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1、Approachtoacuteankleinjury:Doesthispatienthaveafracture?BrandonAuerbach,HMSIIIMondayFebruary22,2010IntrotoAcuteAnkleInjury•AnkleradiographsarethirdmostDDXofacuteankleinjurycommonradiographorderedinthe(1)SprainED,exceededonlybychestandc--Aclinicaldiagnosisspine*-Upto85%ofanklesp
2、rainsarecausedbyinversionforcesduring•Acuteankleinjuryaccountsfor25%plantarflexionwithdamagetotheofsportsinjuriesandarethemostlateralligaments**commoncauseoftimelostinathletics**(2)Dislocation(3)Fracture•Population-levelstudiesofacute~70%unimalleolarankleinjuriespresentingtothe
3、ED~20%bimalleolarindicatethatthatlessthan15%of~10%trimalleolartheseinjurieshavefractures***(4)OtherInjury:nervesorbloodvessels*Dunlop,MG,etal.BMJ1986293(6547):603-605.**Dunfee,WR,etal.RadiolClinNAm40(2002):289–312***Bachman,LM,etal.BMJ2003;326:417.CaseIThepatientisa64year-oldwo
4、manwithoutprevioushistoryoffracturesoranklesprainswhopresentstotheEDafterfallingontheiceandsufferinganinversioninjurytoherrightankle.Shehadimmediatepainanddiscomfortalongthelateralaspectofherankle.Shehasassociatedankleswellingandpain,butdeniesparesthesias.Shehaspainwithambulati
5、ngandnospecificrelievingfactorsotherthanrest.Beforeyouexamineher,youreviewankleanatomyandphysicalexaminationAnterior,crosssectional,andinferiorviewsoftibiaandfibulaKeySyndesmosisLateralLigamentsMedial(Deltoid)LigamentNetter,FH.AtlasofHumanAnatomy,3E,plate496KeySyndesmosisDorsal
6、viewofbonesoffoot,andPosteriorLateralviewofanklebonesandligamentsLigamentsMedial(Deltoid)LigamentNetter,FH.AtlasofHumanAnatomy,3E,plates505and507MedialandlateralviewsofankleKeySyndesmosisLateralLigamentsMedial(Deltoid)LigamentNetter,FH.AtlasofHumanAnatomy,3E,plate509AnkleAnatom
7、y:Nomenclatureandthe“RuleofRings”InterosseousMembraneTibiaFibulaMedialTalus(Deltoid)LigamentLateralLigamentsCalcaneushttp://www.southwest-ortho.com/images/ankles/ankle-joint-components.jpgKoehler,SM,etal.“OverviewofAnkleFractures”.UptoDate17.3.Figure3.FocusedHistoryandPhysicalE
8、xamHistoryBluetermsindicateOttawaRulescriteria-Lengtho
