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Tất cả những gì cần biết về gãy xương sên: Định nghĩa, Dịch tễ, Triệu chứng, Chẩn đoán, Chẩn đoán phân biệt, Biến chứng, Điều trị, Biến chứng sau mổ, Chăm sóc sau mổ. Bài viết bằng tiếng anh được tổng hợp từ nhiều nguồn tài liệu đáng tin cậy từ trong nước và nước ngoài
Talus fracture and dislocation Vũ Hồng Duyên Lê Thị Lan Anh Lê Đức Anh Hoàng Trường Sơn Lê Huỳnh Đức Nguyễn Văn Hậu Overview Anatomy Talus examination and diagnostic Classification Treatment Overview Overview Talus fracture and dislocation is a rare condition of the foot, consisting of 0,1% to 0,85% of all fractures and 5% to 7% of foot injuries Most of them are result of high - energy impact, such as motor vehicle accident or fall from ladder Pure injury of the talus is rare, most of the time it associates with other injuries of nerves and vessels around the bone, resulting in osteonecrosis Anatomy Anatomy Position The talus is the bone in the back of the foot that connects the leg and the foot It sits within the ankle "mortise" or hinge, which is made up of the two leg bones, the tibia and fibula It joins with the two leg bones (tibia and fibula) to form the ankle joint and allows for upward and downward motion of the ankle Anatomy Joints There are three joints: The subtalar joint, which allows for side-to-side movement The talonavicular joint, which has a complicated biomechanical function that controls flexibility of the foot and the arch of the foot The talus has no muscular attachments and is mostly covered with cartilage The ankle, which allows the up-anddown motion of the foot with the leg Anatomy Blood supply of talus is not very profuse Blood Supply because of lack of muscular attachment The vascular supply is dependent on fascial structures to reach the talus, therefore, capsular disruptions may result in osteonecrosis The vascular supply to the talus consists of: Arteries to the sinus tarsi ( peroneal and dorsalis pedis arteries) An artery for the tarsal canal (posterior tibial artery) The deltoid artery( posterior tibial artery), which supplies the medial body Capsular and ligamentous vessels and intraosseous anastomoses Anatomy Nerve supply Talus is innervated by branches from deep peroneal, posterior tibial, and sural nerves Talus examination and diagnostic Treatment Anteromedial: This approach may be extended from a limited capsulotomy to a wide exposure with malleolar osteotomy (as the fracture progresses toward the body) The internal is just medial to the anterior tibial tendon This approach allows visualization of the talar neck and body Care must be taken to preserve the saphenous vein and nerve and, more importantly, the deltoid artery Treatment Posterolateral: This approach provides access to posterior process and talar body The interval is between the peroneus brevis and the flexor hallucis longus The sural nerve must be protected It is usually necessary to displace the flexor hallucis longus from its groove in the posterior process to facilitate exposure Treatment Anterolateral: This approach allows visualization of the sinus tarsi, lateral talar neck, and subtalar joint Inadvertent damage to the artery of the tarsal sinus can occur through this approach Treatment Combined anteromedial–anterolateral: This is often used to allow maximum visualization of the talar neck Treatment Internal fixation Treatment Treatment Treatment Treatment Talar neck fracture: ORIF is performed using lag screws or wires through any approach Lateral Process Fractures: ORIF is performed using lag screws or wires through a lateral approach Posterior Process Fractures: ORIF is recommended if the fragment is large; primary excision is performed if the fragment is small; a posterolateral approach may be used Talar Head Fractures: ORIF is indicated, with primary excision of small fragments through an anterior or anteromedial approach Headless screws or buried implants will be needed for this intra-articular fracture Treatment Pain Management Medications are often prescribed for short-term pain relief after surgery Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics A combination of these medications may be used to improve pain relief, as well as minimize the need for opioids Treatment Early Motion Many doctors encourage motion of the foot and ankle early in the recovery period, as soon as your pain allows Patients who have had surgery are instructed to begin moving the affected area as soon as the wound heals Patients who are treated without surgery will work on regaining motion in the foot and ankle after the cast is removed Treatment Physical Therapy Specific physical therapy exercises can improve the range of motion in the foot and ankle, and strengthen supporting muscles Treatment Weight-bearing Patient should wear a can or a special boot as they begin to walk They should not put all of their weight on their foot for two to three months to prevent the bone pieces from moving out of place As the broken heals and pain improves, they will gradually be able to put more pressure on their foot Sources Lynn S Bickley, Bates' Guide to Physical Examination and History-Taking (11 edition) Kenneth A Egol , Kenneth J Koval , and Joseph D Zuckerman, Handbook of fractures( edition) th http://orthoinfo.aaos.org/topic.cfm?topic=A00170 https://www.slideshare.net/PrashanthKumar132/talus-70430155 th Thank you ...Overview Anatomy Talus examination and diagnostic Classification Treatment Overview Overview Talus fracture and dislocation is a rare condition of the foot, consisting of 0,1% to 0,85% of all fractures... be extended from a limited capsulotomy to a wide exposure with malleolar osteotomy (as the fracture progresses toward the body) The internal is just medial to the anterior tibial tendon This... tibial artery) The deltoid artery( posterior tibial artery), which supplies the medial body Capsular and ligamentous vessels and intraosseous anastomoses Anatomy Nerve supply Talus is innervated