关节镜下治疗前叉止点撕脱性骨折ppt课件

X-ray
CT
MRI
Meyers-McKeever classification
Arthroscopy 2005;21[1]:86-92
➢How to identify fresh or old fractures in imaging
Treatment
➢ I type --- Conservative treatment to keep the knee in a functional position for 6 weeks
➢ Wound freshness
➢To clean and remove all dead, damaged tissue around of the fracture mass
➢To introduce the wire by a lumbar puncture needle
➢To thread through No. 5 Ethibond, and fix fracture with "8" tension band
➢Arthroscopic image of ➢To remove the synovial the reduce fracture tissue of the femoral condyle
➢The reduction of the
➢To cut the transverse
fracture mass is blocked ligament of meniscus
➢ Ⅱ and Ⅲ types --- Manipulation，if fail， selected surgery
➢ Ⅳ type --- Surgery
Reduction
➢The drawer test after extension
P - R - I - C – E program
➢ Protection ➢ Rest ➢ Ice ➢ Compression ➢ Elevate
➢micro-grinding drill to drill
➢ To remove bone mass ➢Enlargement of the with nucleus pulposus condylar fossa
forceps
The picture was taken after reconstruction of anterior cruciate ligament
✓ 14％ of ACL injury
➢ Distribution of age
➢ children——8～14 years old ➢ old women——over 40 years old
Accid E-merg Nurs，2004，12(3)：1 73-1 75． International Journal of Pediatrics, 2012, Article ID 932702, 6 pages
positive ➢ X-ray and CT are conducive to understanding
of fracture ✓ MRI is helpful to understand injury of ACL, and
others combined injury.
Anterior drawer test and Lachman sign
Case 4
Old avulsion fracture of ACL
➢With bone sclerosis, and ACL stretch and tear
➢The bone block cannot be removed with the nucleus pulposus clamp
by the transverse ligament
of the meniscus
➢ To reduce fracture
➢To fixed fracture with k-wire temporarily
➢To drill into second ➢A guide pin is
K-wire
inserted
➢ To screw into the ➢ To inspect after
hollow screw
fixation
Postoperative X-ray
Postoperative functional rehabilitation
➢ To take positive exercise of knee flexion and extension in 2 to 4 weeks
Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.
Relevant anatomical structure
பைடு நூலகம்
Resident ridge
Resident ridge
Branching ridge
placement and removal of cannulated screw for fixation ➢ 2008——Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique
epidemiology
➢ Morbidity——3/100000
Avulsion Fracture of Anterior Cruciate Ligament
Zhijie Xi
History
➢ 1875—— Poncet ➢ 1970——Avulsion fracture of the ACL was
classified by Meyers MH ➢ 1996——Veselko M performed arthroscopic
1
2
Adults - hyperextension of the
…
knee
Young people - knee flexion, tibial internal rotation
Diagnosis
➢ Injury history of hyperextension of knee ➢ Bruise and hyphema ➢ The extension was limited ➢ Anterior drawer test and Lachman sign are
➢To inspect carefully
➢The patients were followed up for 1 month after surgery
Case 3
To use PDSii as the thread
To use PDSii as the thread
To use PDSii as the thread
➢If the fracture of the tibial plateau is combined, first of all, the fracture should be fixed
Case 4
➢X-ray showed ACL avulsion fracture combined with tibial plateau fracture
➢ To load limitedly within 9 weeks ➢ physical exercise can be take 12 weeks later
Thanks for your attention
Footprints
Footprints
➢ The anterior medial bundle is tight in flexion the posterior lateral bundle is tight in the straight position
损伤机制
ACL limits anterior displacement, hyperextension, and internal rotation
No extrusion nail was found before operation
➢impinge
If the fracture mass is small, using Ethibond suture
Case 2
➢ Old fracture of avulsion fracture of ACL
➢It used to be the most commonly treatment program to open reduction and fixed with wire
Case 1
➢A failed case
Single tunnel fixation with steel wire and extrusion screw
Postoperative X-ray
➢followed up for 1 month after surgery
➢For a bigger fracture block, hollow screw is a good choice
➢Lateral meniscus (LM) is being pulled and displaced
➢ MRI
➢To check the stability of knee joint before operation
➢To carefully examine the collapse of the lateral tibial plateau
➢To reduce and fix tibial plateau fractures
➢ Fall injury and traffic accident——51％ ➢ Sports injuries——Skiing and football--14%
The Knee，2008，15(3)：164-167．
➢ Associated with capsule tear of meniscus or articular capsule, sometimes including medial and lateral collateral ligament injury or injury of articular cartilage