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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

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Hindfoot fractures l.jpg

Hindfoot Fractures

Moritz Haager

July 8, 2004


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Jeez, I sure hope I don’t bust my hindfoot..


What articulations comprise the ankle joint complex l.jpg

What articulations comprise the ankle joint complex?


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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


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    AP Radiograph

    • Adequacy

      • Fibula & tibia above talus

      • Open medial clear space

    > 10 mm


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    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


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    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


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    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


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    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


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    Calcaneal anatomy

    Lateral

    malleolus

    apex of

    posterior facet

    Anterior

    process

    Posterior

    tuberosity

    Sustenaculum tali


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    Axial (Harris) View

    Lateral

    malleolus

    Sustenaculum

    tali

    Posterior

    tuberosity


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    Bohlers Angle

    Posterior

    tuberosity

    apex of

    posterior facet

    apex of

    anterior process


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    Calcaneus Fractures

    • Classification

      • Compression #’s

      • Posterior tuberosity #’s

      • Anterior process #’s

      • Sustenaculum tali #’s

    • High energy mechanism  associated injuries

      • 20% will have vertebral fractures


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    Chip (osteochondral) fracture


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    Talus fracture


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    Type 3 talar neck fracture


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    Normal


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    Type 2 talar fracture


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    Oblique View

    Anterior

    process #


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    Posterior tubercle #


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    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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    Questions

    ?


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