踝關(guān)節(jié)骨折分型入路研究進(jìn)展

1、ANKLE FRACTURES,Netbasert undervisning april 05,01,Epidemiology,02,,Incidence: 80–130 per 100 000 persons highest in elderly women67% isolated malleolar fractures25% bimalleolar 8% tri

2、malleolar,ANKLE FRACTURES,National Hospital Discharge Register of Finland 1994Court-BrownCM, McBirnie J, Wilson G. Adult ankle fractures: an increasing problem? Acta Orthop Scand 1998;69:43-47,03,,,Incidence: Ringerike

3、Hospital 1/8 2003 – 31/7 2004: 184 per 70 000 - 100 000 persons 128/184 (69%) isolated malleolar fractures 27/184 (15%) bimalleolar 29/184 (16%) trimalleolar,ANKLE F

4、RACTURES,Epidemiology,04,,,ANKLE FRACTURES,Classification - Why?,Why do we require fracture classifications? for clinical research to understand the literature as an aid to fracture description as an aid to fracture

5、treatment,05,,,AO (Danis/Weber)Type A below the syndesmosisType B at the level of the syndesmosisType C above the syndesmosisDanis R. Les fractures malleolaires. In: Danis R, ed. Théorie et pra

6、ctique de l`osteosynthése. 1949:133-165.Weber BG. Die Verletzungen des oberen Sprunggelenkes, Berne: Hans Huber, 1966. (2nd ed. 1972),Classification – AO (Danis/Weber),ANKLE FRACTURES,06,,,AO AO/OTA(Weber)

7、3 types (A, B, C) 9 groups (A1, A2, A3, B1, B2, B3, C1, C2, C3) 27 subgroupsMüller ME, Allgöwer M, Schneider R, et al.. Manual of internal fixation, 2nd ed. Heidelberg: Springer-Verlag, 1979:28

8、2-299. (3rd ed. 1991).Orthopaedic Trauma Assocoation. Fracture and dislocation compendium. J Orthop Trauma 1996;10:1-55.,Classification – AO/OTA,ANKLE FRACTURES,07,,,AO AO/OTALauge-HansenLauge-Hansen N. Fra

9、ctures of the ankle: combined experimental-surgical and experimental roentgenologic investigations. Arch Surg 1950;60:957-985,Classification – Lauge-Hansen,ANKLE FRACTURES,08,,,AO AO/OTA Lauge-Hansen Supin

10、ation - External rotation (I, II, III, IV) Supination - Adduction (I, II) Pronation - External rotation (I, II, III, IV) Pronation - Abduction (I, II, III),position

11、 deforming force,Classification – Lauge-Hansen,ANKLE FRACTURES,,,,09,,,AO AO/OTA Lauge-Hansen Supination - External rotation (I, II, III, IV) Supination - Adduction (I, II) Prona

12、tion - External rotation (I, II, III, IV) Pronation - Abduction (I, II, III),position deforming force stable ”stable” unstable,Classification – Lauge-Hansen,ANKLE FRACTURES,,

13、,,10,,,AO AO/OTA Lauge-HansenStable versus Unstable (Tile)Tile M. Fractures of the ankle. In: Joseph Schatzker MT, ed. The rationale of operative fracture care. Berlin: Springer-Verlag, 1987:371-404.,The

14、presence or absence of a medial injury is the key to stability of the lateral malleolar fracture. The medial injury determines stability,Classification – Stable/Unstable,ANKLE FRACTURES,11,Weber A,SA I-II,Weber B,SE I-IV

15、,PA I-III,Weber C,PE I-IV,,,,,Danis Weber vsLauge Hansen,ANKLE FRACTURES,Lauge-Hansen Classification (Supination-Adduction, SA I – II),II,I,I Transverse fibula fracture or rupture of talofibular ligaments

16、II Vertical medial malleolus fracture with a transverse distal fibula fracture and possible medial plafond fracture,ANKLE FRACTURES,12,Lauge-Hansen Classification (Supination-Adduction, SA I – II,ANKLE FRACTURES,13,II,I

17、,I Transverse fibula fracture or rupture of talofibular ligamentsII Vertical medial malleolus fracture with a transverse distal fibula fracture and possible medial plafond fracture,,Radiographic view: Supination-Ad

18、duction type II fracture with medial impaction,14,ANKLE FRACTURES,,Radiographic view: Supination-Adduction type II fracture with medial impaction,15,ANKLE FRACTURES,Corrections Impression of medial plafondReposition of

19、 medial malleolusPlating and bone grafting of medial metaphysis,Lauge-Hansen Classification (Supination-External rotation, SE I – IV),II,I,III,IV,I Anterior tibial-fibular sprainII Stable short oblique fracture of

20、the distal fibulaIII Rupture of posterior tibial-fibular ligament or fracture of the posterior marginIV Unstable short oblique fracture of the distal fibula with a medial malleolus fracture or a deltoid ligament di

21、sruption,ANKLE FRACTURES,16,Lauge-Hansen Classification (Supination-External rotation, SE I – IV),II,I,III,IV,I Anterior tibial-fibular sprainII Stable short oblique fracture of the distal fibulaIII Rupture of po

22、sterior tibial-fibular ligament or fracture of the posterior marginIV Unstable short oblique fracture of the distal fibula with a medial malleolus fracture or a deltoid ligament disruption,ANKLE FRACTURES,17,Illustrat

23、ion: Supination-External rotation type II, III and IV,18,Fixation of an oblique fracture of the distal fibula,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV, (1 a),19,ANKLE FRACTURES,Radiographic

24、 view: Supination-External rotation type IV, (1 b),20,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV, (1 c),,21,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV, (1 d),,,,,

25、,,,,,22,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV (2 a),23,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV (2 b),24,ANKLE FRACTURES,Radiographic view: Supination-Exte

26、rnal rotation type IV (3 a),25,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV (3 b),26,ANKLE FRACTURES,,,,III,,IV,Typical fracture line pattern for a SE type fracture,,II,Rupture of the posterior

27、 tibio-fibular ligament,,Rupture of the deltoid ligament,,II,Oblique fracture of the distal fibula,,,,I,Anterior tibio-fibular sprain,,Radiographic view: Supination-External rotation type IV (3 c),27,ANKLE FRACTURES,Radi

28、ographic view: Supination-External rotation type IV (3 d),28,ANKLE FRACTURES,Radiographic view: Supination-External rotation type IV (3 e),29,ANKLE FRACTURES,,,,Radiographic view: Supination-External rotation type IV (3

29、f),30,ANKLE FRACTURES,Male 64 years of age, was proposed a re-operation but chosed to accept the present situation after proper information,Lauge-Hansen Classification (Pronation-Abduction, PA I – III),II,I,III,I Isola

30、ted medial malleolus or deltoid ligament ruptureII Avulsion of Chaput´s tubercle or disruption of the anterior tibiofibular ligamentIII Bending fracture of the lateral malleolus with a transverse and often com

31、minuted pattern with possible lateral tibial impaction,ANKLE FRACTURES,31,Lauge-Hansen Classification (Pronation-Abduction, PA I – III),II,I,III,I Isolated medial malleolus or deltoid ligament ruptureII Avulsion of

32、Chaput´s tubercle or disruption of the anterior tibiofibular ligamentIII Bending fracture of the lateral malleolus with a transverse and often comminuted pattern with possible lateral tibial impaction,ANKLE FRACT

33、URES,32,Illustration: Pronation-Abduction type III,33,Fixation of a comminuted fibula fracture,ANKLE FRACTURES,,Radiographic view: Pronation-Abduction type III, lateral plafond impaction (1 a),34,Limbird and Aaron JBJS A

34、m 69:881, 1987,ANKLE FRACTURES,Radiographic view: Pronation-Abduction type III, lateral plafond impaction (1 b),35,Limbird and Aaron JBJS Am 69:881, 1987,ANKLE FRACTURES,,,,,,III,,II,,I,Lateral impaction,Medial malleolus

35、 fracture,Comminuted lateral malleolus fracture,,,No spiral fracturepattern in the fibula,,Avulsion ofChaput`s tubercle,,,,Radiographic view: Pronation-Abduction type III, lateral plafond impaction (1 c),36,ANKLE FRACT

36、URES,Limbird and Aaron JBJS Am 69:881, 1987,Radiographic view: Pronation-Abduction type III, lateral plafond impaction (1 d),Corrections (mortise view)lenght of the fibulalateral plafond impactionfracture of the media

37、l malleolusposterior malleolar fracture,37,ANKLE FRACTURES,Limbird and Aaron JBJS Am 69:881, 1987,Radiographic view: Pronation-Abduction type III, lateral plafond impaction (1 e),38,Corrections (lateral view)lenght of

38、the fibulalateral plafond impactionfracture of the medial malleolusposterior malleolar fracture,ANKLE FRACTURES,Limbird and Aaron JBJS Am 69:881, 1987,Lauge-Hansen Classification (Pronation-External rotation, PE I – I

39、V),I Isolated medial malleolus or deltoid ligament disruptionII Avulsion of Chaput´s tubercle or disruption of the anterior tibiofibular ligamentIII Short spiral fracture above the syndesmosisIV Disruptio

40、n of the inferior tibiofibular ligament or a posterior malleolar fracture,I,IV,III,II,ANKLE FRACTURES,39,,Lauge-Hansen Classification (Pronation-External rotation, PE I – IV),I,IV,III,II,To be noticed!The typical direct

41、ion of the fracture line in the fibula (lateral view) is different in a Pronation-External rotation type of fracture compared with a Supination-External rotation type of fracture,SE II-IV,PE III-IV,,,,ANKLE FRACTURES,40,

42、,,Lauge-Hansen Classification (Pronation-External rotation, PE I – IV),I Isolated medial malleolus or deltoid ligament disruptionII Avulsion of Chaput´s tubercle or disruption of the anterior tibiofibular ligam

43、entIII Short spiral fracture above the syndesmosisIV Disruption of the inferior tibiofibular ligament or a posterior malleolar fracture,I,IV,III,II,ANKLE FRACTURES,41,Illustration: Pronation External rotation type

44、IV,42,ANKLE FRACTURES,Radiographic view: Pronation-External rotation type I? II? III? IV? (1 a),,43,ANKLE FRACTURES,Radiographic view: Pronation-External rotation type I? II? III? IV? (1 b),,44,ANKLE FRACTURES,,Radiograp

45、hic view: Pronation-External rotation type III or IV (1 c),,45,ANKLE FRACTURES,Radiographic view: Pronation-External rotation type I? II? III? or IV? (2 a),46,ANKLE FRACTURES,Radiographic view: Pronation-External rotatio

46、n type I? II? III? or IV? (2 b),47,ANKLE FRACTURES,,IV,Avulsion of Chaput`s tubercle,,II,,,I,Avulsion type fracture of the medial malleolus,,,Posterior malleolus fracture,,II,Avulsion of Chaput`s tubercle?,,III,?,,Radiog

47、raphic view: Pronation-External rotation type I? II? III? or IV? (2 c),48,ANKLE FRACTURES,,III,!,,,Radiographic view: Pronation-External rotation type I? II? III? or IV? (2 d),49,ANKLE FRACTURES,,II,Avulsion of Chaput`s

48、tubercle?,,IV,Posterior malleolus fracture,,I,Medial malleolus fracture,,,,,Illustration: SE type III and IV - PE type (II), III and IV – PA type II and III,50,Fixation of a total rupture of the syndesmosis,ANKLE FRACTUR

49、ES,Illustration: SE type IV - SA type II – PE type I-IV – PA type I-III,51,Fixation of the medial malleolus,ANKLE FRACTURES,Classification of distal tibia fractures (Rüdi and Allgöwer –79),52,ANKLE FRACTURES –

50、axial loading injuries (Pilon or Plafond fractures),I,II,III,Classification of distal tibia fractures (Müller, Allgöwer, and Schneider et al. –91),53,ANKLE FRACTURES – axial loading injuries (Pilon or Plafond f

51、ractures),A1,A2,A3,B1,B2,B3,C1,C2,C3,Illustration: axial loading injuries,54,ANKLE FRACTURES – axial loading injuries (Pilon or Plafond fractures),Plafond fracture due to axial force, - 46, Male,55,ANKLE FRACTURES,Plafon

52、d fracture due to axial force, - 46, Male,56,ANKLE FRACTURES,Combination of Axial loading force and Supination-external rotation (1 a),57,ANKLE FRACTURES,Combination of Axial loading force and Supination-external rotatio

53、n (1 b),58,ANKLE FRACTURES,Combination of Axial loading force and Supination-external rotation (1 c),59,ANKLE FRACTURES,Combination of Axial loading force and Supination-external rotation (1 d),60,ANKLE FRACTURES,Axial l

54、oading force (2 a),61,ANKLE FRACTURES,Axial loading force (2 b),62,ANKLE FRACTURES,Axial loading force (2 c),63,ANKLE FRACTURES,,II,Avulsion of Chaput`s tubercle?,,,,,,,,,,Large posterior malleolus fracture,,,IV,Several

55、articular fragments,,,Axial loading force (2 d) Peroperative photo,64,ANKLE FRACTURES,,Axial loading force (2 d) Peroperative photo,65,ANKLE FRACTURES,,,,,,,,,,Axial loading force (2 e),66,ANKLE FRACTURES,,Remember to fo