跟骨骨折手术方法

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1、Preoplateraldemonstratingjointdepressiontypeoffracturewithdisplacementofatuberosityandextensionintothecalcanealcuboidjoint.The30degreesemi-coronalandaxialCATscansofthefracture.TALUSDISPLACEDPOSTERIORFACETINTACTPOSTERIORFACETSECONDARYFRACTURELINETUBEROSITYANTE

2、ROLATERALFRAGMENTTHALAMIC(SUSTENTACULAR)FRAGMENTDISPLACEDPOSTERIORFACETThepatientispositionedcarefullyinthelateraldecubituspositionwithpadsundertheaxillaanddownsideperonealnerve.Thedownlegisplacedforwardagainstandparallelwiththeanterioredgeofthebed.Pillowsare

3、placedbetweenthelegsandenoughsheetsbehindthedownlegsuchthattheoperativelegliesparallelwiththegroundandatthelevelofthepatient’ship.Thewrinkletest,asdescribedbySanders,involvesdorsiflexingthefootfromaplantar-fixedpositionandlookingfornormalskinturgor,asevidence

4、dbywrinklingoftheskinalongtheareaofthelateralpartofthefoot.ANTERIORACHILLESBORDERINCISIONPERONEALTENDONSFIFTHMETATARSALTheincisionisslightlycurvedandL-shaped,beginningjustanteriortotheAchilles,curvingattheleveloftheskincolorchange,runningparallelwiththesoleof

5、thefootandthencurvingslightlyupanteriorlyatitsdistalextent.FIBULAWiththetourniquetinflated,thecorneroftheincisionisbroughtdirectlydowntobone.ABDUCTORFASCIATowardthedistalextentoftheincisionthefasciaoftheabductorshouldbeidentifiedanddissectionshouldbeperformed

6、superficiallytothissoasnottodevascularizethemusclelayer.Inordertodissectdirectlyonthecalcaneusinasubperiostealmanner,significanttensionshouldbedevelopedbyholdingtheheelinvertedwiththethumbandpullingdirectlylaterallyawayfromthefootwithasharpretractorhelddeepin

7、theflap.TENSIONThetensionasdevelopedallowsforeasydissectioninasubperiostealmanner,withaknifethatisheldessentiallyparallelwiththebone.Many#15bladeswillbenecessaryinordertodissectouttheentirecalcaneus.PERONEALTENDONSAftertheflapiscompletelyelevated,theperonealt

8、endonsarevisibleatthedistalextentoftheflap.Caremustbetakennottodamagethesetendonsasthedissectionprogressesdistally.LATERALPROCESSOFTALUSCloseupviewdemonstratingthatwithflapelevationthelat