踝关节骨折的Lauge-Hansen分型.ppt

踝关节骨折的Lauge Hansen分型 旋前旋后 内收外展外旋 AdductionAbductionExteral rotation Supination Adduction SA 旋后 内收 Transverseavulsion typefractureofthefibulabelowthelevelofthejointortearofthelateralcollateralligaments 腓骨下端横行撕脱骨折或外侧副韧带撕裂 Verticalfractureofthemedialmalleolus 内踝垂直骨折线 Campbell soperativeorthopaedics11th Supination Eversion External Rotation SER 旋后 外翻 外旋 Disruptionoftheanteriortibiofibularligament下胫腓前韧带断裂 Spiralobliquefractureofthedistalfibula腓骨远端螺旋型骨折 Disruptionoftheposteriortibiofibularligamentorfractureoftheposteriormalleolus下胫腓后韧带断裂或后踝骨折 Fractureofthemedialmalleolusorruptureofthedeltoidligament内踝骨折或三角韧带撕裂 Pronation Abduction PA 旋前 外展 Transversefractureofthemedialmalleolusorruptureofthedeltoidligament内踝横行骨折或三角韧带撕裂 Ruptureofthesyndesmoticligamentsoravulsionfractureoftheirinsertions下胫腓韧带联合撕裂或止点骨折 Short horizontal obliquefractureofthefibulaabovethelevelofthejoint 高位短斜形或水平腓骨骨折 Pronation Eversion ExternalRotation PER 旋前 外翻 外旋 Transversefractureofthemedialmalleolusordisruptionofthedeltoidligament内踝横行骨折或三角韧带撕裂 Disruptionoftheanteriortibiofibularligament下胫腓前韧带撕裂 Shortobliquefractureofthefibulaabovethelevelofthejoint高位腓骨短斜形骨折 Ruptureofposteriortibiofibularligamentoravulsionfractureoftheposterolateraltibia下胫腓后韧带断裂或后外踝骨折 FIGURE53 7SchematicdiagramandcaseexamplesofLauge Hansensupination externalrotationandsupination adductionanklefractures A Asupinatedfootsustainseitheranexternalrotationoradductionforceandcreatesthesuccessivestagesofinjuryshowninthediagram Thesupination externalrotationmechanismhasfourstagesofinjury andthesupination adductionmechanismhastwostages Anteroposterior B andlateral C x raysshowanunstablesupination externalrotationstageIVanklefracturewiththecharacteristicobliquedistalfibulafractureandamedialsideinjury D Ananteroposteriorx rayofasupination adductionanklefracturewithatransversefibulafractureandanimpactedmedialmalleolarfracture FIGURE53 8SchematicdiagramandcaseexamplesofLauge Hansenpronation externalrotationandpronation abductionanklefractures A Apronatedfootsustainseitheranexternalrotationorabductionforceandcreatesthesuccessivestagesofinjuryshowninthediagram Thepronation externalrotationmechanismhasfourstagesofinjury andthepronation abductionmechanismhasthreestages B Ananteroposteriorx rayoftheankleandtibiaandfibulademonstrateahighfibulafracture C Externalrotationstressshowslateraldisplacementofthetalusandwideningofthedistalsyndesmosis Thesex raysarecharacteristicofapronation externalrotationinjury D Ananteroposteriorx rayofatypicalpronation abductionanklefracture Thefibulaislaterallycomminuted Figure59 22Supination adductioninjurypathology Thefirststageislateralfailureofeitherthemalleolusorthecollateralligament Thesecondstageisaverticalfractureofthemedialmalleolus whichmaybeassociatedwithmedialplafondimpaction asshownhere Figure59 25Supination externalrotationinjurypathology Thefirststageisfailureoftheanteriorinferiortibiofibularligament AITFL Thesecondstageisaspirallateralmalleolarfractureattheleveloftheplafond Thethirdstageisposteriorinferiortibiofibularligament PITFL failure Thefourthstageismedialfailureofeithermalleolusorthedeltoidligament Figure59 27Pronation abductioninjurypathology Thefirststageismedialfailureofeithermalleolusorthedeltoidligament Thesecondstageissyndesmosis anteriorinferiortibiofibularligamentandposteriorinferiortibiofibularligament disruption Thethirdstageisabendingfractureofthelateralmalleoluswithatransverse laterallycomminutedpattern Figure59 28Pronation externalrotationinjurypathology Thefirststageismedialfailureofeithermalleolusorthedeltoidligament Thesecondstageisanteriorinferiortibiofibularligamentdisruption Thethirdstageisaspiralfractureo