Management Of Sensitized Kidney Transplant Recipient. by Dr. Suhas S Bavikar
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DR SUHASANKLE FRACTURES
OVERVIEW
ANATOMY
NORMAL X-RAY
CLASSIFICATION
TREATMENT
ANATOMY
Mortise x-ray:• Medial clear space
o Between lateral border of medial malleous and medial talus
o <4mm is normalo >4mm suggests lateral
shift of talus
Lateral x-ray:• Identifies fractures
of o Anterior/posterior
tibial marginso Taluso Displacement of
taluso Os trigonum
Lauge-Hansen
Described by two words1.Position of foot at time of
injury2.Direction of talus within
mortise causing fracture Eg: supination-external rotation Further subdivided into
worsening areas of injury
types
supination-eversion
supination-adduction
pronation-abduction
pronation-eversion
supination-adduction
Transverse avulsion-type fracture of the
fibula below the level of the joint Vertical fracture of the medial
malleolus
10 – 20 %
Supination-Eversion (External Rotation) (SER) 40-75% Disruption of the anterior tibiofibular ligament
Spiral oblique fracture of the distal fibula, which runs from ANT INF to POST SUP
Disruption of the posterior tibiofibular
ligament or fracture of the posterior malleolus
Fracture of the medial malleolus or rupture of the deltoid ligament
Pronation-Abduction (PA)
Transverse fracture of the medial malleolus
Rupture of the syndesmotic ligaments or
avulsion fracture of their insertions Short, horizontal, oblique fracture of the
fibula above the level of the joint . Lateral communition. 5 – 20 %
Pronation-Eversion (External Rotation) (PER 5 – 20%) Transverse fracture of the medial malleolus
Disruption of the anterior tibiofibular ligament
Short oblique fracture of the fibula above the level of the joint. ANT SUP - POST INF
Rupture of posterior tibiofibular ligament or avulsion fracture of the posterolateral tibia
Danis-Weber Defines injury based on level of fibular
fracture A=below tibiotalar joint
No disruption of syndesmosis Usually stable
B=at level of tibiotalar joint Partial disruption of syndesmosis
C=above tibiotalar joint Disrupts syndesmosis to level of fracture unstable
THE MORE PROXIMAL THE FIBULAR # THE MORE SEVERE THE INJURY
Pronation-Eversion
supination-adduction
Medial Malleolus
Undisplaced
Displaced