TIBIAL PILON FRACTURES

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TIBIAL PILON FRACTURES

• ?. ???? ??????

2

• ??????? ???? ??????? ??????? ??????? ???? ????
  ???? ???? ?? ????? ??????? ?????? ?????
  ?metaphysis ??????
• ??? ?????? ??????? ???? ??????? ?? ??????
  metaphysis ?? ??? ??????
• ???? ??pilon ????? ??? ????? ????? ??????
  ??? ??? ??? ??????? ?????? ?? ???? ?????? ??
  ????? ????? ????
• 10-30 ?? ???? ??pilon ???? ????? ??????
• ???? ???? ???? ???? ??pilon ? 3-10 ??? ?? ????
  ??????? ???? ?? 1?? ???? ????? ??????
• ???? ?????? ?????? ?? 70-85 ????? ???????
  ?????
• ????? ???? ?????? ????? ????? ???????
  ???????
• ???? ?????????? ????? ????? ??????? ??????
  ???????

3

• ????? ????? ????? ?????? ???? ????? ????? ??????
• ????? ?????? ??? ????? ???? ????? ???????
  ??????? ????? ??? ?????? ????? ?????? (??? A )
  ????? ?????? ?????? ????
  ????? ???????? ??? ?????? ???? ????? ???????
  ????? ???? Y?? ????? ?????? ?????? ????? (??? B)
  ????? ?????? ??? ???? ???? ????? ???????
  ??????? ?????? ??? ?????? ???? ?????? ????? (???
  C )

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• ????? RUDEI and ALLGOWER
• ???
  1??? ??????? ??????? ??????? ??? ???? ???? ?????
  ???????
• ??? 2 ??? ?? ???? ??? ?? ???? ???????? ?? ?????
  ??????? ?? ???? ????
• ??? 3??? ?????? ?? ???? ?????? ?????? ????

5

• ????? AO
• ???A ???? ??????? ??????? ??????? ???? ??????
• ??? B ??????????? ??????? ??????? ???? ??????
  ???? ???? ???? ???? ??? ????? ??????? ?????????
  ?? ?????
• ???C ???? ??????? ??????? ??????? ???? ??????
  ???? ??? ?? ?????? ?????? ????
• A? B? C???? ??? 1?2?3 ??? ???? ?????? ????????

6

• ??????? ????????
• ??? ?????? ??? ?? ???? ????? ????? ?????? ????
  ?? ???? ?????? ???????? ????? ?????? ??? ?????
  ??????? ???? ?? ???? ??????? ???????
• ?????? ????? ??????? ?????? ??? ???? ????? ????
  ?? ???? ???? ???? ?? ??? ?? ????? ??? ??????
  ??????
• ?????? ????? ?? ????? ????? ?????( ???????) ????
  ???????
• ????? ???????? ??? ???? ???? (?????? ?????
  ?????? mortise- -????? ????? 45 ) ???? ?? ??
  ??? ?????? ???????? ??????? ???????? ???????
  ???????
• ?????? ??????? ??? ?? ??????? ???????
• ??? ?????? ??????? ????????? ??????? ????????
  ??????? (??? ???? ?????? ???? ??? ????? ??????
  ?????? ????? )

7

• ????? ??????
• (1) ??? ?? ??? ????? ????? ?????
• (2) ??? ?? ???? ??????
• (3) ??? ?? ???? ????? ???????
• ??????? ???????? ??????? ??? ?????? ????
• ???? ?? ???? ?????? ????? ????? ????? ?????? ??
  ?????? ???? ????? ???? ?????? ????? ???? ??
  ???? ????? ??????? ????? ????? ????
• ?????? ??????
• ???? ????? ???? ?????? ???? ?????? ?? ?????
  ????
• ????? ????? ???????? ??????? ??????? ???????
  ??????? ?????? ??????? ??????? ?? ???????
• ????? ??????? ?????? ??????? ??????? ??????

8

• ???? ???? ?????? ?? ?????
• ?????? ???? ????? ?? ?????? ??? ????
• ?????? ??????? ????
• ???? ???? ?????? ?????? ?? ????? ????? ???????
  ???????
• ???? ????? ????? ?????? ??????
• ??? ???? ??????? ??????
  ??? ?? ??????
  ????? ??????
• ?????? ?? ?????? ????????
• ????? ???? ?????? ????? ?????? ????? ???
  ???????
• ???? ?????? ?????? ???? ?? ????? ??????
• ????? ??? ???? ???? ????? ???????? ???????
  ??????? ????????
• ?????????? ???? ????? ?? metaphysis ????????
  ????? ?? ???? ??? ????? ????? ???? ??? ??? ??
  ???? ????
• ???? ????? ???? ?? ????? ??? ?????? ?? ??? ???
  ????? ???? ??? ???? ?? ??? ?? talus

9

• ????? ????? ????????
• ??????????? ?????? ???????? ??????? ???????
  ?? ??? ?? ?????? ?? ????? ??????? ???? ?? 2 ???
  ?? ??? ????? ???? ?? 10 ????? ?? ?? ?????
• ???? ???? ???? ??????? ???????? ?? ??? ?????
  ????? ???? ???? ?????? ????? ????????
• ???? ????? ??? B ???? ?? ????? ?????? ??????
  ??????
• ???? ????? ??? C1?C2 ??? ?????? ????? ?????
  ?????? ??????
• ???? ????? ??? C1 ?C2 ?? ?????? ????? ???? ????
  ?????? ??????? ???????
• ????????? ??? C3 ????? ??????? ?? ORIF ???????
  ?? ??????? ???????
• ???? ????? ??? C3 ?? ???? ???? ????? ????? ?????
  ?? ??ORIF

10
??? ????? ??? B
11
??? ????? ??? C2??? ?????? ?????
12
??? ??? ????? C2 ?? ?????? ?????
13

• ??? ??????? ???? ?? ????? ???? ??? ???? ?????
  ???? ????? ??? ??? ??????? ?????
• ???? ??? ???? ????? ??? 6 ????? ????? ?????? ???
  ????? 6 ? ????? 12
• ??? ?? ???? ??????? ??????? ??? ???? ?????? ?????
  ????? ?????? ??????? ???? 7-14 ???
• ???? ????? ??????? ????????? ?????? ????? ?????
  ??????? ?? ?????? ?????? ???? ????? ???????
  ???????

14

• ??????? ????????
• ?????? ??????? ??????? ?????? ??? ?? pilon ????
  ?? ???? ????? ?????? ?? ????? ???? ?????????
  ???? ???? ?????? (????? ????)
• ??????? ??????? ??? ?????? ???? ??? 5-12?? ?????
  7-8??
• ?? ??AO ??????? ?????? ???????? ???? 5-10??? ????
  ????? ??????? ???????? ???? ??? ?????? ?????????
  ???????? ? ????? ????? ????? ?? ????? ??????
• ???? ?????? ?????? ???? ???? ?????? ??????
  ??????? ??????? ??????? ???? ?????? ??????? ????
  ????????? ???????? ????? ?????? ?????? ??????
  ???????
• ???? ??????? ?????? ????? ????? ???? ???? ?????
  ??????? ???????? ???? ????? ( ???? ??? ?????
  ??????? ???????? ???????? ???????)
• ???? ???? ???? ?????? ????? ?????? ?? ???? ??
  pilon
• ???? ????? ???? ???????? ???? ?????? ?????? ???
  ????? ?????? ????? ????? (???? ???? ?????
  ??????? ???? ?????? ????? ??????)

15
(No Transcript)
16

• ????? ???? ??????? ???????? ??????? (ORIF)
• ????? ,RUEDI ALLGOWER ?????? ???? ???????? ??????

17

• ?????? ??????????? ?????
• ?????? ?????? ???? ?????? ?????? ?????? ???
  ?????? ???????? ??????? ???????? ????? ???? ????
  ?????? ????? ????? ???????
• ?? ?????? ?? ?????? ?????? ????? ???? ???????
  ?????? ?????? ??? ???? ????? ????? ?????? ??
  ORIF??????? ??? ???? ?????? ?????
• ???? ?????? ?????? ??? ??????? ?? ?????? ???????
  ??? ?? ???? ?????
• ?? ???? ????? ??????? ???? ?????? ???????
  ??????????? ??????? 3,5??? ???????? ???????
  ???????? ????? ???????
• ???? ?? ?????? ??? ??????? ???? ??? ?? ?? ????
  ???? ???? (?? ???? ?????? ???? ??? ???)

• ????? ???? ?????? ????? ?? ???? ??? ?????? ????
  ??? ???? ?????? ??? ????? ??????? ????????
  ???? ????? ???????? ?????? ???????? ?? ????????
  ?????? ???????? ????? ???? ???? ?? ???? ?????
  ??AO DISTRACTOR ?? ???? ?????

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• ?????? ???????????? ???? ???? ???????
• ??? ???? ????? ??? ??pilon ??? ???? ??? ??????
  ??? ?? ???? ??
• ????? ?????? ????? ??????? ??????
  (tillaux-chaput ? ???? chaput ) ???? ??????
  ??????? ( ???? ??????? )
• ???? ???? ????? ?????? ?? ????? ????? ?????
  (??????? ?????? ????? 4??? ?? ???? ???? LAG 3,5
  ??? )
• ?????? ??????? ??????? ?????? ????? metaphysis
• ???? ?? ????? ?? ??? ??????? ??????
• ?????? ???????? ?? ???? ????? ???? ???????
  ??????? ??????
• ????? ??????? ??????? ???? ?????? ??????? ?????
  ??? ???? ???????? ?? ????? ?????
  metaphysis-diaphysis

19

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• ?????? ??????? ????? ????? metaphysis-diaphysis
• ???????? ??????? ????? ??? ??????? ???????? ???
  ??? ?????
• ???? ????? ????? ????? ???? ???? ??????? ?? ?????
  T ?? ????? ???? ????? ??? ??????
• ???? ??????? ????? ??? ?? ??? ???????
• ?? ?????? ?? ???? ???? ??? ???? ???? ???????
  ??????? ?????? ?????? ????? ???? ???? ???? ????
  ???????? ???? PEIGNE) ) (????? ) ???? ????? ????
  ?? ?????? ??? ?????? ?? ???? ????? ?? ??????
• ???????? ???????? ????????

21
(No Transcript)
22
(No Transcript)
23

• ????? ????? ???? ????? ??????? ???????? ????
  ??? ????? ?? ???? ?????
• ??? ???? ??STAPLE (???? ??? ?????? ??? ??????
  ????? ??? ???? ????? ?????? ??????)
• ???? ?????? ????? ???? ????? ????? ???? ????
  ?????? ??????? ???????? ????? ???? ??????? ????
  ??????? ??????
• ?????? ???????? ??? ???????? ?????? ????? ????
  ????? ????? ??? ?????? ??????? ????? ???? ???????
  ???? ??????? ??????
• ????? ??????? ????????? ???? ??? ????? ??????
  ????? ?? ?????? ????? ?? ????? ???????

24

• ??????? ????? ???????
• ???? ????? 90 ?????? ???? 10-14 ???
• ???? ????? ?????? ???? 2-3 ??? ??? ?????
• ?? ????? ??? ????? ??????? ??????? ??? ???? ?????
  ?????? ??????? ???? ???? 48 ???? ??? ????? ?????
  5-7 ????
• ???? ???? ??? ????? ???? 6-8 ??????
• ?????? ????? ????? 10-16 ????? ??? ???? ????
  ????? ?????? ??? ????? ???? ?? ???? ???? ?????
  ??? ????????
• ?????? ??????? ???? ?? ???? ?????? ??? ????? ???
  ??? ????? ???? ???? ?? 14-26 ?????
• ??? ??????? ?????? ??????? ??? ????? ????? ?????
  ?????? ???? ????? ?????? ???? ???? ?? ?????
  ???????? ??????????
• ??? ???? ????????? ???? ???? ??? 12 ??? ???
  ??????

25

• ????? ??????? ?????? ?????? ?????????
• ???? ????? ?????? ???? ?? ?????? ?? ???? ????? ??
  ?????? ????? ???????? ????? ??? ????? ?? ?????
  ????? ???? ??? ???? ????? ???? ?????
  ????????? ?????
• ????? ???? ?????? ???? ???? ?? ???? ????? ?? ????
  ???? ????? ?? ????? ????? ???? ???? ???? ???
  ???? ??? ????? ?????? ???? ??????
• ???????? ???? ?? pilon
• ????? ????? ?????? ????? 0-37 (???? ??? ????
  ?????? ????? - ?????? ?????- ?????? ???????
  ?????? ?????? ??????)
• ?????? ????? ????? ??????
• (1)??? ???????? ????????? ????? 4-36 ???? ???
  ??????? ?????? ??????? ????? ???? ?? ????? ?????
  metaphysis-diaphysis ?????? ??? ???????? ??? ??
  ???? ??????? ?????? ??????? ??? ??????? ??????
  ???????

26

• ?????? ?????? ??????? ????? 13-54
• ????? ?????( ????? ?????? ????? ????????
  ??????????????- ??????)
• ?? ????? ?????? ?????? ???? ??? ??? ???? ??? ???
  ????? ?? ???????
• ??? ????? ?????? ???????
• ????? ????? ????? ????? ????? ??????? ????????
  ?? ????? ??????? ????? ??????? ???????? ???????
  -??????? ????????

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• ???????? ???????? ????????? ?? ??????? ???????
• ??????? ??? ?????? ????? ???? ???? ?? ???? ????
  ?????? ??????? ?? ??? ?? ???? ????? ??? ????
  ?????? ?????? ?? ???? ??????
• ?????? ???????? ????? ???? ???????

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(No Transcript)
30
???? ??? ???????
31

• ???? ??? ???????
• ????? ???
• ?????? ???????? ???? ????? ?? ???????
• ??? ????? ???? ??? ???????? ??????? (TRAFTON)
• (1) ????? ?? ????? ??? ?? 5 ?????
• (2) ?????? ??????? ???????? ??? ?? 10 ?????
• (3) ??????? ??? 10?????
• (4) ????? ??? ?? 15 ???
• ???? ?? ???? ??? ?????? ?? ???? ??? ???????
• ??????? ????? JOHNER .WRUH

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(No Transcript)
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(No Transcript)
34

• ???? ???? ??? ???????
• 1 ???? ?? ????? ?????
• 2 ???? ????? ??????? ??????? ,??????? ???????
• 3 ????? ??? ??????
• ???? ?????
• ???? ?????? ???? ???? ,??????,?????,?????,???????
  ??? ????? ??????
• ??? ?????? 14 _15 ?????

35
(No Transcript)
36

• ????? ??????? ???????
• ??????? ???? ????? ????? (???? ?? 3 ????? ?????
  )?? ?????? ????????? ???? ???? ???????
• ????? ?????
• ??? ????? ???? ??? ?? ??? ????? ?? ?????? 8_10
  ??????

37

• ??????? ???????? ???? ?????? ??????? ?????
• ??? ??????? ???? ?????? ???? ???? ???? ??????
  ????? ??? ?????
• ????? ????? ?? ??? ??? ????? ???? 6 ??????
• ????? ENDER ???? ?????? ????? ????? ???????
• ???? ?? ?????? ?? ???? ??????? ??????? ?? ????
  ?????? ,???? ?????? ,???? ????? ?????? ???????
  ????? ?? ???? ???? ?????

38
(No Transcript)
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(No Transcript)
40
(No Transcript)
41

• ?????? ?????? ?????? ?????? ?????????????
  ????????? A1,2,3
• ?????? ??????? ??????? ????? ???? ???? ???????
  ????3-4 ?? ????? ?? ???? ??????
• ???? ??????? ?????? ???? ????? ,???? ?? ????
  ??? ???? ???? ?????? ,???? ?????? ??? 3C
• ???? ?????? ?? ????? ?????? ?? ???? ???? ???
  ?????
• ???? ?????? ??? ????? ?????? ?? ???? ???? ???
  ?????
• ??? ?????? ???? ? TMD??????? ??? ???? ???????
  ?????? ??????
• ??????? ?????? ?????? ?????? ???? ????? ????????
  ?????? ???? 22,9 ???
• ????? ??????? ???? ??????? ?????? ?????? ,????
  ???? ?????? ????? ,????? ?????? ????? ???????
  ????? ??? ??????? ???? ?? ??? ?????
• ???? ??? ????? ??? ???? ?????? 4-6 ??????
• ????????? ??? ???? ??????? ( ???? ?????? ?? ????
  ????? ????? ??????? ????? ??? ??????? ?? ?????
  ????? ??????? )

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(No Transcript)
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(No Transcript)
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• ????? ??????? ???????
• ?????? ???????? ??????? ??? 3C ,3B
• ?????? ?? ???? ????
• ?????? ????????? ?? ???? ?? ???? ??? ???? ??????
• ???? ?? ??????? ??????? ?? ???? ??????
• ???? ????? ?????? 6 ????
• ???? ?????? ??? ??????? ??????? ??? 8-12 ?????
• ????? ??? ??????? ?? ????? ??????
• ????? ????? ?????? ??????
• ????????? ?????? ????? ???? ????? ?? ?????
  ????? ???? ?? 6 ????? , ???? ?????? ?? ?????
  ???????? ??? ??????

45
(No Transcript)
46
(No Transcript)
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(No Transcript)
48
(No Transcript)
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(No Transcript)
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• ???? ???????? ?? ???? ???? ??????? 24 ?????
• ????? ??????? ?????? ??? ????? EDWARD
  ?????? ??????? ??? johner,wruh
• ?????????? ????? ????? ??????? ,????????
  ???????, ??? ???????? , ???????? ?????? ,??????
  ?????? ???????

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(No Transcript)
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(No Transcript)
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  ??????? ?? ??? ??????? ???????? ?? ???? ???????
  ??????? ?? ???? ????, ??? ????? ?. ???? ??????.
• ?????? ??? ????? ?? ??????? ??????? ?? ???
  ????????.
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?. ???? ????
Dr. Muayad Kadhim