Lɔk Plɛt Seri - Distal Tibial Kɔmpreshɔn Lɔk Bɔn Plɛt
distal tibial Pilon frakshכn dεm nכ kin bכku, we de mek lεs dan 10% pan di frakshכn dεm we de rawnd di ankכl. di sכft tisu dεm na di distal tibia dεn nכ gεt pwεl tכlerans fכ indekwayt sכft tisu kכvεreshכn, we de inkrεs di difεlεns fכ frakshכn tritmεnt. di pilon frakshכn dεm dεn no fכ kכmminushכn, displεsmεnt fכ di artikul sεf, εn sכft tisu injuri. biכs fכ di chenj dεm na di joyn kכngruiti εn di limb alaynsmεnt, mכst frakshכn dεm nid כpεrayshכn fikseshכn. Difinitiv ɔspitul tritmɛnt fɔ tayla fɔ sɔm patikyula kayn fraktrɔs, sɔft tisu injuri, ɛn pasɛnt dɛn. Di rayt tɛm fɔ ɔpreshɔn na di men tin we go mek dɛn gɛt sakrifays.
Di tin dɛn we de apin na di bɔdi
di pilon frakshכn dεm involv mεtafiz fragmεnt dεm, εn sכmtεm dεn de involv diaphyseal fragmεnt dεm bak. I kin gɛt bak di jɔyn dɛn we kin pwɛl ɛn we kin brok smɔl smɔl. tri bεsik bon fragmεnt dεm de כltεm: di anterolateral fragmεnt, di mεdial malleolar fragmεnt, εn di posterolateral fragmεnt.
tri tכpik εria dεm de fכ di joyn kכminyushכn: di lateral kכminכshכn de apin bitwin di anterolateral εn posterolateral fragmεnt dεm, we kin kכlכs to di fibula. sεntri kכminyushכn kin prεzεnt as fri bon fragmεnt dεm כ kכmpreshכn fכ di posterolateral fragmεnt. di mεdial kכminyushכn involv pat pan di mεdial fragmεnt כ kכmpreshכn we de nia di mεdial malleolus.
di kכminishכn kin apin usay di frakshכn layn dεm de intasek. εvri wan pan di tri men frakshכn fragmεnt dεm kin kכmכt εn gεt כda frakshכn layn dεm. I impɔtant fɔ protɛkt di blɔd vesel dɛn na di anklɛ. di sכft tisu dεm fכ tek tεm εn dεn fכ כnli pul dεm bak we nid de fכ avכyd wund - hiling prכblεm. fכ avכyd fכ strip di frakshכn fragmεnt dεm pasmak fכ mek di fragmεnt dεm nεkrכsis bכku bכku wan.
Di we aw pɔsin kin wund
Ay - ɛnaji injuri: Fɔdɔm frɔm ayt, ski, motoka aksidɛnt, ɛn ɔda tin dɛn Lɔw - ɛnaji injuri: Trip pan flat say.
Dairekshɔn fɔ vaylɛns: Akshal kɔmpreshɔn; Rotashɔnal shia fɔs; Varus shia fɔs; Valgus shear fɔs fɔ di tin dɛn we dɛn de yuz.
Varus fכs vaylεns: I kin kכmכn pan yכng pipul dεm, wit mכr siriכs trauma εn hεy - εnεji injuri. di frakshכn layn de na di sajital plen, εn di fibula kin intakt bכku tεm.
Valgus fɔs vaylɛns: I kin apin mɔ pan ol pipul dɛm, wit less trauma ɛn low - ɛnaji injury. di frakshכn layn de na di koronal plen εn i kin kכl fכ fibular frakshכn.
Ɛgzamin dɛn fɔ Imej
rutin standad anteroposterior, lateral, εn mortise view dεn de tek X - ray dεm na di ankכl. wan ful - lεng X - ray fכ di tibia kin sho di alaynsmεnt εn di kכn jכint we de oba. fכ sכm pasεnshכn dεm we gεt mכr komplεks frakshכn, dεn de tek εks - ray fכ di kכntralateral limb fכ gi rεfrεns fכ frakshכn rεkכnstrכkshכn εn fכ dεtekt di anatomical כ congenital vεryushכn dεm we bin de bifo.
di injuri mεkanism dεn kin prεdikt frכm di tכp fכ di fibular frakshכn pan εks - rayt εn dεn kin klas am as: Kכmprεsiv vaylεns (valgus difכmiti), Tεnsil vaylεns (varus), Akshal lod (intakt fibula). if di fibula intakt, i jεnarali na siriכs pat pan intra - artikulכr (Tayp B) injuri. di aksial lod injuri dεm nכ de mek bכku displεsmεnt bכt i de rizulta in big amoun fכ akshal lod na di distal tibia, wit mכltipכl sכm sכm artikul sכfayz fragmεnt dεm εn wan pwεl prכgnosis sεkכnd to artikulכr kכtilaj kכmpreshכn. di dairekshכn fכ frakshכn fragmεnt displεsmεnt kin bi prεdikt frכm di lateral X - ray we de sho di tכp fכ talar displεsmεnt (usually antεriכr displεsmεnt).
Tu - dimɛnshɔnal ɛn tri - dimɛnshɔnal CT rikostrɔkshɔn impɔtant. dεn kin gi infכmeshכn inklud di digri we di frakshכn kכmכt, di posishכn εn nכmba fכ di bon fragmεnt dεm, εn di dεyshכn we di bon dεm de displεs.
Distal Lateral Fibular Lɔk Plɛt
VA distal mεdial tibia lכk plet
Klasifikɛshɔn
AO/OTA Fraktrɔs - Dislɔkeshɔn Klasifikɛshɔn
εkstra - artikulכr Tayp A frakshכn dεm kin sho se i simpul bכt i kin kכnεkt wit signifyant sכft tisu injuri dεm. di tכpik pat pan intra - artikulכr Tayp B frakshכn dεm involv artikulכr kכmminushכn εn i nid bכtres plet fכ ridyus di intra - artikulכr fragmεnt dεm. komplit intra - artikulכr Tayp C frakshכn dεm de sho se hכy - enεji injuri dεm we de sho se di tibio - talar jכint de kכmכt, injuri to di distal tibio - fibular syndesmosis, fibular frakshכn, εn tibial mεtaphyseal frakshכn, εn dεn kin kכl am wit siriכs sכft tisu injuri.
Ruedi - Allgower Klasifikeshɔn
Tayp I: Na 'T' - shep split fraktrɔs we nɔ gɛt signifyant displeysmɛnt.
tayp II: Split pan di artikulכr sεf wit klia displεsmεnt fכ di frakshכn layn εn mכdarεt kכminishכn.
Tayp III: siriכs kכmminut εn kכmprεsiv frakshכn dεm na di distal tibial artikulכr sεf εn mεtafiz.
Nɔn - ɔspitul Tritmɛnt
Nɔn - ɔspitul tritmɛnt fɔ distal tibial Pilon fraktrɔs nɔ kin bɔku. Di indikεshכn dεm na minimally displaced fracture types εn pasεnshכn dεm wit komorbiditi dεm we de inkrεs di risk fכ כspitul tritmεnt. εkstra - artikulכr frakshכn wit sכm chenj dεm na di כvala tibial alaynsmεnt dεn kin trit dεm bak wit plasta imכbilizεshכn we dεn nכ כpεrayshכn. Fɔs, dɛn kin yuz splint te di swɛlin stɔp, dɔn dɛn kin put plasta. siriכs chenj dεm na di tibial כ artikulכr sεf alayns kin mek prכblεm wit di limb alayns εn stεbiliti. kכntinyu fכ du εks - ray egzamεn dεm nid fכ mek sכh se di jכint kכngruiti εn di limb alaynsmεnt.
sεlektiv intra - artikulכr frakshכn dεm kin trit bak nכn - כpεrayshכn. fכ intra - artikulכr frakshכn wit less dan 2 mm fכ fraktכs displεsmεnt εn less dan 3 mm fכ stεp - כf, dεn kin tink bכt nכn - sכjεk tritmεnt fכ pasεnshכn dεm we gεt lכw fכnshכnal rikwaymεnt.
Indikeshɔn dɛn fɔ Ɔpreshɔn
Atikul sεf stεp - כf big pas 2 mm.
Valgus anguleshɔn we big pas 5°.
Eni varus anguleshɔn.
Opin fraktrɔs dɛn.
Sindrom we de na di kɔmpawtmɛnt.
Vaskul injuri we pɔsin kin gɛt.
Bɔku bɔku injuri dɛn.
Di Tɛm we dɛn De Du di Ɔpreshɔn
(1) Imejɛnsi tritmɛnt: Ridyus ɛn fiks di dislɔkeshɔn; Fraktrɔs dɛn we opin; Injuri dɛn we gɛt fɔ du wit vaskul; Sindrom we de na di kɔmpawtmɛnt.
(2) Fכs - stej (Rεstכreshכn fכ di limb lεngth εn alaynsmεnt): di kalkanal trakshכn; Fikseshɔn we de na do; rεdukshכn εn intanal fiksεshכn fכ di fibular frakshכn dεm, limited opin rεdukshכn εn intanal fiksεshכn fכ di posita tibial malleolar frakshכn dεm; Fɔ mek yu nɔ gɛt trombos.
(3) sεkכn - stej: lεk 10 - 14 de dεm afta dat, opin rεdukshכn εn intanal fiksεshכn fכ di tibial frakshכn.
.
Di we aw dɛn kin du ɔpreshɔn
(1) Maksimayz di ɛksplɔshɔn fɔ di fraktrɔs layn.
(2) Sɔlv ɔl di fraktrɔs wit di smɔl ɔpreshɔn we dɛn kin du.
(3) Nɔ tek say dɛn we nɔ gɛt bɛtɛ sɔft tisu.
(4) Tink bɔt di we aw pɔsin kin wund.
(5) Tink bɔt di say we dɛn put di plet.
fכ frakshכn wit varus difכmiti, dεn de sεlekt wan mεdial bכtres plet, εn dεn de yuz wan anteromedial aprכch.
fכ frakshכn wit valgus difכmiti, dεn de sεlekt wan lateral bכtres plet, εn dεn de yuz wan anterolateral aprכch.
di distans bitwin di tu insishכn dεm fכ bi at le 5 - 7 cm.
CZMEDITECH Prodakt dɛn we dɛn mek
