距下关节后关节面塌陷性骨折的治疗新进展.ppt

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,Open reduction internal fixation for intraarticular calcaneal fractures,距下关节后关节面塌陷性骨折的治疗新进展,Calcaneal fracture,ORIF is becoming widely accepted as the treatment of choice for displaced fractures,In the past 20 years,several plates have been used in treating this fracture,Until recent years,special plates designed for use in calcaneus are available in Taiwan,Small AO T-plate,Journal of trauma 2002,Lack of direct subtalar fragment fixation,Y-shaped reconstruction plate,Smith and Nephew Galveston plate,Depuy perimeter plate,The AO calcaneal plate,A-plus 3D calcaneal locking plate,ORIF indication,Displaced intra-,articular,calcaneal,fracture,Sanders CT classification(1993):based on the numbers of displaced fragments at the,subtalar,joint:,type I,type II,type III,type IV,ORIF done as soon as possible,no later than 4 weeks(when soft tissue condition permits)Injury 2013 July,Methods,Lateral decubitus position,Extensile lateral approach,Periosteum elevation with skin flap,Reduce tuberosity fragment,subtalar joint elevation,lateral wall reduction,C-C joint,Temporary K-wire fixation,Check fluoro,Apply calcaneal plate,No routine bone grafting,The approach for calcaneus fracture?,Medial,:McReynolds(1982),Extensile Lateral,:Benirschke(1990),Sanders(2000),Zwipp(2004),Combined medial and lateral,:Stephenson(1987),Extensile lateral approach has been the standard in recent literatures,Extensile lateral approach,Watch for sural n.and peroneus tendon,Bulging lateral wall,Joint depression seen after lateral wall elevation,Lateral wall,Reduce subtalar fragment,Ant.Column collapse,Reduce ant.column and apply calcaneal plate,Ant.column reduced,Final check,Post-op care,Posterior splint immobilization,Suture removal at 3rd week,ROM exercise,Non-weight bearing for 10 weeks,evaluation,Follow up X-rays,Creighton-Nebraska Health Foundation Score for Fracture of Calcaneus,Any complication?,Need further surgery?,Results:Creighton-Nebraska score,Sanders type,II,:86.7,Sanders type,III,:78.2,Sanders type,IV,:61.3,Complications,Lateral foot numbness,:5,Wound infection,:2 cases,one case healed after wound care and oral antibiotic,one case progressed to osteomyelitis,Implant irritation,:2 cases,patients ask implant removal,38 y/o male,both calcaneal fractures,wound infection,implant remove&debride,33 y/o male,Joint depression,Sanders type II,Post-op,14 months,68 y/o female,tongue type,Sanders type II,Post-op,I year follow up,52 y/o male,tongue type,Sanders type III,Post-op,11 months OA(+),After plate removal,37 y/o male,joint depression,Sanders type IV,Post-op,13 months,32 y/o male,Sanders type III,Conventional plates for use in calcaneal fractures,Without locking mechanism,Not anatomical pre-contoured,Need bending during surgery,Possibility of screw loosening,Soft tissue irritation,eg.peroneal tendon,sural nerve,Calcaneus Locking Plate,Sulcus calcanei fin,Plantar fin,Achilles Angular Locking Screw,Achilles fin,A tent pole for Bone graft,Sustentaculum Tali Angular Locking Screw,30 years old,male,Bone grafting?,No routine bone graft in our series,Union:no problem,No subsequent collapse,Strict non-weight bearing for 10 weeks,結論,Intraarticular calcaneal fracture,ORIF results in better clinical outcome for displaced fracture,Key step:reduce subtalar fragment,reconstruct calcaneal height and width,Need surgical learning curve,A good device can certainly help,Calcaneal locking plate,3D precontoured,no need for bending,Small,medium,large 3 sizes available,Increase fixation for ant.Column,subtalar fragment and tuberosity,Decrease soft tissue impingement,