Prijelomi u području gležnja

master's thesis

• Title (english): Ankle region fractures
• Author: David Horvatić
• Mentor: Esmat Elabjer (mentor)
• Committee member: Ivan Dobrić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Esmat Elabjer (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Prijelomi u području gležnja čine 9% svih koštanih prijeloma u odraslih. Najčešće nastaju kao posljedice pada, skakanja, traume i sportskih ozljeda. Prema dobi prijelomi gležnja imaju bimodalnu distribuciju s najvećim brojem ozljeda u mladoj životnoj dobi kod
muškaraca i u starijoj životnoj dobi kod žena. Mogu biti otvoreni i zatvoreni, pri čemu su otvoreni rijetki sa svega 5% incidencije. Postupak zbrinjavanja je isti s razlikom da se kod otvorenih radi sekundarna obrada rane (odloženi šav). Liječenje ovisi o vrsti prijeloma, stabilnosti zgloba te stanju pacijenta, a za pomoć u odabiru terapijskog postupka postoje brojne klasifikacije. Najznačajnije su: Lauge-Hansenova, Danis-Weberova te AO/OTA klasifikacija. Lauge-Hansenova klasifikacija je osnovna za razumijevanje patomehanike prijeloma gležnja, a češće se koristi AO/OTA koja je praktičnija i opisuje lokaciju frakture, broj uključenih maleola te kongruenciju zgloba. Uz status i anamnezu neophodna je radiološka procjena. Snima se u AP, LL te projekciji ležišta u kojoj se najbolje prikazuju prijelomi gležnja. Liječenje može biti konzervativno i operativno. Konzervativno liječenje indicirano je u stabilnijih prijeloma s malim rizikom pomaka te u pacijenata s kontraindikacijama za kiruruško liječenje. Sastoji se od imobilizacije u trajanju od šest tjedana sa što ranijom mobilizacijom. Operativno liječenje indicirano je kod nestabilnih prijeloma. Princip operativnog liječenja je otvorena repozicija ulomaka te njihova fiksacija. Koriste se vijci, pločice i Kirschnerove žice, a u slučaju otvorenog prijeloma prema stupnju koristi se vanjska fiksacija. Ciljevi liječenja su postizanje anatomske repozicije, fiksacija te što ranija mobilizacija. Najčešće komplikacije su pomak ulomaka pri fiksaciji, kontrakture,
ukočenost gležnja i infekcija nakon operativnog liječenja.

Abstract (english)

Fractures in the ankle area account for 9% of all bone fractures in adults. They most commonly occur as a result of falls, jumps, trauma, and sports injuries. According to age, ankle fractures have a bimodal distribution and with the largest number of injuries among young men and older women. Fractures can be open and closed, while open occur in only 5%
of the cases. The care procedure is the same, with the difference of debridement and usually the delayed closure of the open fractures. The treatment depends on the type of fracture, stability of the joint and patient's condition. There are several classifications to help us decide how to treat the fractures. The most important classifications are the Lauge-Hansen, Danis-
Weber and AO / OTA. Lauge-Hansen's classification is essential for understanding the pathomechanics of ankle fractures but AO/OTA is more commonly used because it is more practical and describes fracture location, number of malleolae involved and joint congruity. In addition to status and medical history, radiological assessment is also necessary. Images are
recorded in AP, LL and the mortise view in which the ankle fractures are best shown. Treatment can be conservative and operative. Conservative treatment is indicated in more stable fractures with a low risk of displacement and if contraindications for surgical treatment are present. It consists of six weeks immobilization, following the earliest possible
mobilization. Surgical treatment is indicated in unstable fractures. The principle of operation is open reduction of fragments and their fixation. Screws, plates and Kirschner wires are used, but additional external fixation may be required if fracture is open. The goal of treatment is to achieve anatomical reduction, fixation and mobilization as soon as possible. The most
common complications are displacement of fragments during fixation, contractures, ankle stiffness and postoperational infections.

• Keywords: prijelomi gležnja; klasifikacija prijeloma; repozicija; fiksacija
• Keywords (english): ankle fractures; fracture classification; reduction; fixation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:641995
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-08-24 11:14:40