DYUPYUITRENA CHANGE ( G. Dupuytren , the fr. surgeon, 1777 — 1835) — a fracture of a medial anklebone and fibular bone in the lower third with a rupture of linking of an intertibial syndesmosis. At this change quite often there comes the incomplete dislocation of foot of a knaruzha. Dative meets often;
the Origins == Origins of this change — pronatsionno-abduction are described by G. Dyupyuitren in 1819 ==. Foot has the natural valgus installation equal 10 ° and therefore it at injuries turns up knaruzh more often. At the same time owing to the fortress of a medial (deltoid) sheaf there comes the avulsion fracture of a medial anklebone, and the astragalus acquires the valgus provision. The block of an astragalus rests against a lateral anklebone, and there is its change to a rupture of a lobby or a thicket of both intertibial sheaves.
The clinical picture
At Dative usually is defined a swelling in an ankle joint. In case of an incomplete dislocation of foot of a knaruzha there is patol, a valgus installation of foot especially accurately visible at survey behind. Palpatorno is determined sharp morbidity in a medial anklebone, by the course of a fibular bone and in the field of an intertibial syndesmosis. The active and passive movements in a joint are sharply painful and limited.
On the roentgenogram in a direct projection at Dative the line of a fracture of medial anklebone which is usually passing at the level of a joint crack, and also a lateral anklebone at the level of a joint crack or above it is well visible. At the same time clearly act the shift of fragments and possible diastases, i.e. discrepancy of «fork» of a joint (fig. 1 and 2). Comparative study of perednezadny pictures (made on one film) both ankle joints in usual laying or with symmetric internal rotation on 27 ° is of great importance for diagnosis of a rupture of the lower intertibial syndesmosis.
The outside incomplete dislocation of foot is distinguished on the basis of increase or expansion of a crack between a joint contour of a medial anklebone and adjacent to it joint edge of an astragalus, normal equal width of other part of a joint crack of an ankle joint.
On the side roentgenogram the plane of a fracture of fibular bone and character of shift of fragments usually clearly is visible. The line of a change most often has the slanting direction from top to down and behind beforehand, and the change — splintered and quite often is extraarticular. Besides, on the side roentgenogram character of shift of a medial anklebone is usually visible. Careful studying is demanded by a picture in a side projection for recognition of a change of the first or rear edge of an epiphysis of a tibial bone and the corresponding incomplete dislocation of foot in an ankle joint that is very important for the correct reposition of fragments.
Treatment, as a rule, conservative. It consists in manual reposition, edges is made at once after arrival of the patient (after a preliminary X-ray analysis). Anesthesia the general or local (15 — 20 ml of 1% of solution of novocaine are entered into a cavity of a joint and between fragments of a fibular bone). After reposition and imposing of a plaster bandage according to the control roentgenogram judge the provision of fragments and recovery of proper correlations of bones in an ankle joint.
For prevention of secondary shift in a plaster bandage A. V. Kaplan (1967) offered the method of transarticulary fixing of foot and the closed (transdermal) osteosynthesis spokes which is that after manual reposition and imposing of a plaster bandage through windows in it Kirchner's spokes fix an ankle joint, bone fragments and an intertibial syndesmosis (fig. 3). In 4 — 5 weeks of a spoke delete, and leave a plaster bandage for the term necessary for full consolidation of a change.
At conservative treatment of Dative fixing by a plaster bandage is carried out during 12 weeks; in the subsequent appoint to lay down. gymnastics, massage. Working capacity is recovered in 3,5 — 4 months.
In case of unsuccessfulness of conservative treatment an operative measure is shown. Fixing of bone fragments is carried out metal fixers (spokes, screws, bolts). At old or incorrectly accrete Dative depending on prescription of a change make various recovery operations in the field of the former change, a wedge-shaped resection over anklebones or an artrodezirovaniye ankle joint (see).
Bibliography: Kaplan A. V. The closed injuries of bones and joints, M., 1967; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 1, page 140, M., 1968; At about t with about n-D about N with River. Fractures of bones and injury of joints, the lane with English, M., 1972; Dupuytren G. Myo-moire sur la fracture de l’extremite inferieu-re du perone, les luxations et les accidents qui en sont la suite, Ann. med. - chir. Hop. Paris, t. 1, p. 1, 1819.
V. V. Kuzmenko; G. A. Zedgenidze (rents.).