Tibia plateau fraktur -...
Transcript of Tibia plateau fraktur -...
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Jeppe BarckmanAarhus Universitetshospital
AO Basic Principles CourseMiddelfart april 2017
TibiaplateaufrakturFrakturtyper,behandlingogkirurgiskeadgange
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Bløddele !• Tyndt bløddelslag• Høj/lav energi• Neurovaskulæreforhold
• Compartmentsyndrom
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Bløddele !
Thomas P Rüedi, MD, Professor, Founding and honorary member of the AO Foundation
“a fracture first and foremost is a soft-tissue injury, in which the bone happens to be broken”
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Classification of proximal tibial fractures (41-A)
• A: Ekstraarticulær– A1: avulsion– A2: metaphyseal simple– A3: metaphyseal multifragmentær
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• B: Partial articular– B1: pure split– B2: pure depression– B3: split-depression
Classification of proximal tibial fractures (41-B)
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• C: Complete articular– C1: articular simple, metaphyseal simple– C2: articular simple, metaphyseal multifragmentær– C3: articular multifragmentær
Classification of proximal tibial fractures (41-C)
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Schatzker
Schatzker J, McBroom R, Bruce D (1979)Clin Orthop Rel Res 138:94–104
Schatzker I Schatzker II Schatzker III
Schatzker IV Schatzker V Schatzker VI
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Lateral Medial
Hvilken type?
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33årkvinde.Vridihøknæunderridning
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33årkvinde.Vridihøknæunderridning
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33årkvinde.Vridihøknæunderridning
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Radiologiskvurdering– MR
Røntgen• APoglateral
CT• 2DRekonstruktion• 3D
Evt.MR
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Behandlingsmålproximal tibia
• Anatomiskrekonstruktionafledfladeinkl.kondylbredde
• Absolutstabilitet(ommuligt)
• Genskabeakserogrotation
• Stabilfiksationtilmetafyse/diafyse
• Tidligbevægelse
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Behandling
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• Anterolateral• Posteromedial• Posterior
KirurgiskadgangeDistal humerusfraktur
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33årkvinde.Vridihøknæunderridning
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33årkvinde.Vridihøknæunderridning
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33årkvinde.Vridihøknæunderridning
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33årkvinde.Vridihøknæunderridning
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Ilizarov eksternfiksation
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Fordele:• Minimalforstyrrelseafbløddelei
frakturområdet• Mulighedatstabilisereknæetved
ligamentærløshed
Ulemper:• Udvendigfiksator,kræverpleje;fjernesførst
nårfrakturenerhelet• Hyppigepin-hulinfektioner- hyppige
ambulantekontrollerhosproblempatienter• Forhindrerfuldfleksion
Ilizarov eksternfiksation
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?
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• Opmærksom på bløddele• afgør valg af behandling + timing
• Operations mål: • anatomisk reponering af ledflade• Korrekt akse og rotation. • God fiksation til metafyse/diafyse
• God præoperativ planlægning . Altid CT
• Ved dårlig bløddele er ringfiksation1.valg.
• YDMYGHED – det er svært!!!
Take-home messages