最新Foot and Ankle Fractures PEM Database足和踝关节骨折PEM数据库-药学医学精品资料.ppt

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1、最新FootandAnkleFracturesPEMDatabase足和踝关节骨折PEM数据库-药学医学精品资料AnatomyThreegroupsofstabilizingligaments:1)Lateral-anteriortalofibularligament(ATFL)-calcaneofibularligament(CFL)-posteriortalofibularligament(PTFL).-limitankleinversionandpreventanteriorandlateralsubluxationofthetalusSpecialTes

2、tsAnteriorDrawer-integrityoftheATFL-grasptheheelwithonehandandapplyaposteriorforcetothetibiawiththeotherhand,whiledrawingtheheelforward.-laxityiscomparedwiththeopposite(uninjured)ankle.-positivetest:adifferenceof2mmsubluxationcomparedwiththeoppositesideoravisibledimplingoftheanterior

3、skinoftheaffectedankle(suctionsign)SqueezeTest-teststheintegrityofthesyndesmoticligaments-examinerplaceshishand6to8inchesbelowthekneeandsqueezesthetibiaandfibulatogether-positivetest:resultsinpainintheankle,whichindicatesinjuryofthesyndesmoticligamentX-raysX-rays-approx.10-15%ofalltr

4、aumaticradiographsareoftheankle-80%ofallankleinjuriesgetanx-ray,fewerthan15%haveasignificantfractureViews-AP,lateral,mortiseview(15-20degreesofinternalrotation)-AP:malleoli,plafond,talardome,lateralprocessofthetalus-Lateral:ant/posttibialmargins,talarneck,post,talarprocessandcalcaneu

5、s-Mortise:mostimportantview,medialclearspaceshouldnotexceed4mmXrayMeasurmentsAnkleFracturesClassificationDanis-Weber-basedonmechanismofinjury-threefracturetypes(i.e.,A,B,C),definedbythelocationofthefibularfracture-A-belowthetibiotalarjoint-B-atthelevelofthetibiotalarjoint-C-abovethet

6、ibiotalarjointUnimalleolarFracturesLateral-anyavulsion<3mminsizecanbetreatedasananklesprainUnimalleolarFractures-LateralStabilitydependsonthelocationofthefracture-TypeA(belowtibiotalarjoint)-nomedialtenderness-BNwalkingcast-f/u1wktoensurenodisplacement-non-wtbearingx3wksthenwtbearing

7、foranother3-5wks-medialtenderness(checkmortisefordisplacement)-orthoconsultUnimalleolarFractures-LateralTypeBandC(atorabovethetibiotalarjoint)-orthopedicconsult?ORIF-typeB:50%associatedwithtibiofibulardisruptionUnimalleolarFractures-MedialMedial-commonlyassociatedwithlateralandposter

8、iormalleolar