編輯版ppt1距骨骨折TalusFracture編輯版ppt2Anatomy編輯版ppt3編輯版ppt4Thetortoise編輯版ppt5Bloodsupply編輯版ppt6編輯版ppt7編輯版ppt8編輯版ppt9Tecontributionofthebloodsupplytothetaluswas16.9%fortheperonealartery,36.2%fortheanteriortibialartery,and47.0%fortheposteriortibialartery

編輯版ppt10X-ray

Canale位

編輯版ppt11X-rayBroden位一般用于術(shù)中評(píng)估。

編輯版ppt12ThetypeoftalusfractureTalarneckfracture(50%,1%ofanklefracture)Corporatalifracture（25%）TalarheadfractureLateralprocessoftalusfracture（雪橇踝）Posteriorprocessoftalusfracture（外突-牧羊人骨折，

內(nèi)突-Cedell骨折）

編輯版ppt13編輯版ppt14編輯版ppt15編輯版ppt161.TALARHEADFRACTURES

Fracturesoftheheadofthetalushavebeenreportedtoconstitute5%to10%oftalarinjuries.AxiallydirectedloadingandcompressionofthetalarheadandAdorsalcompressionfractureoftheanteriortibialplafond.Recognitionofthisfracturecanbedifcult

編輯版ppt17TreatmentAdorsalincision.Fixationcanbeplaced

directlyorpercutaneouslyfromthemedialsideasneeded.

Tereportedrateofosteonecrosisofthissegmentoftheheadis10%,andifdegenerativearthrosisoccurs,talonaviculararthrodesismaybeindicated.

編輯版ppt18編輯版ppt192.TALARNECKFRACTURES

In1919,Anderson,havingobserved18patientswithtalarinjuriesintheRoyalFlyingCorps,coinedthetermaviator’sastragalus.

In1952,Coltartreviewed25,000fracturessustainedduringWorldWarII.Hefound228talar

fractures,106ofwhichwereclassifedastalarneckfractures.Hereportedosteonecrosisratesof35%withsubtalardislocationand95%withankleandsubtalardislocation.

編輯版ppt20In1970,Hawkinspublishedalandmarkpaperontheresultsof57talarneckfracturesin55patients.In1978，CanaleandKellyatthisclinicclinicallyandradiographicallyreviewed71fracturesoftheneckofthetalusin70patientswithanaveragefollow-upof12.7years.TheynamedatypeIVfracture.

編輯版ppt21HAWKINA

Classification1.距骨頸無或輕度移位骨折2.距骨頸+距下關(guān)節(jié)3.距骨頸+距下關(guān)節(jié)+脛距關(guān)節(jié)4.距骨頸+距下+脛距+距舟關(guān)節(jié)編輯版ppt22HAWKINA

ClassificationInnondisplacedverticalfracturesoftheneck(groupIfractures),osteonecrosisdidnotoccurandallfracturesunited.Alldisplacedfractureswithsubluxationordislocationofthesubtalarjoint(groupIIfractures)united,althoughosteonecrosissubsequentlydevelopedin42%.Infractureswithdislocationofthesubtalarandtheanklejoints(groupIIIfractures),nonunionoccurredin11%andosteonecrosisdevelopedin91%.Anincreasingpercentageoffairandpoorresults(75%)wasnotedingroupIIIfracturescomparedwithgroupIIfractures.Thepresenceofosteonecrosisalsocorrelatedwithfairorpoorresults(88%).

編輯版ppt23TREATMENT

TYPEIFRACTURES

CTscansandevaluatethestabilityofsubtalarjoint.thefractureshouldbeimmobilizedinabelowkneecastfor8to12weeks,withweightbearingdelayeduntiltrabeculationacrossthefractureisseen.

編輯版ppt24TYPESII,III,ANDIVFRACTURES

PromptORIFTypeIIIandtypeIVfracturesconstituteanorthopaedicemergency.

編輯版ppt25TALARBODYFRACTURES

Sneppenetal.classifedtalarbodyfracturesintofvemajortypesbasedonanatomiclocation:typeI,osteochondralortranschondral;typeII,coronal-sagittal,horizontal,noncomminuted,shear;typeIII,posteriortubercle;typeIV,lateralprocess;typeV,crush.

編輯版ppt26編輯版ppt27編輯版ppt28編輯版ppt29PosttraumaticArthritisNotallpatientswithosteonecrosisaresymptomatic,especiallyifcollapsedoesnotoccur.Therateofposttraumaticarthritisvariedfrom36%to94%andagainwasmorecommoninpatientswithcomminutedandopenfractures.Approximately17%to44%ofpatie