Cudurka Canqawga & Cagaha Cudurka Arthritis-ka & Dhaawaca I | El Paso, TX.

Jabka anqawga

• 10% dhammaan jabka. 2nd m/c daba socota qoorta femoral Fx. Tirakoobka dadka: ragga da'da yar ee firfircoon iyo dheddigga lafaha ka weyn
• Stable Fx: saadaasha guud waa wanaagsan tahay
• Fx aan degganayn: waxay u baahan tahay ORIF. 15%-20% fursadaha 2nd OA.
• Doorka sawir-qaadista waa in la go'aamiyo kakanaanta, xasilloonida iyo qorsheynta daryeelka (ie, operative vs. muxaafidka)
• Kala soocida weberku waxay tixgelisaa jeexjeexa tibial-fibular syndesmosis ee fog iyo xasillooni-darrada iman karta
• Weber A - ka hooseeya syndesmosis. Deggan, sida caadiga ah avulsion of malleolus fibular fog
• Weber B - heerka syndesmosis: waxa laga yaabaa inuu ka baxsan yahay syndesmosis oo xasilloon ama dillaacsan syndesmosis oo aan degganayn
• Weber C - oo ka sarreeya syndesmosis. Had iyo jeer degenaansho la'aan d/t jeexjeexa syndesmosis
• Kala duwanaanshaha jabka ayaa laga yaabaa inay ku lug yeeshaan booska/doorka lafta talus inta lagu jiro Fx (tusaale, afduub, dhejin, wareeg, iwm.) tan waxaa loo yaqaan kala soocida Lauge-Hanson

Tibiofibular Syndesmosis & Xasiloonida Anqawga

• Denis-Weber kala soocidda jabka canqowga

Saxnaanta Dx Clinical

• Jabka anqawga waxaa fududayn kara "Xeerka Ottawa. "

Mortise & Aragtida AP

AP, Medial Oblique & Aragtida Dabadeed

• Muuji infrasyndesmotic Fx ee fibular malleolus (Weber A)
• Dhaawac xasiloon
• Daryeelka muxaafidka ah ee qaabka kabaha lugaha gaaban ee kabaha / kabaha ayaa la isticmaali karaa. Soo kabasho wacan Haddii aysan jirin caddaynta dhaawaca osteochondral, fursadaha yar ee dhaawaca OA ka dambeeya
• Sawir kale looma baahna. MRI ayaa laga yaabaa inay ku caawiso inay muujiso xanuunka lafaha iyo dhaawaca lafaha lafaha

Weber B ee Heerka Syndesmosis

• Waxay noqon kartaa mid deggan ama aan degganayn. Mararka qaarkood, go'aanka waxaa la sameeyaa xilliga sahaminta qalliinka.
• Baaritaanka CT-ga ayaa laga yaabaa inuu ku caawiyo qiimeyn dheeraad ah
• Maareynta: waxay ku xiran tahay xasilloonida. Xasillooni dheeraad ah ayaa loo baahan yahay haddii syndesmosis uu dillaaco

Weber C

• AP, aragtiyaha dhexdhexaadka ah iyo kuwa dambe waxay muujinayaan Weber C - dhaawaca suprasyndesmotic oo ay weheliso kala-goysyada aan caadiga ahayn ee ballaarinta d/t khalkhalka tib-fib syndesmosis. Dhaawac aad u deggan.
• Mararka qaarkood, marka Weber C Fx uu 6-cm ka dhigo cidhifka malleolus lateral, waxaa loo yaqaan Pott's anqaw Fx (magaca ka dib Percival Pott's kaas oo soo jeediyay soocidda asalka ah ee jabka canqowga iyada oo ku saleysan xasilloonida iyo heerka wareega). Eraygu xoogaa waa duugoobay.
• Maareynta: hawlwadeen leh xasilin dheeri ah oo syndesmosis ah

Jabka Maisonneuve

• Inta badan jabka laf dhabarta ee fibula u dhow oo ay weheliso dhaawac canqowga ah oo aan degganayn
• Ma jiro jab canqowga ah oo degdeg ah oo lagu xusay shucaac ahaan, sidaas awgeed waa la waayi karaa aragtida canqowga waxayna u baahan tahay tibia iyo aragtiyo fibula
• Tilmaamaha Rad: balaarinta canqowga d/t syndesmosis jeexjeexa iyo marmarka qaarkood khalkhal ku yimaada seedaha deltoid. Xuubka interosseous waxa lagu jeexjeexay fibular u dhow Fx oo ay sababtay u soo jiidasho leh xoog wareeg dibadda ah
• Maareynta: hawlwadeen

Bimalleolar & Trimalleolar Fx

• Sawirrada sare Bimalleolar Fx v. aan degganayn, natiijada u janjeersiga iyo afduubka/wareejinta dibadda. Rx: ORIF.
• Trimalleolar Fx: 3-qaybood oo canqowga ah Fx. Malleolus dhexdhexaad ah iyo lateral iyo avulsion ee dhinaca dambe ee plafond tibial. Degenaansho la'aan badan. Rx: hawl gal

Tillaux Fx

• Fx ee carruurta ee saameeya ilmaha ka weyn marka dhinaca dhexe ee jidhku xiran yahay ama ay ku dhowdahay in la xiro dhinaca dambe ilaa uu ka furmo. Kacsi ay sameeyaan seediga hore ee tibi-fibular. Dhibaatooyinka: 2aad qalalan/OA dhicis ah. Rx: waxay noqon kartaa muxaafid haddii ay xasiloon tahay kabka bootinta.

Dhaawacyada Saxanka Kobaca Carruurta

• Kala soocidda Salter-Harris waxay caawisaa in la baaro oo la saadaaliyo dhaawacyada jirka.
• Xanuunka maskaxda ee waxtarka leh: SALTR
• S: nooca 1-sibix iyada oo saxanka koritaanka
• A: nooca 2-korka, Fx waxay ku fidsan tahay metaphysis
• L: nooca 3-hoosee, intra articular Fx wuxuu ku fidaa epiphysis-ka
• T: nooca4, "iyada" Fx waxay ku fidsan tahay dhammaan: physis, metaphysis, iyo epiphysis.
• R: nooca 5, "burburtay." Burburka dhaawac jirka ah oo u horseedaya dhimasho dhammaystiran ee saxanka koritaanka
• Nooca 1 iyo 5: jooga oo aan lahayn jab
• Nooca 2: wuxuu leeyahay saadaasha ugu fiican waxaana loo arkaa midka ugu caansan.
• Maareynta: u gudbinta dhakhtarka lafaha ee carruurta
• Dhibaatooyinka: Xiritaanka fiisigiska hore, gaabin addimada, OA dhicis ah iyo kuwa kale.

Jabka Calcaneal

• Inta badan tarsal Fx. 17% furan Fx
• Mechanisms: loading axial (intra-articular Fx ee kala-goysyada hoose-talar iyo calcaneal-cuboid ee kiisaska 75%). Avulsion by achilles tendon (m/c ee lafaha lafaha). Cadaadiska (daalka) Fx.
• Intra articular Fx waxa ay xanbaarsan tahay saadaal liidata. Caadi ahaan waa la joojiyay Rx: hawl gal.
• B/I calcaneal intra-articular fx oo leh isku xidhka laf dhabarta Fx oo leh isku xidhka vertebral Fx (T10-L2) oo inta badan loo yaqaan Casanova aka Don Juan (Lover's) fx.
• Sawirka: raajo raajo oo ay weheliso "muuqaal cidhib" tallaabada 1aad. Iskaanka CT ayaa u fiican Dx iyo qorshaynta kahor-op.
• Radiography: Xagasha Bohler (<20-degrees) xagasha Gissane>130-degrees. Tilmaan Calcan, Fx.

Lafaha Tarsal

• M/C lafta daamur ee jaban waa Talus. Gobolka M/C: qoorta dheer (30-50%). Mechanism: Culayska axial ee dorsiflexion. Dhibaatooyinka: Ischemic osteonecrosis (AVN) ee talus. dhicis (2nd OA). Sawirka: Tallaabada 1aad: Sawir-qaadista, CT waxay ku caawin kartaa qeexid dheeraad ah
• Kala soocidda Hawkins waxay ka caawisaa Dx, saadaalinta & daaweynta. "Calaamadaha Hawkins" ee filimka cad/ CT scan ayaa laga yaabaa inay ku caawiyaan AVN Dx. (Sare fallaadhaha buluuga ah waxay muujinayaan saadaasha wanaagsan d/t xariiqda radiolucent oo tilmaamaysa AVN ma jiro sababtoo ah lafta ayaa xididaysan oo markaa dib u soo baxay)
• Rx: Nooca 1: muxaafid leh kabka lugaha gaaban ama kabaha (khatarta AVN-0-15%), Nooca 2-4-ORIF (khatarta AVN 50%-100%)

Sawirka Anqawga & Cagaha