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;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.;;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;;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, demonstrating reduction of the facet, the anterior calcaneus and the tuberosity.;After the bone is repositioned and held in place with K-wires,
it is plated. In this example, two mini-fragment plates
are used. However, many options are available f
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