醫(yī)療護(hù)理醫(yī)學(xué)培訓(xùn) 踝關(guān)節(jié)骨折的Lauge-Hansen分型課件

踝關(guān)節(jié)骨折的Lauge-Hansen分型旋前旋后內(nèi)收外展外旋AdductionAbductionExteral-rotationSupination-Adduction(SA)

旋后-內(nèi)收

*Transverseavulsion-typefractureofthe

fibulabelowthelevelofthejointortear

ofthelateralcollateralligaments

.

腓骨下端橫行撕脫骨折或外側(cè)副韌帶撕裂。

*Verticalfractureofthemedialmalleolus.

內(nèi)踝垂直骨折線。Campbell'soperativeorthopaedics11thSupination-Eversion(External-Rotation)(SER)旋后-外翻（外旋）*Disruptionoftheanteriortibiofibularligament

下脛腓前韌帶斷裂

*Spiralobliquefractureofthedistalfibula

腓骨遠(yuǎn)端螺旋型骨折*Disruptionoftheposteriortibiofibularligamentorfractureoftheposteriormalleolus

下脛腓后韌帶斷裂或后踝骨折*Fractureofthemedialmalleolusorruptureofthedeltoidligament

內(nèi)踝骨折或三角韌帶撕裂Pronation-Abduction(PA)旋前-外展*Transversefractureofthemedialmalleolusorruptureofthedeltoidligament

內(nèi)踝橫行骨折或三角韌帶撕裂*Ruptureofthesyndesmoticligamentsoravulsionfractureoftheirinsertions

下脛腓韌帶聯(lián)合撕裂或止點骨折*Short,horizontal,obliquefractureofthefibulaabovethelevelofthejoint.

高位短斜形或水平腓骨骨折Pronation-Eversion(ExternalRotation)(PER)旋前-外翻（外旋）

*Transversefractureofthemedialmalleolusordisruptionofthedeltoidligament

內(nèi)踝橫行骨折或三角韌帶撕裂*Disruptionoftheanteriortibiofibularligament

下脛腓前韌帶撕裂

*Shortobliquefractureofthefibulaabovethelevelofthejoint

高位腓骨短斜形骨折*Ruptureofposteriortibiofibularligamentoravulsionfractureoftheposterolateraltibia下脛腓后韌帶斷裂或后外踝骨折FIGURE53-7SchematicdiagramandcaseexamplesofLauge-Hansensupination-externalrotationandsupination-adductionanklefractures.A.Asupinatedfootsustainseitheranexternalrotationoradductionforceandcreatesthesuccessivestagesofinjuryshowninthediagram.Thesupination-externalrotationmechanismhasfourstagesofinjury,andthesupination-adductionmechanismhastwostages.Anteroposterior(B)andlateral(C)x-raysshowanunstablesupination-externalrotationstageIVanklefracturewiththecharacteristicobliquedistalfibulafractureandamedialsideinjury.D.Ananteroposteriorx-rayofasupination-adductionanklefracturewithatransversefibulafractureandanimpactedmedialmalleolarfracture.FIGURE53-8SchematicdiagramandcaseexamplesofLauge-Hansenpronation-externalrotationandpronation-abductionanklefractures.A.Apronatedfootsustainseitheranexternalrotationorabductionforceandcreatesthesuccessivestagesofinjuryshowninthediagram.Thepronation-externalrotationmechanismhasfourstagesofinjury,andthepronation-abductionmechanismhasthreestages.B.Ananteroposteriorx-rayoftheankleandtibiaandfibulademonstrateahighfibulafracture.C.Externalrotationstressshowslateraldisplacementofthetalusandwideningofthedistalsyndesmosis.Thesex-raysarecharacteristicofapronation-externalrotationinjury.D.Ananteroposteriorx-rayofatypicalpronation-abductionanklefracture.Thefibulaislaterallycomminuted.Figure59-22

Supination-adductioninjurypathology.Thefirststageislateralfailureofeitherthemalleolusorthecollateralligament.Thesecondstageisaverticalfractureofthemedialmalleolus,whichmay

beassociatedwithmedialplafondimpaction,asshownhere.

Figure59-25Supination-externalrotationinjurypathology.Thefirststageisfailureoftheanteriorinferiortibiofibularligament(AITFL).Thesecondstageisaspirallateralmalleolarfractureattheleveloftheplafond.Thethirdstageisposteriorinferiortibiofibularligament(PITFL)failure.Thefourthstageismedialfailureofeithermalleolusorthedeltoidligament.Figure59-25Supination-externalrotationinjurypathology.Thefirststageisfailureoftheanteriorinferiortibiofibularligament(AITFL).Thesecondstageisaspirallateralmalleolarfractureattheleveloftheplafond.Thethirdstageisposteriorinferiortibiofibularligament(PITFL)failure.Thefourthstageismedialfailureofeithermalleolusorthedeltoidligament.Figure59-27Pronation-abductioninjurypathology.Thefirststageismedialfailureofeithermalleolusorthedeltoidligament.Thesecondstageissyndesmosis(anteriorinferiortibiofibularligamentandposteriorinferiortibiofibularligament)disruption.Thethirdstageisabendingfractureofthelateralmalleoluswithatransverse,laterallycomminutedpattern.Figure59-28Pronation-externalrotationinjurypathology.Thefirststageismedialfailureofeithermalleolusorthedeltoidligament.Thesecondstageisanteriorinferiortibiofibularligamentdisruption.Thethirdstageisaspiralfractureofthefibulaabovetheleveloftheplafond.Thefourthstageisposteriorinferiortibiofibularligamentfailure,demonstratedasaposteriormalleolarfailure.備用工具&資料Figure59-27Pronation-abductioninjurypathology.Thefirststageismedialfailureofeithermalleolusorthedeltoidligament.Thesecondstageissyndesmosis(anteriorinferiortibiofibularligamentandposteriorinferiortibiofibularligament)disruption.Thethirdstageisabendingfractureofthelateralmalleoluswithatransverse,laterallycomminutedpattern.Figure59-22

Supination-adductioninjurypathology.Thefirststageislateralfailureofeitherthemalleolusorthecollateralligament.Thesecondstageisaverticalfractureofthemedialmalleolus,whichmay

beassociatedwithmedialplafondimpaction,asshownhere.

Figure59-22

Supination-adductioninjurypathology.Thefirststageislateralfailureofeitherthemalleolusorthecollateralligament.Thesecondstageisaverticalfractureofthemedialmalleolus,whichmay

beassociatedwithmedialplafondimpaction,asshownhere.

內(nèi)收外展外旋AdductionAbductionExteral-rotationSupination-Eversion(External-Rotation)(SER)旋后-外翻（外旋）*Disruptionoftheanteriortibiofibularligament

下脛腓前韌帶斷裂

*Spiralobliquefractureofthedistalfibula

腓骨遠(yuǎn)端螺旋型骨折*Disruptionoftheposteriortibiofibularligamentorfractureoftheposteriormalleolus

下脛腓后韌帶斷裂或后踝骨折*Fractureofthemedialmalleolusorruptureofthedeltoidligament

內(nèi)踝骨折或三角韌帶撕裂