手术-jones骨折切开复位内固定术

1、Jonesmann骨折指第五跖十骺端与骨十连接部骨折。英国骨科医生Sir Robert Jones (1857 -933)自己跳舞后发生此类骨折并首先 描述，故此得名。Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break t

2、hat occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.A Jones fracture is a fracture of the diaphysis of the fifth metatarsal of the foot. The fifth metatarsal is

3、 at the base of the small toe. The proximal end, where the Jones fracture occurs, is in the midportion of the foot. Patients who sustain a Jones fracture have pain over this area,swelling, and difficulty walking. The fracture was first described by British orthopedic surgeonSir Robert Jones, who sus

4、tained this injury himself while dancing, in the Annals of Surgern 1902.Fractures of the fifth metatarsal of the foot are surprisingly controversial among radiologists, particularly concerning proximal metatarsal fractures. Some term these fractures Jones fractures, others dancers fractures, while o

5、thers simply term them proximal metatarsal fractures. According to Orthopedic Radiology (Adam Greenspan, 3rd edition), a true Jones fracture occurs one inch distal to the base of the fifth metatarsal. It is not due to peroneus brevis tendon avulsion but rather a twisting inversion injury to the foot

6、. Greenspan states that more proximal injuries are frequently misinterpreted as Jones fractures but really are avulsion fractures by the peroneus brevis tendon. These latter fractures heal quickly, while more distal fractures may undergo fibrous union only.A patient stepped off a curb and sustained

7、a fracture of the proximal aspect of the fifth metatarsal. According to Greenspan, this would be termed a true Jones fracture.In contradistinction, this patient sustained a fracture of the proximal aspect of the fifth metatarsal. Greenspan terms this an avulsion injury.In an avulsion fracture, a sma

8、ll piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.AviJ sxri I rad ltbIrlMdMid -shirft 但匕炽!I r-UJ 1LTE!Treatment:I

9、f a Jones fracture is not significantly displaced, it can be treated with a cast, splint or walking boot for four to eight weeks. Patients should not place weight on the foot until instructed by their doctor. Three-fourths of fractures treated like this should heal.In the case of acute fracture in a

10、n athlete, a dynamic compression plate can be placed on the tension side of the fracture, K-Wire with Monofiament wire in a figure 8 fashion due to the nature of a transverse fracture. Internal fixation with cortical or cancellous screw would require an oblique fracture that could be addressed throu

11、gh The rule of 2s in regards to Internal fixation with screws.Other treatments commonly encouraged are increased intake of vitamin D and calcium.This injury must be differentiated from the physiologic developmental apophysis commonly and normally occurring at this site in adolescents. Differentiatio

12、n is possible by characteristics such as absence of sclerosis of the fractured edges (in acute cases) and orientation of the lucent line: transverse (at 90 degrees) to the metatarsal axis for the fracture (due to avulsion pull by the peroneus brevis muscle inserting at the proximal tip) - and parall

13、el to the metatarsal axis in the case of the apophysis.Jones fractures can become chronic conditions if the fracture fails to unite, or heal. If this is the case, surgery will likely be recommended to secure the fracture in place with a screw, and bone graft may be used to stimuate a healing respons

14、e.-Surgical Treatment: (Jones Frx);-patient is position in partial lateral position on bean bag;-flouroscopy:-under flourscopicguidence, a K wire is inserted for determination of proper position and length;-most common mistake is to direct the drill plantarly, rather than parallel w/ the shaft of me

15、tatarsal;-second mistake is too position the guide wire using the oblique view;-note that the metatarsal shaft is more narrow on the AP view, and it is possible for the pin to be centered on the oblique viewwhere as on AP view the pin is eccentrically positioned;-incision:-longitudinal incision is m

16、ade over distal metatarsal;-take care to avoid branches of the sural nerve which can course dorsally, and laterally over metatarsal;-peroneus brevis is retracted inferiorly;-insertion of this tendon may obscure the proper drill entry site;-local bone graft:-can be obtained from tuberosity and from b

17、one bits from the drill;-implants:-consider insertion of 4.5 cancellous bone screws, 4.5 mm cannulated screws (which are used in most cases) but have available 5.5 cannulated (and solid) screws and 6.5 mm cannulated screws;-diameter should depend on width of the canal (let the screw tap help determi

18、ne the best size);-in either case, threads must cross the frx line;-length is usually between 40-55 mm;-consider countersinking the screw to avoid prominence of the screw head;-in report by IP Kelly, authors noted that failure is more likely when smaller diameter screws are used;-experimental Jones

19、fractures were created in 23 pairs of human cadaver fifth metatarsals, which were fixed using either 5.0 mm or 6.5 mm screws;-frx stiffness and pull-out strengths were measured for either screw type and relationships with bone density and canal diameter were determined;-poor thread purchase within t

20、he medullary canal was noted with the 5.0 mm screws, while excellent purchase was noted with 6.5 mm screws;-pull-out strength testing revealed significantly higher pullout strengths for the larger 6.5 mm screws;-the authors conclude that larger diameter screws may be more appropriate for intramedullary screw fixation of Jones fractures;-ref: Treatment of Jones Fracture Nonunions and Refractures in the Elite Athlete Outcomes of IM Screw Fixation With Bone Grafting-post op: patients will require protected postope