Chapter 31 - Rearfoot
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Which of the 3 fusions in a triple arthrodesis requires the longest time for revascularization?
What is the order of resection and fixation for Triple?
- -resect MTJ (CC then TN) this allows access to STJ
- -resect STJ
- -temporarily fixate STJ
- -temporarily fixate MTJ (TN then CC)
- -check with C-arm
- -fixate STJ
- -fixate MTJ
Name the 5 portals for ankle arthroscopy
- 1. Anterior medial portal: medial to ATT and lateral to medial mal.
- 2. Anterior lateral portal: Lateral to Peroneus tertius tendon and medial to lateral mal
- 3. Anterior central portal: lateral to EHL tendon and medial to EDL tendon
- 4. Posterior medial portal: medial to Achilles, lateral to tarsal canal. Avoid the PT artery and tibial nerve
- 5. Posterior lateral portal - lateral to achilles and medial to fibular malleolus
Calcaneal repairs should be done within what window of time after surgery?
Within 4 hours or wait 7-10 days until swelling has subsided. Perform ORIF within 2 weeks.
What is the classification system for calcaneal fracture? There are 3.
- Essex Lopresti:
- Joint depression and Tongue type
- A, B, C, D.
- A is superior medial fragment
- B is anterolateral fragment
- C Lateral fragment in joint depression type (semilunar fragment, but with tongue type it's termed thalamic or comet fragement.
- D Tuberosity
- Type 1A: medial tuberosity fx
- Type 1B: sustentaculum Tali fx
- Type 1C: Anterior process fx
- Type IIA: Posterior beak fx (no achilles involvement)
- Type IIB: Posterior beak fx (achilles involved).
- Type III: Extraarticular body fx
- Type IV - Intraarticular body fx without depression
- Type V - Intraarticular body fx with depression (comminution).
- Type I - any nondisplaced intraarticular fracture
- Type II - 1 fracture through posterior facet (creating 2 fragments)
- Type III - 2 fracture through posterior facet (creating 3 fragments)
- Type IV - 3 or more intraarticular fracture lines (comminution).
ABC are lines on the posterior calcaneus: A is most lateral and C is most medial.
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