Fracturile Maleolare
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Fracturile maleolareFracturile maleolare
Conf. Dr. M. NicolescuConf. Dr. M. Nicolescu
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FrecventaFrecventa
local III dupa FED local III dupa FED si fracturile de col si fracturile de col
femuralfemural
MecanismMecanism componente componente
multiplemultiple
compresiecompresie
abductie/adductieabductie/adductie
rotatie externarotatie externa picior blocat picior blocat
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Leziuni elementareLeziuni elementare1.1. Traiect maleolar externTraiect maleolar extern
transversaltransversal
transversal transversal spiroid spiroid +cominutie+cominutie
adductie rotatie abductie adductie rotatie abductie
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Leziuni elementareLeziuni elementare2.2. Traiect maleolar externTraiect maleolar extern 3.3. Leziunile Leziunile
acoperisului acoperisului mortezeimortezei
1.smulgere extraarticulara1.smulgere extraarticulara 2.fractura trimaleolara Cotton2.fractura trimaleolara Cotton 3.fractura tuberculo-margino- 3.fractura tuberculo-margino-
maleolara post. maleolara post. 4.fractura marginala ant.4.fractura marginala ant.
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Clasificare (Duparc)Clasificare (Duparc) Tip I (5%)Tip I (5%)
adductieadductie
Tip II (20%)Tip II (20%)
abductieabductie
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Clasificare (Duparc)Clasificare (Duparc) Tip III (20%)Tip III (20%) rotatie externa rotatie externa supratubercularasupratuberculara
ligament tibio-peronierligament tibio-peronier ant. - ruptant. - rupt post. - +/- indemnpost. - +/- indemn
Tip IV (50%)Tip IV (50%) rotatie externarotatie externa intertubercularaintertuberculara
ligament tibio-peronierligament tibio-peronier ant. - indemnant. - indemn
post. - rupt post. - rupt
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Factori de gravitateFactori de gravitate
Cominutia peroneuluiCominutia peroneului
Fracturi asociate ale pilonului Fracturi asociate ale pilonului
tibialtibial
Instabilitatea sindesmozeiInstabilitatea sindesmozei
Subluxatia tibio-astragalianaSubluxatia tibio-astragaliana
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ClinicClinic
Fracturi prin rotatie-abductie :Fracturi prin rotatie-abductie :
picior in rotatie externa si picior in rotatie externa si eversiuneeversiune
tibia se palpeaza sub pieletibia se palpeaza sub piele
gamba scurtatagamba scurtata
tendon achilean concav posteriortendon achilean concav posterior Fracturi prin adductie :Fracturi prin adductie :
tablou inversattablou inversat
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Complicatii imediateComplicatii imediate
Leziuni cutanate : fracturi deschise tip ILeziuni cutanate : fracturi deschise tip I
flicteneflictene
Leziuni vasculo-nervoase : rareLeziuni vasculo-nervoase : rare
Leziuni asociate : fracturi la alte niveluriLeziuni asociate : fracturi la alte niveluri
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TratamentTratament Conservator :Conservator : reducere + imobilizarereducere + imobilizare ! daca fractura era cu deplasare, ! daca fractura era cu deplasare,
Rx deRx de control dupa reducerecontrol dupa reducere Chirurgical :Chirurgical : OS peroneuOS peroneu OS maleola internaOS maleola interna repararea leziunilor ligamentarerepararea leziunilor ligamentare +/- reducerea subluxatiei tibio-+/- reducerea subluxatiei tibio- astragalieneastragaliene