下胫腓螺钉固定.pdf

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1、SYNDESMOSISSCREWS--WHENNECESSARY?WangManyiBeijingJishuitanHospitalThestabilizationstructuresofanklecanbedividedintothreecomplexes(medial,lateralandsyndesmosis).Iftwoofthethreecomplexescanberestored,themortisecanbestabilized.AO-Danis-WeberclassificationofanklefracturesTypeA:syn

2、desmosiscomplexisintactTypeB:interosseousmembraneisintact,syndesmosiscomplexisusuallystableTypeC:interosseousmembraneisusuallytorntotheleveloffibularfractureⅠ,TypeADoesthisfracturedislocationneedsyndesmosisscrews?Afterthelateralmalleoluswasreducedandfixed,twocomplexeswasrestor

3、ed.Syndesmosisscrewswerenotnecessary.Ⅱ,TypeBDoesthisfracturedislocationneedsyndesmosisscrews?Syndesmosisscrewswerenotnecessary.So,typeAandtypeBfracturedislocationusuallyneednosyndesmosisscrews.Thesyndesmosiscomplexisstable.Twocomplexescanberestored,afterfixingthelateralmalleo

4、lus.Ⅲ,TypeC?Doesthisfracturedislocationneedsyndesmosisscrews?Deepdeltoidligamentandinterosseousmembranewereruptured.Afterfixingthefibula,onlyonecomplexwasrestored.X-rayphotoundervalgusandexternalrotationstress.So,asyndesmosisscrewwasneeded.Doesthisfracturedislocationneedsyndesm

5、osisscrews?SyndesmosisscrewsAfter2years,themortisewasgood.werenotnecessary.So,ifmedialandlateralfracturescanbeanatomicallyreducedandfixed,andthedeepdeltoidligamentisintact,syndesmosisscrewsarenotnecessary(twostabilizedcomplexescanrestorethemortisestability).Aspecialcase---Doesth

6、isfracturedislocationneedsyndesmosisscrews?•Thedeepdeltoidligmentisorientedtransverselyandinsertsintotheposteriorcolliculusofthemidialmalleolus.Itmaybeexposedonlyafterosteotomyorfractureofthemedialmalleolus.•Itcannotbeeffectivelyrepaired.Themedialmalleolusfractureinvolvedonlythe

7、anteriorcolliculus.Theposteriorcolliculuswasintact,butthedeepdeltoidligamentwastornfromit.Afterfixingthemedialmalleolus(anteriorcolliculus),themedialcomplexwasnotrestored,becauseoftheinjureddeltoidligament.Asyndesmosisscrewwasneeded.InterpositionoflooseingbodyDoesthisfractured

8、islocationneedsyndesmosisscrews?Maisonn