Pisiform process fracture

　　1. Etiology

　　It is usually caused by vertical compression fractures when the foot is in a plantar flexed position during the injury of high-fall.

　　2. Pathogenesis

　　When falling from a height, the foot is in a plantar flexed position and the heel hits the ground, causing the talus to impact the posterior part of the tibia and causing injury.

　　The following complications can occur:

　　1. Fascial Compartment Syndrome:Fractures or soft tissue injuries such as muscle in the lower leg, blood clots, and reactive edema can increase the pressure within the fascial compartment, causing circulatory disorders and leading to fascial compartment syndrome. Among them, the incidence of anterior compartment syndrome is the highest.

　　The anterior compartment is located on the anterior-lateral side of the lower leg, with the anterior tibial muscle, long extensor muscle, extensor hallucis longus, third peroneal muscle, common peroneal nerve, and anterior tibial artery and vein located within it. When anterior compartment syndrome occurs, the anterior-lateral side of the lower leg becomes hard and there is marked tenderness, and the pain increases when the toes are passively extended or flexed. The pain is related to the degree of compression of the peroneal nerve, and in the early stage

　　Sensory impairment between the first and second toes can occur, followed by paralysis of the extensor digitorum longus, extensor hallucis longus, and anterior tibial muscle. Since the peroneal artery has communicating branches with the anterior tibial artery, the dorsalis pedis artery can be palpated early.

　　2. In addition to the anterior compartment fascia, the three compartments at the posterior tibia can also develop this syndrome.Among them, the incidence of posterior deep compartment syndrome is higher than that of posterior superficial compartment and lateral compartment. The characteristics are posterior compartment pain, numbness of the sole, weakened toe flexion strength, and increased pain when the toes are passively extended. The tension of the deep fascia at the distal medial side of the gastrocnemius muscle increases, and the tenderness is obvious. If the symptoms continue to develop without timely treatment, muscle ischemic contracture within the compartment can occur, leading to claw-shaped feet. A lower leg posterior-medial incision can be made, starting from the origin of the tibialis posterior muscle, and the deep fascia can be longitudinally incised. If necessary, the epimysium can also be incised to achieve decompression.

　　Predisposed compartment syndrome is formed by the continuous increase of pressure within the compartment, vasoconstriction, increased tissue osmotic pressure, and tissue ischemia and hypoxia. Especially in cases of closed tibiofibular fractures with obvious soft tissue contusions, there is a possibility of developing fascial compartment syndrome, so early fracture reduction and intravenous infusion of 20% mannitol should be performed to improve microcirculation and reduce edema, and close observation should be made.

　　In addition to the fascial compartment syndrome, the inferior orifice of the anterior tibial compartment near the ankle joint, the anterior tibial muscle, the long extensor muscle, and the toe long extensor tendon are closely attached to the tibia. The healing of the fracture in this area, after the formation of bone callus, can cause tendons to be worn, causing symptoms. In necessary cases, surgical incision of the fascia should also be performed for decompression.

　　There is obvious swelling, pain, deformity, dysfunction, marked tenderness locally after injury, and the ankle joint is afraid to move.

　　Posterior malleolar fractures often occur simultaneously with other injuries of the ankle joint, and only 0.8% to 2.5% are pure posterior malleolar fractures. If a posterior malleolus fracture of the tibia is diagnosed without finding injury to the medial malleolus or lateral malleolus, attention should be paid to accompanying soft tissue injuries, such as tears of the anterior tibiofibular syndesmosis and deltoid ligament injuries, and check if there is a fracture at the proximal part of the fibula.

　　This disease is caused by a fall from a height when the foot is in a plantar flexed position, and the heel hits the ground, the talus impacts the posterior part of the tibia and causes injury. It can also be directly caused by a fall, a fall, or an emergency brake when driving. Therefore, attention should be paid to living habits, high-risk workers such as construction workers, miners, and drivers are prone to injury, and protection should be taken during the work process. Stay calm in emergencies and avoid emotional excitement leading to conflict, which can lead to this disease. Secondly, early discovery, early diagnosis, and early treatment are also of great significance for the prevention of this disease.

　　X-ray films can show fractures and make a diagnosis. Posterior malleolar fractures often occur simultaneously with other injuries of the ankle joint, and only 0.8% to 2.5% are pure posterior malleolar fractures. If a posterior malleolar fracture of the tibia is diagnosed without finding injury to the medial malleolus or lateral malleolus, attention should be paid to accompanying soft tissue injuries, such as tears of the anterior tibiofibular syndesmosis and deltoid ligament injuries, and check if there is a fracture at the proximal part of the fibula. A diagnosis can be made through magnetic resonance imaging.

　　What kind of food is good for the body in the case of posterior malleolus fracture of the tibia?

　　1, In the early stage of fracture (1-2 weeks after injury), the diet should focus on light, appetizing, easy to digest, and easy to absorb foods.Such as vegetables, eggs, bean products, fruits, light fish soup, lean meat, etc. The preparation is mainly steamed and simmered, and fried and fried should be avoided. It is worth noting that the common soybean and bone soup in folk is greasy, contains more fat, and is not easy to digest and absorb, so it is best not to eat it at this stage.

　　Animal liver, seafood, soybeans, sunflower seeds, mushrooms contain a lot of zinc; animal liver, eggs, beans, green leafy vegetables, wheat flour contain more iron; oatmeal, rapeseed, egg yolks, cheese contain more manganese, and fracture patients can eat more of them. Animal liver and pork blood have the effect of replenishing blood, and play a particularly important role in timely blood replenishment after bleeding caused by trauma, so they can be eaten regularly.

　　2, In the middle stage of fracture (2-4 weeks after injury), dietary intake should be shifted from light to moderate high-nutrient supplementation to meet the needs of bone growth.The initial diet can be supplemented with bone soup, notoginseng chicken stew, fish, eggs, milk, and animal liver, and eat more vegetables rich in vitamin C such as green peppers, tomatoes, amaranth, and radishes.

　　3. In the late stage of fracture (more than 5 weeks after injury), there are no dietary restrictions, and various high-nutrient foods and foods rich in calcium, phosphorus, iron, and other minerals can be eaten.The diet during this period can be supplemented with old hen chicken soup, pork kidney soup, sheep kidney soup, deer tendons soup, fish soup, etc.

　　(The above information is for reference only, for details, please consult a doctor.)

　　I. Treatment

　　When the joint load-bearing surface is not involved and the joint stability is not affected, in general, when the fibula is reduced during the fracture, the small bone fragments of the posterior lip of the tibia are reduced at the same time. Therefore, the treatment of this type of posterior lip fracture depends on the trauma of other tissues. However, if the joint surface is involved, the fracture fragments move upwards, and when the bone fragments include 25% to 35% of the tibial joint surface, open reduction and internal fixation should be performed.

　　1. Surgical Approach:If there is no fracture of the fibula, a posterior lateral longitudinal incision about 10 cm long can be made.

　　2. Fracture Reduction and Fixation:Pay attention not to strip the ligament attachments of the bone fragments, use the periosteal剥离器 to reduce the bone fragments. First insert two Kirschner wires for temporary fixation, and then use two screws to fix after confirming the reduction of the bone fragments with fluoroscopy or radiography. Since the posterior lip of the tibia is very fragile, apply slow movement to tighten the screws or place a washer at the site of screw fixation to increase the fixation effect.

　　3. Surgical Treatment of the Posterior Lip of the Tibia in Cases of Fibula shaft Fracture

　　(1) If there is a fracture of the fibula shaft: After exposing the fibula from the posterior approach, separating the distal fibular fragment, first reduce and fix the posterior lip fracture fragment, then reduce the fibula, and fix it with a 1/3 tubular plate and cortical bone screws, and stabilize the tibiofibular syndesmosis if necessary.

　　(2) Sometimes there is a severe comminuted fracture of the fibula: and it is located at the lower tibiofibular syndesmosis, and the posterior tibiofibular syndesmosis fuses spontaneously thereafter. For this reason, during surgery, the cortex of the fibular notch of the tibia is removed, the fibula is placed inside, and the tibiofibular syndesmosis is fixed with screws.

　　II. Prognosis

　　Good Prognosis.