I-Ankle & Iinyawo Ukuchonga Ukujonga Ukuphefumula I-Arthritis & I-Trauma I | El Paso, TX.

IAnkle Fractures

• I-10% yazo zonke iifractures. I-2nd m / c ilandela intamo ye-femoral Fx. Ubalo lwabantu: amadoda aselula asebenzayo kunye nabasetyhini abadala be-osteoporotic
• I-Stable Fx: Ukugqitywa ngokubanzi kulungile
• I-Fx engaqinisekanga: ifuna i-ORIF. 15% -20% amathuba we-2nd OA.
• Indima yomfanekiso kukuqinisekisa ukuntsonkotha, uzinzo kunye nesicwangciso sokhathalelo (okt, ukusebenza ngokuchasene nolondolozo)
• Uhlobo lwe-Weber lubona ukugqithwa kwe-distal tibial-fibular syndesmosis kunye nokungazinzi
• I-Weber A - ngaphantsi kwe-syndesmosis. Izinzile, ngokuqhelekileyo ukuvuswa kwe-distal fibular malleolus
• I-B B - kwinqanaba le-syndesmosis: ingaba ngaphandle kwe-syndesmosis kunye ne-stndesmosis eqinile okanye yokuqhawula kwaye ingaqiniseki
• I-Weber C - ngaphezulu kwe-syndesmosis. Ngalo lonke ixesha ingazinzanga d/t ukukrazuka kwe-syndesmosis
• Ukwahluka kweefractures kunokubandakanya isikhundla / indima yethambo le-talus ngexesha le-Fx (umzekelo, ukuthunjwa, ukunyuswa, ukujikeleza, njl.) Oku kwaziwa ngokuba yi-Lauge-Hanson classification

I-Tibiofibular Syndesmosis kunye nozinzo lwe-Ankle

• Ukuhlelwa kweDenis-Weber ye ukwaphuka kweqatha

I-Clinical Dx Ukuchaneka

• IAnkle Fractures inokubakhokelwa "I-Ottawa Rule. "

UkuBona nokuBonwa kwe-AP

I-AP, iMedical Oblique kunye neMibono yeLateral

• Ukutyhila i-infrasyndesmotic Fx ye-fibular malleolus (Weber A)
• Ukulimala okuzinzileyo
• Ukunyamekelwa kwe-Conservative ngendlela ye-short-leg walk cast / boot ingasetyenziswa. Ukuchacha kakuhle. Ukuba akukho bungqina bokulimala kwe-osteochondral, amathuba aphantsi kakhulu e-OA yasemva kokwenzakala
• Akukho mfanekiso wokucinga ofunekayo. I-MRI inokukunceda ukutyhila i-bone disusion kunye nokulimala kwe-osteochondral

Weber B kwiNqanaba leSyndesmosis

• Unokuzinza okanye ungazinzi. Ngezinye izihlandlo, isigqibo senziwa ngexesha lokuhlola.
• Ukutshekisha kwe-CT kunokuncedisa ukuphonononga kwakhona
• Ulawulo: kuxhomekeke ekuzinzileyo. Uzinzo olongezelelweyo olufunekayo ukuba i-syndesmosis yaphuka

Weber C

• I-AP, i-oblique ye-medial kunye neembono zecala zityhila i-Weber C - ukulimala kwe-suprasyndesmotic kunye nokwandisa okungaqhelekanga kwe-d / t ukuphazamiseka kwe-tib-fib syndesmosis. Ukwenzakala okungazinzanga kakhulu.
• Ngamanye amaxesha, xa i-Weber C Fx ibeka i-6-cm ukusuka kwincam ye-malleolus esecaleni, inokubizwa ngokuba yi-Pott's ankle Fx (igama emva kwePercival Pott's oye wacebisa ulwahlulo lwangaphambili lwe-ankle fractures ngokusekelwe kuzinzo kunye neqondo lokujikeleza). Eli gama liphelelwe lixesha.
• Ulawulo: ukusebenza kunye nokuzinza okongezelelweyo kwe-syndesmosis

I-Maisonneuve Fracture

• Ngokuphindaphindiweyo ukuqhuma okuvuthayo kwe-fibula ehamba phambili idibene nokulimala kwe-ankle
• Akukho fracture yangasese ephawulwayo ephawulwa ngamazwe, ngoko ke unokuphosakelwa kwiimbono ze-ankle kwaye ufune i-tibia kunye ne-fibula
• Izixhobo zeRad: Ukwandisa kwe-ankle d / t syndesmosis zigqabhule kwaye ngamanye amaxesha i-deltoid ligament ukuphazamiseka. I-membrane ye-interosseous ichithwe ngeFx-Fx-proximal Fx ebangelwa ukubethelwa kwamandla ngokujikeleza kwangaphandle
• Ulawulo: ukusebenza

IBimalleolar kunye neTrimalleolar Fx

• Ngaphezulu kwemifanekiso ephezulu Bimalleolar Fx v. engazinzanga, isiphumo sokubiza kunye nokuphanga / ukujikeleza kwangaphandle. Rx: ORIF.
• I-Trimalleolar Fx: I-3-inxalenye ye-ankle Fx. I-malleolus ephakathi kunye ne-lateral kunye ne-avulsion ye-posterior aspect of tibial plafond. Okungazinzanga ngakumbi. Rx: usebenza

Tillaux Fx

• I-Pediatric Fx echaphazela umntwana omdala xa i-medial side ye-physis ivaliwe okanye malunga nokuvala ngecala elisecaleni lize livule. Ukuvuswa yi-tibi-fibular ligament yangaphambili. Iingxaki: I-2nd dry / OA yangaphambi kwexesha. Rx: inokugcinwa ukuba izinzile ngokukhutshwa kwe-boot.

Ukulimala kweZiko lokuKhula

• Udidi lweSalter-Harris lunceda ukuxilonga nokuxela ukulimala kwamagciwane.
• Inomemonic encedisayo: SALTR
• S: uhlobo 1-ukutyibilika kwipleyiti yokukhula
• A: uhlobo lwe-2-ngasentla, i-Fx idlulela kwi-metaphysis
• L: Uhlobo lwe-3-oluphantsi, i-intra-articular Fx ludlulela kwi-epiphysis
• T: type4, "nge" Fx idlulela kuzo zonke: i-physis, i-metaphysis, kunye ne-epiphysis.
• R: uhlobo 5, “yonakele.” Ukutyumza ukwenzakala kwiphysis ekhokelela ekufeni okupheleleyo kwepleyiti yokukhula
• Uhlobo lwe-1 kunye ne-5: lukhoyo ngaphandle kokuphulwa
• Uhlobo lwe-2: lunesisombululo esilungileyo kwaye saqwalaselwa ngokuqhelekileyo.
• Ulawulo: ukuthunyelwa kugqirha wamathambo wabantwana
• Iingxaki: ukuvala kwangaphambili kwe-physis, ukunciphisa umlenze, i-OA ngaphambi kwexesha kunye nabanye.

Ukuqhekeka kwamabala

• Uninzi lweTarsal Fx. 17% evulekile iFx
• Iinkqubo: ukulayishwa kwe-axial (i-intra-articular Fx kwi-sub-talar kunye ne-calcaneal-cuboid joints) kwiimeko ze-75%). Ukuvuswa kwethambo le-Achilles (m / c kwithambo le-osteoporotic). Ukuxinezeleka (ukukhathala) Fx.
• I-intra-articular Fx ithatha i-prognosis. Ngokuqhelekileyo zatshintshiwe. Rx: ukusebenza.
• B / I-fx intra-articular fx kunye ne-vertebra compression Fx kunye noxinzelelo lwe-vertebral Fx (T10-L2) idla ngokuba nguCasanova aka Don Juan (Lover's) fx.
• Ukufanekisa: x-radiografi ngokufakela "umbono wesithende" I-1st inyathelo. Ukutshekisha kwe-CT kukulungele iDx kunye nokucwangcisa kwangaphambili.
• Radiography: I-angle ye-Bohler (<20-degrees) i-angle yeGissane> i-130-degrees. Chaza iCalcan, Fx.

Amathambo eTarsal

• I-M / C i-tarsal bone iTarsal. Ummandla we-M / C: intamo ye-talar (30-50%). Indlela: Ukulayishwa kweexial kwi-dorsiflexion. Iingxaki: Ischemic osteonecrosis (AVN) yeetalus. Ukuqala (2nd OA). Ukufanekisa: I-1st inyathelo: ii-radiographs, i-CT inokukunceda xa kuqhubeka ukucaciswa
• Ukuhlelwa kwe-Hawkins kunceda nge-Dx, i-prognosis & nonyango. "Umqondiso we-Hawkins' kwifilimu ecacileyo / i-CT scan inokunceda nge-AVN Dx. (ngaphezu kweentolo eziluhlaza zibonisa i-prognosis elungileyo d/t umgca we-radiolucent obonisa ukuba akukho AVN kuba ithambo li-vascularized kwaye ngenxa yoko lifakwe kwi-resorbed)
• Rx: Thayipha i-1: ulungelelaniso ngomlenze omfutshane okanye umlenze (ingozi ye-AVN-0-15%), Thayipha i-2-4-ORIF (ingozi ye-AVN 50% -100%)

Ukujonga i-Ankle kunye neenyawo