Hindfoot fractures
Download
1 / 36

Hindfoot Fractures - PowerPoint PPT Presentation


  • 268 Views
  • Updated On :

Hindfoot Fractures. Moritz Haager July 8, 2004. Jeez, I sure hope I don’t bust my hindfoot. What articulations comprise the ankle joint complex?. What articulations comprise the ankle joint complex?. Talocrural joints Distal tibia – talus Medial malleolus – talus Lateral malleolus – talus

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Hindfoot Fractures' - adamdaniel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Hindfoot fractures l.jpg

Hindfoot Fractures

Moritz Haager

July 8, 2004




What articulations comprise the ankle joint complex4 l.jpg
What articulations comprise the ankle joint complex?

  • Talocrural joints

    • Distal tibia – talus

    • Medial malleolus – talus

    • Lateral malleolus – talus

    • Distal tibia – distal fibula (distal tibiofibular joint)

      • Collectively allow dorsiflexion and plantarflexion

  • Subtalar joints

    5. Talus – Calcaneus

    • Contributes to inversion and eversion

  • Hence the talus & calcaneus are key to ankle function

  • 4

    1

    2

    3

    5


    Ap radiograph l.jpg
    AP Radiograph

    • Adequacy

      • Fibula & tibia above talus

      • Open medial clear space

    > 10 mm


    Lateral radiograph l.jpg
    Lateral Radiograph

    • Adequacy

      • Malleoli superimposed

      • Joint space cleary visible w/o overlap

    • Look for signs of ankle effusion

      • Lucency anterior or posterior to joint capsule


    Mortise view l.jpg
    Mortise View

    • Evaluates articular surface

    • Technique

      • Leg is internally rotated 15 – 20o

      • X-ray beam perpendicular to intermalleolar line

    • Adequacy

      • No overlap of talar dome & joint space

      • Med. & lat. clear spaces open

    • Articular surfaces should be parallel throughout i.e. uniform joint width

    • Should see mild (>1 mm) overlap of tibia & fibula

    • Medial clear space should not exceed 4 mm

    • Lateral clear space should not exceed 5.5 mm

    lateral clear

    space

    (< 5.5 mm)

    medial clear

    space

    >1 mm


    Talus anatomy l.jpg
    Talus anatomy

    Talar dome or trochlea

    Head

    Body

    Neck

    • Midfoot

      (Chopart joint)

    Subtalar joint

    • What is the risk with talar neck fractures? Why?

    • Avascular necrosis

      • Most of the vascular supply to body via neck


    Talar fractures l.jpg
    Talar fractures

    • Minor talar fractures

      • Chip and avulsion fractures of neck ,head, and body.

      • Usually same mechanism as ankle sprains

    • Talar neck fractures

      • 50% of major talar injuries.

      • extreme dorsiflexion force (aviator’s astralagus)

      • Frequent associated fractures

      • Hawkins classification

    • Talar body fractures

      • 23% of all talar fractures (including minor fractures)

      • Major talar body fractures are uncommon

        • usually axial loading (e.g. falls)

    • Talar head fractures

      • Uncommon (5-10%)

      • compressive force transmitted up through the talonavicular joint applied on a plantarflexed foot


    Hawkins classification of talar neck fractures l.jpg
    Hawkins Classification of Talar Neck Fractures

    • Type 1: = nondisplaced;

    • Type 2: subtalar subluxation

    • Type 3: dislocation of the talar body (50% open #’s)

    • Type 4: dislocation of the talar body & distraction of the talonavicular joint.

      • Fracture type influences management & prognosis


    Calcaneal anatomy l.jpg
    Calcaneal anatomy

    Lateral

    malleolus

    apex of

    posterior facet

    Anterior

    process

    Posterior

    tuberosity

    Sustenaculum tali


    Axial harris view l.jpg
    Axial (Harris) View

    Lateral

    malleolus

    Sustenaculum

    tali

    Posterior

    tuberosity


    Bohlers angle l.jpg
    Bohlers Angle

    Posterior

    tuberosity

    apex of

    posterior facet

    apex of

    anterior process


    Calcaneus fractures l.jpg
    Calcaneus Fractures

    • Classification

      • Compression #’s

      • Posterior tuberosity #’s

      • Anterior process #’s

      • Sustenaculum tali #’s

    • High energy mechanism  associated injuries

      • 20% will have vertebral fractures







    Oblique view l.jpg
    Oblique View

    Anterior

    process #



    Key concepts l.jpg
    Key Concepts

    • Plain films tend to underestimate hindfoot fractures

      • often require CT or MRI for better evaluation

    • Calcaneal fractures are

      • frequently bilateral

      • associated with other injuries

    • Abnormal Bohlers angle may be only clue

    • Talus fractures are at risk for AVN



    ad