reasons why we do not know why fractures do not heal. Of course, sometimes there is a violation of the operation technique: the screws are incorrectly inserted, the plate is incorrectly installed.It happens less often, but it happens.
Another complication is when a person does not really understand. The fracture heals for a long time, several months, a person should impose restrictions on himself at this time. He must understand which ones. If his leg is broken, this does not mean that he needs to jump and dance on this leg, he should walk on crutches. If a person leads an inadequate lifestyle, for example, he drinks, he drank – he is knee-deep in the sea, he got up and walked on this leg. It was like a day, two, three, four, then the plate broke, the wound festered, everything fell apart.Therefore, sometimes there are such options. But complications, again I say, from anesthesia, such complications also happen, but they are extremely rare.
Is there fracture prevention? If the bones are weak and predisposed.
Yes, it exists. Prevention is, of course, very important. Unfortunately, as women age, their bones begin to weaken. This disease is called osteoporosis. X-rays even show that the bones become lighter, their density decreases.This is due to a certain hormonal change in women, menopause occurs, calcium is washed out from them faster, so such patients need to be treated. It is treated by rheumatologists, endocrinologists, endo-orthopedists. There are special groups of drugs, calcium D3 Nycomed, which has set everyone on edge. But this is, first of all, treatment, a person – a woman or a man – receives calcium, vitamin D. For a long time, for years people are treated, it turns out, and with food, and plus drugs in tablets.
That is, all the same, you have to follow a certain diet.
Yes, diet. There should be a balanced diet, in which there is a lot of calcium, protein, roughly speaking, a building material for all cells of the body. Plus calcium, vitamin D, and bisphosphonates, these are also special drugs that reduce the leaching of calcium from the bones. A person takes these drugs for a long time and, indeed, statistically, the number of fractures per capita in such people decreases. That is, osteoporosis must be treated without fail.There are a large number of these drugs, they can only be prescribed by a doctor.
But, osteoporosis is a diagnosis, and we are talking about prevention.
I’m talking about prevention and I’m talking about prevention of fractures in the elderly. To understand if you have osteoporosis, a special study is done – osteometry. From it we can estimate bone density. Parts of the body are selected – either the femoral neck, or the distal metaepiphysis of the radius, or the spine, the vertebral body, a study is done, and we see that a person has osteoporosis and osteopenia.Depending on this, the doctor, usually a rheumatologist or endocrinologist, prescribes adequate treatment. A person takes it for years and the risk of fractures decreases. For prevention of fractures, young people, first of all, should correlate their desires with their capabilities.
To determine the presence of osteoporosis, a special study is done – osteometry
Is it about dancing, skating?
Dancing, maybe not, but extreme sports, extreme adventures, skydiving, biking – in general, a lot of sports where the risk of getting a fracture or damage to ligaments, joints, dislocations is much higher than just a person who walks down the street. Of course, in the winter season, you also need to measure it, no one is immune from falls, you have to choose where to walk, what shoes to wear. Elderly people are better off when the soles are non-slip and walk when necessary.If you are 80 years old, if there is ice on the street and snow has fallen, and everyone is falling, you can see it from the window – you probably shouldn’t go to the store, maybe call your children or grandchildren, ask them to bring bread or milk, and not go outside. It is necessary, of course, to measure your desires a little with your capabilities, otherwise later the problems that you will make for yourself, on your own head, can be very big. It should be understood that after an injury, even with the most modern treatment, the use of the most expensive implants, it is not always possible for a person to return to their usual way of life.There are irreversible things. Or science just doesn’t yet know how to return after a fracture. Not all people become the same as before the fracture; a person experiences unpleasant, uncomfortable sensations in the limbs or in previously damaged joints.
Yes, or he says: “By the rain begins to whine, to the change of weather.”
This is the simplest one. For example, take an athlete. He was an extra-class athlete, tearing the cruciate ligament …
For an athlete, this is practically the end of a career.
Not always, but sometimes it happens. But, if you are a football player and you break your shin, I think that your career is likely to end, even if you do the best surgery. The loads that a person can endure, or the skill that he had, is not always possible to repeat, so you must always think. Yes, of course, an active lifestyle, extreme sports is very much presented in society, it progresses with the help of television, beautiful marketing, but you must understand that a beautiful picture taken with a GoPro video camera on your head is like someone flies from a mountain, without a parachute – You must understand that you can crash into a mountain in such a flying suit.
But that’s why they are extreme sports.
Unfortunately, either end your life, or break your arms, legs and you will have big problems in your life. Therefore, I would like to advise at the end of our program to our listeners: be careful! Watch yourself as one of the singers used to sing.
Thank you very much! It was the Trauma Center program.I, Yana and Maxim, say goodbye to you.
90,000 Ankle fracture: signs, symptoms, treatment, prices for ankle fracture surgery
To date, doctors processed statistics of injuries sustained by people for various reasons, and most often, increased injuries were noted in the winter season. During the ice, there is a risk of falling, as a result of which you can get a bruise, fracture or dislocation of varying complexity. Sports injuries are also observed.Doctors recorded that the most common fracture of the musculoskeletal system is ankle fracture. This damage has complications due to its anatomical structure.
The ankle is part of the ankle, and the ankle is the joint (complex and strong connection) that joins the foot to the bones of the lower leg.
It consists of the following bones:
- Outer ankle;
- inner ankle;
- distal end of the tibia;
- talus block.
In fact, the structure of the ankle is similar to a hinge, whose function is to support, shock absorption, and provide normal movement. For this reason, ankle fracture is a serious injury that causes a lot of discomfort and unpleasant sensations.
Main causes of ankle fracture
Ankle fracture is most often formed as a consequence of indirect injuries, such as slipping, twisting and other similar situations. Ankle fracture is accompanied by the formation of bone fragments of the ankle joint.Sprains of ligaments and tendons are also possible. In the most difficult situations, ligament ruptures and fractures can be traced. Direct injury (impact, falling of a heavy object on the foot, road accident, etc.) can also cause ankle fracture.
Ankle fracture can result from a lack of calcium. Calcium is the basis of strong bones; without it, they become loose and brittle. At risk are the elderly, menopausal women, pregnant and lactating mothers. Calcium deficiency can occur for various reasons, the main thing is to identify and fix the problem in time.
Specialists have identified the main types of fractures that can be found:
- closed fracture – only the bone is damaged, and the surrounding soft tissues retain their integrity;
- open fracture – when such an injury is received, the bone and surrounding soft tissues are damaged;
- A displacement fracture is defined when parts of the bones are pulled apart on an incorrect axis by muscle force.
Ankle fracture is divided into several types:
- Fracture of the external malleolus with displacement;
- fracture of the external malleolus without displacement;
- fracture of the inner ankle without displacement;
- Fracture of the inner ankle with displacement;
- fracture of the ankles and posterior edge of the tibia (three-malleolar fracture)
Each type of injury occurs as a result of different situations. The most difficult case is considered to be a fracture of both ankles with displacement.As a result of the injury, both the inner and outer ankle breaks. Traumatologists recorded that in some cases, when exposed to traumatic factors, the inner ankle is preserved, and a fracture in the area of the outer ankle with displacement of fragments is accompanied by a rupture of a powerful deltoid ligament of the ankle joint. This fracture of the ankle is quite rare.
Ankle fracture is a serious injury that must be diagnosed and treated promptly.
90,000 Splints, sling and relief for fractures and joint injuries
Splints, slings and relief for fractures and joint injuries
There are two types of fractures: open and closed.With an open fracture, a bone sticks out of the wound, with a closed one – it is not visible. First aid in both cases is the same, only with an open fracture it is necessary to close the wound so that no infection gets there (see pp. 247–249, section “How to handle wounds”). Such a fracture is easy to diagnose because the broken bone is clearly visible. A closed fracture is more difficult to identify – this requires an x-ray.
Sprains and dislocations of joints are no less painful than fractures. Symptoms of these injuries: the joint cannot be touched, its shape changes, it swells, any movement is painful or difficult.If you are unsure if the bone is intact, treat the dislocation as if it were a fracture. Better to be safe than sorry.
First aid for all fractures is the same. Sit or lay down the victim. Then fix the joints above and below the fracture with your hand or bandage so that the injured limb does not move, and call a doctor. The limb must be immobilized so as not to deepen the wound. To do this, apply a sling-like bandage and / or bandage; splint for extra support.They can be made from a flat wooden or metal plate. If you are in the forest, then a thin, but strong stick or branch is perfect for this purpose, just cover the victim’s skin with something soft, and then apply a splint. How to apply splints for the most common fractures are described below.
There are two types of these fractures: shoulder and forearm fractures. The easiest way to immobilize the arm and create the necessary support for both types is with a sling band.To make such a bandage, take a triangular piece of fabric (if not, fold the rectangular piece in half). The stages of applying a triangular bandage are shown in figure c. 256.
For additional arm support, wrap a bandage around the chest with a wide bandage. For shoulder fractures, the bandage should pass below the fracture area. After applying a bandage, call your doctor immediately.
If the fracture is very severe, it is better to apply a splint.Find two splints long enough to cover the joints above and below the fracture (shoulder and elbow for a fractured shoulder, and an ulnar and carpal for a fracture of the forearm). Attach them to your arm with a bandage or piece of cloth in three places – around the fracture site, near the joints above and below it.
A leg can be broken in the thigh, calf or both. In any case, a splint should be applied to the entire leg. For a fracture above the knee, it is necessary that the splint extends above the hip, all the way to the armpit.
Fracture of the leg above the knee
Fracture of the leg below the knee
If you suspect that the kneecap is broken, fix the knee in the most comfortable position to avoid further damage. Wrap a piece of cloth around the knee gently and wrap the leg from mid-calf to mid-thigh. Fold the jacket over and place it under the knee so that it rests on it, and then apply a splint as described above. Knee fractures are especially painful and should never be moved.See a doctor right away.
Only X-ray can determine if a rib is broken. Therefore, it is better to play it safe and take a picture. Broken rib symptoms include pain and difficulty breathing. If a broken rib bone has damaged a lung, the victim will cough up foaming, bright red blood. A sling-like bandage on the arm (see the section “Fractures of the arm”) on the injured side will help immobilize the chest — in this case, the broken rib will not move.If you suspect that the fracture is severe, bandage the arm against your chest (see Fracture of the collarbone or humerus), or lay the victim down and wrap at least one bandage around his chest to restrict chest movement. Put on something soft and then tie a bandage over the side of your chest that is opposite the fracture.
If the dressing is uncomfortable, remove it. And if the ribcage is depressed, do not apply it at all.
Fracture of the nose
A fracture of the nose is very easy to recognize as the shape of the nose changes. Nevertheless, the diagnosis must be made by a doctor; he will also determine if there are other head injuries. There is no splint on the nose, but other fracture symptoms need to be addressed. If there is blood flowing from the nose, sit down the victim, throw his head back and tell him to breathe through his mouth. Pinch his nose below the bone with your index and thumb for 10 minutes, and then slowly release the pressure. If blood is still flowing, pinch your nose again for 10 minutes.If the bleeding still does not stop, see your doctor immediately. If facial skin is damaged, pinch it with a sterile bandage.
Take a person with a broken jaw immediately to the hospital for doctors to check for other head injuries. The fact that a person has a fracture can be judged by the position of the jaws – they do not fit together. Talking or chewing hurts him and his gums may bleed. To reduce pain and swelling, apply ice or cold water to your broken jaw.
Fracture of the clavicle or humerus
If a person has a broken collarbone or shoulder, he will subconsciously try to lower him forward, bending his arm at the elbow and pressing his forearm to his chest. With the other hand, he will support the elbow. You need to apply two sling-like bandages to fix the hands in this position. Tie one arm around the bent arm (see fig.), And fold the other in half twice, making a wide bandage out of it, and tie it around the arm and chest to fix the forearm pressed against it.Just do not pull it too tight – this will interfere with blood circulation.
Fractured foot / toes
A broken foot or toe swells very quickly. Therefore, remove the boot and sock as soon as possible – if necessary, cut them open with a knife. Raise the injured leg and fix it in this position – this will slightly reduce the pain. Apply cold to your foot or toe. Wrap them in a napkin and bandage them.
Fracture of the finger
While the broken finger is not swollen, remove the rings from it, if any.Secure the entire arm with a tissue and, pressing it to your chest, make a bandage as shown in the upper illustration on p. 260.
Dislocation is damage to tissues around the joint. The most common dislocations are the ankles, fingers, wrists, and knees. Symptoms are similar to those of a closed fracture. If you cannot understand what your victim has – a fracture or dislocation – consider that it is a fracture.
Dislocation is not as serious an injury as a fracture. It is best to apply ice to the damaged area – but it may not be there in field conditions! A sprained ankle puts a person out of action, so you need to know how to handle it.You can leave the boot on, only untie the laces – in case the leg starts to swell. The conditions for the treatment of dislocation are as follows:
• prohibit the victim from walking – the injured ankle must be at rest;
• Apply ice to it, and if you do not have it, soak a towel in cold water and tie it around the wound;
• Arrange your leg in a comfortable position and apply a tightening bandage on the leg – from the joint below the injury to the joint above it;
• Raise your leg and put something under it to prevent it from falling.
This text is an introductory fragment.
Continuation for liters
90,000 Rehabilitation after ankle (ankle) fracture, recovery after surgery in the BaltReaTech rehabilitation center
Post-fracture rehabilitation program
We have developed an ankle fracture rehabilitation program at home because:
- Ankle fracture is one of the most common injuries Medical statistics provide the following data: this injury has occurred at least once in one person in a hundred.Persons of both sexes are susceptible to it, however, women in the period of menopause are more vulnerable to it due to the development of osteoporosis. Ice is the time of the year when ankle fractures are most common because they are caused by falling on the twisted leg.
- If you have a broken ankle, do not step on your foot. Therefore, it is extremely difficult for a person who has received such an injury to come to the rehabilitation center
- Lack of rehabilitation treatment after ankle fracture can lead to dysfunction of the ankle joint and the development of arthrosis.
What are the types of ankle fractures?
The clinical classification of ankle fractures is quite extensive.
There are several main types of fractures:
- Single-ankle injury of one (medial or lateral malleolus)
- Two-malleolus – simultaneous injury of two ankles
- Three-malleolar injury to two malleolles and to the distal epiphysis of the tibia.
Also, with fractures of the ankles, damage to the ligamentous apparatus of the ankle joint often occurs – ruptures of the tibiofibular syndesmosis, damage to the deltoid ligament
Rehabilitation after ankle fracture consists of 5 steps
- Examination by specialists of the rehabilitation team and drawing up an individual treatment plan.
- Walking on crutches. Mastering this skill is necessary not only for daily activities, but also for the successful passage of the subsequent stages of rehabilitation.
- Elimination of edema. Edema usually accompanies injury. With a fracture of the ankles, swelling can persist for a long time. This is due to the peculiarity of the tissues around the ankle joint. Swelling usually limits movement in the joint and makes it painful. In addition, edema disrupts microcirculation and slows down recovery.
- Restoration of support load on the ankle joint. This part of the rehabilitation is the most important. Too early expansion of the regimen can lead to repeated damage, and prolonged limitation of the load, on the contrary, leads to a slowdown in bone fusion and the development of osteoporosis.
- Restoration of the range of motion in the joint. This is necessary for the joint to function fully in daily life.
Each stage of rehabilitation has its own tasks and methods of treatment.
The basis of rehabilitation after ankle fracture is
- exercise therapy classes with an instructor,
During the program, patients are monitored by a traumatologist-orthopedist and a rehabilitation therapist.
As additional procedures, the program may include:
- CPM Therapy
- Kinesio taping
- Manual therapy and osteopathy
We will also help you choose orthopedic products (orthoses or bandages) for the ankle joint and show you how to wear them correctly.
Comprehensive rehabilitation programs ***
Services included in the program:
|Program duration||14 days|
|Selection of a nurse, selection and assistance in purchasing equipment and technology, selection and assistance in purchasing orthopedic products||yes|
|Doctors on-site primary consultations|
|Physician exercise therapy||1|
|Doctors on-site follow-up consultations|
|physiotherapy (according to indications)||5|
Services included in the program:
|selection of a nurse, selection and assistance in purchasing equipment and technology, selection and assistance in purchasing orthopedic products||yes|
|doctors on-site primary consultations|
|Exercise therapy doctor||1|
|Doctors on-site follow-up consultations|
|Exercise therapy doctor||1|
|exercise therapy instructor||10|
|physiotherapy (according to indications)||10|
Services included in the program:
|selection of a nurse, selection and assistance in purchasing equipment and technology, selection and assistance in purchasing orthopedic products||yes|
|doctors on-site primary consultations|
|Exercise therapy doctor||1|
|Doctors on-site follow-up consultations|
|Exercise therapy doctor||1|
|exercise therapy instructor||15|
|physiotherapy (according to indications)||15|
* The service is performed in the absence of individual contraindications
** Service provided by partner companies
*** The cost of one day of the program is calculated from the total cost of the course calculated for 28 calendar days.