Maisonneuveova zlomenina (MZ) je definována jako luxační zlomenina hlezna, kde došlo vždy ke zlomenině proximální čtvrtiny fibuly a roztržení lig. tibiofibulare anterius a lig. tibiofibulare interosseum. Další poranění jsou variabilní. Recentní CT studie ukázaly, že MZ je mnohem komplexnější poranění, než se předpokládalo. Proto je třeba zásadním způsobem změnit pohled na tuto problematiku. MZ je spojena přibližně v 80 % případů se zlomeninou malleolus posterior a dále s malpozicí distální fibuly v incisura fibularis tibiae (IFT). Přesné zhodnocení těchto poranění vyžaduje úrazové CT, které by mělo být u MZ v dnešní době standardem. Hlavním cílem ošetření je anatomická repozice distální fibuly do IFT. To vyžaduje v případě odlomení většího fragmentu malleolus posterior provést nejdříve jeho repozici a fixaci z posterolaterálního přístupu. Tím dojde k obnovení integrity IFT. Zavřená repozice distální fibuly je spojena s malpozicí až v 50 % případů. Proto se dává přednost otevřené repozici z krátkého anterolaterálního přístupu. Přesnost repozice je nutné vždy ověřit pooperačním CT.
Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.
- Klíčová slova
- Maisonneuveova zlomenina,
- MeSH
- dislokace kloubu chirurgie MeSH
- fibula * chirurgie diagnostické zobrazování zranění MeSH
- fraktury fibuly * chirurgie diagnostické zobrazování MeSH
- fraktury kotníku * chirurgie diagnostické zobrazování MeSH
- lidé MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: During study of anatomy of a fractured posterior malleolus of the ankle on CT scans, the authors noticed a prominent crest on the lateral malleolus, which they termed the lateral malleolar crest (LMC). As, in their view, LMC is a clinically important structure which was only briefly mentioned by a few authors without an official term, they focused on the anatomy of this structure. MATERIALS AND METHODS: A total of 352 dry fibulae were analyzed and the following parameters recorded: (F) length of the fibula, (LMC) total length of LMC, (A) length of the part of the examined crest from the superior border of the articular facet of the lateral malleolus (AFLM) to its most proximal intersection with the midline of the fibula, (B) height of the medial triangular rough surface, and (A/F) A/F ratio. RESULTS: The crest was observed in all specimens. (F) was 346.5 ± 26 mm (95% confidence interval [CI] 344-349), (LMC) was 85.4 ± 11.6 mm (95% CI 84.2-86.6), (A/F) was 25% ± 3% (95% CI 24.7-25.3) in the whole group. (A) was 25.9 ± 6.5 mm (95% CI 24.8-26.8) in the whole group, (B) was 34.9 ± 4.7 mm (95% CI 34.3-35.5) in the whole group, 36 ± 6.1 mm (95% CI 35.1-36.9). CONCLUSION: LMC is an important structure on the lateral malleolus. The knowledge of its anatomy is essential for placement of syndesmotic screws or/and the fibular plate.
- MeSH
- fibula * diagnostické zobrazování anatomie a histologie MeSH
- fraktury kotníku * diagnostické zobrazování chirurgie MeSH
- hlezenní kloub diagnostické zobrazování chirurgie anatomie a histologie MeSH
- klinická relevance MeSH
- kotník MeSH
- lidé MeSH
- tibie anatomie a histologie MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Separation of C2 growth plates and dens fractures are the most common types of injuries to the axis (C2) in children. Operative treatment of these injuries with the use of direct osteosynthesis requires a profound knowledge of detailed anatomy and dimensions of the axis. The main issue addressed by the study was the age at which the size of the dens is adequate at all levels to accommodate two screws, and the size of the posterior dens angulation angle (PDAA) in a healthy child in individual age periods. METHODS: Dimensions and angles of the dens and C2 in individual age categories in both boys and girls were measured in a series of 203 CT scans of individuals 0-18 years old and on anatomical specimens (42 samples). In addition, 5 histological series of this region from the fetal period were reviewed. RESULTS: Dimensions of the dens gradually increase with age, with a considerable acceleration during growth spurt periods that are different in boys and girls. PDAA is markedly changing with age; in the fetal period, the dens shows a slight anterior angulation which gradually transforms into posterior angulation, as early as between 4 and 6 years of age. The screw insertion angle changes accordingly. CONCLUSION: During growth, there occur changes in PDAA that should be respected in evaluation of transformation of anterior into posterior angulation, as shown by imaging methods. Dens dimensions theoretically allow insertion of two 3.5 mm screws as early as from the age of 1 year.
- MeSH
- dens axis * diagnostické zobrazování zranění chirurgie MeSH
- dítě MeSH
- fraktury páteře * diagnostické zobrazování chirurgie MeSH
- kojenec MeSH
- kostní šrouby MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- rentgendiagnostika MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
INTRODUCTION: Reduction of the distal fibula into the fibular notch (FN) poses a problem that has not been fully resolved, yet. A number of methods have been developed for the assessment of the position of the fibula in the FN, but none of them is ideal. A majority of authors assess the FN 1 cm above the tibiotalar joint space, without specifying the reason for the choice of this distance. None of the previous studies has addressed at what level the FN is the deepest. Our findings show that it is 4-5 mm above the ankle joint space and verification of this hypothesis has been the aim of this study. MATERIALS AND METHODS: Dry adult tibial bone specimens from the Pachner's collection of the Institute of Anatomy of 1st Faculty of Medicine, Charles University, Prague were used in the study. Height of the FN at its widest point, 3 mm and 10 mm above the articular surface of the distal tibia were measured in each specimen, as well as the depth of the FN at the deepest point, 3 mm and 10 mm above the articular surface of the distal tibia and the distance between the highest point of this surface and the deepest point of the notch. RESULTS: The mean length of the tibia was 350 mm; the mean height of the FN was 42.5 mm; the mean width of the FN at its widest point was 23.6 mm, at 3 mm above the tibiotalar joint space 22 mm, 10 mm above this articular surface of distal tibia (tibial plafond) 18.9 mm. The mean depth of the notch at 3 mm above the tibial plafond was 3.8 mm, at 10 mm above this surface 4.1 mm. The maximum mean depth of the notch was 4.5 mm, the distance from this point to the highest point of the tibial plafond was 5.3 mm. CONCLUSION: The deepest point of the FN lies 5 mm above the articular surface of the tibial plafond, with the mean value of the depth being 4.5 mm. This region is, therefore, ideal for assessment of the position of the distal fibula in the FN.
