Ʋuʋu ƒe Kplu Series - Distal Tibial Compression Ʋu ƒe Ƒu ƒe Kplu
Distal tibial Pilon ƒe gbagbã mebɔ o, eye mede 10% le gbagbã siwo ƒo xlã afɔkpodzi la me o. Lãmetsi falɛfalɛ siwo le afɔkpodzi si le didiƒe la mete ŋu nɔa te ɖe lãkusi falɛfalɛ siwo metsyɔ nu nyuie o nu o, si wɔnɛ be eƒe gbagbãdɔdada sesẽna ɖe edzi. Wonya pilon ƒe gbagbã be egbãna, ʋuka ƒe akpa si le ʋuʋum, eye lãmeka falɛfalɛwo xɔa abi. Le tɔtrɔ siwo vaa ƒunukpeƒewo ƒe sɔsɔ kple abɔ kple afɔ ƒe sɔsɔme me ta la, ehiã be woawɔ dɔ na ƒunukpeƒewo ƒe gbagbã akpa gãtɔ. Ele be woatrɔ asi le amekoko ƒe atikewɔwɔ si ŋu kakaɖedzi le ŋu wòasɔ ɖe lãmeka ƒe gbagbã ƒomevi aɖewo koŋ nu, lãmeka falɛfalɛwo ƒe abixɔxɔ, kple dɔnɔwo. Ɣeyiɣi si sɔ si woatsɔ awɔ dɔ na amekokoe nye nu vevitɔ si ana woakpɔ dzidzedze.
Ŋutilã ƒe Nɔnɔmewo
Pilon ƒe gbagbã lɔ metaphyseal kakɛwo ɖe eme, eye ɣeaɖewoɣi la, diaphyseal kakɛwo hã. Ƒunukpeƒewo ƒe blanuiléle kple ƒunukpeƒewo ƒe gbagbã siwo le sue hã li. Ƒu kakɛ vevi etɔ̃ nɔa anyi ɣesiaɣi: ƒu ƒe akpa si le ŋgɔgbe, titina ƒe ƒu ƒe kakɛ, kple megbeƒu ƒe kakɛ.
Nuto etɔ̃e li siwo me ƒunukpeƒetetedɔ dzena le: Axadzi ƒe gbagbã dzɔna le ŋgɔgbe kple megbeƒu ƒe kakɛwo dome, eye zi geɖe la, ete ɖe fibula ŋu. Titina ƒe ʋuʋu ate ŋu adze abe ƒu kakɛ siwo le ablɔɖe me ene alo megbeƒu ƒe kakɛa ƒe tete. Medial comminution lɔ titina kakɛ alo nutete si te ɖe medial malleolus ŋu ƒe akpa aɖe ɖe eme.
Zi geɖe la, afisi fli siwo gbagbã la do go le. Woate ŋu atso gbagbãƒe vevi etɔ̃awo dometɔ ɖesiaɖe eye fli bubuwo nanɔ wo ŋu. Ele vevie be woakpɔ afɔkpodzi ƒe ʋukawo ta. Ele be woawɔ dɔ ɖe lãkusi falɛfalɛawo ŋu nyuie eye ne ehiã ko hafi woahe wo ɖe megbe be woaƒo asa na abi - dɔyɔyɔ ƒe kuxiwo. Ele be woaƒo asa na kakɛ siwo gbã la ɖeɖeɖa fũ akpa be woaxe mɔ ɖe ʋuka siwo me ʋu sina tona ƒe necrosis si le kakɛawo ŋu nu.
Nuveviwɔame ƒe Mɔnuwo
Nuveviwɔame siwo ŋu ŋusẽ mele o: Adze anyi tso kɔkɔƒe, tsikpedzizɔzɔ, ʋufɔkuwo, kple bubuawo.
Ŋutasẽnuwɔwɔ ƒe mɔfiame: Axial compression; Trɔtrɔ ƒe ʋuʋudedi ƒe ŋusẽ; Varus ƒe lãɖeɖe ƒe ŋusẽ; Valgus ƒe ʋuʋudedi ƒe ŋusẽ.
Varus force violence: Ebɔ ɖe sɔhɛwo me wu, kple nuveviwɔame sesẽwo kple abi siwo ŋu ŋusẽ le wu. Fli si gbã la le sagittal plane me, eye zi geɖe la, fibula la megblẽna o.
Valgus force violence: Ebɔ ɖe ame tsitsiwo me wu, eye nuveviwɔame si nu mesẽ boo o kple abi siwo ŋusẽ mele o. Fli si gbã la le coronal plane me eye zi geɖe la, edo ƒome kple fibular fracture.
Nɔnɔmetatawo Dodokpɔwo
Woɖea afɔkpodzi ƒe X - keklẽ siwo wowɔna edziedzi le ŋgɔgbe kple megbe, axadzi, kple afɔkpodzi ƒe ŋkume. X - ray si didi bliboe si woɖe le afɔkpodzia ŋu ate ŋu aɖe alesi woɖoe ɖe ɖoɖo nu kple klo ƒe ƒunukpeƒe si le etame la afia. Le dɔnɔ aɖewo siwo ƒe gbagbã sesẽ wu gome la, woɖea abɔ si le axadzi ƒe X - keklẽwo tsɔ naa nusi dzi woanɔ te ɖo agbugbɔ abɔ kple afɔ agbã eye woatsɔ ade dzesi ŋutilã ƒe wɔwɔme alo vidzidzi ƒe tɔtrɔ siwo nɔ anyi do ŋgɔ.
Woateŋu agblɔ abi ƒe mɔnu ɖi tso fibular fracture ƒomevi si le X - rays dzi eye wodae ɖe hatsotso me be: Compressive violence (valgus deformity), Tensile violence (varus), Axial loading (intact fibula). Ne fibula la me gblẽ o la, zi geɖe la, enyea abi si nu sẽ ŋutɔ le ƒunukpeƒe ƒe akpa aɖe (Type B). Axial loading injuries mehea ʋuʋu geɖe vɛ o gake ehea axial loading gbogbo aɖe vɛ le distal tibia dzi, eye articular surface kakɛ suesuesue geɖewo nɔa eŋu eye nyagblɔɖi nyui aɖeke menɔa anyi o si nye evelia le articular cartilage compression megbe. Woate ŋu agblɔ afisi gbagbã ƒe kakɛ ƒe ʋuʋu ayi la ɖi tso axadzi X - ray si ɖe talar ƒe ʋuʋu ƒomevi fia (zi geɖe la, ŋgɔgbe ʋuʋu).
CT gbugbɔgatu siwo ƒe akpa eve kple akpa etɔ̃ le vevie. Woate ŋu ana nyatakaka siwo dometɔ aɖewoe nye alesi gbegbe ƒu gbagbãa nu tsoe, afisi ƒu kakɛwo le kple woƒe xexlẽme, kple afisi woʋu le.
Distal Lateral Fibular Ʋuʋu ƒe Kplu
VA Distal Medial Tibia ƒe Ʋuƒo ƒe Kplu
Woƒe hatsotsowo me toto
AO/OTA Fracture - Ʋuʋudedi ƒe hatsotso
Zi geɖe la, ƒunukpeƒetetedɔ ƒomevi A ƒe gbagbã dzena bɔbɔe gake ate ŋu ado ƒome kple abi gã siwo woxɔna le lãmeka falɛfalɛwo ŋu. B ƒomevi ƒe akpa aɖe ƒe gbagbã le ƒunukpeƒetetedɔ me lɔa ƒunukpeƒe ƒe gbagbã ɖe eme eye wòhiã be woatsɔ buttress plates awɔe be woaɖe ƒunukpeƒe kakɛ siwo le ƒunukpeƒea me dzi akpɔtɔ. Intra - articular Type C fractures bliboe fiaa ŋusẽ gã ƒe abi siwo do ƒome kple tibio - talar ƒunukpeƒe ƒe gbagbã, abixɔxɔ le distal tibio - fibular syndesmosis, fibular fractures, kple tibial metaphyseal fractures, eye zi geɖe la, wodoa ƒome kple abi sesẽ siwo woxɔna le lãkusi falɛfalɛwo ŋu.
Ruedi - Allgower ƒe hatsotso
Ƒomevi I: 'T' - ƒe nɔnɔme si me mama ƒe gbagbã si me ʋuʋu ɖedzesi aɖeke mele o.
Ƒomevi II: Ƒunukpeƒea ƒe mama si me wòdze ƒã be fli si me wogbãe le la ʋuna eye wòtsona le mɔ si sɔ nu.
Ƒomevi III: Distal tibial articular surface kple metaphysis ƒe gbagbã sesẽ siwo vuvu kple esiwo te ɖe wo nɔewo ŋu.
Non - amekoko Atikewɔwɔ
Dɔdamɔnu si menye amekoko o na distal tibial Pilon fractures mebɔ o. Nusiwo woɖena fianae nye gbagbã ƒomevi siwo meɖea wo le teƒe boo o kple dɔnɔ siwo ŋu dɔléle bubu siwo kpena ɖe ame ŋu siwo dzia amekoko ƒe afɔkua ɖe edzi. Woate ŋu atsɔ plaster immobilization hã awɔ dɔ na extra - articular fractures siwo me tɔtrɔ sue aɖe koe le tibial alignment bliboa me. Wozãa aŋenu gbã vaseɖe esime vuvua nu fa, eye emegbe wotsɔa aŋɔ si wotsɔa aŋɔ ƒoa nui la dea eme. Tɔtrɔ sesẽ siwo ava le afɔkpodzi alo ƒunukpeƒe ƒe akpa si le ƒunukpeƒewo ƒe ɖoɖo nu ate ŋu ahe kuxiwo vɛ le abɔ kple afɔ ƒe ɖoɖowɔwɔ kple woƒe liƒo ŋu. X - ray dodokpɔ atraɖii hiã be woakpɔ egbɔ be ƒunukpeƒewo sɔ eye abɔ kple afɔwo sɔ.
Woate ŋu ada ƒunukpeƒetetedɔ tiatia aɖewo hã to amekoko manɔmee. Le ƒunukpeƒe ƒe gbagbã siwo me ƒu ƒe gbagbã ƒe ʋuʋu mede milimeta 2 o eye afɔɖeɖe ƒe ʋuʋu mede milimeta 3 o gome la, woate ŋu abu atikewɔwɔ si menye amekoko o ŋu na dɔnɔ siwo ƒe dɔwɔwɔ ƒe hiahiãwo mede o.
Amekoko ƒe Dzesiwo
Articular surface step - off lolo wu 2 mm.
Valgus ƒe dzogoe si lolo wu 5°.
Varus ƒe dzogoe ɖesiaɖe.
Gbagbãƒe siwo le ʋuʋu ɖi.
Compartment syndrome ƒe dɔléle si nye Compartment syndrome.
Ʋukawo ƒe abixɔxɔ.
Nuveviwɔame geɖe.
Amekoko ƒe Ɣeyiɣi
(1) Atikewɔwɔ kpata: Nusiwo woɖena le lãme na ame dzi ɖeɖe kpɔtɔ kple wo léle ɖe te; Gbagbãƒe siwo le ʋuʋu ɖi; Ʋukawo ƒe abi siwo do ƒome kplii; Compartment syndrome ƒe dɔléle si nye Compartment syndrome.
(2) Gbãtɔ - afɔɖeɖe (Afɔ ƒe didime kple eƒe ɖoɖowɔwɔ gbugbɔgaɖoanyi): Calcaneal traction; Gotagome fixation; Fibular fractures dzi ɖeɖe kpɔtɔ kple ememe léle ɖe te, posterior tibial malleolar fractures ƒe ʋuʋu dzi ɖeɖe kpɔtɔ si seɖoƒe li na kple ememe fixation; Mɔxexe ɖe ʋuka me ʋu ƒe sisi nu.
(3) Evelia - afɔɖeɖe: Anɔ abe ŋkeke 10 - 14 megbe la, ʋuʋu dzi ɖeɖe kpɔtɔ kple ememe fixation na tibial fracture.
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Amekoko ƒe Mɔnuwo
(1) Na fli si gbã la nadze nyuie wu.
(2) Tsɔ amekokomɔnu ʋɛtɔ kekeake kpɔ ƒu gbagbãwo katã gbɔ.
(3) Ƒo asa na teƒe siwo lãmeka falɛfalɛwo ƒe nɔnɔme mede ame dzi o.
(4) De ŋugble le nuveviwɔame ƒe mɔnu ŋu.
(5) Bu afisi woatsɔ agbalẽviawo aɖoe ŋu kpɔ.
Le gbagbãƒe siwo me varus ƒe nɔnɔme gblẽ gome la, wotiaa medial buttress plate, eye wozãa anteromedial mɔnu.
Le gbagbãƒe siwo ƒe valgus ƒe dɔmawɔmawɔ nyuie gome la, wotiaa axadzinu si wotsɔ léa nu ɖe te, eye wozãa ŋgɔgbekpa dzi mɔnu.
Ele be didime si le lãɖeɖe eveawo dome nanye sentimeta 5 - 7 ya teti.
CZMEDITECH ƒe Adzɔnuwo
