CALCANEU跟骨骨折.ppt
- 文档编号:1899687
- 上传时间:2022-10-25
- 格式:PPT
- 页数:28
- 大小:4.67MB
CALCANEU跟骨骨折.ppt
《CALCANEU跟骨骨折.ppt》由会员分享,可在线阅读,更多相关《CALCANEU跟骨骨折.ppt(28页珍藏版)》请在冰豆网上搜索。
Preoplateraldemonstratingjointdepressiontypeoffracturewithdisplacementofatuberosityandextensionintothecalcanealcuboidjoint.The30degreesemi-coronalandaxialCATscansofthefracture.TALUSDISPLACEDPOSTERIORFACETINTACTPOSTERIORFACETSECONDARYFRACTURELINETUBEROSITYANTEROLATERALFRAGMENTTHALAMIC(SUSTENTACULAR)FRAGMENTDISPLACEDPOSTERIORFACETThepatientispositionedcarefullyinthelateraldecubituspositionwithpadsundertheaxillaanddownsideperonealnerve.Thedownlegisplacedforwardagainstandparallelwiththeanterioredgeofthebed.Pillowsareplacedbetweenthelegsandenoughsheetsbehindthedownlegsuchthattheoperativelegliesparallelwiththegroundandatthelevelofthepatientship.Thewrinkletest,asdescribedbySanders,involvesdorsiflexingthefootfromaplantar-fixedpositionandlookingfornormalskinturgor,asevidencedbywrinklingoftheskinalongtheareaofthelateralpartofthefoot.ANTERIORACHILLESBORDERINCISIONPERONEALTENDONSFIFTHMETATARSALTheincisionisslightlycurvedandL-shaped,beginningjustanteriortotheAchilles,curvingattheleveloftheskincolorchange,runningparallelwiththesoleofthefootandthencurvingslightlyupanteriorlyatitsdistalextent.FIBULAWiththetourniquetinflated,thecorneroftheincisionisbroughtdirectlydowntobone.ABDUCTORFASCIATowardthedistalextentoftheincisionthefasciaoftheabductorshouldbeidentifiedanddissectionshouldbeperformedsuperficiallytothissoasnottodevascularizethemusclelayer.Inordertodissectdirectlyonthecalcaneusinasubperiostealmanner,significanttensionshouldbedevelopedbyholdingtheheelinvertedwiththethumbandpullingdirectlylaterallyawayfromthefootwithasharpretractorhelddeepintheflap.TENSIONThetensionasdevelopedallowsforeasydissectioninasubperiostealmanner,withaknifethatisheldessentiallyparallelwiththebone.Many#15bladeswillbenecessaryinordertodissectouttheentirecalcaneus.PERONEALTENDONSAftertheflapiscompletelyelevated,theperonealtendonsarevisibleatthedistalextentoftheflap.Caremustbetakennottodamagethesetendonsasthedissectionprogressesdistally.LATERALPROCESSOFTALUSCloseupviewdemonstratingthatwithflapelevationthelateralprocessandposteriorfacetofthetalusisidentified.AK-wireisplacedintothetalarbodyfromthelateralprocessandusedtoretracttheflap.PININFIBULAPININTALUSDISPLACEDPOSTERIORFACETThelateralwallanddisplacedportionoftheposteriorfacetofthecalcaneususremoved.TUBEROSITYINTACTPOSTERIORFACETOFCALCANEUSPOSTERIORFACETTALUSDISPLACEDPOSTERIORFACETAbonehookcanbeusedtopullthetuberositydowntoitsnormalposition;thisreductionisnecessarytoallowforreductionoftheposteriorfacetwithoutstericinterference.TUBEROSITYINTACTPOSTERIORFACETOFCALCANEUSPOSTERIORFACETTALUSDISPLACEDPOSTERIORFACETInthisfigure,theposteriorfacetofthetalusisvisiblewiththeintactmedialportionoftheposteriorfacetofthecalcaneusremaininginitsreducedposition.Thefracturedlateralportionofthefacetisvisibleasitisbeingremoved.K-WIREFREERELEVATORAftercleaningthefragment,theposteriorfacetisreducedanatomicallywiththeaidofaFreerelevatorinpalpatingthereduction,whichissometimesverydifficulttosee.ThisisheldinplacewithaK-wireK-WIREFREERELEVATOROncethereductionisconfirmedunderdirectvisionandfluoroscopy,itisfixedwithcorticallagscrews(nextimage).Thefractureisanatomicallyreducedandvisiblewithforcefulinversionoftheheel.POSTERIORFACETTALUSPOSTERIORFACETREDUCTIONAheadlampcandirectlightagainsttheposteriorfacetofthecalcaneusbyreflectingitofftheposteriorfacetofthetalus.Thelateralx-raydemonstratingK-wireholdingthetuberosityinposition.AlsonoteaK-wireintheareaoftheangleofGissane,holdingtheanterolateralfragmentreduced.Reductionoftheanterolateralfragmentisusuallyobtainedbyforcefulmanipulationwitheitheraballspikeorperiostealelevator.AK-wirecanthenbeplacedintheanterolateralfragmentintotheintactmedialsustentacularfragment(arrow).ANGLEOFGISSANEThelateralwallfragmentsarepiecedbackaswellaspossible,giventhattheyaresometimescomminuted.Lateralradiographandclinicalpictureaftertheanterolateralandanteriorportionofcalcaneushavebeenfixedwithlagscrews,demonstratingreductionofthefacet,theanteriorcalcaneusandthetuberosity.AftertheboneisrepositionedandheldinplacewithK-wires,itisplated.Inthisexample,twomini-fragmentplatesareused.However,manyoptionsareavailablefortheplatefixation.Lateralradiographafterinitialplatefixation.Theclosureisexceedinglyimportantandmustbedoneinseverallayers.Thedeepfasciamustberepairedtotheperiosteumoftheflapwithinterruptedsutures.DRAINThesuturesshouldallbeplacedandtagged,thenclosedfromthe
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- CALCANEU 骨折