踝关节骨折的Lauge-Hansen分型PPT课件

.,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。,Campbellsoperativeorthopaedics11th,.,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.Thethirdstageisaspiralfractureofthefibulaabovetheleveloftheplafond.Thefourthstageisposteriorinferiortibiofib