slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Peroneal and Achilles tendon problems with surgical management PowerPoint Presentation
Download Presentation
Peroneal and Achilles tendon problems with surgical management

Loading in 2 Seconds...

play fullscreen
1 / 14

Peroneal and Achilles tendon problems with surgical management - PowerPoint PPT Presentation


  • 176 Views
  • Uploaded on

Peroneal and Achilles tendon problems with surgical management. Peroneal tendon stabilisation. Anatomy. Peroneal tendons course behind the distal fibula The peroneus brevis may have degenerative changes if the injury is not identified in a timely fashion. What happens and what you see.

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 'Peroneal and Achilles tendon problems with surgical management' - rupali


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
anatomy
Anatomy

Peroneal tendons course behind the distal fibula

The peroneusbrevis may have degenerative changes if the injury is not identified in a timely fashion

what happens and what you see
What happens and what you see

The peronealretinaculum may be avulsed from the fibula or calcaneus or lifted up enough to allow tendon dislocation

Forceful contraction of peroneals

during sudden dorsiflexion and

inversion

classification
Classification

Figure 26-65 Classification of pathology in peroneal tendon dislocations. A, Normal. B, Grade I: superior peronealretinaculum stripped off fibula. C, Grade II: fibrous rim avulsed from the posterolateral aspect of the fibula along with the superior peronealretinaculum. D, Grade III: bony avulsion of the posterolateral part of the fibula by the superior peronealretinaculum. (Modified from Eckert WR, Davis EA Jr: J Bone Joint Surg Am 58:670-673, 1976.)

management 1 direct repair
Management 1 Direct repair
  • If acute repair correctly
  • Anchors useful to aid stabilisation of retinaculum
management 2 groove deepening repair
Management 2 Groove deepening repair

Split the fibula distally leaving a posterior hinge intact, by curetting out some of the cancellous bone and replacing the hinge the groove will be deepened

Like trochleoplasty of the knee allowing a deeper grove for the tendons to sit in, minimising further dislocation

management 3 duvries bone block lateral fibula osteotomy procedure
Management 3 DuVries Bone block lateral fibula osteotomy procedure

Modification of Kelly procedure

Creates new groove for tendons to sit in, posterior to the fibula

approach to achilles haglunds
Approach to Achilles/Haglunds
  • Can approach medially or laterally
    • If lateral find and protect the sural nerve
  • Try and avoid central/splitting incision
haglunds decompression i
Haglunds decompression I
  • Try to remove degenerative tissue and decrease impingement
  • Can take away more than you think
haglunds decompression ii
Haglunds decompression II

Can resect/decompress with osteotome or burr. If involving greater than 50% of achillesstabilsie with anchors

fhl transfer
FHL transfer
  • Severe unremitting insertionaltendinopathy
  • Excessive calcificinsertionaltendinopathy
  • Failed anchors resulting in pullout
principles of fhl transfer
Principles of FHL transfer

2 incisions: Medial over Achilles and Medial over knot of Henry

Deliver FHL into Achilles wound and secure to OS Calsis with biotenodesis screw at appropriate tension

NB don’t forget to tenodese distal FHL with FDL to enable flexion at big toe