外科学教学课件：Fracture of Lower Extremities2

FractureofLowerExtremitiesFracture

of

Patella

FractureofthetibiaandfibulaFractureofAnkle

FractureofthepatellaPatellarfracturesaccountforabout1%ofallfractureAnatomyPatellaisthebiggest

sesamoidboneItiscoveredbyquadricepsfemorisaponeurosisanteriorly,patellaligamentisbeneathitFormspatellafemoraljointwithfemoralpatellarsurface.Patella

is

one

componentofkneeextension

DeviceFunctionofpatella1.Transmitthestrengthofquadricepsfemorisinordertoextendleg.2.Decreasethefrictionbetweenquadricepsfemoristendonandfemoralcondyleinordertodecreasearthritisofpatellafemoraljoint.

CausesoffractureIndirectviolence:patellaissplittedbythestrongcontractionstrengthofquadricepsfemoris,andthepatellarfractureistransverse.Displacementoffractureisobviously.Directviolence:fallandgodownonons’sknee,patellaknockonthegrounddirectlyandthefractureiscomminuted,thereisnodisplacementiftheperiosteumofpatellaandpatellaretinaculumisintegrate.

ClassificationAOClassification撕脱骨折横行骨折纵形、外侧纵形、内侧Clinicalmanifestationanddiagnosis１、thekneeisswelling,ecchymosis,cannotmoveaftertrauma.２、PE：tendernessanteriortopatella,fractureendcanbetouched,floatingpatellatest(+)becauseofhematocele.３、Xray：makesurethefracturesite,typeanddisplacement.

Treatment

1.nonoperativetreatmentisappliedtonondisplacementfracturekneeextendandexternalfixationwithplasterfor4—6weeks,ifthehematomaofkneejointissevere,punctionanddrawhematomaisrequired.

2.operativetreatment

OpenreductionandInternalFixationKirschnertensionbandFractureofthetibiaandfibula

１tibiaisthemainweightbearingboneofleg,fibulaisthemainattachmentformuscles.

Tibialcrestisimportantsignofreduction.thedistal1/3istheintersectionofbonyshapethatmakeitistobebroken.2tibiaisjustunderskin,sofractureendcanperforatetheskineasilyandresultinopenfracture.３theproximalanddistalarticularsurfaceisparallel,ifalignmentoffractureisbad,theparallelofthearticularsurfacewillbelost,asaresultthearthririsofkneejointandanklejointistobedevelopment.Anatomy4

proximal1/3tibiafracture,posteriortibiaarteryiseasytobeinjuriedandresultindisturbanceofbloodcirculationofleg.

5medial1/3fracture,bleedingandseveresofttissueinjuryresultinosteofascialcompartmentsyndrome,andmusclesandnerveswouldbenecrosis,eventhelegwouldbenecrosis.

Anatomy6、Distal1/3tibiafracture,therateofnonunionishigh.maincauses:1)nutrientarteryisinjuried,thebloodsupplyforthedistal1/3tibiadecreaseobviously.2)thereisnomuscleattach.

7、peronealnervepassbyfibularheadandneck,sothefractureoffibularheadorneckiseasytoinjuryfibularnerve.

AnatomyCausesoffractureandclassification

1.directviolencethefractureoftibiaandfibulaisonthesameplane,thetypeoffractureistransverseorshortobliqueorcomminuted.Softtissueinjuryisoftensevereandthefracturemayopenfracture.

2.indirectviolenceitisoftencausedbytorsionalviolenceandthefibulafractureplaneisupperthantibia’s.Thefracturetypeisspiralorshortoblique.

X-rayClinicalManifestationanddiagnosis

1.historyoftrauma2.symptomsandsigns3.bloodandnerveinjury4.x-ray

Treatment

Goalsoftreatment：correctangulationandrotationdisplacement,regaintheparallelrelationshipbetweenkneeandanklearticularsurfaceandthelengthofleg.１.StablefractureManipulativereductionandexternalfixationwithsplintorplasterorbonytraction.２.Unstablefracture1)Skeletaltractionandmanipulativereductionandsplintfixation2)Openreductionandinternalfixation.Externalfixation,plateandscrewinterlockingintramedullarynailExternalfixationMIPOMinimallyInvasivePlateOsteosynthesisInterlockingintramedullarynailFractureofAnkletheanklejoint

is

composed

of

distaltibia,distalfibularandtalusAnatomyClasification1.Singlemalleolusfracture单踝骨折2.Bimalleolarfracture双踝骨折3.Trimalleolarfracture三踝骨折4.Malleolusfracturewithdislocation踝骨骨折伴脱位Self-studyLauge-HansenClassificationDanis-WeberClassificationClinicalmanifestationanddiagnosis1.historyoftrauma.Mainfracturesarecausedbyindirectviolence.2.symptomsandsigns3.x-rayTreatmentPrincipaloftreatment：

Regaintheanatomicalstructureandstabilityofankle.Internalfixationisoftenneededtokeepreduction.Distal1/3fibulaanddistaltibiofibularjointiskeystructureforthestabilityofankle,soreductionandfixationareneeded.KeyPoi