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Hindfoot Trauma

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

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Hindfoot Trauma

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  1. Hindfoot Trauma August 14, 2002

  2. 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

  3. 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

  4. Plain Film Findings • Make diagnosis • Little info about state of subtalar posterior facet • CT mandatory if considering operative treatment

  5. Bohlers Angle

  6. Gissane’s Angle

  7. Calcaneal FracturesTypes • Extra articular vs. intra articular • Intra articular • Joint depression vs. tongue type

  8. Intra-articular fracture • Primary and secondary fracture lines • Primary same for both types • Secondary Fracture line determines type

  9. Primary Fracture line

  10. Secondary Fracture LineTongue Type

  11. Secondary Fracture LineJoint Depression Type

  12. Sanders Classification

  13. Surgical Fixation • Decision • Principles

  14. Surgical Fixation

  15. Case 1

  16. Case 1

  17. Case 1

  18. Case 2

  19. Case 2

  20. Case 3

  21. Case 3

  22. Case 3

  23. Salvage Procedures • Sources of pain • Wide heel • Peroneal tendonitis • Post traumatic OA • Short heel cord

  24. Salvage • Distraction arthrodesis with lateral decompression

  25. Talar Fractures • OCD • Neck • Lateral Process • Posterior process

  26. 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

  27. OCD • Burnt and Hardy Classification

  28. OCD • Treatment • Skillful neglect in children • Arthroscopic debridement

  29. Case 1

  30. Case 1

  31. Case 2

  32. Case 2

  33. Talar Neck Fractures • MVA’s forced dorsiflexion • Displaced require ORIF • Long term sequelae – AVN body and varus mal-union

  34. Talar neck Fractures • Plain films often diagnostic • Canale view

  35. 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%

  36. Case 1

  37. Case 1

  38. Case 1

  39. Hawkins Sign • Positive Prognostic Factor • Subchondral Disuse osteopenia in body of the talus

  40. Lateral Process Fractures • Difficult to diagnose on plain films • High index of suspicion • Eversion Injury

  41. Lateral Process Fractures

  42. Case 1

  43. Case 1

  44. Fractures Posterior Process

  45. Hindfoot Dislocations • Rare • Subtalar (peritalar) most common • Subtalar and Talo-navicular • 85% medial • 10-40% open • Malleolar and base of 5th #’s common

  46. Summary • Fractures of the hindfoot bones uncommon • Not always easy to diagnose on plain films • High clinical index of suspicion required

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