fracturi bazin
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Transcript of fracturi bazin
![Page 1: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/1.jpg)
Fracturile de bazin
![Page 2: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/2.jpg)
MECANISM DE PRODUCERE
- ENERGIE JOASA – Fracturi izolate ale oaselor bazinului
- ENERGIE INALTA – Fracturi ale inelului pelvin
![Page 3: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/3.jpg)
ENERGIE JOASA- Ram iliopubian sau/si ischiopubian.
- Avulsia de: spina iliaca anterosuperioara spina iliaca anteroinferioara tuberozitate ischiatica.
- Izolata (transversala) de sacru.
- Aripa iliaca
![Page 4: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/4.jpg)
ENERGIE INALTA
- Autovehicule- impact anteroposterior - impact lateral - tablou de bord- Motocicleta - impact in sezut - impact in genunchi- Pieton - impactul cu vehiculul- - frontal - lateral
![Page 5: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/5.jpg)
ENERGIE INALTA
- Cadere de la inaltime
- – in “picioare” - pe “o parte”Mecanisme
penetrante - – arme de foc - arme albe
- Zdrobire
![Page 6: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/6.jpg)
CLASIFICAREIstoric - Clasificare anatomica in functie de sediul leziunii
-Clasificare anatomopatologica in functie de numarul de intreruperi ale inelului pelvin.
- In functie de mecanismul de producere: compresiune anteroposterioara compresiune laterala forfecare verticala (axiala)
![Page 7: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/7.jpg)
Clasificarea fracturilor de bazin
• Fractura de bazin de tip A– Parcelare
• Fractura de bazin de tip B– Ruptura incompleta a arcului posterior
• Fractura de bazin de tip C– Ruptura completa a arcului posterior
![Page 8: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/8.jpg)
Clasificarea fracturilor de bazin
Fractura de bazin de tip AParcelare
Fractura de bazin de tip BRuptura incompleta a arcului posterior
Fractura de bazin de tip CRuptura completa a arcului posterior
![Page 9: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/9.jpg)
Fractura de bazin de tip A
• Smulgere– Spina iliaca Ant-Sup si Ant-Inf– Creasta iliaca– Ischion
• Soc direct– Aripa iliaca– Ramurile pubiene
• Fractura de sacrum
![Page 10: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/10.jpg)
Fractura de spina iliaca antero inf
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Fractura de spina iliaca antero sup.
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Fractura de creasta iliaca
![Page 14: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/14.jpg)
Fractura de ischion
![Page 15: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/15.jpg)
Tractiunea exercitata de ischiogambieri poate smulge suruburile
![Page 16: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/16.jpg)
Aspecte sechelare
![Page 17: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/17.jpg)
Fractura de aripa iliaca
![Page 18: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/18.jpg)
Photo J. Chouteau
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Fracturile parcelare
![Page 21: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/21.jpg)
Fractura de bazin de tipRuptura incompleta a arcului posterior
• In rotatie “carte deschisa” ( open book)– Disjunctie sacroiliaca anterioara– Fractura de sacru
• In rotatie interna “compresie laterala”– Fractura tasare anterioara a sacrului– Luxatie partiala sacro-iliaca
• Leziune incompleta de arc post, bilaterala
![Page 22: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/22.jpg)
Fracturile de bazin de tip CRuptura completa a arcului posterior
• Ruptuptura completa a arcului posterior unilaterala
• Ruptura completa a arcului posterior de o parte si incompleta de partea contralaterala
• Ruptura completa a arcului posterior bilaterala
![Page 23: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/23.jpg)
Compresie ant-post
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Compresie laterala
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« Forfecare » verticala. Cadere de la inaltime. Aterizare pe un singur picior
Disjunctiesacro-iliaca Fract Voillemier Fract Malgaigne
![Page 30: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/30.jpg)
Disjunctie sacro-iliacaForfecare (Compresie) verticala
![Page 31: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/31.jpg)
Fractura a articulatiei sacroiliace
![Page 32: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/32.jpg)
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Compresie asimetrica
![Page 35: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/35.jpg)
Deplasarile
Compresie neurologica Compresie vasculara
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EXAMENUL CLINIC- Palparea crestelor iliace- SIAS – Manevra de apropiere sau departare – ATENTIE! Exacerbarea hemoragiei- Tuseu vaginal sau/si rectal eventual anoscopie. Uretrografie Examen neurologic Examen vascular
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EXAMENUL RADIOLOGIC
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EXAMENUL RADIOLOGIC
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EXAMENUL RADIOLOGIC
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DIAGNOSTIC
TOMOGRAFIA COMPUTERIZATA RECONSTRUCTIA TRIDIMENSIONALA
RMN
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LEZIUNI ASOCIATE
Hemoragia- Cea mai redutabila complicatie- Sursa: focarul de fractura- leziuni arteriale sau/si venoase - locale- leziunmi de vase mari- Tratament: laparatomie cu hemostaza- arteriografie+ embolizare- fixare externa
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LEZIUNI ASOCIATE
Aparatul urinarVEZICA URINARA- Extraperitoneal: peretele anterolateral- Intraperitoneal: domul (peretele sup.)URETRA- membranoasa sau portiunea initiala a- uretrei bulbocavernoaseDIAGNOSTIC- Sangerarea la nivelul meatului urinar- Sondaj vezical- Uretrografie si cistografie- Cistoscopie
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LEZIUNI ASOCIATE
GENITALE: Vagin Uter
INTESTINALE: Rect Anus iliac
URGENTA
![Page 45: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/45.jpg)
FRACTURILE DESCHISE
- Rare- Deschise in: perineu, rect, vagin, - vezica urinara, - exterior (aripa iliaca).- TRATAMENT- Controlul hemoragiei- Debridarea- Anus iliac (spre linia mediana)- Stabilizarea fracturilor
![Page 46: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/46.jpg)
TRATAMENT
TRACTIUNEA: - Numai ca tratament provizoriu - Grevata de multe complicatii“MANTIA” PNEUMATICA - Tratament de urgenta - Previne socul (hipotensiunea) - Ca o imobilizare gipsata pneumaticaSUSPENSIA IN “HAMAC”
![Page 47: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/47.jpg)
Tratament ortopedic
Hamac de suspensie
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Hamac + tractiune pentru reducerea unei forfecari verticale
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TRATAMENTCHIRURGICAL
FIXATORUL EXTERN - Metoda buna de urgenta - Pentru controlul hemoragiei - Poate ramane si ca tratament
definitiv - Probleme la pacientii obezi - Infectii cutanate la fise - NU stabilizeaza complexul posterior E necesara tractiune sau OS post.
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FIXATORUL EXTERN
GANZ
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FIXATORUL EXTERN
SLATIS
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FIXARE INTERNA
Fixaresacroiliacapercutana
![Page 54: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/54.jpg)
FIXARE INTERNA
Fixaresacroiliacapercutana
![Page 55: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/55.jpg)
FIXARE INTERNAOsteosinteza simfiza pubiana
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FIXARE INTERNA
Fixaretransiliaca pentrufracturi de sacru
![Page 57: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/57.jpg)
FIXARE INTERNA
Fixaretransiliaca pentrufracturi de sacru
![Page 58: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/58.jpg)
Disjunctia simfizei pubiene
Complicatii ureterale
![Page 59: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/59.jpg)
Placa Fixator extern
Tratamentul chirurgical al disjunctiei cu conservarea ligamentelor posterioare
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Disjunctia instabila
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Deschidere sacro-iliaca ant si post
![Page 68: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/68.jpg)
Tratamentul chirurgical al disjunctiei sacroiliace complete
Abord posterior
Bulonaj transversal Reducere si OS cu suruburi percutan sau sub control CT
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Sechele
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Sechele
Disjunctie neglijata (compresie verticala cu fract ramurilor)
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Sechele
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Fractura bazinului asociata unei fracturi de cotil
Tractiune
![Page 74: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/74.jpg)
COMPLICATII
INFECTIA- 0-25%
TROMBOEMBOLISMUL
CALUSUL VICIOS
PSEUDARTROZA
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Care sunt modalitatile terapeutice in disjunctia anterioara a simfizei pubiene fara forfecare ( compresie) vertical?
Care sunt inconvenientele terapeuticii?
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Care sunt modalitatile terapeutice in disjunctia anterioara a simfizei pubiene fara forfecare ( compresie) verticala?
Care sunt inconvenientele terapeuticii?
1/ Tratament ortopedic prin procedeul hamac inconveniente: decubit prelungit si nursing dificil
2/ Osteosinteza simfizei cu placa si suruburiinconveniente: risc de infectie si osteita pubiana
3/ Osteosinteza cu fixator extern cu fise in aripa iliaca si compresie cu ajutorul barelor situate anterior de abdomen
inconveniente: material voluminos fisele din os uneori sunt greu de tolerat
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Fracturile de cotil
Sunt fracturi intraarticulare ce pot interesa si restul bazinului
Adesea asociate cu alte leziuni in cadrul politraumatismelor
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Anatomie Cele trei componente care
constituie bazinul
IlionIschionPubis
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Incidente radiologice ale cotilului : bazin de fata si
2 incidente de trei sfert
Trei sferturi alara Trei sferturi obturatorie
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CONCEPTIA OSULUI ILIAC IN DOUA COLOANE
os iliac intact coloana anterioara
Coloana posterioara
os iliac intact
Coloana anterioara
Coloana posterioara
no man’s land
Coloana posterioara
Coloana posterioara
no man’s land
Trei sferturi alara Fata Trei sferturi obturatorie
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Studiul celor 9 repere radiologice
Repere anterioare Repere ale No man’s land
Repere posterioare
Aripa iliaca Tavan Marginea posterioara a cotilului
Margine anterioaraa cotilului
U Linia ilio-ischiatica
Rebordul superior Cadrul obturator Marginea posterioara osului iliac
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Repere anterioareRepere anterioare
Aripa iliaca
Margine anterioaraa cotilului
Rebordul superior
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Tavanul
U Cadrul obturator
Repere ale No man’s land
Tavan
U
Cadrul obturator
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Repere posterioare
Marginea posterioara a cotilului
Linia ilio-ischiatica
Marginea posterioara osului iliac
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CT de cotil
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Clasificarea fracturilor de cotil JUDET si LETOURNEL
R. Judet E. Letournel
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Fracturile de cotil
• Fracturi de perete posterior• Fracturi de coloana posterioara• Fracturi de coloana anterioara• Fracturi transversale• Fracturi in T• Fracturi complexe
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Fracturi de perete posterior
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Fracturi de perete posterior
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Fractura cu luxatia capului femural
![Page 94: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/94.jpg)
Incarcerarea posibila a unui fragment dupa luxatie
![Page 95: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/95.jpg)
Fracturi de coloana posterioara
Coloana post + perete post
![Page 96: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/96.jpg)
Fracturi de coloana anterioara
![Page 97: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/97.jpg)
Fracturi de coloana anterioara
![Page 98: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/98.jpg)
Fracturi de coloana anterioara
![Page 99: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/99.jpg)
Fracturi transversale
![Page 100: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/100.jpg)
Fracturi in T
![Page 101: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/101.jpg)
Fracturi complexe
![Page 102: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/102.jpg)
Colona anterioara + hemitransversala posterioara
Fracturi complexe
![Page 103: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/103.jpg)
Fractura celor 2 coloane
Fracturi complexe
![Page 104: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/104.jpg)
Fracturi atipice
![Page 105: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/105.jpg)
Fractura transversala + perete posterior
![Page 106: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/106.jpg)
Fractura celor 2 coloane
![Page 107: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/107.jpg)
Fracturi complexe
![Page 108: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/108.jpg)
Fracturi complexe
![Page 109: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/109.jpg)
Fracturi complexe
![Page 110: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/110.jpg)
Reconstructia 3D prezinta interes pentru planing-ul preoperator
![Page 111: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/111.jpg)
Reconstructia 3D prezinta interes pentru planing-ul preoperator
![Page 112: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/112.jpg)
CT cu « sustragerea » capului femural
![Page 113: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/113.jpg)
Tratamentul de asteptare al fracturilor de cotil : tractiunea
Tractiune prin brosa transtibiala
Care poate fi uneori asociata cu o tractiune laterala prin trohanterul mare pentru a dezinclava un cap femural protruzionat
![Page 114: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/114.jpg)
Reducere prin tractiune
![Page 115: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/115.jpg)
Osteosinteza posterioara
![Page 116: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/116.jpg)
Cale de abord posterioara
( Langen Beck)
Cu sau fara osteotomia marelui trohanter
![Page 117: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/117.jpg)
Osteosinteza posterioara
Abord transtrohanterian si placa posterioara mulata cu scopul de a reface relieful coloanei posterioare
Osteosinteza cotilului se face sub tractiune continua pe masa ortopedica
![Page 118: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/118.jpg)
Osteosinteza peretelui posterior
Cale de abord posterioara Langen Beck . Mai multe suruburi care fixeaza peretele posterior al cotilului
![Page 119: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/119.jpg)
Complicatie chirurgicala : Surub in conflict cu capul femural
![Page 120: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/120.jpg)
Osteosinteza anterioara
Fracturile coloanei anterioare sunt fixate pe cale de abord ilioinghinala
![Page 121: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/121.jpg)
Sechelele fracturilor de cotil
Coxartroza dezvoltata pe un calus vicios al cotilului: indicatie de proteza de sold
![Page 122: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/122.jpg)
Proteza totala de sold pentru sechele de fractura de cotil cu protruzie : Capul este utilizat ca grefa pentru reconstructia fundului cotilului si s-a implantat o proteza necimentata
![Page 123: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/123.jpg)
Proteza totala pentru sechele de fractura de cotil
![Page 124: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/124.jpg)
Luxatii traumatice de sold
![Page 125: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/125.jpg)
![Page 126: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/126.jpg)
Luxatiile pubiene si obturatorii sunt rare
Mecanism de abductie rotatie ext
![Page 127: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/127.jpg)
Luxatiile posterioare iliace si ischiatice
Cele mai frecvente
Traumatisme prin soc direct pe genunchi, cu soldul in flexie si adductie
(accidente cu soc de bord)
![Page 128: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/128.jpg)
Dupa o luxatie de sold posterioara, membrul pelvin este intr-una din
pozitiile?
A Flexie Abductie Rotatie externa
B Extensie Abductie Rotatie externa
C Flexie Adductie rotatie interna
D Extensie adductie rotatie interna
E Extensie adductie rotatie externa
![Page 129: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/129.jpg)
Dupa o luxatie de sold posterioara, membrul pelvin este intr-una din pozitiile?
A Flexie Abductie Rotatie externa
B Extensie Abductie Rotatie externa
C Flexie Adductie rotatie interna
D Extensie adductie rotatie interna
E Extensie adductie rotatie externa
![Page 130: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/130.jpg)
Luxatie posterioara pura
![Page 131: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/131.jpg)
Enumerati leziunile posibile legate direct de o Enumerati leziunile posibile legate direct de o luxatie posterioara de sold:luxatie posterioara de sold:
![Page 132: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/132.jpg)
Enumerati leziunile posibile legate direct de o Enumerati leziunile posibile legate direct de o luxatie posterioara de sold:luxatie posterioara de sold:
• Fractura peretelui posterioar al cotilului
• Fractura parcelara de cap femural sau leziuni cartilaginoase de pasaj
• Ruptura larga a capsulei articulare posterioare
• Ruptura ligamentului rotund
• Risc de devascularizare a capului femural ( necroza secundara)
• Compresia trunchiului nervului sciatic prin capul femural
![Page 133: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/133.jpg)
Leziuni asociate
• Fractura peretelui cotilului
• Fractura parcelara a capului
• Paralizia nervului sciatic
![Page 134: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/134.jpg)
Luxatia posterioara asociata cu o fractura de perete posterior al cotilului
Accidente ale socului de bord
Leziuni asociate :
– Ruptura lig incrucisat posterior
– Fractura rotulei
![Page 135: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/135.jpg)
Dupa o luxatie de sold posterioara, reducerea trebuie facuta in urgenta. Care sunt manevrele
si care sunt modalitatile de imobilizare?
![Page 136: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/136.jpg)
Reducerea
• Reducere sub anestezie generala
• Subiectul in decubit dorsal
• Se practica tractiunea pe genunchiul
flectat, mentinand soldul in flexie,
adductie si rotatie interna ( un ajutor
fixeaza bazinul)
• Se observa reintegrarea capului in
cotil. Atunci se poate face extensia
soldului
![Page 137: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/137.jpg)
• Reducere sub anestezie generala
• Subiectul in decubit dorsal
• Se practica tractiunea pe genunchiul flectat, mentinand
soldul in flexie, adductie si rotatie interna ( un ajutor fixeaza
bazinul)
• Se observa reintegrarea capului in cotil. Atunci se poate
face extensia soldului
• Se va mentine soldul in extensie printr-o tractiune llipita de gamba sau printr-o simpla atela de genunchi. Sunt interzise miscarile de flexie timp de 6 saptamani
• Merge fara sprijin 1-2 luni ( risc de necroza). Urmarire scintigrafica sau RMN
![Page 138: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/138.jpg)
Risc de necroza cefalica
• Scintigrafie osoasa pentru a verifica integritatea capului femural
• RMN
Radiografie simpla
![Page 139: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/139.jpg)
Osteosinteza peretelui posterior al cotilului
![Page 140: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/140.jpg)
Luxatia posterioara
Fractura de cotil asociata
![Page 141: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/141.jpg)
![Page 142: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/142.jpg)
Fragmente de os incarcerate in articulatie
![Page 143: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/143.jpg)
Leziunile capului si cotilului
Tratamentul, in acest caz, cu proteza totala de sold. Insertul metalic al
protezei este fixat cu suruburi ce joaca rol de osteosinteza interna
![Page 144: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/144.jpg)
Mecanism: Soc de bord bilateral
Luxatia soldului si fracturile de cap femural
![Page 145: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/145.jpg)
Clasificarea PIPKIN’S (4 STADII)- fracturi luxatii de cap femural
![Page 146: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/146.jpg)
CT al ambelor solduri
![Page 147: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/147.jpg)
Reducere prin anestezie generala cu manevre externe
Apoi brose percutanate la dreapta si suruburi la stanga
![Page 148: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/148.jpg)
CT de control postoperator
![Page 149: fracturi bazin](https://reader033.fdocument.pub/reader033/viewer/2022061319/5571fa074979599169910fe9/html5/thumbnails/149.jpg)
• Complicatii postoperatorii:Necroza capului femuralCoxartrozaOsificarile periarticulare