Healthcare Sector: Management of Ankle Fracture - Essay Example

Management of Ankle Fracture Ankle fracture also universally referred to as a broken ankle experiencedwhen one or more bones, which comprise the ankle joint gets broken. Ankle fractures affect people of different ages. Gumann (2010) asserts that in the past 30-40 years, physicians have recognized an elevation in the number of ankle fractures, as a result of a very active and aged population. Generally, broken ankles are becoming a matter of concern and need arises for much emphasis on matters concerning it and its prevention methods. This essay seeks to avail ample information concerning ankle fractures and issues regarding its management. According to most epidemiologists, ankle fractures have quite an extensive occurrence and the groups at high risk include adults, especially the elderly. For instance, Egol et al (2013) imply that that broken ankles have an incidence of approximately 174 cases per 100 000 adults yearly. While Parekh, Patel and Parekh (2012) assert that, the new occurrences could amount to approximately 187 fractures per 100,000 individuals every year. Nevertheless, the approximations seem to be much closer. Generally, according to Egol et al (2013) the correct treatment and categorization normally provides a decisive significance for clinical outcome. Since the mid-1900s, the rate of ankle fractures occurrences has significantly augmented in most of the industrialized states, most probably due to the growth in the number of individuals who get involved in athletics as well as the size of the aging population. Further, Parekh, Patel and Parekh (2012) indicate that the malleolar fractures (a type ankle fracture) has a vast prevalence, whereby the percentage for unimalleolar ranges from 60% to 70%. On the other hand, other fractures like bimalleolar fractures occur at a rate of 15% to 20% while the occurrence of trimalleolar fractures range at 7% to 12%. The overall rate of occurrence of the fractures especially between the genders, according to Maxey and Magnusson (2012), has a similarity. Despite this, the rate of occurrences is much higher in men especially when they are at a younger age. While higher rates of the fractures occurrence in women happens between the age group of the 50 to 70 years. Additionally, a heightened BMI and smoking have been associated with an augmented likelihood of the occurrence of broken ankle. In contrast to the radius’ fractures and other ankle fractures widespread among postmenopausal and premenopausal females, the density of the bone has not completely shown evidently as a key risk factor (Rynders & Hart, 2013, 56). Generally, before the management of ankle fracture, categorization plays a vital role. Classification or categorization of ankle fractures encompasses utilization of multiple approach schemes. According to the Lauge-Hansen system, the basis of ankle fractures categorization focuses on the foot’s position and the forces that act on it during the event of injury. Conversely, the Danis-Weber system depends on the intensity of fibular fracture. However, according to Calhoun and Laughlin (2009) neither scheme of categorization has been established to be analytical. Therefore, prompting emergency medical physicians normally label broken ankles in accordance to the number of fractures existing in the ankle (unimalleolar, bimalleolar, trimalleolar). Often, most physicians apply the Danis-Weber classification that classifies the fractures according to the appearance of the component of the fibular and the fracture’s location. Somewhat, Smith et al, (2011) assert that Weber categorization compares with requirement for an operative stabilization and orthopedic surgeons often use this categorization system. Bohndorf et al (2011) however, provides a much better form of classification. They provide that there exists three classifications; type A, type B, and type C. Type A shows a transverse fibular avulsion ankle fracture, which occasionally has an oblique medial malleolus fracture. This occurs because of an internal adduction and rotation and usually has stability. Type B depicts an oblique fracture of the malleolus (the lateral one). This may or may not exhibit a break of the tibiofibular syndesmosis and a medial injury (either deltoid rupture or medial malleolus fracture). It occurs due to an external rotation, and occasionally has some instability. Further, Type C exemplifies a high fibular break that has the medial malleolus having a transverse avulsion fracture, and a rupture of the tibiofibular ligament. Generally, Type C exhibits syndesmotic injury more than Type B. Type C fracture results from abduction or adduction with an external rotation, and always has instability, therefore calls for operative repair. In addition, some of the major and common causes of ankle fractures embrace rotation or twisting of the ankle, rolling the ankle, falling or tripping, and impact during accidents (Baxter, Porter & Schon, 2008, p.147). Considering the mechanisms in ankle fracture, Beaty, Kasser, and Rockwood (2009) stress that ankle fractures occur in distal fibula, distal tibia, calcaneus, and talus. The ankle joint comprises of two joints, which include the subtalar and the true ankle joints. The latter comprises the tibia, the fibula and the talus. Often, the foot can point toward the ceiling (tibia) or the floor (talus) through the true ankle joint. Also, according to Calhoun and Laughlin (2009), the subtalar joint includes the calcaneus and the talus. The former stated joint mainly enables the leg to be averted or inverted, which implies the foot’s sole can face outward (averted) or face inward (inverted) via the subtalar joint. In management of ankle fractures, at the time of the evaluation of the ankle fractures, the injury mechanism (like plantar flexion, dorsiflexion, inversion, eversion), and the need for immobilization (splint) should receive more focus. Moreover, associated injuries (capsular, ligamentous, vascular) as well as recommendation for a referral to a specialist for advanced evaluation or treatment have high implication. Generally, some of the care factors regarded essential include additional rehabilitation, surgery, or immobilization known to ensure quick recuperation (Bucholz, 2012, p.81). Management normally begins with evaluation of the patient so as to determine any occurrence of trauma. In the case of an isolated ankle fracture, physicians normally consider making a confirmation of the neurovascular status of the fractured limb, reduce pain and limit or prevent any possible occurrence of further damage. After this, most physicians often cover the open fractures using wet sterile gauze. Normally, an important fact to consider during management includes stabilization of the suspected fracture. This can be done using bulky Jones dressing, a pillow splint, or air splint, just before transportation of the patient. Comfort and Abrahamson (2010) assert that the ankle can be immobilized in a neutral position; however, excessive handling should be avoided. Immobilization simply helps in reduction of bleeding, pain and damage to the limb’s surrounding soft tissues. Constantinou and Brown (2010), however, mention that in case the fracture needs a high level of care (emergency cases) patients must first undergo an evaluation of multisystem trauma. If the physician rules out the occurrence of a multisystem trauma, the fracture has to be identified whether it has some form of stability or instability. Often, unstable fracture comprises any bimalleolar or trimalleolar fracture, any fracture-dislocation, or any form of lateral malleolar fracture with a significant talar shift. In the case where neurovascular status faces some compromise, the physician should consider reducing the ankle fracture with immediate effect. The physician should also ensure that they maintain the reduction during the healing process, internal fixation, or external fixation. Generally, ankle fractures, especially the open ankle fractures should be protected from any further contamination through covering wounds using a wet sterile dressing, which has loosely wrapped dry sterile gauze to secure it. According to Matthews (2012), physicians before managing an ankle fracture, should confirm a patient’s current tetanus immunization. In case the patient lacks immunity and has a severely contaminated wound, the physician should administer tetanus immunoglobulin. Additionally, a physician should consider recommending antibiotic prophylaxis. In such a case, Blok, Cheung and Platts-Mills (2012) recommend administration of cefazolin for moderately contaminated wounds. This should be done with addition of aminoglycoside in case the wound becomes highly contaminated. Moreover, Matthews (2012) insists that gentamicin and vancomycin should be administered if the patient has allergies for penicillin. The blisters should be left intact, since once they rupture there exists high chances of skin flora contamination. In some instances, the fracture may be closed (no wound). In such a situation, physicians normally manage the fracture through reducing the dislocation. Constantinou and Brown (2010) stress on the importance of physicians being skilled in the initial management of ankle fractures because it requires reduction of the dislocation. However, Gumann (2010) asserts that instant reduction of the dislocation may not be necessary if the blood flow to the foot has no compromise. Other processes of management of closed fractures can involve application of a procedural sedation or local anesthesia. The physician can also consider manipulating the limb so that it reverses the direction of the initial deforming forces. During the management of ankle fractures, several ethical issues normally arise. Such issues relate to factors such as follow-up, documentation and record keeping, and risk management and decision-making (Gengenbach & Hyde, 2007, p.387). In the case of follow-up, ethics holds that a physician should ensure that they follow-up a patient after treatment purposely to ascertain whether the patient adheres to the treatment offered. This action aims to ensure quality care. Moreover, according to Brunner and Smeltzer (2010) ethics holds that a physician should refer a patient for further medication and treatment elsewhere when they do not have enough qualification to treat the level of fracture. In addition, Fry, Veatch and Taylor (2011), comment that decisions made on how to manage a patient’s fracture and prevent further risks should be done carefully and by a qualified medical professional. On the other hand, with regards to documentation and record keeping, Greaves, Greaves-Porter and Porter (2009) confirm that all the documentations and records kept about the information concerning the patient with fracture ankle should have a high level of confidentially. Such information should not reach unauthorized individuals. As a conclusion, it would be appropriate to assert that management of ankle fractures involves consideration of several factors just like management of other minor or major medical conditions. Additionally, ankle fractures have become a matter of concern; therefore, it should receive much priority, purposely to help control the rate of its occurrence among individuals of all age groups. References Baxter, D. E., Porter, D. A., & Schon, L. (2008). 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