(精编)【医学课件】 Office Fracture Care教学课件.pptVIP

Talar Tilt Test: CF ligament /images/Ankle_CF_drawer__w_arrow_300w.JPG Squeeze Test: Syndesmosis /medicine/pediatrics/pemxray/v3c03h.jpg External Rotation Stress Test /wp-content/uploads/2006/03/ankle-4-150x150.jpg Ottowa Rules Inability to bear weight (4 steps) immediately and in office Bony tenderness at posteror edges or tip (distal 6 cm) of either malleoli Bony tenderness at base of 5th metatarsal or navicular (Pain in midfoot) Ottowa Ankle Rules Not 100% sensitive, may miss small avulsion fractures More effective at ruling out fracture than ruling one in, negative predictive value 99% Intended to be applied in the acute setting Radiographs Standard: AP, lateral, mortise Studies suggest 95% of fractures can be seen on lateral and either AP or mortise view Avulsion fractures are usually transverse, talar impact fractures are usually oblique Radiographs: Evaluating Instability Medial Clear Space: on the mortise view look for space between the lateral border of medial malleolus and medial border of talar dome. Should be equal to space between talus and plafond and lateral malleolus or less than 4mm If evaluated with foot in plantarflexion can get false widening Radiographs: Without medial injury, acceptable lateral malleolar fracture displacement is less than 2mm. Unimalleolar fracture: Displaced medial or lateral malleolar fractures Medial (or lateral) malleolar fractures with significant lateral (or medial)collateral ligament injury Lateral malleolar fractures with widened medial clear space Unimalleolar fracture with syndesmotic diastasis Fibular fracture at or proximal to the tibiotalar joint line Displaced posterior malleolar fracture or involving more than 25% of joint space Bimalleolar fractures Trimalleolar fractures Intraarticular fractures with step deformity Open fractures Pilon fractures Indications for Referral Isolated Nondisplaced Malleolar Fracture Initial: Posterior splint Definitive: Short leg cast for 4-6 weeks Consider rehab af