跟骨骨折手术方法技术总结.ppt

* 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. TALUS DISPLACED POSTERIOR FACET INTACT POSTERIOR FACET SECONDARY FRACTURE LINE TUBEROSITY ANTEROLATERAL FRAGMENT THALAMIC (SUSTENTACULAR) FRAGMENT DISPLACED POSTERIOR FACET 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 INCISION PERONEAL TENDONS FIFTH METATARSAL The incision is slightly curved and L-shaped, beginning just anterior to the Achilles, curving at the level of the skin color change, running parallel with the sole of the foot and then curving slightly up anteriorly at its distal extent. FIBULA With the tourniquet inflated, the corner of the incision is brought directly down to bone. ABDUCTOR FASCIA Toward the distal extent of the incision the fascia of the abductor should be identified and dissection should be performed superficially to this so as not to devascularize the muscle layer. 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 The tension as developed allows for easy dissection in a subperiosteal manner, with a knife that is held essentially par