Fracturile platoului tibial
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Transcript of Fracturile platoului tibial
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Fracturile platoului Fracturile platoului tibialtibial
Conf. Dr. M. NicolescuConf. Dr. M. Nicolescu
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EtiologieEtiologie
Accidente auto & moto (70%)Accidente auto & moto (70%)
Caderi banaleCaderi banale
Accidente de munca sau sportAccidente de munca sau sport
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MecanismMecanism Compresie laterala :Compresie laterala : Bistolfi-HultenBistolfi-Hulten Watson-JonesWatson-Jones
Compresie axiala+/-Compresie axiala+/-lateralizatalateralizata
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Compression axialeCompression axiale
Fracture bitubérositaire Fr. spinotubérositaires externes et internes Fracture bitubérositaire Fr. spinotubérositaires externes et internes
Compression latéraleCompression latérale
Fracture-séparation externe et interne Fracture tassement Fr mixtes Fracture-séparation externe et interne Fracture tassement Fr mixtes
Classification en fonction du mécanismeClassification en fonction du mécanisme
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ClasificareClasificare1.1. Fractura unituberozitara externa (40-55%):Fractura unituberozitara externa (40-55%): separare / tasare / mixtaseparare / tasare / mixta
2.2. Fractura unituberozitara interna (8-10%)Fractura unituberozitara interna (8-10%)
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Fractures unitubérositaires
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Fractures unitubérositaires
+ ruptures ligamentaires
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ClasificareClasificare3.3. Fractura spinotuberozitara (5-15%) :Fractura spinotuberozitara (5-15%) :
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Fractures spino-tubérositaires
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ClasificareClasificare4.4. Fractura bituberozitara Fractura bituberozitara (30%) :(30%) : simpla : T,V,Y inversatesimpla : T,V,Y inversate complexacomplexa cominutiva cominutiva
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Leziuni asociateLeziuni asociate Fractura extremitatii superioare a peroneuluiFractura extremitatii superioare a peroneului
Leziunea nervului peronier comunLeziunea nervului peronier comun
Fractura unicondiliana femuralaFractura unicondiliana femurala
Leziuni meniscaleLeziuni meniscale
Leziuni ligamentare (ligamente incrucisate)Leziuni ligamentare (ligamente incrucisate)
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EvolutieEvolutie
Calus vicios, dezaxareCalus vicios, dezaxare
Laxitate ligamentara cronicaLaxitate ligamentara cronica
Redoare articularaRedoare articulara
GonartrozaGonartroza
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TratamentTratamentConservator :Conservator : TMP Apley – de Mourgues TMP Apley – de Mourgues
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TratamentTratament Conservator :Conservator : TMP Apley – de Mourgues TMP Apley – de Mourgues Chirurgical :Chirurgical : fractura separare : suruburifractura separare : suruburi buloanebuloane fractura tasare : ridicare + grefa + surubfractura tasare : ridicare + grefa + surub fractura mixta : ridicare + grefafractura mixta : ridicare + grefa bulonaj +/- placabulonaj +/- placa fixator externfixator extern reducere percutana + artroscopiereducere percutana + artroscopie
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Fractures-séparation
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Fractures séparation+enfoncements
• Le traitement est chirurgical• Relever le plateau (fragments de spongieux avec le cartilage)• Étayer par une greffe osseuse en dessous (± des broches)• Faire une ostéosynthèse du fragment séparé avec des vis ou
une plaque vissée• Mobilisation douce et précoce pour récupérer la flexion
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Fractures-enfoncements