fracturile bazinului
DESCRIPTION
FRACTURILE BAZINULUI POLITRAUMATISME DE MARE ENERGIE ASOCIATE CU HEMORAGII IMPORTANTE Ş I MORTALITATE RIDICATÃ. FRACTURILE ACETABULARE SUNT FR. ARTIC. PROGNOSTICUL LOR ESTE ÎN PRIMUL RÂND PROGNOSTICUL ARTICULAR. FRACTURILE BAZINULUI. INCIDEN Ţ A. - PowerPoint PPT PresentationTRANSCRIPT
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FRACTURILE BAZINULUI
• FRACTURILE BAZINULUI
• POLITRAUMATISME DE MARE ENERGIE
• ASOCIATE CU HEMORAGII IMPORTANTE ŞI MORTALITATE RIDICATÃ
• FRACTURILE ACETABULARE
• SUNT FR. ARTIC.• PROGNOSTICUL
LOR ESTE ÎN PRIMUL RÂND PROGNOSTICUL ARTICULAR
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INCIDENŢA
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MALGAIGNE, SEC.19 PARIS ÎN 11ANI, 10 FRACTURI
ASTĂZI: 20% DIN POLITRAUMATISMELE GRAVE-Bărbaţii tineri, activi
Joseph Francois
Malgaigne
1806-1865
Hotel Dieu la 1860
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NOŢIUNI ANATOMICE
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STRUCTURA BAZINULUI
INEL COLOANE
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FRACTURI DE BAZIN
MECANISM DE PRODUCERE
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Mecanism de producereCOMPRESIUNE A.P.
OPEN BOOK FRACTURE
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Mecanism de producereCOMPRESIUNE A.P.
OPEN BOOK FRACTURE
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Mecanism de producereCOMPRESIUNE L.L.
OVERLAPING PELVIS
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Mecanism de producereCOMPRESIUNE L.L.
OVERLAPING PELVIS
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Mecanism de producereATERIZARE ASIMETRICĂ
VERTICAL SHEAR FRACTURE
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Mecanism de producereATERIZARE ASIMETRICĂ
VERTICAL SHEAR FRACTURE
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Mecanism de producereNECLASIFICABIL
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Mecanism de producereCONTRACŢII MUSCULARE
LOVITURI DIRECTE
NU AFECTEAZĂ STBILITATEA
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Mecanism de producereMICĂ ENERGIE VÂRSTNICI
NU AFECTEAZĂ STABILITATEA
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CLASIFICAREA TILE
1. Tipul A - StabileA1—fracturi ale bazinului ce nu afecteazã inelul pelvinA2—stabile cu minimă deplasare
2. Tipul B – Rotaţional instabile, vertical stabile
B1—Open book- prin compresiune antero posterioarăB2—Overlaping pelvis – prin compresiune laterală ipsilat. B3—Overlaping pelvis – prin compresiune laterală contr . 3. Tipul C – Rotaţional şi vertical instabileC1—Rotaţional şi vertical instabileC2—BilateraleC3—Asociate cu o fractură acetabulară
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Mecanism de producereFRACTURI ACETABULARE
• TRANSMITEREA FORŢEI
-în lungul diafizei femurale -în lungul colului femural
• POZIŢIA CAPULUI FEMURAL IN COTIL ÎN MOMENTUL IMPACTULUI
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ClasificareFRACTURI ACETABULARE
•ZONE PORTANTE
•ZONE NEPORTANTE
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Robert Judet1909-1980
Emile Letournel1927-1994
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CLASIFICAREA FR. ACET. JUDET-LETOURNEL
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EXAMENUL CLINIC
• ANAMNEZA
• INSPECŢIA
1. ATITUDINI VICIOASE
2. SCURTĂRI, DEFORMĂRI
3. ECHIMOZE, HEMATOAME
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EXAMENUL CLINIC
•CĂUTAREA DUR. ÎN PUNCT FIX
• CĂUTAREA DUR. LA DISTANŢĂ
• EVALUAREA STABILITĂŢII
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EVALUAREA IMAGISTICĂ A FRACTURILOR DE BAZIN
SE EFECTUEAZĂ APOI INCIDENŢE SPECIALE
•FRACTURI ACETABULARE
•FRACTURI DE BAZIN
SE ÎNCEPE ÎNTOTDEAUNA CU O INCIDENŢĂ ANTEROPOSTERIOARĂ
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PE O RADIOGRAFIE VEDEM DOAR CEEA CE CUNOAŞTEM
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INCIDENŢA A.P.
1) linia iliopectinee2) linia ilioischiatica3) “U”-ul radiologic4) domul (acoperisul) acet.5) marginea ant. a acet.6) marginea post. a acet.7) aripa iliacã8) gaura obturatorie
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1) linia iliopectinee 2) linia ilioischiatica 3) “U”-ul radiologic 4) domul (acoperisul) acet. 5) marginea ant. a acet. 6) marginea post. a acet. 7) aripa iliacã 8) gaura obturatorie
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INCIDENŢA OBLICĂ ALARĂ
COLOANA ILIOISCHIATICÃ
MARGINEA ANT. A COTILULUI
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INCIDENŢA OBLICĂ ALARĂ
COLOANA ILIOISCHIATICÃ
MARGINEA ANT. A COTILULUI
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INCIDENŢA OBLICĂ OBT.
COLOANA ILIOPUBIANÃ
MARGINEA POST. A COTILULUI
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INCIDENŢA OBLICĂ OBT.
COLOANA ILIOPUBIANÃ
MARGINEA POST. A COTILULUI
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UNGHIURILE ARCURILOR DE ACOPERIRE
MEDIAL ANTERIOR POSTERIOR
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Vederea de intrare în bazin
1. Configuraţia de inel a bazinului
2. Îngustarea sau lărgirea acestui inel
3. Deplasarea posterioară a fragmentului fracturat
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• Deplasarea posterioară a fragmentului fracturat
• Linia sacrogluteală
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Vederea de ieşire din bazin
1. Translarea verticală a hemibazinului fracturat
2. Sacrul şi gaurile sacrale
3. Partea inferioară a arcului anterior
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1. Translarea verticală a hemibazinului fracturat
2. Sacrul şi gaurile sacrale
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Vederea de ieşire din bazin
1. Translarea verticală a hemibazinului fracturat
2. Sacrul şi gaurile sacrale
3. Partea inferioară a arcului anterior
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COMPUTER TOMOGRAFIA
UTILĂ FR. BAZIN & FR. ACETAB.
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TRATAMENTUL FRACTURILOR DE
BAZIN
•TRATAMENTUL COMPLICAŢIILOR
•TRATAMENTUL FRACTURII
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ALGORITM TRATAMENT
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COMPLICAŢII VASCULARE
CAUZĂ DE MORTAL. PRECOCE
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COMPLICAŢII VASCULARE
PANTALONI PNEUMATICI ANTIŞOC
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COMPLICAŢII VASCULARE
STABILIZAREA DE URGENŢÃ CU SCOP HEMOSTATIC
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COMPLICAŢII VASCULARE
PELVIC C CLAMP
PENTRU STABILIZAREA POSTERIOARĂ
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COMPLICAŢII VASCULARE
ANGIOGRAFIA ŞI EMBOLIZAREA
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COMPLICAŢII UROLOGICE
CELE MAI FRECVENTE 10-15%
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COMPLICAŢII UROLOGICE
RUPTURI VEZICALE INTRA SAU EXTRAPERITONEALE
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COMPLICAŢII NEUROLOGICE
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COMPLICAŢII NEUROLOGICE
1.NERVUL SCIATIC CU FASCICOLUL SCIATIC POPLITEU EXTERN
2.NERVUL OBTURATOR
3.NERVUL RUŞINOS
4.NERVUL FEMURO CUTANAT
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COMPLICAŢII DIGESTIVE
•LEZIUNI RECTALE
•LEZIUNI ALE SIGMOIDULUI
•LEZIUNI ALE INTESTINULUI SUBŢIRE
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COMPLICAŢII GINECOLOGICE
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COMPLICAŢII SISTEMICE
1.DECES 20-50%
2.TROMBOFLEBITA VENOASĂ CU EMBOLIE PULMONARĂ
3.EMBOLIA GRĂSOASĂ
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FRACTURI DE BAZIN TRATAMENT
• IN FUNCŢIE DE TIPUL ŞI GRAVITATEA LEZIUNII
• FRACTURI TIP A1 SAU A2
•FRACTURI INSTABILE
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FRACTURI DE BAZIN TRATAMENT
• FRACTURI STABILE
TIP A1 SAU A2
1. REPAUS PÂNĂ LA CEDAREA DURERILOR
2. RELUAREA PROGRESIVĂ A ACTIVITĂŢII
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FRACTURI DE BAZIN TRATAMENT
•FRACTURI INSTABILE
1.TRATAMENT ORTOPEDIC
2.TRATAMENT CHIRURGICAL
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FRACTURI DE BAZIN TRATAMENT ORTOPEDIC
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FRACTURI DE BAZIN TRATAMENT ORTOPEDIC
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FRACTURI DE BAZIN TRATAMENT ORTOPEDIC
Fixator extern pentru fracturi cu inst. rotatorie
Asociată cu tracţiune dacă avem şi o instabilitate verticală
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FRACTURI DE BAZIN TRATAMENT CHIRURGICAL
leziunea anterioară
leziunea posterioară
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FRACTURI DE BAZIN TRATAMENT CHIRURGICAL
Leziunea posterioară poate fi abordată posterior faţă de art. sacroiliacă - bulonaj ilioiliac
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FRACTURI DE BAZIN TRATAMENT CHIRURGICAL
Şuruburi iliosacrale introduse percutanat sub control rx tv
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FRACTURI DE BAZIN TRATAMENT CHIRURGICALAbordată anterior de articulaţia sacroiliacă – placă şi şuruburi
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COMPLICAŢII TARDIVE
1. CALUSURILE VICIOASE CU SCURTĂRI DE MEMBRU
2. ENTORSELE CRONICE
3. PSEUDARTROZELE
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FRACTURI ACETABULARETRATAMENT
• ARTICULAŢIE CONGRUENTĂ
• ARTICULAŢIE CONCENTRICĂ
Sunt fracturi articulare
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FRACTURI ACETABULARETRATAMENT ORTOPEDIC
1. FRACTURI CU MINIMĂ DEPLASARE2. FRACTURI CU DEPLASARE ÎN ZONĂ
NEPORTANTĂ3. FRACTURI DE AMBE COLOANE CU
CONGRUENŢĂ SECUNDARĂ4. CONTRAINDICAŢII MEDICALE5. FRACTURI CU MARE COMINUŢIE
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FRACTURI ACETABULARETRATAMENT ORTOPEDIC
TRACŢIUNE CONTINUĂ 6 SĂPTĂMÂNI
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FRACTURI ACETABULARETRATAMENT ORTOPEDIC
TRACŢIUNE CONTINUĂ 6 SĂPTĂMÂNI
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FRACTURI ACETABULARETRATAMENT CHIRURGICAL
1. FRACTURI CE NU ÎND. CRITERIILE TRATAMENTULUI ORTOPEDIC
2. POLITRAUMATIZAŢI CE TREBUIESC MOBILIZAŢI
3. REDUCERE NECONCENTRICĂ4. PREVENIREA PSEUDARTROZELOR5. FRACTURI DE PERETE POSTERIOR >50%
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FRACTURI ACETABULARETRATAMENT CHIRURGICAL
ANTERIOR ILIOINGHINAL
POSTERIOR KOCHER-LANGENBACK
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FRACTURI ACETABULARETRATAMENT CHIRURGICAL
ANTERIOR ILIOINGHINAL
POSTERIOR KOCHER-LANGENBACK
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FRACTURI ACETABULARECOMPLICAŢII
1. INFECŢIA 1-5%
2. NECROZA AVASCULARĂ 2-8%
3. LEZIUNI NEUROLOGICE 10-15%
4. OSIFICĂRI HETEROTOPICE 14-50%
5. COMPL. TROMBOEMBOLICE 8-61%
6. ARTROZA POSTTRAUMATICÃ