Shahram Shahmary Hindfoot Trauma

Information about Shahram Shahmary Hindfoot Trauma

Published on January 9, 2009

Author: shahmary

Source: authorstream.com

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

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