小结
定义
病史和体格检查
关键诊断因素
- 近期外伤
- 踝关节疼痛和肿胀
- 不能负重
- 内踝和/或外踝肿胀和触痛
其他诊断因素
- 摔倒时“啵”的一声
- 踝关节畸形
- 捻发音
- 腓骨近端触痛
- 内踝表面皮肤顶起
- 渥太华踝关节规则
- 骨质疏松症病史
- 频繁跌倒史
- 血管损害
危险因素
- 骨质疏松症
- 多次摔伤
- 低能量摔伤
- 踝关节内翻损伤
- 运动损伤
诊断性检查
首要检查
- X 线平片
需考虑的检查
- X 线平片“应力位图”或站立正位 X 片
- CT
- 核磁共振成像 (MRI)
治疗流程
开放性骨折
闭合骨折脱位
单纯外踝骨折
单纯内踝骨折
双踝和三踝骨折
撰稿人
作者
Ewout S. Veltman, MD
Resident Orthopaedic Surgery
Joint Research
OLVG
Amsterdam
The Netherlands
利益声明
ESV declares that he has no competing interests.
Rudolf W. Poolman, MD, PhD
Consultant Orthopaedic Surgeon
Joint Research
Onze Lieve Vrouwe Gasthuis
Amsterdam
The Netherlands
利益声明
RWP has been a member of the Dutch Orthopedic Association Committee, has received grants for the ZonMW ESCAPE trial, DART trial, Achmea Escape trial and Van Rens Fonds REDEP trial, and has contributed to the following educational events: the Waldemar Link hip course and the J&J hip course.
鸣谢
Dr Ewout S. Veltman and Dr Rudolf W. Poolman would like to gratefully acknowledge Dr Mohit Bhandari and Dr Brad Petrisor, previous contributors to this topic, as well as Dr Victor A. van de Graaf and Dr Dirk P. ter Meulen for their assistance with the final draft. MB and BP declare that they have no competing interests.
同行评议者
Charles Court-Brown, MB ChB
Professor of Orthopaedic Surgery
Consultant Orthopaedic Surgeon
Edinburgh Orthopaedic Trauma Unit
Royal Infirmary of Edinburgh
Edinburgh
UK
利益声明
CCB is an author of several references cited in this topic.
James C. Puffer, MD
Professor
University of Kentucky School of Medicine
President and Chief Executive Officer
American Board of Family Medicine
Lexington
KY
利益声明
JCP declares that he has no competing interests.
Philip H. Cohen, MD
Clinical Assistant Professor of Medicine
Robert Wood Johnson Medical School
University of Medicine and Dentistry of New Jersey
Piscataway
NJ
利益声明
PHC declares that he has no competing interests.
鉴别诊断
- 踝关节外侧韧带损伤（距腓前韧带和跟腓韧带）
- 跟腱断裂
- 距骨骨折
更多 鉴别诊断指南
- 开放性骨折的管理标准
- 美国放射学会（ACR）标准：踝关节急性创伤
更多 指南
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