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Fracturile maleolare

Fracturile maleolare. Conf. Dr. M. Nicolescu. Rappel anatomique. Frecventa local III dupa FED si fracturile de col femural. Mecanism componente multiple compresie abductie/adductie rotatie externa picior blocat. Leziuni elementare.

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Fracturile maleolare

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  1. Fracturile maleolare Conf. Dr. M. Nicolescu

  2. Rappel anatomique

  3. Frecventa local III dupa FED si fracturile de col femural Mecanism componente multiple compresie abductie/adductie rotatie externa picior blocat

  4. Leziuni elementare • Traiect maleolar extern transversal transversal spiroid +cominutie adductie rotatie abductie

  5. Traiect maleolar extern Leziunile acoperisului mortezei 1.smulgere extraarticulara 2.fractura trimaleolara Cotton 3.fractura tuberculo-margino- maleolara post. 4.fractura marginala ant. Leziuni elementare

  6. Tip I (5%) adductie Tip II (20%) abductie Clasificare (Duparc)

  7. Tip III (20%) rotatie externa supratuberculara ligament tibio-peronier ant. - rupt post. - +/- indemn Tip IV (50%) rotatie externa intertuberculara ligament tibio-peronier ant. - indemn post. - rupt Clasificare (Duparc)

  8. FRACTURA in ADDUCTIe STADIUL 2 STADIUL 1 -

  9. 2/ FRACTURA in ABDUCTIE Stadiul 1 Fractura orizontala a maleolei interne Stadiul 2 - Ruptura lig. peroneo-tibiale : diastazis - Ruptura membranei interosoase Stadiul 3 Fractura peroneului

  10. Factori de gravitate • Cominutia peroneului • Fracturi asociate ale pilonului tibial • Instabilitatea sindesmozei • Subluxatia tibio-astragaliana

  11. Clinic • Fracturi prin rotatie-abductie : picior in rotatie externa si eversiune tibia se palpeaza sub piele gamba scurtata tendon achilean concav posterior • Fracturi prin adductie : tablou inversat

  12. Complicatii imediate • Leziuni cutanate : fracturi deschise tip I flictene • Leziuni vasculo-nervoase : rare • Leziuni asociate : fracturi la alte niveluri

  13. Tratament • Conservator : reducere + imobilizare ! daca fractura era cu deplasare, Rx de control dupa reducere • Chirurgical : OS peroneu OS maleola interna repararea leziunilor ligamentare +/- reducerea subluxatiei tibio- astragaliene

  14. Fracture en rotation externe sus-ligamentaire Ostéosynthèse du péroné par plaque Réduction du diastasis T-P inf par 1 vis + Suture du LLI

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