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  1. Hindfoot Trauma August 14, 2002

  2. Hindfoot Fractures • Much less common than ankle fractures • Complex anatomy often make plain radiographs less than ideal • Bone scans, CT and MR often necessary for diagnosis and preop planning

  3. Calcaneal Fracture • Young men, fall from height • Most Common Hindfoot fracture • Often less than ideal clinical result • Surgical treatment helpful??? • Types • Primary and secondary fracture lines • State of the posterior facet

  4. Plain Film Findings • Make diagnosis • Little info about state of subtalar posterior facet • CT mandatory if considering operative treatment

  5. Bohlers Angle

  6. Gissane’s Angle

  7. Calcaneal FracturesTypes • Extra articular vs. intra articular • Intra articular • Joint depression vs. tongue type

  8. Intra-articular fracture • Primary and secondary fracture lines • Primary same for both types • Secondary Fracture line determines type

  9. Primary Fracture line

  10. Secondary Fracture LineTongue Type

  11. Secondary Fracture LineJoint Depression Type

  12. Sanders Classification

  13. Surgical Fixation • Decision • Principles

  14. Surgical Fixation

  15. Case 1

  16. Case 1

  17. Case 1

  18. Case 2

  19. Case 2

  20. Case 3

  21. Case 3

  22. Case 3

  23. Salvage Procedures • Sources of pain • Wide heel • Peroneal tendonitis • Post traumatic OA • Short heel cord

  24. Salvage • Distraction arthrodesis with lateral decompression

  25. Talar Fractures • OCD • Neck • Lateral Process • Posterior process

  26. OCD • “chronic ankle pain after sprain” • Was thought to be idiopathic, now most likely traumatic • Anterior lateral – posterior medial • Plain films sometimes neg. • Bone scan and CT diagnostic

  27. OCD • Burnt and Hardy Classification

  28. OCD • Treatment • Skillful neglect in children • Arthroscopic debridement

  29. Case 1

  30. Case 1

  31. Case 2

  32. Case 2

  33. Talar Neck Fractures • MVA’s forced dorsiflexion • Displaced require ORIF • Long term sequelae – AVN body and varus mal-union

  34. Talar neck Fractures • Plain films often diagnostic • Canale view

  35. Classification • Hawkins • Type 1 undisplaced • Type 2 displaced Subtalar joint subluxed • Type 3 Ankle also dislocated • Type 4 T-N joint • Prognosticates AVN 0 – 42 – 90 – 100%

  36. Case 1

  37. Case 1

  38. Case 1

  39. Hawkins Sign • Positive Prognostic Factor • Subchondral Disuse osteopenia in body of the talus

  40. Lateral Process Fractures • Difficult to diagnose on plain films • High index of suspicion • Eversion Injury

  41. Lateral Process Fractures

  42. Case 1

  43. Case 1

  44. Fractures Posterior Process

  45. Hindfoot Dislocations • Rare • Subtalar (peritalar) most common • Subtalar and Talo-navicular • 85% medial • 10-40% open • Malleolar and base of 5th #’s common

  46. Summary • Fractures of the hindfoot bones uncommon • Not always easy to diagnose on plain films • High clinical index of suspicion required