Beck E
Universitätsklinik für Unfallchirurgie, Innsbruck.
Orthopade. 1991 Mar;20(1):33-42.
Peripheral fractures of the talus, such as fractures of the posterior and lateral process, need no special therapy. Larger fragments with dislocation require open reduction and screw fixation. Small flake fractures with stability of the joint can be removed arthroscopically, but larger fractures should be repositioned with K-wires, small screws. Ethipin or fibrin sealant. Dislocated fractures of the head of the talus should be reduced and fixed by screws or K-wires. Fractures of the neck of the talus with anteromedial or lateral dislocation can be treated by closed reduction and external fixation, irreducible fractures by open reduction and screw fixation. Fractures of the neck and body of the talus with dorsal dislocation or subluxation in the talonavicular joint require osteotomy of the internal malleolus, open reduction and screw fixation. Comminuted and open fractures of the body of the talus are treated by minimal osteosynthesis with K-wires or external fixation. In necrosis of the talus, revascularization using iliac crest bone with vascular pedicle seems to be successful. In arthrosis cases, triple arthrodesis is the best solution.
距骨的周围骨折，如后突和外侧突骨折，无需特殊治疗。伴有脱位的较大骨折块需要切开复位和螺钉固定。关节稳定的小片状骨折可通过关节镜切除，但较大骨折应使用克氏针、小螺钉、Ethipin或纤维蛋白密封剂进行复位。距骨头脱位骨折应通过螺钉或克氏针进行复位和固定。距骨颈伴有前内侧或外侧脱位的骨折可通过闭合复位和外固定治疗，不可复位的骨折则通过切开复位和螺钉固定。距骨颈和体部伴有距舟关节背侧脱位或半脱位的骨折需要内踝截骨、切开复位和螺钉固定。距骨体粉碎性和开放性骨折通过使用克氏针进行微创接骨术或外固定治疗。在距骨坏死的情况下，使用带血管蒂的髂嵴骨进行血管重建似乎是成功的。在关节病病例中，三关节融合术是最佳解决方案。
