Fraktura malog prsta
Zoran Vranjican
potrebna?
--
Zoran
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Life is short, science is long,
opportunity is elusive,
experiment is dangerous...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Damir (DMS)
> Terapija frakture malog prsta na nozi? Pretpostavljam da imobilizacija nije potrebna?
Dovoljno je flasterom medusobno ucvrstiti IV i V prst nekoliko dana
dok ne prode algicna faza.
Ako je prst deformiran (zbog dislokacije fragmenata ili luksacije MTP ili IP zglobova)
moze biti kasnije problema kod nosenja elegantnijih cipela. U tom slucaju
treba prst reponirati bez obzira na funkcionalnu i estetsku nevaznost malog prsta.
P.S.
Ne postoji fraktura prsta, samo fraktura neke od kostiju.
--
Pozdrav
Damir
Never take life seriously. Nobody gets out alive, anyway.
Zoran Vranjican
fraktura nego se otkrhnuo dio baze falange, bez dislokacije. Zapravo me i ne
boli tako jako. Nisam isao kirurgu jer sam pretpostavljao da nije potrebna
imobilizacija (a i bojim se doktora :-))
sasa
> Hvala ti na odgovoru. Sredio sam si mali prst na lijevoj nozi. Nije
poprecna
> fraktura nego se otkrhnuo dio baze falange, bez dislokacije. Zapravo me i
ne
> boli tako jako. Nisam isao kirurgu jer sam pretpostavljao da nije potrebna
> imobilizacija (a i bojim se doktora :-))
>
> Zoran
>
Dobrodosao u klub doktora s polomljenim prstima koji ne idu doktoru. Ja sam
proslog ljeta slomio palac lijevog stopala (ne navodim koju kost jer nisam
slikao), vjerojatno je nesto u IP zglobu ili blizu jer sad imam
kontrakturu - fleksija do 15 st.
Sasa (FMR)
Stari Bak
sasa wrote in message
> Zoran Vranjican wrote in message
> > boli tako jako. Nisam isao kirurgu jer sam pretpostavljao da nije
potrebna
> > imobilizacija (a i bojim se doktora :-))
>
> Dobrodosao u klub doktora s polomljenim prstima koji ne idu doktoru. Ja
sam
> proslog ljeta slomio palac lijevog stopala (ne navodim koju kost jer nisam
> slikao), vjerojatno je nesto u IP zglobu ili blizu jer sad imam
> kontrakturu - fleksija do 15 st.
Fleksiju do 15 ja mogu na zdravom, a na ovom kojeg sam lomio (i nisam
slikao) prije par mjeseci, i koji je donedavno znao i zaboliti, i manje.
Dobrodosao u klub doktora koji imaju kontrakturu haluksa...
kao posljedicu pokusaja preskakanja konopa :o(i zapinjanja)
[paste from file]
Chapter Contents
INJURIES OF THE TOES
Fractures of the Great Toe
Mechanisms and Signs of Fracture
Two mechanisms are responsible for most hallux fractures: direct blows from
objects being dropped on the unprotected foot and "stubbing" injuries as
described by Jahss.594 Most of these injuries can be prevented by use of
proper protective footwear. Shiraishi and associates722 reported three
patients with stress fractures of the base of the proximal phalanx in
athletes. They postulated that repeated forced dorsiflexion of the
metatarsophalangeal joint was the cause.
Patients have persistent pain after injury, frequently presenting 24 hours
or more after the injury with significant swelling and a subungual hematoma.
Rarely is there significant deformity, because most fractures are only
minimally displaced. X-rays in the anteroposterior and oblique projections
demonstrate most fractures. On occasion, a lateral view is required. This
projection should be obtained with the lateral four toes passively
dorsiflexed to avoid overlap with the hallux. Another method to achieve
adequate x-ray visualization in the lateral projection is to use a dental
x-ray film inserted between the first and second toes with the x-ray being
directed laterally to obtain an isolated view of the great toe.
Treatment
All toe injuries are persistently painful and require adequate splinting and
analgesic medication for 2 to 3 weeks. A nondisplaced fracture of the great
toe may be adequately but minimally immobilized by adhesive plaster taping
using the uninjured second toe as a splint. A hard-soled shoe or a
postoperative wooden-soled shoe should be worn, and the patient should be
given crutches to allow partial weight-bearing as tolerated. If taping does
not provide adequate pain relief, then the foot should be immobilized in a
short-leg walking cast with a toe plate to provide firm support for the
injured toe. After 10 to 14 days the cast can usually be replaced by a
firm-soled shoe.
Displaced intra-articular fractures of the interphalangeal joint require
reduction. Frequently this can be achieved by longitudinal traction applied
through finger traps (Fig. 32-135). Once reduced, the fragments are
sometimes stable and the fracture can be treated by short-leg walking cast
immobilization. If a stable, adequate reduction is not achieved by closed
means, the interphalangeal joint should be opened through a midlateral
incision and the fragments reduced and fixed with small-diameter Kirschner
wires or small screws.711 Occasionally displaced intra-articular fracture
fragments do not heal, producing a painful subcutaneous mass or crepitus on
joint motion (Fig. 32-136). Jones715 believed that this pattern of fracture
may be caused by fatigue failure after repetitive stress. These ununited,
displaced fragments can be treated best by excision of the fragment and
repair of the capsule and any attached collateral ligament.
Dislocations of the Interphalangeal Joint
Dislocation or fracture-dislocation of the interphalangeal joint usually
occurs when an axial load is applied to the end of the digit, as when the
foot kicks a wall. Most dislocations are dorsal and can be reduced with
digital block anesthesia and traction combined with gentle manipulation of
the distal phalanx. Once reduced, the dislocation is usually stable and
requires only 2 to 3 weeks of productive splinting to the second toe to
allow healing of soft tissues.
As with the first metatarsophalangeal joint, irreducible (complex)
dislocation of the interphalangeal joint can occur.717,718,719,720,723,724
Miki and colleagues,719 in a review of the world literature, found reports
of 22 cases. Two distinct patterns were seen, and in all cases the displaced
plantar plate (often containing a sesamoid bone) blocked closed reduction.
In one type of injury, the plate was displaced into the interphalangeal
joint, producing a widened joint space. In these cases, the toe is slightly
elongated but does not have significant deformity otherwise. In the second
pattern, the interphalangeal joint is locked in hyperextension because the
plate is completely displaced dorsally over the neck of the proximal
phalanx. I have treated one case of dorsal fracture-dislocation of the
interphalangeal joint that was irreducible due to interposition of the
plantar plate and sesamoid by closed means (Fig. 32-137).
Irreducible dislocations with severe deformity are easy to diagnose, but
the pattern with just residual displacement of the plantar plate into the
interphalangeal joint may not be recognized unless careful attention is paid
to the width of the joint space after "reduction" of an interphalangeal
joint dislocation.
All complex dislocations require open reduction to replace the plantar
plate and its sesamoid in its proper position. Reduction can be accomplished
through a dorsal approach, and, once reduced, the joint is usually stable
and requires only cast immobilization for 4 to 6 weeks to allow healing of
soft tissue.719
Injuries of the Lesser Toes
Fractures
Fractures of the lesser toes are quite common, resulting from direct blows
or from striking the unprotected toe against a hard object (Fig. 32-138). As
with the great toe, these injuries are quite painful and may cause
significant impairment of function for 2 to 3 weeks until stabilized by
fracture callus. Anteroposterior, oblique, and lateral forefoot x-rays (with
the uninjured toes pulled dorsally) adequately demonstrate the fracture. If
significant displacement or angulation is present, these can be reduced by
longitudinal manual traction or with wire finger traps. Usually, displaced
fractures are stable when reduced. Moderate degrees or persistent fracture
angulation or displacement can be accepted on x-ray if the general, overall
appearance of the toe is acceptable clinically. The toe should be splinted
to the adjacent toe with adhesive tape after a gauze pad is placed in the
web space to prevent skin maceration. Splinting with tape, combined with the
use of a firm-soled shoe and adequate oral analgesics for 2 to 3 weeks,
allows healing in virtually all instances.708
Dislocations
Dislocation of the distal interphalangeal (DIP) or proximal interphalangeal
(PIP) joints of the toes is rare. Manual reduction under digital block is
easy to accomplish and is usually stable. The toe should be splinted to the
adjacent toe for 10 days to 2 weeks to allow capsular healing. Katayama and
associates716 have reported 3 cases of complex dislocation of the DIP joint
of the second toe. Closed reduction was prevented by interposition of the
plantar plate, and open reduction was successful through a dorsal approach.
Fugate and coworkers711 reported an irreducible fracture- dislocation of the
PIP joint of the third toe due to interposition of the flexor tendon.
Jahss713 reported an interesting series of ten patients with persistent,
unreduced dislocation or recurrent dislocation of the PIP joint of the fifth
toe after untreated abduction injury to that digit. The patients complained
of deformity and toe irritation from shoes but no joint pain. The surgical
treatment found most effective for these chronic problems was resection
arthroplasty of the joint combined with syndactylization of the toe to the
adjacent fourth toe (Fig. 32-139).
Reference po zelji.
--
Woah Stari Bak