Lauge Hansen SER Supination External Rotation (Eversion) Ankle Fracture
ฝัง
- เผยแพร่เมื่อ 2 มิ.ย. 2010
- Surgery of the Foot and Ankle: astore.amazon.com/nichogiovi-20
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With the foot in a fixed supinated position the forces start along the lateral axis of the fibula. The leg undergoes an internal rotation creating tension on the anterior inferior tibio-fibular ligament. In a Stage 1 injury, one of two pathologies may occur; rupture of the anterior inferior tibio-fibular ligament or a fracture of the distal lateral tibia (aka Tillaux-chaput fracture).
As the leg continues to internally rotate the talus collides with the distal fibula, creating a spiral fracture of the fibula beginning at the level of the syndesmosis. This describes a Stage 2 injury, which is the most commonly encountered ankle fracture. A Wagstaffe fracture can also occur during this stage.
As the force progresses a Stage 3 injury will either involve a rupture of the posterior tibio-fibular ligament or fracture of the posterior malleolus of the tibia (aka Volkman's fracture).
Supination external rotation injuries that reach stage 3 rarely stop at this point and usually progresses to the final stage. Continued unrestrained lateral rotation of the talus will result in a Stage 4 injury involving either a rupture of the deltoid ligament complex or a transverse fracture of the medial malleolus.
(Take home points)
-The injury begins along the lateral axis of the fibula.
-The spiral fracture seen in stage 2 is unique to supination-external rotation injuries.
Project Leads:
William Hoffman
Hummira Hassani
Contributing Authors:
Julia Bernardini
Scott Crismon
Technical Advisor:
Thomas Vitale
Narration:
Matrona Giakoumis
Producer:
Nicholas Giovinco
© 2010
www.DrGlass.org
glass.dpm@gmail.com
I'm glad you enjoyed them.
Thank you so much for creating these videos!
What a useful vid, there isn't a simplest way to explain this
I agree. Closed kinetic chain supination injuries are associated with an unbalanced inversion moment of force acting across the STJ. Due to the 2 coupled 2 DoF there will be a corresponding unbalanced moment of vertical axial lateral rotation of the proximal tibia. If the angle at the knee joint is small and the condoyles interlocked so accessory rotation is minimal the force will manifest itself in the ankle complex.
Dr Glass, awesome videos!
Clarification!
@hotingneusvoel No problem. I'm glad you found it useful
This was the worst pain I have ever felt
I was fully willing to to have the paramedics just cut my foot off lol
So greatful for their humor and caring.
Thank you for the video
Agreed, i screamed so loud it was heard t2 floors below me....
she meant to say "external rotation" at 0:18 ... right??
soo made easy, thankyou
Thanks!
@BridgeLoungeFL I'lll have to improve that for future projects.
@doctormoo NY accents are quite particular, indeed...
The original cadaver studies, for which the published classification is based on, describe a fixed leg (nailed to the table) and the foot was forcefully rotated externally.
Not all fracture patterns follow this action
Dr Glass, this is exactly what has been puzzling me: does the "external rotational force on the talus" mean that the leg (lower leg) is rotated internally, i.e. endo rotation? From your remark I would guess so. In an actual trauma situation I would expect the foot to be in a fixed position, with the lower leg rotating internally. Is that right?
@@wouterengel1345 hi do u found ur answer
@@wouterengel1345 Yes, You are right. It's just Easier to describe both Movements using the foot "external rotation force on the supinated foot"...... In most traumatic situations as you would Imagine the Tibia is the one Internally rotating on the supinated foot, either by HIP JOINT Internally Rotating or KNEE Tibifemoral Joint Internally Rotating.
It's logical but You can see how complicated it got.
@@yogeshlakshman8488 Hopefully You didn't shift careers man. lol.
Hope You doing Good.
@@indiscernibleStranger Thanks for asking
Now I am a medical graduate
Have a great day ahead
@moinkhanmd Thanks
narrator's voice is annoying and distracting. Otherwise, graphics, mechanism of injury, well done