Fratura do Tálus- Aula para Médicos Residentes de Ortopedia- Preparativo TEOT- Sprint Ortopedia.

Summary

The video script discusses fractures of the talus and ankle, highlighting the importance of proper diagnosis and treatment. It delves into the history of the 'Guardian of the Light' myth, drawing parallels to the fragility of the talus bone in relation to osteonecrosis. The script covers various fracture types, their associations with high-energy trauma, and the necessity of imaging studies like CT scans for accurate diagnosis. It also touches on surgical approaches, fixation materials, and the critical incidence of avascular necrosis, emphasizing the significance of early detection and intervention.

Takeaways

• 📘 The script discusses fractures of the talus bone, specifically focusing on the lateral process and posterior process fractures, and their association with high-energy traumas, such as those from snowboarding.
• 🏥 It emphasizes the importance of imaging studies like X-rays and CT scans for proper diagnosis, highlighting the need for specific angles and techniques to visualize the fractures clearly.
• 🛠️ The lecture mentions various surgical approaches and fixation methods for treating these fractures, including the use of K-wires, screws, and plates, with an emphasis on achieving anatomical reduction and stability.
• 💡 The 'Hawkins sign' is highlighted as an important radiographic indicator for assessing the viability of the talus body, which can help in diagnosing avascular necrosis post-fracture.
• ⚠️ Avascular necrosis is identified as a common complication associated with displaced talus fractures, with an incidence rate ranging from 20% to 58%, depending on the fracture type.
• 🔍 The script underscores the significance of early diagnosis of avascular necrosis through the disappearance of the Hawkins sign between 6 to 8 weeks post-surgery.
• 🛑 The potential for post-traumatic arthritis and deformity of the retro-patellar region is mentioned as another complication that can arise from these fractures.
• 🔨 The choice of fixation material is discussed, with titanium being preferred over steel due to its visibility in MRI scans and its properties for better osseointegration.
• 📚 The importance of understanding the fracture pattern and pre-operative planning is stressed, as it is crucial for intra-operative decision-making and successful surgical outcomes.
• 📈 The script provides a classification system for talus fractures, categorizing them into different types based on the location and severity, which aids in determining the appropriate treatment approach.
• 📝 Lastly, the lecture concludes with a quiz to reinforce the learning points, focusing on the most common associated fracture with talus neck fractures and the complications of avascular necrosis and post-traumatic arthritis.

Q & A

What is the significance of the story of the Colossus of Rhodes in the context of the lecture?

The story of the Colossus of Rhodes is used as a metaphor to illustrate the concept of a 'guardian' with a single point of vulnerability, similar to how the talus bone, the focus of the lecture, can be susceptible to fractures and osteonecrosis due to its blood supply.

What is the most common bone to be fractured in the foot?

The talus is the second most commonly fractured bone in the foot, with the calcaneus being the first.

How are high-energy traumas to the ankle and neck often caused?

High-energy traumas to the ankle and neck are often caused by sports injuries, particularly from lateral processes such as snowboarding, where there is a forced inversion, dorsiflexion, and eversion of the ankle.

What imaging technique is recommended for a better visualization of talus fractures?

A computed tomography (CT) scan is recommended for better visualization of talus fractures, especially in a coronal cut.

What is the association between talus fractures and osteonecrosis?

Talus fractures are associated with a risk of osteonecrosis due to the potential for damage to the blood supply of the talus bone, which can lead to avascular necrosis.

What is the most sensitive and specific examination for demonstrating osteonecrosis?

Magnetic resonance imaging (MRI) is the most sensitive and specific examination for demonstrating osteonecrosis.

What material is considered the best for fixation devices in the context of bone fractures?

Titanium is considered the best material for fixation devices due to its properties and the technology of the new machines that can handle it effectively.

What is the most common associated fracture with talus neck fractures, according to the lecture?

Medial malleolar fractures are the most commonly associated with talus neck fractures, accounting for 19% of cases.

What is the significance of the 'Hawkins sign' in the context of talus fractures?

The Hawkins sign refers to the appearance of subchondral atrophy on an anteroposterior radiograph around the 6th to 8th week post-injury, which can indicate the viability of the talus and help exclude the diagnosis of avascular necrosis.

What is the recommended treatment approach for undisplaced talus neck fractures?

For undisplaced talus neck fractures, the recommended treatment approach includes immobilization with a cast, restricting weight-bearing for 6 to 8 weeks, and monitoring for the development of osteonecrosis and fracture consolidation.

What are the three key factors for achieving absolute stability in talus fractures?

The three key factors for achieving absolute stability in talus fractures are anatomical reduction, interfragmentary compression, and rigid fixation.