fracturile maleolare
DESCRIPTION
Fracturile maleolare. Conf. Dr. M. Nicolescu. Rappel anatomique. Frecventa local III dupa FED si fracturile de col femural. Mecanism componente multiple compresie abductie/adductie rotatie externa picior blocat. Leziuni elementare. - PowerPoint PPT PresentationTRANSCRIPT
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Fracturile maleolareFracturile maleolare
Conf. Dr. M. NicolescuConf. Dr. M. Nicolescu
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Rappel anatomique
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FrecventaFrecventa
local III dupa FED local III dupa FED si fracturile de col si fracturile de col
femuralfemural
MecanismMecanism componente multiplecomponente multiple
compresiecompresie
abductie/adductieabductie/adductie
rotatie externarotatie externa picior blocat picior blocat
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Leziuni elementareLeziuni elementare1.1. Traiect maleolar externTraiect maleolar extern
transversaltransversal transversal transversal spiroid spiroid +cominutie +cominutie
adductie rotatie abductie adductie rotatie abductie
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Leziuni elementareLeziuni elementare2.2. Traiect maleolar externTraiect maleolar extern 3.3. Leziunile acoperisului Leziunile acoperisului
mortezeimortezei
1.smulgere extraarticulara1.smulgere extraarticulara
2.fractura trimaleolara Cotton2.fractura trimaleolara Cotton
3.fractura tuberculo-margino- 3.fractura tuberculo-margino- maleolara post.maleolara post.
4.fractura marginala ant.4.fractura marginala ant.
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Clasificare (Duparc)Clasificare (Duparc) Tip I (5%)Tip I (5%)
adductieadductie
Tip II (20%)Tip II (20%)
abductieabductie
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Clasificare (Duparc)Clasificare (Duparc) Tip III (20%)Tip III (20%) rotatie externa rotatie externa supratubercularasupratuberculara
ligament tibio-peronierligament tibio-peronier ant. - ruptant. - rupt post. - +/- indemnpost. - +/- indemn
Tip IV (50%)Tip IV (50%) rotatie externarotatie externa intertubercularaintertuberculara
ligament tibio-peronierligament tibio-peronier ant. - indemnant. - indemn
post. - rupt post. - rupt
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STADIUL 1-
STADIUL 2
FRACTURA in ADDUCTIeFRACTURA in ADDUCTIe
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Stadiul 1 Fractura
orizontala a maleolei
interne
Stadiul 2 - Ruptura
lig. peroneo-tibiale : diastazis
- Ruptura membranei
interosoase
Stadiul 3 Fractura
peroneului
2/ FRACTURA in ABDUCTIE2/ FRACTURA in ABDUCTIE
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Factori de gravitateFactori de gravitate
Cominutia peroneuluiCominutia peroneului
Fracturi asociate ale pilonului tibialFracturi asociate ale pilonului tibial
Instabilitatea sindesmozeiInstabilitatea sindesmozei
Subluxatia tibio-astragalianaSubluxatia tibio-astragaliana
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ClinicClinic Fracturi prin rotatie-abductie :Fracturi prin rotatie-abductie :
picior in rotatie externa si eversiunepicior in rotatie externa si eversiune
tibia se palpeaza sub pieletibia se palpeaza sub piele
gamba scurtatagamba scurtata
tendon achilean concav posteriortendon achilean concav posterior Fracturi prin adductie :Fracturi prin adductie :
tablou inversattablou inversat
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Complicatii imediateComplicatii imediate
Leziuni cutanate : fracturi deschise tip ILeziuni cutanate : fracturi deschise tip I
flicteneflictene
Leziuni vasculo-nervoase : rareLeziuni vasculo-nervoase : rare
Leziuni asociate : fracturi la alte niveluriLeziuni asociate : fracturi la alte niveluri
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TratamentTratament Conservator :Conservator : reducere + imobilizarereducere + imobilizare ! daca fractura era cu deplasare, Rx de! daca fractura era cu deplasare, Rx de control dupa reducerecontrol dupa reducere Chirurgical :Chirurgical : OS peroneuOS peroneu OS maleola internaOS maleola interna repararea leziunilor ligamentarerepararea leziunilor ligamentare +/- reducerea subluxatiei tibio-+/- reducerea subluxatiei tibio- astragalieneastragaliene
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Fracture en rotation externe sus-ligamentaire
Ostéosynthèse du péroné par Ostéosynthèse du péroné par plaque Réduction du diastasis T-P plaque Réduction du diastasis T-P inf par 1 vis + Suture du LLIinf par 1 vis + Suture du LLI