The bottom of the talus sits on the cleanses or the heel bone (Huffy & Ceilings 2010). The way in which ankle fractures are classified is with regard o the three malleable, also referred to as Volcano’s triangle (Huffy & Ceilings 2010). This ‘triangle’ is made up of the medial malleable, lateral malleable and posterior malleable and the ankle is categorized depending on how many malleable are fractured (Saucer & Cooper 2013). A bimolecular fracture involves two fractures, one to each of the medial malleable and lateral malleable (Tourney et al 2009).
Reticular cartilage, highly specialized connective tissue, covers the bones inside the joint, allowing the smooth movement of bone against bone (Fox et al 2009). This cartilage is approximately 2 to 4 mm thick and is soft, acting as a shock absorber, whilst also being tough to ensure it is not easily damaged (Fox et al 2009). Figure 1. The anatomy of the ankle (Crisis 2013). Segments And Tendons Two very important structures of the ankle, particularly in regards to movement, are ligaments and tendons.
The difference between these two structures is that tendons attach muscles to bones, whilst ligaments are soft tissues, which attach bones to bones (Pal 2014). Ligaments and tendons are both made Of collagen, which bundles to form, what is referred to, as a rope- eke structure and the thickness of these structures are what determine its strength (Pal 2014). The ligaments that make up the lateral ligament complex include the anterior tailboard ligament, the calcareousness ligament and the posterior tailboard ligament (Saucer & Cooper 2013). The deltoid ligament is particularly important in supporting the medial ankle.
The ankle syndromes is point where the fibula meets the tibia and this area is supported by, the anterior inferior tabulation ligament, the posterior fibular tabulation ligament, the transverse ligament and the intercourse ligament -? “a long heed of connective tissue that connects the entire length of the tibia and fibula, from the knee to ankle” (Pal 2014). Ligaments are also important in assisting the formation of the joint capsule, which is comprised of both the ligaments surrounding the joint and the soft tissues, which form the sac between the ligaments (Pal 2014).
Tendons, fibrous connective tissues, which attach muscles to bone, ensure the ankle joint is supported. The most essential tendon required for movement, in particular, walking, running and jumping, is the Achilles tendon, which attaches the cleanses to the calf muscles (Huffy & Ceilings 2010). The posterior tibia tendon, which attaches the underside of the foot to smaller calf muscles, enables the movement of the foot inwards and is important in regards to supporting the arch of the foot (Huffy & Ceilings 2010).
The anterior tibia tendon provides the ability to raise the foot. The Personals are two tendons, which run behind the lateral malleable and are responsible for enabling the movement of the foot both downwards and outwards (Huffy & Ceilings 2010). The muscles of the lower leg provide the predominant motion of the ankle through contraction. These muscles in the leg are connected to the foot wrought the tendons, which pass by the ankle.
The muscles in the ankle, which are essential in providing movement, include the following (Huckleberry 2006); The posterior tibias -? responsible for positioning the foot inwards and supporting the foots arch The anterior tibias – responsible for moving the ankle upwards The gastroenteritis and coleus, or calf muscles – responsible for the connection to the cleanses by with Achilles tendon and through the tightening of these muscles, the ankle is able to bend down The personals; prosperous longs and prosperous braves – responsible for moving the ankle downwards and outwards The most essential nerves acquired in the ankle are the ones which crosses in front of the ankle, passes the outer edge of the ankle and the tibia nerve which passes behind the ankle, specifically, behind the medial malleable (Saucer & Cooper 2007).
These nerves which pass through the ankle and then to the foot, in particular, the nerves on the top and the edge of the ankle, are essential in controlling the muscles in those areas and providing the foot with sensation (Huffy & Ceilings 2010). Blood Vessels The ankle attains its blood supply from arteries, which pass through the ankle o the foot. The predominant arteries utilized by the ankle to supply blood are the dorsal piped and the posterior tibia artery (Huckleberry 2006). The dorsal piped runs in front of the ankle whilst the posterior tibia artery runs behind the ankle, particularly, behind the medial malleable (Huffy & Ceilings 2010).
Other arteries, which enter the foot from various alternate directions are involved in supplying blood to the ankle, however the majority is attained through the two arteries mentioned and the posterior tibia artery also sends blood to the inside of the ankle joint through smaller blood vessels Huckleberry 2006). WHAT IS A BIMOLECULAR FRACTURE? A bimolecular fracture is an ankle fracture, which occurs when both the medial malleable and the lateral malleable are fractured (Figure 2), causing the ankle joint to become unstable. This instability is a result of the fracture causing disruption to the “structural integrity of the ankle (joint)” (Browner 2009).
In these types of fractures, surgery is typically required in order to stabilize the injury as left untreated, the joint is much more susceptible to further damage and osteoarthritis (Hong et al 2013). Figure 2. X-ray of bimolecular fracture (Levine, 2013). Signs And Symptoms Depending on the severity Of the fracture, the Symptoms Of a bimolecular fracture can include some or all of the following to the injured ankle: extreme pain, swelling, bruising, limited range of motion, inability to weight bear, tenderness and the sound of a break when the injury first occurred (Hong et al 2013). Factors Which Increase Risk As with most injuries, there are risk fractures associated.
Some factors, which may increase or put an individual at higher risk of suffering a bimolecular fracture, include; older age, osteoporosis, vehicle accidents and sports such s skateboarding and skiing also increase risk (Tourney et al 2009). TREATMENT OF BIMOLECULAR Fractures The treatment associated with ankle fractures can be categorized into either surgical or non-surgical. In order for a fracture to be treated without surgery, the stability of the ankle mortise must not be disturbed (Huffy & Ceilings 2010). Generally, simple fractures of the lateral malleable can be treated in this way as in most cases, the talus position would be maintained, assuming the medial structures remain in tact (Huffy & Ceilings 2010).
In bimolecular fracture cases, surgical treatment, in particular, open reduction; internal action would be required due to the fracture and placement of the bones. If a bimolecular fracture was not treated with surgery, there is a significant risk the fracture ends will become displaced and not heal with the correct alignment (Tourney et al 2009). This is referred to as malison and in many cases malison, or if the ankle, after it has healed becomes unstable, will lead to osteoarthritis in the applicable joint (Tourney et al 2009). Surgical Treatment The most common course of treatment for bimolecular fractures involves open reduction and internal fixation (ROOF) (Crisis 2013).
This surgery entails neural aesthetic and an incision is made over the ankle so that the surgeon is able to have clear sight of the broken bones (Crisis 2013). The open reduction part of the surgery refers to placing the bones back together to ensure they heal in the correct placement (Crisis 2013). The broken bones are then internally fixated with, in most cases, metal plates and screws (Figure 3) (Crisis 2013). This internal fixation provides the stability required for movement to occur as the bones begin to heal and together with open reduction provide the opportunity for full recovery, in particular, ability to eight bear and full range of movement restored (Crisis 2013). Figure 3. (Left) X-ray Of bimolecular ankle fracture. Right) X-ray Of the surgical repair of a bimolecular fracture using metal hardware, in particular, plates and screws (Crisis 2013). Risks Associated With Surgical Treatment As with any surgery, there are risks associated. Some of the risks applicable with surgery for bimolecular fractures include; infection, blood clots and or bleeding, pain, arthritis, damage to nerves, tendons and or blood vessels, issues associated with the healing of the bones, pain from any hardware used ND the requirement to later remove any or all hardware (Tourney et al 2009). Complications With The Healing Of Bimolecular Fractures In regards to the healing of bimolecular fractures, there are factors, which can potentially affect the way in which the injury heals.
Some of these factors can include but are not limited to the age of the individual, if the individual suffers from diabetes, steroid use, osteoporosis, peripheral vascular disease and smoking and alcoholism can also have a significant effect (Tourney et al 2009). These factors can lead to a definite deficiency in both the healing of the mound and the healing of the bones. Conclusion After analyzing the causes and treatment of bimolecular fractures, although it is an injury, which an individual is unlikely to sustain when participating in daily activities, surgical treatment, along with other necessary appropriate medical care, provides the possibility Of full recovery. Browner, B 2009, Skeletal Trauma: Basic management and reconstruction, 4th Eden. Saunders, Canada.