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asbryobvrz · Wysłany: Nie 23:52, 06 Mar 2011

Open 44 cases of ankle fracture-dislocation

Screws in 4 cases,[link widoczny dla zalogowanych], separation of the line under the tibiofibular joint screw fixation in 4 cases; tibia from the dislocation line Steinmann pin fixation in 22 cases. Row triangular ligament repair in 12 cases, after debridement reduction and internal fixation, all the plaster fixation. 3 Results The follow-up treatment of 34 cases, the time is 0.5 - 3 years, an average of 1.5 years. Functional assessment standards ...} excellent,[link widoczny dla zalogowanych], range of motion was normal, to engage in violent activities, pain or occasional pain in rainy days; good, normal ankle mobility side of 2 / 3. To maintain normal activities,[link widoczny dla zalogowanych], pain after walking more; can, ankle mobility was normal side 1 / 2 to 1 / 3, the section stiffness and mild pain in a sense; shame, joint stiffness and instability, recurrent swelling and pain significantly . Claudication. Results 34 cases, excellent in 8 cases. Good in 12 cases, 10 cases and poor in 4 cases. Good rate of 58% and 4 discuss the 4.1 debridement must first close the wound debridement as soon as possible as soon as possible. Our approach is; in tourniquet controlled surgery. First shaving surface planing and avulsion of the skin around the hair, soft soap, and sterile saline three times repeated brushing. Then 1 / 5000 benzalkonium bromide solution for 5 minutes, normal saline, hydrogen peroxide and washed 2 to 3 times. General skin disinfection, shop towels. Clear profile of blood clots and foreign bodies, removal of the organization will lose its vitality and contusion of the planing edge organization. Surgery is still necessary to fully expose the joint cavity. Cavity loss of vitality of the cartilage, bone fragments and foreign matter. Must be removed and. Every 2 - * the exchange of experience on the impact of removing large areas of bone joint stability should be managed fixed. Debridement of the group basis. Suture of the wound in 24 cases. 8 cases of skin necrosis infection reasons, first, injury to the skin exfoliation sneak lack of awareness, inspection is not careful, its early performance are still not clear, thorough debridement is not willing; two cases where there is tension force will be no blood Win the skin sewn back into place. 6 cases of large skin avulsion of the avulsion skin. After thorough cleaning and disinfection, the use of drum mechanism take skin thickness skin graft 【NCKU Photo Sichuan. Removal of the bruise with bleeding spots section. Mu to the profile. Class All the wounds healed, the treatment time later, wound heavy pollution and a large soft tissue defects were, after debridement should be delayed in closing the wound, later decided to use depending on the development of methods covered by section, which is the prevention of serious infections detours important measures: the group of 4 sides by two skin graft. Although the doctor later, the skin contusion larger defects, but the profile without infection, healing well. 4.2 The treatment of internal fixation of fractures and dislocations (1) medial malleolus fracture or optional screw tension band wire fixation (2) above the level of lateral malleolus fractures in the joints of the transverse fracture can choose Kirschner wire fixation. Oblique or spiral fracture plate can be used to prevent the joint locking and lateral move. Below the level of articular fracture, Kirschner wires or screws can be used. (3) of the ankles or three fixation of ankle fractures usually the first or after lateral ankle, and then fixed the medial malleolus of ankle fractures after restoration in order to smooth articular surface, but also to protect the ligaments on the fracture fragment contact, so as not to bow from the fracture 『 non-union or avascular necrosis. Tibiofibular joint separation associated with those to be given a fixed restoration, then after ankle. If the medial and lateral malleolus and the tendon repaired by a fixed ankle joint to be stable. Can not under the tibiofibular joint fixation. (4) Dislocation after tibiotalar instability after restoration, should the line from the tibial fixation with the ankle joint neutral position is set by the foot through the calcaneus, talus to the tibia to the bottom for the orientation Steinmann pin fixation, pin tail remain in the skin outside. (5) triangular ligament rupture, and they should be patching, accompanied by lower tibiofibular joint separation, and they should be fixed to ensure the stability of the ankle joint. 4.3 functional training and functional recovery after open ankle injuries, are often left with varying degrees of dysfunction,[link widoczny dla zalogowanych], this addition to the degree of the original injury, but also due to the strict fixed, brake,[link widoczny dla zalogowanych], body muscle disuse occurred atrophy, protein degradation increased negative balance of krypton in the entire treatment process, the early rational, functional training is necessary. Can prevent muscle atrophy and joint stiffness. No effect on the activities of fracture fragments can also improve the local blood circulation, speed up fracture healing and prevention of other complications. Poor evaluation function in this group 4 cases, in addition to damage, serious pollution, the postoperative external fixation time was half as long and thirty-three more than in October. Not according to the principle of combining static and dynamic functional training management platform. Also has an important relationship