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Hindfoot Trauma

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					Hindfoot Trauma

  August 14, 2002
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
 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
  facet
 CT mandatory if considering operative
  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
 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

      Post traumatic OA

      Short heel cord
Salvage
   Distraction arthrodesis with lateral
    decompression
Talar Fractures
 OCD
 Neck
 Lateral Process
 Posterior process
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
   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
  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

 Prognosticates AVN 0 – 42 – 90 – 100%
Case 1
Case 1
Case 1
Hawkins Sign
 Positive Prognostic Factor
 Subchondral Disuse osteopenia in body of
  the talus
Lateral Process Fractures
 Difficult to diagnose on plain films
 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
 Not always easy to diagnose on plain films
 High clinical index of suspicion required
cion required



				
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