talus fracture
Introduction
Introduction to talus fracture The talus is one of the proximal bones of the humerus of higher vertebrates and is considered to be equivalent to the fusion of the temporal bone of the lower vertebrates with the intermediate medium [talus]: the weight of the human body, in the ankle and calf Bone. The talus fracture and dislocation is a common injury in the foot. After the injury, the lower part of the ankle joint is swollen, painful, unable to stand and carry weight. Dysfunction is very significant, easy to distinguish from simple ankle sprain. basic knowledge The proportion of illness: 0.24% Susceptible people: no specific population Mode of infection: non-infectious Complications: ischemic necrosis, traumatic arthritis
Cause
Cause of talus fracture
Causes of talus fracture:
(1) talus neck and body fractures: more from the height of the ground, heel strikes the ground, the violence is down the humerus, the reaction force is from the heel up, the front of the foot is strong dorsiflexion, so that the lower edge of the lower end of the humerus is inserted into the neck of the talus. Between the body, resulting in talus or talus neck fracture, the latter more, such as strong varus or valgus, can cause talus fracture and dislocation, talus neck fracture, talus due to circulatory disorders, can occur ischemic Necrosis.
(2) talus anterior fracture: the strong flexion of the foot is caused by the impact of the posterior border of the humerus or the upper edge of the calcaneus.
Prevention
Talar fracture prevention
The disease is caused by traumatic factors, so pay attention to production and life safety, avoiding trauma is the key to prevent this disease, and should pay attention to active treatment and thorough debridement to prevent infection and traumatic arthritis.
Complication
Talar fracture complications Complications ischemic necrosis, traumatic arthritis
The main complications of this disease are as follows:
1. Astragalus ischemic necrosis
The talus fracture is common in fall injury. The talus is at the apex of the arch of the foot. When it falls, it is impacted by the up and down direction. It is easily broken. After the rupture, it is pulled by the distance boat and the talus ligament, so that the bone is easy to move forward or backward. Lateral transfer and dislocation, coupled with the destruction of attached soft tissue, the stability is very poor, and the destruction of the blood supply system is likely to lead to avascular necrosis of the bone.
2, traumatic arthritis
Articular cartilage destruction and articular surface irregularities in any of the 6 articular surfaces of the talus can lead to traumatic arthritis in the future, but the incidence of each is not consistent. Once it occurs, joint fusion is the only choice, generally not It is recommended to remove the talar body for heel and fusion, because it shortens the limb and has foot deformity, which affects the function.
3, malformation healing
There are two kinds of talus deformity healing: back extension and varus. Some scholars have used the method of resection of the dorsal olecranon to obtain satisfactory curative effect. The varus deformity is easy to occur when the conservative treatment is ineffective in the early stage of type II talar neck fracture. The fixation of the screw to the bone can also cause this deformity. The varus deformity will directly restrict the joint movement of the lower joint. The previous treatment was limited to the joint fixation. The curative effect is not predictable. Some scholars suggest that the talus should be shortened to obtain the inner column. The length is to correct the deformity of the internal and external valgus. The most effective treatment for the healing of the bone deformity is prevention. Once the patient is unable to perform arthrodesis, only the unconnected bone can be removed.
Symptom
Symptoms of talus fractures Common symptoms of anterior and posterior tibiofibular swelling and pain, heel pain and foot numbness and burning sensation of talus necrosis
Examine
Examination of talus fracture
In addition to positive, lateral X-ray film, should also be based on the injury to shoot a special body phase, such as the opening position (upper cervical spine injury), dynamic lateral position (cervical vertebra), axial position (scaphoid, calcane, etc.) and For tangential position (tibia), complex pelvic fractures or suspected intraspinal fractures, orthodontic or CT examination should be performed as appropriate.
Diagnosis
Diagnostic diagnosis of talus fracture
diagnosis
1, ask about the injury
Including the cause of the injury, time, location, body posture at the time of injury and where the first landing, if there is a wound or bleeding, should also ask about the wound treatment, whether to use the tourniquet and the upper tourniquet time.
2, comprehensive physical examination
Pay attention to whether there is shock, soft tissue injury, bleeding, check the size, shape, depth and pollution of the wound, whether there is bone end exposure, whether there are nerves, blood vessels, craniocerebral, visceral injuries and other parts of the fracture, which must be carried out quickly for serious wounded .
3, X-ray inspection
In addition to positive, lateral X-ray film, should also be based on the injury to shoot a special body phase, such as the opening position (upper cervical spine injury), dynamic lateral position (cervical vertebra), axial position (scaphoid, calcane, etc.) and For tangential position (tibia), complex pelvic fractures or suspected intraspinal fractures, orthodontic or CT examination should be performed as appropriate.
Differential diagnosis
Because the clinical manifestations of this disease are not characteristic, it is necessary to distinguish from diseases with similar symptoms. The most common is the differentiation from simple ankle sprain.
In addition, the talus fractures should be differentiated. The talus fractures and dislocations are divided into talar neck fractures and posterior talar fractures. The types of talar neck fractures and dislocations are classified into type I according to the modified Hawkin's classification, and there is no dislocation of the talus neck fractures; , talus neck fracture combined with subtalar joint dislocation; type III, fracture combined with talus dislocation, that is, sacral joint and subtalar joint dislocation; type IV, talar neck fracture combined with dislocation of the joint and dislocation of the talus.
