距下关节后关节面塌陷性骨折的治疗新进展课件

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,*,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,Open reduction internal fixati,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,Calcaneal fractureORIF is beco,Small AO T-plate,Journal of trauma 2002,Lack of direct subtalar fragment fixation,Small AO T-plateJournal of tra,Y-shaped reconstruction plate,Y-shaped reconstruction plate,Smith and Nephew Galveston plate,Smith and Nephew Galveston pla,Depuy perimeter plate,Depuy perimeter plate,The AO calcaneal plate,The AO calcaneal plate,A-plus 3D calcaneal locking plate,A-plus 3D calcaneal locking pl,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,ORIF indicationDisplaced intra,距下关节后关节面塌陷性骨折的治疗新进展课件,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,MethodsLateral decubitus posit,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,The approach for calcaneus fra,Extensile lateral approach,Watch for sural n.and peroneus tendon,Extensile lateral approachWatc,Bulging lateral wall,Bulging lateral wall,Joint depression seen after lateral wall elevation,Lateral wall,Joint depression seen after la,Reduce subtalar fragment,Ant.Column collapse,Reduce subtalar fragmentAnt.C,Reduce ant.column and apply calcaneal plate,Ant.column reduced,Reduce ant.column and apply,Final check,Final check,Post-op care,Posterior splint immobilization,Suture removal at 3rd week,ROM exercise,Non-weight bearing for 10 weeks,Post-op carePosterior splint i,evaluation,Follow up X-rays,Creighton-Nebraska Health Foundation Score for Fracture of Calcaneus,Any complication?,Need further surgery?,evaluationFollow up X-rays,Results:Creighton-Nebraska score,Sanders type,II,:86.7,Sanders type,III,:78.2,Sanders type,IV,:61.3,Results:Creighton-Nebraska sc,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,ComplicationsLateral foot numb,38 y/o male,both calcaneal fractures,wound infection,38 y/o male,both calcaneal fr,implant remove&debride,implant remove&debride,33 y/o male,Joint depression,Sanders type II,33 y/o male,Joint depression,Post-op,14 months,Post-op14 months,68 y/o female,tongue type,Sanders type II,68 y/o female,tongue type,San,Post-op,I year follow up,Post-opI year follow up,52 y/o male,tongue type,Sanders type III,52 y/o male,tongue type,Sande,Post-op,11 months OA(+),After plate removal,Post-op11 months OA(+)After pl,37 y/o male,joint depression,Sanders type IV,37 y/o male,joint depression,Post-op,13 months,Post-op13 months,32 y/o male,Sanders type III,32 y/o male,Sanders type III,距下关节后关节面塌陷性骨折的治疗新进展课件,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,Conventional plates for use in,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,Calcaneus Locking PlateSulcus,距下关节后关节面塌陷性骨折的治疗新进展课件,30 years old,male,30 years old,male,距下关节后关节面塌陷性骨折的治疗新进展课件,距下关节后关节面塌陷性骨折的治疗新进展课件,距下关节后关节面塌陷性骨折的治疗新进展课件,距下关节后关节面塌陷性骨折的治疗新进展课件,Bone grafting?,No routine bone graft in our series,Union:no problem,No subsequent collapse,Strict non-weight bearing for 10 weeks,Bone grafting?No routine bone,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,結論Intraarticular calcaneal fr,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,Calcaneal locking plate3D prec,