talus fracture dislocation
Introduction
Introduction to talus fracture and dislocation The talus in the bones of the whole body is the only bone with no muscles to stop. Only the synovial membrane, joint capsule and ligament are connected, so the blood supply is poor, and the non-healing and aseptic necrosis are more common. The incidence of such injuries accounts for about 1% of foot fractures. Although it is very rare, it causes many problems, and it is one of the difficult problems that everyone pays attention to in clinical practice. The talus is divided into the head, the neck and the body; the head and the scaphoid form the scapular joint, and the rear is the narrow talus neck; the talus is located at the rear, which is not only the largest, but the upper part is formed by the trochlear shape and the lower end of the tibia. Here, the part with the most concentrated force transmission is easy to cause damage. About 60% of the surface of the talus is covered by the cartilage surface, and the edge of the upper joint surface also has cartilage continuation. The talus can slide forward and backward in the "blinking". It can also tilt and rotate the left and right. There is a protruding posterior nodule at the back of the talus. If it is not fused with the body during development, it forms a free triangular bone. The peripheral part is smooth and often found on the X-ray plain film, which is easy to be confused with the avulsion fracture. The talus has no muscle attachment, but is connected to the joint capsule and the synovium, and has blood vessels accompanying it. If tear occurs during trauma, it is easy to cause ischemic necrosis due to interruption of blood supply. basic knowledge The proportion of illness: 0.036% Susceptible people: no special people Mode of infection: non-infectious Complications: ischemic necrosis, traumatic arthritis
Cause
Causes of talus fracture and dislocation
Causes
Often caused by compression and compression violence. Most of them are caused by compression when falling from a height, or by squeezing violence; especially when the foot is stretched, it is more likely to occur. At this time, the talus neck fracture is multiple, the second is the talus fracture, and the foot is in the middle position. The talus fracture is more common in the talus and the posterior talus fracture is more common. The similar violence can cause dislocation of the talus.
Prevention
Talus fracture and dislocation prevention
Mostly injured by direct violent crushing or indirect crushing by high ground, so you should pay attention to safety in your life. Take relatively safe measures. Pay attention to daily life, pay attention to diet, and take a light and nutritious diet to avoid stimulating spicy food.
Complication
Complications of talus fracture and dislocation Complications ischemic necrosis, traumatic arthritis
1. Avascular necrosis of the talus Due to the blood supply characteristics of the talus, such complications are more common, especially in the case of total talus dislocation.
(1) Early: Non-surgical treatment is the main method, which can be used to avoid weight-bearing, local braking and blood-activating drugs. If necessary, talar drilling can also be used to introduce blood supply.
(2) Late stage: Part or all of the necrotic bone should be removed, and then the artificial talus should be implanted, or Blair surgery, or heel fusion.
2. Traumatic arthritis is also more common, especially in patients with poor reduction, but also secondary to the talus.
After ischemic necrosis.
(1) Early: Reduce or no weight, the ankle joint can be braked with zinc oxide cream or ankle guard.
(2) Late stage: more need for arthrodesis, as appropriate, with the joint, three or four joint fusion; the latter is used as little as possible, or as the last surgical option.
3. The formation of talus pseudoarthrosis is more common in talus fractures. At this time, if the ankle joint is normal or near normal, it is feasible to have a joint or a three-joint fusion. If the ankle joint has occlusion variation or associated with arthritis. Four joint fusion is required.
Symptom
Talus fracture and dislocation symptoms Common symptoms Lower limb weight-bearing disorder Severe pain Limb ischemia
The ankle is swollen, severe pain, obvious pain, active joint activity disappears, and lower limb weight-bearing disorder.
The talus fracture is generally divided into the following 5 types:
1. A talus fracture: more comminuted, less common.
2. talus neck fracture: more hair, depending on the fracture situation can be divided.
(1) Simple talus neck fracture, without dislocation.
(2) The talus neck fracture with posterior dislocation of the talus is more complicated and has more problems in the later stage.
3. talus fractures: can also be divided into 3 types:
(1) A talus fracture without displacement.
(2) displaced talar fractures.
(3) comminuted talar fractures.
4. Posterior talar fracture: easy to be confused with the triangular bone.
5. talus cartilage fractures: mostly caused by lesser violence, especially in the case of shocks and violence.
Examine
Examination of talus fracture and dislocation
The talus fracture and dislocation examination X-ray examination of the positive position, lateral position and oblique position can confirm the diagnosis.
The density resolution of CT CT is significantly better than that of X-ray film, which is more conducive to clear the size, extent and density of joint and soft tissue lesions, as well as the invasion of bone disease to adjacent tissues. Certain types of fractures and cartilage-damaged lesions are indications for CT examination.
Visual examination showed swelling of the ankle, severe pain, obvious pain, active joint activity disappeared, and lower limb weight-bearing disorder.
Diagnosis
Diagnosis and diagnosis of talus fracture and dislocation
Generally, there is no difficulty. It can be diagnosed according to the patient's history of trauma, clinical symptoms and X-ray film (positive position, lateral position and oblique position). The main clinical symptoms are swelling of the ankle joint, pain and activity limitation, tenderness. The points are mostly confined to the underside of the ankle joint, and are consistent with the fracture classification and the fracture line. In addition to the talus posterior fracture, the lower limb weight bearing function is more difficult.
