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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

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hindfoot fractures

Hindfoot Fractures

Moritz Haager

July 8, 2004

what articulations comprise the ankle joint complex4
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
AP Radiograph
  • Adequacy
    • Fibula & tibia above talus
    • Open medial clear space

> 10 mm

lateral radiograph
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
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
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
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
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
Calcaneal anatomy

Lateral

malleolus

apex of

posterior facet

Anterior

process

Posterior

tuberosity

Sustenaculum tali

axial harris view
Axial (Harris) View

Lateral

malleolus

Sustenaculum

tali

Posterior

tuberosity

bohlers angle
Bohlers Angle

Posterior

tuberosity

apex of

posterior facet

apex of

anterior process

calcaneus fractures
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
Oblique View

Anterior

process #

key concepts
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
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