Trauma Vascular y Luxación de rodilla
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Transcript of Trauma Vascular y Luxación de rodilla
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LUXACION DE RODILLA.
DR. ANDREI LARA R2 PG. ORTOPEDIA Y TRAUMATOLOGIA
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LUXACION DE RODILLA•Traumática •Infrecuente •Lesión vascular
▫13% amputación
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LUXACION •INESTABILIDAD MULTIDIRECCIONAL
•ANTERIOR 40%•POSTERIOR 30%•MEDIAL 18%•LAERAL 4%
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ESTADISTICA• 11% DE LESIONES DE RODILLA
• 80000 POR AÑO
• 70% LCA + LCM
• 11% LCA + LCL
Griffin LY, Agel J, Albohm MJ, Arendt EA, et al. Noncontact anterior cruciate ligament injuries: Risk factors and prevention strategies. J Am Acad Orthop Surg2000
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•LESION VASCULAR▫30% ▫ARTERIA POPLITEA
• DEFORMIDADES ▫VARO/VALGO
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MECANISMOS DE ACCION.
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MECANISMO LESION
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MECANISMO DE LESION
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CLASIFICACION •TIEMPO •DESPLAZAMIENTO •INESTABILIDAD
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CLASIFICACION DE KENNEDY
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CLASIFICACIÓN DE SCHENCK
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LUXACION ANTERIOR •40% •Hiperextensión•LCA rotura completa •LCP intacto / rotura completa
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LUXACION POSTERIOR•33% •Accidentes de transito •LCP y LCA rotura completa
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LUXACION ROTACIONAL •5% •FUERZA ROTACIONAL •POSTEROLATERAL OJAL ABIERTO
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IMAGEN •Rx •RMN•ARTERIORAFIA
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RX
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RX
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RESONANCIA MAGNETICA
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LESION VASCULAR
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ARTERIA POPLITEA
• AVULSION • RANSECCION • RUPTURA DE INTIMA• OCLUSIONES
Vascular and Nerve Injury After Knee Dislocation, Clinical Orthopaedics and Related Research
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LESION VASCULAR•5% AL 64%
▫20 A 40 AÑOS
▫PEOR PRONOSTICO A MAYOR EDAD
Kyle M. Natsuhara BS, Michael G. Yeranosian MD, Jeremiah R. Cohen BS, Jeffrey C. Wang MD, David R. McAllister MD, Frank A. Petrigliano MD _ The Association of Bone and Joint Surgeons1 2014
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•LUXACION ANERIOR Y POSTERIOR ▫MAYOR LESION.
•PESIMO PRONOSTICO
•86% amputación ▫ REPARACION POSTERIOR A LAS 8 HORAS
Kyle M. Natsuhara BS, Michael G. Yeranosian MD, Jeremiah R. Cohen BS, Jeffrey C. Wang MD, David R. McAllister MD, Frank A. Petrigliano MD _ The Association of Bone and Joint Surgeons1 2014
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•HOMBRES > MUJERES ▫4.8% VS 1.9% (p\0.001, OR = 2.59)
•267 CASOS DE LESION VASCULAR ASOCIADO A LUXACION DE RODILLA
•34 NECESITARON REPARACION VASCULAR
Kyle M. Natsuhara BS, Michael G. Yeranosian MD, Jeremiah R. Cohen BS, Jeffrey C. Wang MD, David R. McAllister MD, Frank A. Petrigliano MD _ The Association of Bone and Joint Surgeons1 2014
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Kyle M. Natsuhara BS, Michael G. Yeranosian MD, Jeremiah R. Cohen BS, Jeffrey C. Wang MD, David R. McAllister MD, Frank A. Petrigliano MD _ The Association of Bone and Joint Surgeons1 2014
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MECANISMO DE LESION •ROTURA DE LA INTIMA
▫LUX ANTERIOR
•ROTURA COMPLETA ▫LUX POST▫HIPEREXTENSIÓN 50°
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DIAGNOSTICO
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DIGNOSTICO •ITB
▫(E87%/S97%)
Mills WJ, Barei DP, Mc Nair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004;56:1261---5.
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•SIGNOS DE ISQUEMIA▫PULSOS DISTALES (94% VPP/100%VPN)
Miranda FE, Dennis JW, Veidenz HC, Dovgan PS, Frykberg ER. Confirmation of the safety and accuracy of physical examination in the evaluation of the knee dislocation for injury of the popliteal artery: a prospective study. J Trauma. 2002;52:247---52.
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ARTERIORAFIA
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DIAGNOSTICO •ARTEREOGRAFIA
▫INDICE TB ANORMAL
•90% ANGIOGRAFIA •DUPLEX ultrasonography (24%)•ABI (19%)•MR angiography (9.5%)
Vascular and Nerve Injury After Knee Dislocation, Clinical Orthopaedics and Related Research
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TRATAMIENTO•AGUDO
▫Vascular Reducción
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CIRUGÍA URGENCIAINDICACIONES
LESION VASCULAR
SINDROME COMPARTIMENTAL
LESION EXPUESTA
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ORTESIS VS FIJADOR EXTERNO
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TUTOR EXTERNO
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TRATAMIENTO DEFINITIVO•QUIRURICO vs NO QUIRURICO
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NO QUIRÚRGICO •CONSERVADOR
▫RODILLA ESTABLE/RIGIDA▫6 SEMANAS▫Ángulo DE FLEXION ??
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TRATAMIENTO
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QUIRÚRGICO •TIEMPO •QUE REPARAR •TECNICA QUIRURICA •INJERTO
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MOMENTO QUIRURGICO •AGUDO < 3 SEMANAS
•CRONICO > SEMANAS
Journal of Orthopaedic Surgery 2011;19(3):297-302
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TIEMPO IDEAL •14 DIAS
▫ARTROFIBROSIS ▫VASCULAR
•> 3 SEMANAS▫RECUPERAR MOVILIDAD
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TRATAMIENTO
Journal of Orthopaedic Surgery 2011;19(3):297-302
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MOMENTO QUIRURGICO
• MEJORES RESULTADOS EN PACIENTES TRATADOS EN UN TIEMPO MENOR A 2 SEMANAS
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RECONSTRUCCION VS REPARACION
• INDICES DE FRACASO MAYORES PARA REPARACION VS RECONSTRCCION.
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LESION VASCULAR