tailieunhanh - Tài liệu Trật khớp

Cấp tính lệch hindfoot được đặc trưng bởi chuyển Thông thường Cả hai talocalcaneal và talonavicular khớp. Lệch trung gian là phổ biến hơn hơn những người bên. Thông thường đóng cửa giảm IS Thu được dễ dàng. Khi nỗ lực đóng cửa không, phẫu thuật thăm dò và loại bỏ các trở ngại để giảm được công nhận cần thiết. | Hindfoot Dislocations When Are They Not Benign Charles Saltzman MD and J. L. Marsh MD Abstract Acute hindfoot dislocations are usually characterized by displacement of both the talocalcaneal and the talonavicular joints. Medial dislocations are more common than lateral ones. Closed reduction is usually obtained easily. When closed attempts fail surgical exploration and removal of recognized obstacles to reduction are necessary. Associated open wounds necessitate aggressive operative management to prevent infection. Postreduction radiographs should be scrutinized for the presence of associated fractures that require fixation or surgical removal. A short-leg walking cast should be used for 3 to 6 weeks. In rare instances the tibiotalar joint is also dislocated which usually necessitates open reduction or if the injury is open extruded and contaminated talar excision. All hindfoot dislocations result in some stiffening of the hindfoot. Painful degenerative arthrosis sometimes develops after this injury. Factors that predispose to poor outcomes include high-energy mechanisms the presence of open wounds and fractures and lateral dislocations. Painful arthrosis that does not respond to conservative treatment can be treated with selective hindfoot arthrodesis. J Am Acad Orthop Surg 1997 5 192-198 Hindfoot dislocations are relatively rare injuries. The outcome depends on the magnitude of the original impact. Low-energy injuries generally respond to early reduction and cast immobilization. High-energy injuries carry a greater risk of infection and substantial chondral and osteochondral damage. Proper initial treatment of these dislocations requires aggressive treatment of open injuries and careful assessment of all involved joints with early removal or fixation of displaced intra-articular fragments. Late complications including arthrosis and persistent pain may necessitate a selective hindfoot arthrodesis to obtain a satisfactory clinical outcome. Epidemiology and .