外伤性髌骨关节内脱位并嵌入股骨外髁骨折端一例

外伤性髌骨关节内脱位为少见的脱位类型,髌骨关节内脱位疳嵌入股骨外髁骨折端目前报道极少。我院收治1例,疗效满意,现报告如下。     

膝关节后脱位髌骨置留股骨髁后1例报告

患者 ,男 ,38岁 ,司机 ,因车肇事致伤左膝关节。查体 :左膝关节中度肿胀前后径增大。置于过伸 10°位。膝前可触及髌骨近端及股骨髁 ,胫骨近端压痛 ,可触及骨擦音及异常活动 ,足背及胫后动脉搏动有力。各足趾血运、感觉良好 ,活动自如。X线片显示 :髌骨骨折 ,髌骨远端与胫骨平台后移脱位至股骨髁后胫骨平台骨折 (见图 1)。入院后行手术切开复位 ,术中见髌骨远折端正嵌于股骨髁后 ,上提股骨髁拉出髌骨远端 ,复位膝关节 ,见前后交叉韧带于股骨髁附着处断裂。修复前后交叉韧带 ,髌骨行张力带固定 ,胫骨平台用螺丝钉固定(见图 2 )。术毕膝关节…     

髌骨骨折合并同侧股骨髁骨折的治疗

自１９８２￣１９９２年间，我们共收治髌骨骨折合并同侧股骨髁骨折１８例。５例髌骨骨折采用保守治疗，１３例用手术方法治疗。１６例股骨髁骨折采用内固定方法治疗、２例采用保守方法治疗。随访１５个月￣８年，结果属优４例，良８例，尚可２例，差４例。优良率６６．７％。我们认为这种损伤早期宜行坚强内固定。     

动力髁螺钉治疗股骨髁上骨折

目的观察应用动力髁螺钉(DCS)内固定治疗股骨髁上骨折40例的疗效。方法对40例股骨髁上骨折采用动力髁螺钉(DCS)治疗。结果骨折愈合率为100%。膝关节功能优良率为90%。结论DCS治疗股骨髁上骨折具有固定牢靠确定,操作方便,能早期进行功能锻炼等优点。     

DCS内固定治疗股骨髁骨折

股骨髁部骨折治疗方法较多，均非尽善尽美。今将我院近5年来应用动力髁螺钉治疗股骨髁骨折情况总结报导如下。     

股骨外侧髁冠状面骨折的手术治疗

目的 探讨前外侧入路切开复位内固定治疗股骨外侧髁冠状面骨折的方法及临床疗效.方法 采用前外侧入路切开复位,松质骨拉力螺钉或联合防滑动钢板内固定治疗股骨外侧髁冠状面骨折11例.结果 本组随访8～36个月,骨折全部愈合,未见切口感染及骨坏死.膝关节功能参照Letenneur评定标准:优7例.良3例,差1例.结论 前外侧入路切开复位内固定治疗股骨外侧髁冠状面骨折是一种安全有效的治疗方法,拉力螺钉联合防滑动钢板可以较好地克服骨折端的剪切应力,避免了内固定螺钉的松动.     

动力髁螺钉治疗股骨远端骨折129例体会

股骨远端骨折 ,在临床上较多见 ,其发生率约占股骨骨折的 4%～ 7% ,既往临床治疗效果不满意的原因为常常并发膝关节僵硬 ,我们 1998～ 2 0 0 2年 ,采用动力髁螺钉 (DCS)治疗 12 9例 ,效果良好 ,报告如下。临床资料1.一般资料 :本组男 93例 ,女 3 6例 ,平均年龄 43 .2岁。股骨髁     

动力髁螺钉内固定治疗股骨髁上、髁间骨折24例

动力髁螺钉 (DCS)内固定是“AO”倡导用于股骨远端骨折一种内固定方法[1] ,我们自 1 997年以来 ,采用 DCS内固定治疗股骨髁上骨折和股骨髁间骨折 2 4例 ,取得了满意疗效 ,报告如下。临床资料一、一般资料　本组病例 2 4例 ,均系新鲜骨折 ,男性 1 8例 ,女性 6例。年龄最小 1 9岁 ,最大 61岁 ,平均 41 .2岁。左侧 1 5例 ,右侧 9例。受伤原因 :交通事故 1 4例 ,坠落伤 7例 ,直接暴力 3例。骨折类型 :按“AO”分型 [2 ] ,A1型 2例 ,A2型 5例 ,A3型例 ,C1型 1 2例 (其中 T型 4例 ,Y型 8例 ) ,C2型 3例。闭合性骨折 1 9例 ,开放性骨折 5例…     

少见的股骨外侧髁骨折1例报告

目的 报道1例少见的股骨外侧髁骨折,介绍其诊疗经验。方法 患者,男性,21岁,因“高处坠落后右膝部疼痛、活动受限1小时”入院,经体查、膝关节正侧位X片、CT及MRI检查诊断为股骨外侧髁骨折。完善术前准备后于伤后第二天在全麻下行股骨外侧髁骨折切开复位内固定术。术中见骨折块位于股骨外侧髁前下方,向后上移位,予以复位骨折块,埋头空心钉垂直加压,抗滑钢板固定。结果 手术顺利,术后3 d出院。术后3月门诊随访,已弃拐行走,CT检查提示骨折愈合。膝关节Neer评分为96分,HSS评分为98分,膝关节功能等级为“优”。结论 青年股骨远端骨折往往为高能量损伤,术前应仔细查体并完善X线摄片、CT、MRI检查,制定完善的手术方案,术中解剖复位、坚强内固定,术后早期康复锻炼,才能取得满意的临床效果。按现有的股骨远端骨折分类标准不能涵盖此种骨折,故其分类标准有待完善,以帮助骨科医生更好地理解和规范治疗此类骨折。     

Locked lateral patellar dislocation with impaction fracture of patella

Irreducible lateral patellar dislocation is rare. It has previously been described with rotation around a vertical axis. We describe a case of irreducible lateral patellar dislocation in a 66-year-old lady with an impaction fracture of medial facet of patella locked on the lateral femoral condyle. Closed reduction was unsuccessful and the patient was treated by total knee replacement. Such a case has not been described previously in the literature.     

Posteromedial dislocation of the elbow with lateral condyle fracture in children

Posteromedial dislocation of the elbow in children is an extremely rare injury. The current study describes four boys with posteromedial dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle. The patients ranged in age from 6 to 12 years (average age, 9 years 6 months). Closed reduction of the elbow dislocation and open reduction of the lateral humeral condyle fracture with fixation by Kirschner wires by a lateral approach was done in each patient. This was followed by 4 weeks immobilization wearing a long-arm cast. There were three excellent results and one good result. Healing and return of normal function occurred in all but one patient who had minor loss of full extension. Average duration of followup was 7 years 6 months (range, 3-13 years). Dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle can be treated by closed reduction of the elbow dislocation and open anatomic reduction and fixation of the lateral condyle fracture with good results.     

Posteromedial dislocation of the elbow with lateral condyle fracture: The fractured lateral condyle adheres to the radial head

Posteromedial dislocation of elbow with lateral condyle fracture is a rare with only a few reported cases. This study describes two children who presented with posteromedial dislocation of elbow with lateral condylar fracture of the distal humerus in which the fractured lateral condyle adhered to the radial head through the intact posterior capsule and lateral collateral ligament. These cases demonstrate the mechanism of this type of injury: during a direct fall onto an outstretched hand, varus force is exerted, resulting in an avulsed lateral condyle while the radial head maintains its relationship with the displaced capitellum through the intact posterior capsule and lateral collateral ligament.     

Malunited lateral condyle fracture of humerus with elbow dislocation: a diagnostic dilemma

European Journal of Orthopaedic Surgery & Traumatology - Fracture of lateral condyle with dislocation of the elbow joint is rare in pediatric age. Diagnosis and management of these injuries...     

Weight-bearing osteochondral lesions of the lateral femoral condyle following patellar dislocation in adolescent athletes

In patients with patellar dislocation, osteochondral injury is often an indication for early surgical intervention. However, no studies have identified a relationship between injury to the weight-bearing surface of the lateral femoral condyle following a patellar dislocation and the eventual need for surgical treatment. The authors hypothesized that a significant number of patients sustain injury to the weight-bearing surface of the lateral femoral condyle following an acute patellar dislocation.Radiographs and magnetic resonance images were retrospectively reviewed and the patterns of injury were evaluated for 80 patients with a diagnosis of acute patellar dislocation, including the presence of osteochondral damage, the location of the medial patellofemoral ligament injury, and concomitant meniscal pathology. Magnetic resonance imaging identified a 27.5% incidence of osteochondral injury involving the articular, weight-bearing region of the lateral femoral condyle following an acute lateral patellar dislocation. Surgical intervention was performed in more than 60% of these injuries, and most were not identified with plain radiographs. Injury to the weight-bearing surface of the lateral femoral condyle following patellar dislocation was 3.6 times more common in boys in the current study population.Osteochondral injury to the weight-bearing surface of the lateral femoral condyle may occur in a high percentage of patients following a lateral patellar dislocation and in a higher percentage of boys than girls. Patients with tenderness over the lateral femoral condyle following an acute lateral patellar dislocation should undergo magnetic resonance imaging.     

Hoffa骨折合并同侧髌骨脱位及踝关节骨折1例

患者,女,62岁,因下楼梯时摔倒后出现左下肢肿痛、活动受限6d入院.伤后曾到当地附近医院就诊,行膝关节CT示左股骨外侧髁骨折合并髌骨脱位(图1a,1b,1c,1d),后于另一医院就诊,予以髌骨脱位手法复位,患肢石膏固定后进一步踝关节X线检查发现左内、外踝骨折(图1e).为进一步治疗来我院就诊.患者既往体健.查体:双下肢...     

Hip dislocation with femur head fracture

It is talked about the classification, the therapy and the late results of the traumatic dislocation of the hip joint with a fracture of the femoral head. Twelve patients with an average age of 36 years (from 18 to 77 years) were treated between the years 1972 and 1982. The rarer anterior dislocation of the hip including a fracture of the femoral head should be specifically classified, in order not to cause any errors for the therapeutic and prognostic assessment following the Pipkin classification. Type I and II with posterior dislocation justify a closed trial of reposition. The miscarried trial, and a continuing fragmental dislocation with a disturbance of the joint's function, or fragments participating in the load area of the femoral head necessitate an open reposition. Small fragments may be taken away, the larger ones require the screwing osteosynthesis. Smaller fragments from the load area must be sustained in an anterior dislocation ("IIb"). The type III injury gives primarily--in exceptional cases sometimes secondarily--an indication for an alloplastic false hip joint. Injuries of type IV should be restored operatively, respectively, it is necessary to perform a secondary operation to set in an endoprosthetic substitute. With the operative therapy--that is: 5 times extirpation of fragments, 4 times screwing osteosynthesis of the femoral head, twice screwing osteosynthesis of the acetabulum--we obtained good results in injuries of type I, II and IV. We performed 3 times a primary total false hip joint in type III injuries.