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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

Fracturile maleolare

Conf. Dr. M. Nicolescu

slide3
Frecventa

local III dupa FED si fracturile de col

femural

Mecanism

componente multiple

compresie

abductie/adductie

rotatie externa

picior blocat

leziuni elementare
Leziuni elementare
  • Traiect maleolar extern

transversal

transversal spiroid +cominutie

adductie rotatie abductie

leziuni elementare1
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
clasificare duparc
Tip I (5%)

adductie

Tip II (20%)

abductie

Clasificare (Duparc)
clasificare duparc1
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)
stadiul 1

FRACTURA in ADDUCTIe

STADIUL 2

STADIUL 1

-

slide11

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

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

complicatii imediate
Complicatii imediate
  • Leziuni cutanate : fracturi deschise tip I

flictene

  • Leziuni vasculo-nervoase : rare
  • Leziuni asociate : fracturi la alte niveluri
tratament
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

fracture en rotation externe sus ligamentaire
Fracture en rotation externe sus-ligamentaire

Ostéosynthèse du péroné par plaque Réduction du diastasis T-P inf par 1 vis + Suture du LLI