Modifikovana tehnika lečenja iščašenja gornjeg golenjačnolišnjačkog zgloba

  • Nemanja M Gvozdenović Univerzitet u Novom Sadu, Medicinski fakultet, Klinički Centar Vojvodina, Klinika za ortopediju i traumatologiju
  • Katarina Gvozdenović Department of Radiology, Clinical Centre of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Mirko Obradović Department of Orthopedic Surgery and Traumatology, Clinical Centre of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Milan Stanković Department of Orthopedic Surgery and Traumatology, Clinical Centre of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP150318177G
Ključne reči: knee dislocation||, ||koleno, iščašenje, joint instability||, ||zglob, nestabilnost, diagnosis||, ||dijagnoza, orthopedic procedures||, ||ortopedske procedure, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Dislokacija gornjeg golenjačnolišnjačkog zgloba je retka povreda. Postavljanje dijagnoze se zasniva na anamnezi, kliničkom pregledu i RTG dijagnostici oba kolena. U literaturi nisu zabeležene velike serije ovih povreda, te su opisani kao pojedinačni slučajevi koji su lečeni različitim tehnikama. Cilj rada bio je da se predstavi modifikovana tehnika lečenja nestabilnosti gornjeg golenjačnolišnjačkog zgloba koja rezultuje brzim oporavkom bolesnika. Prikaz bolesnika. Fudbaler, star 24 godine, povredio se na početku treninga prilikom uklizavanja kada je osetio jak bol u desnom kolenu. Odmah je dovezen na pregled u Urgentni centar Vojvodine gde je dijagnostikovano prednje spoljašnje iščašenje gornjeg golenjačnolišnjačnog zgloba. Pokušana je ortopedska repozija u kratkotrajnoj intravenskoj anesteziji, ali nije bila uspešna te je pacijent bio pripreman za hirurški zahvat – otvorene repozije golenjačnolišnjačnog zgloba i njegovu fiksaciju sa jednim zavrtnjem kroz tri korteksa. Postoperativno nije postavljena imobilizacija i odmah su započete pasivne i aktivne vežbe u kolenu, ali bez oslonca na operisanu nogu. Nakon isteka šest postoperativnih nedelja odstranjen je zavrtanj i dat je pun oslonac na nogu i nastavljeno je fizikalno lečenje. Zaključak. U slučaju iščašenja gornjeg golenjačnolišnjačkog zgloba prvi metod izbora lečenja je ortopedska repozicija, a ukoliko ona ne da rezultate, pristupa se otvorenoj repoziciji i unutrašnjoj fiksaciji. Otvorena repozicija i unutrašnja fiksacija bez postoperativno postavljene imobilizacije i odmah započeta rehabilitacija dovode do bržeg oporavka i brzog vraćanja sportskim aktivnostima.

Biografija autora

Nemanja M Gvozdenović, Univerzitet u Novom Sadu, Medicinski fakultet, Klinički Centar Vojvodina, Klinika za ortopediju i traumatologiju
Srbija

Reference

Nelaton A. Elements de pathologic chirurgicale. Paris: Librairie Germer Ballière; 1874.

Ogden JA. Subluxation and dislocation of the proximal tibio-fibular joint. J Bone Joint Surg Am 1974; 56(1): 145−54.

Turco VJ, Spinella AJ. Anterolateral dislocation of the head of the fibula in sports. Am J Sports Med 1985; 13(4): 209−15.

Harvey GP, Woods GW. Anterolateral dislocation of the proxi-mal tibiofibular joint: Case report and literature review. Today's OR Nurse 1992; 14(3): 23−7.

Ogden JA. The anatomy and function of the proximal tibiofibular joint. Clin Orthop Relat Res 1974; 101: 192−7.

Laing A, Lenehan B, Ali A, Prasad C. Isolated dislocation of the proximal tibiofibular joint in a long jumper. Br J Sports Med 2003; 37(4): 366−7.

Falkenberg P, Nygaard H. Isolated anterior dislocation of the proximal tibiofibular joint. J Bone Joint Surg Br 1983; 65(3): 310−1.

Arziman I, Katırcı Y, Bilgiç S, Tuncer SK. Isolated dislocation of the head of the fibula. J Clin Anal Med 2011; 2: 99−100.

Parkes JC, Zelko RR. Isolated acute dislocation of the proximal tibiofibular joint. Case report. J Bone Joint Surg Am 1973; 55(1): 177−83.

Milankov M, Kecojević V, Gvozdenović N, Obradović M. Dislocation of the proximal tibiofibularjoint. Med Pregl 2013; 66(9−10): 387−91.

Sekiya JK, Kuhn JE. Instability of the proximal tibiofibular joint. J Am Acad Orthop Surg 2003; 11(2): 120−8.

Lyle HH. Traumatic luxation of the head of the fibula. Ann Surg 1925; 82(4): 635−9.

Weinert CR, Raczka R. Recurrent dislocation of the superior tibiofibular joint. Surgical stabilization by ligament reconstruc-tion. J Bone Joint Surg Am 1986; 68(1): 126−8.

Tanner SM, Brinks KF. Reconstruction of the proximal tibio-fibular joint: A case report. Clin J Sport Med 2007; 17(1): 75−7.

Horst PK, Laprade RF. Anatomic reconstruction of the chronic symptomatic anterolateral proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc 2010; 18(11): 1452−5.

Crothers OD, Johnson JT. Isolated acute dislocation of the prox-imal tibiofibular joint. Case report. J Bone Joint Surg Am 1973; 55(1): 181−3.

Miettinen H, Kettunen J, Väätäinen U. Dislocation of the proximal tibiofibular joint.A new method for fixation. Arch Orthop Trauma Surg 1999; 119(5−6): 358−9.

Robinson Y, Reinke M, Heyde CE, Ertel W, Oberholzer A. Trau-matic proximal tibiofibular joint dislocation treated by open reduction and temporary fixation: A case report. Knee Surg Sports Traumatol Arthrosc 2007; 15(2): 199−201.

Eichenblat M, Nathan H. The proximal tibiofibular joint: an ana-tomical study with clinical and pathological considerations. Int Orthop 1983; 7(1): 31−9.

Bozkurt M, Yilmaz E, Atlihan D, Tekdemir I, Havitcioglu H, Gunal I. The proximal tibiofibular joint: an anatomic study. Clin Or-thop Relat Res 2003; 406: 136−40.

Aladin A, Lam KS, Szypryt EP. The importance of early diag-nosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee 2002; 9(3): 233−6.

Ellis C. A case of isolated proximal tibiofibular joint dislocation while snowboarding. Emerg Med J 2003; 20(6): 563−4.

Ares O, Conesa X, Seijas R, Carrera L. Proximal tibiofibular dis-location associated with fracture of the tibia: a case report. Cases Journal 2009; 2(1): 196.

Turco VJ, Spinella AJ. Anterolateral dislocation of the head of the fibula in sports. Am J Sports Med 1985; 13(4): 209−15.

Laprade RF, Terry GC. Injuries to the Posterolateral Aspect of the Knee: Association of Anatomic Injury Patterns with Clini-cal Instability. Am J Sports Med 1997; 25(4): 433−8.

Goldstein Y, Gold A, Chechik O, Drexler M. Dislocation of the proximal tibiofibular joint: A rare sports-related injury. Isr Med Assoc J 2011; 13(1): 62−3.

Morrison T, Shaer J, Little J, Bilateral . Atraumatic, Proximal Tibiofibular Joint Instability. Orthopedics 2011; 34(2): 133.

Horan J. Proximal tibiofibular dislocation. Emerg Med J 2006; 23(5): e33.

Andersen K, Lind T. Simultaneous fracture of the ankle and dis-ruption of the superior tibiofibular joint: A case report. Acta Orthop Scand 1991; 62(4): 399−400.

Burke NG, Robinson E, Thompson NW. An isolated proximal tibiofibular joint dislocation in a young male playing soccer: A case report. Cases J 2009; 2(1): 7261.

Capps GW, Hayes CW. Easily missed injuries around the knee. Radiographics 1994; 14(6): 1191−210.

Ellis C. A case of isolated proximal tibiofibular joint dislocation while snowboarding. Emerg Med J 2003; 20(6): 563−4.

van den Bekerom MP, Weir A, van der Flier RE. Surgical stabiliza-tion of the proximal tibiofibular joint using temporary fixation: a technical note. Acta Orthop Belg 2004; 70(6): 604−8.

Semonian R, Denlinger P, Duggan R. Proximal tibiofibular sublux-ation relationship to lateral knee pain: A review of proximal tibiofibular joint pathologies. J Orthop Sports Physical Ther 1995; 21(5): 248−57.

Laing A, Lenehan B, Ali A, Prasad C. Isolated dislocation of the proximal tibiofibular joint in along jumper. Br J Sports Med 2003; 37(4): 366−7.

Objavljeno
2017/06/21
Broj časopisa
Vol. 74 Br. 3 (2017)
Rubrika
Prikaz bolesnika