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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
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