跟骨骨折手术方法重点.pptVIP

;Preop lateral demonstrating joint depression type of fracture with displacement of a tuberosity and extension into the calcaneal cuboid joint.;The 30 degree semi-coronal and axial CAT scans of the fracture.;The patient is positioned carefully in the lateral decubitus position with pads under the axilla and downside peroneal nerve. The down leg is placed forward against and parallel with the anterior edge of the bed.;Pillows are placed between the legs and enough sheets behind the down leg such that the operative leg lies parallel with the ground and at the level of the patient’s hip.;The wrinkle test, as described by Sanders, involves dorsiflexing the foot from a plantar-fixed position and looking for normal skin turgor, as evidenced by wrinkling of the skin along the area of the lateral part of the foot. ;ANTERIOR ACHILLES BORDER;With the tourniquet inflated, the corner of the incision is brought directly down to bone.;ABDUCTOR FASCIA;In order to dissect directly on the calcaneus in a subperiosteal manner, significant tension should be developed by holding the heel inverted with the thumb and pulling directly laterally away from the foot with a sharp retractor held deep in the flap.;TENSION;PERONEAL TENDONS;LATERAL PROCESS OF TALUS;PIN IN FIBULA;TUBEROSITY;TUBEROSITY;K-WIRE;K-WIRE;POSTERIOR FACET TALUS;The lateral x-ray demonstrating K-wire holding the tuberosity in position. Also note a K-wire in the area of the angle of Gissane, holding the anterolateral fragment reduced.;Reduction of the anterolateral fragment is usually obtained by forceful manipulation with either a ball spike or periosteal elevator. A K-wire can then be placed in the anterolateral fragment into the intact medial sustentacular fragment (arrow).;The lateral wall fragments are pieced back as well as possible, given that they are sometimes comminuted.;Lateral radiograph and clinical picture after the anterolateral and anterior portion of calcaneus have been fixed with lag screws, demo