跟骨骨折手术方法.ppt

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1、Preoplateraldemonstratingjointdepressiontypeoffracturewithdisplacementofatuberosityandextensionintothecalcanealcuboidjoint.The30degreesemi-coronalandaxialCATscansofthefracture.TALUSDISPLACEDPOSTERIORFACETINTACTPOSTERIORFACETSECONDARYFRACTURELINETUBEROSITYANTEROLATERALFR

2、AGMENTTHALAMIC(SUSTENTACULAR)FRAGMENTDISPLACEDPOSTERIORFACETThepatientispositionedcarefullyinthelateraldecubituspositionwithpadsundertheaxillaanddownsideperonealnerve.Thedownlegisplacedforwardagainstandparallelwiththeanterioredgeofthebed.Pillowsareplacedbetweenthelegsan

3、denoughsheetsbehindthedownlegsuchthattheoperativelegliesparallelwiththegroundandatthelevelofthepatient’ship.Thewrinkletest,asdescribedbySanders,involvesdorsiflexingthefootfromaplantar-fixedpositionandlookingfornormalskinturgor,asevidencedbywrinklingoftheskinalongthearea

4、ofthelateralpartofthefoot.ANTERIORACHILLESBORDERINCISIONPERONEALTENDONSFIFTHMETATARSALTheincisionisslightlycurvedandL-shaped,beginningjustanteriortotheAchilles,curvingattheleveloftheskincolorchange,runningparallelwiththesoleofthefootandthencurvingslightlyupanteriorlyati

5、tsdistalextent.FIBULAWiththetourniquetinflated,thecorneroftheincisionisbroughtdirectlydowntobone.ABDUCTORFASCIATowardthedistalextentoftheincisionthefasciaoftheabductorshouldbeidentifiedanddissectionshouldbeperformedsuperficiallytothissoasnottodevascularizethemusclelayer

6、.Inordertodissectdirectlyonthecalcaneusinasubperiostealmanner,significanttensionshouldbedevelopedbyholdingtheheelinvertedwiththethumbandpullingdirectlylaterallyawayfromthefootwithasharpretractorhelddeepintheflap.TENSIONThetensionasdevelopedallowsforeasydissectioninasubp

7、eriostealmanner,withaknifethatisheldessentiallyparallelwiththebone.Many#15bladeswillbenecessaryinordertodissectouttheentirecalcaneus.PERONEALTENDONSAftertheflapiscompletelyelevated,theperonealtendonsarevisibleatthedistalextentoftheflap.Caremustbetakennottodamagetheseten

8、donsasthedissectionprogressesdistally.LATERALPROCESSOFTALUSCloseupviewdemonstratingthatwithflapelevationthelat