《跖骨骨折》ppt课件.pptVIP

;AP and lateral radiograph（正、侧位） of homolateral Lisfranc (tarso跗骨,-metatarsal joint跖关节) dislocation脱臼, 转位;Fluoroscopic radiographX线透视的 in the operating room;With adduction内收 the tarso-metatarsal joints fall into general alignment. However, there is still significant dorsal displacement which is palpable.;The incision is placed between the second and third metatarsals. This allows access from the second to the fourth tarsal metatarsal joints, as well as the lateral aspect of the first metatarsal joint. ;This incision is preferred as opposed to an incision between one and two, which is where the dorsalis pedis artery is located. ;Oblique view of the foot, demonstrating the incision.;The skin incision is brought down through the level of the subcutaneous tissue.;The short extensor muscles are retracted bluntly.;LATERAL CUNEIFORM;REDUCTION;Closeup of the reduction of the second metatarsal base to the middle cuneiform and the third metatarsal base to the lateral cuneiform. ;Once the reduction is obtained, a K-wire is placed across the reduction in an area that will not interfere with screw fixation.;K-WIRE;K-WIRE;Because of the very sharp angle with respect to the bone, the countersink should be used to create a hole in the metatarsal base. ;If this is not done, then the posterior aspect of the screw head will abut the base of the metatarsal before it is engaged in the hole and has the potential to displace the joint.;The screw being placed into the countersunk hole.;The screw once seated. A second screw has been placed between the third metatarsal base and the lateral cuneiform.;Once the dorsal incision has been utilized to gain good stability of the 2nd and 3rd (depending on the case) metatarsal bones back to the cuneiforms, there may still be instability on the medial aspect of the foot.;In this case, the first tarsal metatarsal joint was unstable and was addressed. A second incision, which is very short, is made directly over the tarsal metatarsal joint