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Hindfoot Trauma - Hindfoot Trauma Hindfoot Fractures Much...

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Unformatted text preview: Hindfoot Trauma August 14, 2002 Hindfoot Fractures Much less common than ankle fractures Complex anatomy often make plain Complex radiographs less than ideal radiographs Bone scans, CT and MR often necessary for Bone diagnosis and preop planning diagnosis Calcaneal Fracture Young men, fall from height Most Common Hindfoot fracture Often less than ideal clinical result Surgical treatment helpful??? Types Primary and secondary fracture lines State of the posterior facet Plain Film Findings Make diagnosis Little info about state of subtalar posterior Little facet facet CT mandatory if considering operative CT treatment treatment Bohlers Angle Gissane’s Angle Calcaneal Fractures Types Extra articular vs. intra articular Intra articular Joint depression vs. tongue type Intra-articular fracture Primary and secondary fracture lines Primary same for both types Secondary Fracture line determines type Primary Fracture line Secondary Fracture Line Tongue Type Secondary Fracture Line Joint Depression Type Sanders Classification Surgical Fixation Decision Decision Principles Surgical Fixation Case 1 Case 1 Case 1 Case 2 Case 2 Case 3 Case 3 Case 3 Salvage Procedures Sources of pain Wide heel Peroneal tendonitis Peroneal Post traumatic OA Short heel cord Salvage Distraction arthrodesis with lateral Distraction decompression decompression Talar Fractures OCD Neck Lateral Process Posterior process OCD “chronic ankle pain after sprain” Was thought to be idiopathic, now most Was likely traumatic likely Anterior lateral – posterior medial Plain films sometimes neg. Bone scan and CT diagnostic OCD Burnt and Hardy Classification OCD Treatment Skillful neglect in children Arthroscopic debridement Case 1 Case 1 Case 2 Case 2 Talar Neck Fractures MVA’s forced dorsiflexion Displaced require ORIF Long term sequelae – AVN body and varus Long mal-union mal-union Talar neck Fractures Plain films often diagnostic Canale view Classification Hawkins Type 1 undisplaced Type 2 displaced Subtalar joint subluxed Type 3 Ankle also dislocated Type 4 T-N joint Type Prognosticates AVN 0 – 42 – 90 – 100% Case 1 Case 1 Case 1 Hawkins Sign Positive Prognostic Factor Subchondral Disuse osteopenia in body of Subchondral the talus the Lateral Process Fractures Difficult to diagnose on plain films Difficult High index of suspicion Eversion Injury Lateral Process Fractures Case 1 Case 1 Fractures Posterior Process Hindfoot Dislocations Rare Subtalar (peritalar) most common Subtalar and Talo-navicular 85% medial 10-40% open Malleolar and base of 5th #’s common Summary Fractures of the hindfoot bones uncommon Fractures Not always easy to diagnose on plain films High clinical index of suspicion required ...
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