醫學筆記匯整 ED Notes

Bohler angle ＜ 20 會懷疑 posterior facet calcaneus fx 
  a. 有3個點：(a) anterior process；(b) posterior facet；(c) tuberosity
  b. 如圖，(a)(b)連線和(b)(c)連線的夾角正常應為20-40度
  c. 若是 > 40度 或 < 20度就應開刀治療

- 因由高處掉落，所以跟骨骨折時須檢查其他承載重量的骨頭是否也受損
   A. 20%：胸椎。需照X光或是用敲打脊椎的方式檢視胸椎是否受傷
   B. 15%：恥骨
   C. 10%：股骨幹

- 可分為
A. extra-articular fracture : 占25-30%, 範圍包含anterior process、粗隆(tuberosity)、內側突(medial process)、載距突(sustentaculum tail)和體(body)
B. intra-articular fracture : 占70-75%, 依Essex-Lopresti可分為tongue type和joint depression type
a. joint depression type : 骨折線(fracture line)後端的部分因阿基里斯腱(Tendo calcaneus；Achilles tendon)的牽引導致向後位移 圖C
b. tongue type : 骨折線延伸到阿基里斯腱的附著點，形成舌頭狀(圖F游標處)

Blanching of the skin, or partial- or full-thickness skin breakdown, require emergent treatment.
Association with significant soft-tissue injury and potential soft-tissue complications.
Because of marked disruption of the posterior soft tissues,
if it does not present as an open fracture at the time of admission to hospital,
the pressure from within on the posterior skin will soon cause it to break down and convert it into an open fracture.