Ẹsẹ oju-iwe & Ẹsẹ-aisan Arthritis & Iṣẹlẹ II | El Paso, TX.

Lisfranc Fracture-Dispartcation

• M / C dislocation ti ẹsẹ ni iṣiro-metatarsal articulation (asopọ Lisfranc). Imudara taara tabi ibalẹ ati gbin tabi dorsal flexing ẹsẹ. Lisiga Lisfranc ti o mu 2nd MT base ati 1st Cu ti ya. Ṣe afihan pẹlu tabi w / o ipalara-fifa.
• Aworan: Igbesẹ akọkọ: redio ẹsẹ ni ọpọlọpọ igba to Dx. MSK US le ṣe iranlọwọ: ṣafihan idilọwọ Cu1-Cu1. ligament ati aaye gbooro> 2mm. MRI le ṣe iranlọwọ ṣugbọn kii ṣe pataki. Wiwo ti nso iwuwo Dx.
• 2-orisi: homolateral (1st MTP isẹpo ni olubasọrọ) ati divergent (2-5 MT nipo ni ita ati 1st MT medially)
• Idojukọ: Itọju iṣẹ jẹ pataki
• NB Atraumatic Lisfranc dislocation jẹ iṣiro loorekoore ti ẹsẹ ẹsẹ Charcot kan

Igbẹyin Osteochondral ti Talus (OCD)

• Wọpọ. Iini-ailo-ara-ara ti a ri ni ẹda ti o gaju-medial. Itọju ailera le ni ipa lori dome ti aarin-ori.
• Atilẹgun iwosan: irora / idapọ / titiipa. Aworan jẹ pataki.
• Igbesẹ 1st: redio le ṣe afihan apẹrẹ rediocenti / halo, iṣiro.
• MRI wulo esp. ti OCD jẹ cartilaginous ati lati ṣe afihan edema egungun.
• Idojukọ: ti kii ṣe isẹ: ẹsẹ simẹnti / immonbilization-4-6 wk. isẹ: arthrocsopic removal.
• Awọn iloluwọn: 2nd DJD ti a ti kojọpọ

Awọn ipalara Metatarsal

• Awọn eegun nla & Wahala jẹ wọpọ: m / c 5th MT & 2nd, 3rd MT.
• Jones Fx: afikun-articular Fx ti metaphysis isunmọ ti 5th MT. Prone si ti kii-apapo. Nigbagbogbo ti o wa titi operatively.
• Aago-iṣẹ-Jones: intra-articular avulsion of 5th MT styloid/base by eccentric contraction of Peroneus Brevis M. Ti iṣakoso ni iloniwọnba: iṣipopada bata-simẹnti. Mejeeji Jones & Pseudo-Jones Dx nipasẹ ẹsẹ jara redio.
• Ailara Fx. Calcaneus, 2nd, 3rd, 5th MTs. Tunṣe ikojọpọ (nṣiṣẹ) tabi “ẹsẹ March” 2nd/3rd MT. Isẹgun: irora lori iṣẹ-ṣiṣe, dinku nipasẹ isinmi. Dx: x-ray nigbagbogbo ko ni ere tẹlẹ. MRI tabi MSK US le ṣe iranlọwọ. Ṣakoso: Conservatively. Awọn ilolu; ilọsiwaju sinu pipe Fx
• Atokun Turf: Ayẹwo idaraya ti o wọpọ ti 1st MTP-sesamoid/ gbin eka awo ti n ya. 1st MTP riru / loose. Ti ṣakoso ni iṣẹ-ṣiṣe.

Arthritis ti Ẹsẹ & Ẹsẹ

• DJD ti kokosẹ: ko wọpọ a jc OA. Ni igbagbogbo ndagba bi 2nd si ibalokanjẹ / AVN, RA, CPPD, Hemophilic arthropathy, Arthritis Idiopathic Juvenile, ati bẹbẹ lọ farahan bi DJD: osteophytes, JSL, cysts subchondral gbogbo ti a rii lori awọn egungun x-ray.
• Arthritisan Ẹrun: RA le ni idagbasoke ninu awọn kokosẹ tabi eyikeyi isẹpo synovial. Yoo ṣafihan ni deede pẹlu awọn Ọwọ/ẹsẹ RA ni ibẹrẹ (2nd, 3rd MCP, wrists, MTPs ni awọn ẹsẹ) nigbagbogbo pẹlu ogbara, aṣọ JSL, osteopenia juxta-articular, ati awọn subluxations idaduro.
• HLA-B27 spondyloarthropathies: ti o wọpọ ni ipa lori igun isalẹ: igigirisẹ, esp kokosẹ ni Reactive (Reiter). Ilọsiwaju egungun erosive-productive jẹ Dx pataki kan.
• Arthrit ti Ojurọ: wọpọ ni apa isalẹ. kokosẹ, ẹsẹ aarin-ẹsẹ esp 1st MTPs. Ibẹrẹ ibẹrẹ: arthritis ti gouty nla pẹlu iṣan ST ati pe ko si awọn erosions/tophi. Gout tophaceous onibaje: peri-articular, intra-osseous punched-out erosions with over-iked egbegbe, ko si ni ibẹrẹ JSL/osteopenia, ST. Tophi le ri.
• Oniruuru arthropathy: PVNS. Ko wọpọ. Ni ipa lori awọn ọdun 3-4th ti igbesi aye. Abajade ti isodipupo synovial pẹlu Macrophages ati awọn sẹẹli Giant pupọ-pupọ ti o kun fun hemosiderin ati ikojọpọ ọra le ja si igbona, ibajẹ kerekere, awọn eegun eegun extrinsic. Dx: x-ray jẹ aibikita, MRI modality ti yiyan. Biopsy Synovial. Isakoso: iṣiṣẹ, le nira.

Neuropathic Osteoarthropathy

• (Charcot isẹpo) Wọpọ ati lori dide d/t ajakale ni iru 2 DM. Le wa pẹlu irora ni ibẹrẹ (50% awọn iṣẹlẹ) ati arthropathy apanirun ti ko ni irora bi ifihan pẹ. Tete Dx: idaduro. Aworan jẹ pataki: x-ray: ni ibẹrẹ ti ko ni ere, diẹ ninu effusion SF ni a rii. MRI ṣe iranlọwọ pẹlu Dx ni kutukutu ati pipa-ikojọpọ. Late Dx: awọn ipadasẹhin ti ko le yipada, ṣubu, alaabo. Akiyesi: Lisfrance dislocation ni Charcot isẹpo
• M/C aarin-ẹsẹ (TM isẹpo) ni 40% ti awọn iṣẹlẹ, kokosẹ 15%. Ilọsiwaju: Ẹsẹ-apata-isalẹ, ọgbẹ, awọn akoran, ailera ti o pọ si, ati iku.
• Dx Dx: nipasẹ MRI jẹ pataki. Fura o ni awọn alaisan ti o ni iru 2 DM paapa ti o ba ni irora ti ko ni ipalara-ẹsẹ / ikọsẹ.

Kokosẹ & Aworan Ẹsẹ