距骨骨折英文.ppt

距骨骨折,TalusFracture,.,Anatomy,Thetortoise,Bloodsupply,Tecontributionofthebloodsupplytothetaluswas16.9%fortheperonealartery,36.2%fortheanteriortibialartery,and47.0%fortheposteriortibialartery,X-rayCanale位,X-rayBroden位一般用于术中评估。,Thetypeoftalusfracture,Talarneckfracture(50%,1%ofanklefracture)Corporatalifracture（25%）TalarheadfractureLateralprocessoftalusfracture（雪橇踝）Posteriorprocessoftalusfracture（外突-牧羊人骨折，内突-Cedell骨折）,1.TALARHEADFRACTURES,Fracturesoftheheadofthetalushavebeenreportedtoconstitute5%to10%oftalarinjuries.AxiallydirectedloadingandcompressionofthetalarheadandAdorsalcompressionfractureoftheanteriortibialplafond.Recognitionofthisfracturecanbedifcult,Treatment,Adorsalincision.Fixationcanbeplaceddirectlyorpercutaneouslyfromthemedialsideasneeded.Tereportedrateofosteonecrosisofthissegmentoftheheadis10%,andifdegenerativearthrosisoccurs,talonaviculararthrodesismaybeindicated.,2.TALARNECKFRACTURES,In1919,Anderson,havingobserved18patientswithtalarinjuriesintheRoyalFlyingCorps,coinedthetermaviatorsastragalus.In1952,Coltartreviewed25,000fracturessustainedduringWorldWarII.Hefound228talarfractures,106ofwhichwereclassifedastalarneckfractures.Hereportedosteonecrosisratesof35%withsubtalardislocationand95%withankleandsubtalardislocation.,In1970,Hawkinspublishedalandmarkpaperontheresultsof57talarneckfracturesin55patients.In1978，CanaleandKellyatthisclinicclinicallyandradiographicallyreviewed71fracturesoftheneckofthetalusin70patientswithanaveragefollow-upof12.7years.TheynamedatypeIVfracture.,HAWKINAClassification,1.距骨颈无或轻度移位骨折2.距骨颈+距下关节3.距骨颈+距下关节+胫距关节4.距骨颈+距下+胫距+距舟关节,HAWKINAClassification,Innondisplacedverticalfracturesoftheneck(groupIfractures),osteonecrosisdidnotoccurandallfracturesunited.Alldisplacedfractureswithsubluxationordislocationofthesubtalarjoint(groupIIfractures)united,althoughosteonecrosissubsequentlydevelopedin42%.Infractureswithdislocationofthesubtalarandtheanklejoints(groupIIIfractures),nonunionoccurredin11%andosteonecrosisdevelopedin91%.Anincreasingpercentageoffairandpoorresults(75%)wasnotedingroupIIIfracturescomparedwithgroupIIfractures.Thepresenceofosteonecrosisalsocorrelatedwithfairorpoorresults(88%).,TREATMENT,TYPEIFRACTURESCTscansandevaluatethestabilityofsubtalarjoint.thefractureshouldbeimmobilizedinabelowkneecastfor8to12weeks,withweightbearingdelayeduntiltrabeculationacrossthefractureisseen.,TYPESII,III,ANDIVFRACTURES,PromptORIFTypeIIIandtypeIVfracturesconstituteanorthopaedicemergency.,TALARBODYFRACTURES,Sneppenetal.classifedtalarbodyfracturesintofvemajortypesbasedonanatomiclocation:typeI,osteochondralortranschondral;typeII,coronal-sagittal,horizontal,noncomminuted,shear;typeIII,posteriortubercle;typeIV,lateralprocess;typeV,crush.,PosttraumaticArthritis,Notallpatientswithosteonecrosisaresymptomatic,especiallyifcollapsedoesnotoccur.Therateofposttraumaticarthritisvariedfrom36%to94%andagainwasmorecommoninpatientswithcomminutedandopenfractures.Approximately17%to44%ofpatientsrequi