Evaluation of Maisonneuve Fracture, Focused on Trauma Mechanism and Treatment
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Potīšu lūzumi ir bieži sastopami traumatoloģijā. Retākais potīšu lūzuma veids ir Maisonneuve lūzums. Maisonneuve lūzums ir mazā lielakaula (fibulas) proksimālās trešdaļas spirālveida lūzums, kas saistīts ar apakšējo tibiofibulāro saiti un apakšstilba starpkaulu membrānas plīsumu. Pētījuma mērķis bija novērtēt Maisonneuve lūzumu raksturojumu saistībā ar traumas mehānismiem un ārstēšanas principiem.
Metodes: Tika meklēti atbilstoši raksti par Maisonneuve lūzumu PubMed, Science Direct, ProQuest datu bāzēs, SAGE un Ovid Wolters Kluwer žurnālu arhīvos, kas tika publicēti laika posmā no 1976. līdz 2021. gadam. Lai iegūtu dziļāku izpratni un sniegtu sīkāku informāciju par šo pētījumu, tika izmantoti arī citi avoti, kā piemēram AO fonda ķirurģijas atsauces vietne.
Rezultāti: Pēc Lauge-Hansen klasifikācijas Maisonneuve lūzums tiek klasificēts kā pronācijas - ārējās rotācijas trauma, pēc Pankoviča klasifikācijas kā supinācijas - ārējās rotācijas trauma, bet pēc AO/OTA klasifikācijas kā Weber C lūzums un 44C3 trauma. Maisonneuve lūzumi biežāk sastopami vīriešiem un tie veido aptuveni 2–5% no slimnīcā ārstētajamo potīšu lūzumu gadījumiem. Lielākā daļa šo lūzumu gadījumi tiek iegūti kā pronācijas-ārējās rotācijas trauma, bet ir iespējams arī supinācijas-ārējās rotācijas traumas mehānisms. Tādejādi Maisonneuve lūzums prezentējas kā mazā lielkakaula (fibulas) proksimālās daļas spirālveida lūzumu ar priekšējās distālās tibiofibulārās sindesmozes bojājumu un mediālās vai sānu potītes traumu. Potīšu lūzumu klīniskās izmeklēšanas laikā ir svarīgi izpalpēt mazā lielakaula (fibulas) proksimālo daļu. Lielākā daļa pētījumu ir vienisprātis par Maisonneuve lūzumu ārstēšanu, uzsverot, ka vislielākā nozīme ir potītes stabilitātei un tiešu fiksāciju lauztajam kaulam var neveikt. Ķirurģiskās pieejas un izmantotojamie materiāli ir līdzīgi kā biežāk sastopamo potīšu lūzumu gadījumos, bet rutīnā, lai nodrošinātu lielāku stabilitāti, parasti tiek izmantoti divi stabilizatori, vairumā gadījumu tās ir trans-sindesmotiskās skrūves (trans-syndesmotic lag screws). Pārsvarā ķirurģiskas iejaukšanās rezultāti ir apmierinoši, bet sarežģītākos gadījumos slikts iznākums var būt paredzams pēc sākotnējās prezentācijas.
Secinājums: Maisonneuve lūzums ir mazā lielakaula (fibulas) proksimālās trešdaļas spirālveida lūzums, kas saistīts ar apakšējo tibiofibulāro saiti un apakšstilba starpkaulu membrānas plīsumu. Visbiežāk tas notiek pronācijas-ārējās rotācijas traumu dēļ, lai gan supinācija-ārēja rotācija ir arī iespējams traumas mehānisms. Tā nestabilā rakstura dēļ ārstēšanas pamatā ir ORIF, lai gan, ja var pieņemt, ka stabilitāte ir, var apsvērt slēgtu samazināšanu un liešanu.
Introduction: Ankle fractures are commonly encountered in traumatology. A less frequent fracture type among them is the Maisonneuve fracture. The Maisonneuve fracture is a spiral fracture of the proximal third of the Fibula associated with a tear of the inferior tibiofibular ligament and the interosseous membrane of the leg. The aim of the study was to evaluate the Maisonneuve fracture characteristics, in relation to trauma mechanisms, and principles of the treatment. Methods: The PubMed, Science Direct, ProQuest, SAGE journals and Ovid Wolters Kluwer journal archives were searched for articles published between 1976 to 2021 on the Maisonneuve fracture and if feasible included. Other sources e.g. the surgery reference website by the AO foundation were used to gain a deeper understanding and provide further detail in this research. Results: The Maisonneuve fracture is classified as a pronation-external rotation injury according to the Lauge-Hansen classification, a supination external rotation injury according to the Pankovich classification, a Weber C fracture and a 44C3 injury according to the AO/OTA classification. Maisonneuve fractures make up around 2-5% of ankle fracture cases treated in the hospital. Among patients with a Maisonneuve fracture a male predominance was found. The majority of cases are obtained as a pronation-external rotation injury but supination-external rotation injuries are also possible. Thus, a Maisonneuve fracture will present with a spiral fracture of the proximal fibula, a disruption of the anterior distal tibiofibular syndesmosis and injuries of the medial or lateral ankle. On the clinical examination of ankle fractures it is important to palpate the proximal fibula. Most researches agree on the treatment of Maisonneuve fracture in which the stability of the ankle mortise is of the highest importance and a direct fixation of the fractured proximal fibula can be neglected. Surgical approaches and materials used are similar to those in more common ankle fractures, though routinely two stabilizers, in most cases trans-syndesmotic lag screws, are used in order to provide greater stability. Outcome with surgical intervention is generally reported to be satisfactory, though in more complicated cases a bad outcome may be predictable from the initial presentation. Conclusion: The Maisonneuve fracture is a spiral fracture of the proximal Fibula often together with a tear of the inferior tibiofibular ligament and the interosseous membrane of the leg. It most commonly occurs due to pronation-external rotation injuries, though supination-external roation is also a possible injury mechanisms. Due to its unstable nature the mainstay of treatment involves ORIF, though if stability can be assumed, closed reduction and casting may be considered.
Introduction: Ankle fractures are commonly encountered in traumatology. A less frequent fracture type among them is the Maisonneuve fracture. The Maisonneuve fracture is a spiral fracture of the proximal third of the Fibula associated with a tear of the inferior tibiofibular ligament and the interosseous membrane of the leg. The aim of the study was to evaluate the Maisonneuve fracture characteristics, in relation to trauma mechanisms, and principles of the treatment. Methods: The PubMed, Science Direct, ProQuest, SAGE journals and Ovid Wolters Kluwer journal archives were searched for articles published between 1976 to 2021 on the Maisonneuve fracture and if feasible included. Other sources e.g. the surgery reference website by the AO foundation were used to gain a deeper understanding and provide further detail in this research. Results: The Maisonneuve fracture is classified as a pronation-external rotation injury according to the Lauge-Hansen classification, a supination external rotation injury according to the Pankovich classification, a Weber C fracture and a 44C3 injury according to the AO/OTA classification. Maisonneuve fractures make up around 2-5% of ankle fracture cases treated in the hospital. Among patients with a Maisonneuve fracture a male predominance was found. The majority of cases are obtained as a pronation-external rotation injury but supination-external rotation injuries are also possible. Thus, a Maisonneuve fracture will present with a spiral fracture of the proximal fibula, a disruption of the anterior distal tibiofibular syndesmosis and injuries of the medial or lateral ankle. On the clinical examination of ankle fractures it is important to palpate the proximal fibula. Most researches agree on the treatment of Maisonneuve fracture in which the stability of the ankle mortise is of the highest importance and a direct fixation of the fractured proximal fibula can be neglected. Surgical approaches and materials used are similar to those in more common ankle fractures, though routinely two stabilizers, in most cases trans-syndesmotic lag screws, are used in order to provide greater stability. Outcome with surgical intervention is generally reported to be satisfactory, though in more complicated cases a bad outcome may be predictable from the initial presentation. Conclusion: The Maisonneuve fracture is a spiral fracture of the proximal Fibula often together with a tear of the inferior tibiofibular ligament and the interosseous membrane of the leg. It most commonly occurs due to pronation-external rotation injuries, though supination-external roation is also a possible injury mechanisms. Due to its unstable nature the mainstay of treatment involves ORIF, though if stability can be assumed, closed reduction and casting may be considered.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Maisonneuve lūzums, Lauge-Hansen, Pankovičs, AO/OTA, pronācija - ārējā rotācija, supinācija - ārējā rotācija, ORIF, Maisonneuve fracture, Lauge-Hansen, Pankovich, AO/OTA, pronation - external rotation, supination - external roation, ORIF