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The first 25 slides, exactly as they appear. The full deck has 111 content slides.
Orthopaedics
Calcaneus Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
11 sections · 111 slides
Overview
- How to read this deck
The Heel Bone and Its Fractures
What the calcaneus is, who breaks it, and why the trouble starts after the fracture
- Meet the calcaneus
- Calcaneus fractures by the numbers
- Who breaks it, and how
- Why complications are so common
Applied Anatomy: Reading the Bone
The facets, the two key angles, the arch, the lever, the trabeculae, and the soft-tissue envelope
- The four articular facets of the calcaneus
- The four joint surfaces that matter
- Böhler's angle and Gissane's angle
- Böhler's angle — the height check
- Gissane's angle — the crucial angle
- The foot arch as an engineered structure
- How the foot carries load — and where it goes
- Four mechanisms hold the arch up
- Motion axes of the hindfoot and midfoot joints
- Why the joints must cooperate
- The calcaneus as a lever for the Achilles tendon
- The calcaneus is a lever arm
- Trabecular architecture and the neutral triangle
- Inside the bone: trabeculae and a weak spot
- Where screws actually hold
- Blood supply to the calcaneus and foot skin
- Blood supply — why the skin is the enemy
- The sural nerve — protect it
- Ligaments around the calcaneus
- The ligaments that anchor the fragments
- Tendons that pay for a wide heel
How the Calcaneus Breaks
Direct and indirect forces, the constant primary fracture line, and the tongue-type pattern
- Direct violent force
- Indirect (pulling) force
- How the fracture propagates
- The primary fracture line is (almost) always there
- Secondary line and the tongue-type fracture
Naming the Pattern: Classification
Extra-articular subtypes, the Beavis avulsion system, and the Sanders CT classification
- Extra-articular fractures: sparing the facet
- Beavis classification of tuberosity avulsions
- Beavis classification of tuberosity avulsions
- Sanders classification on coronal CT
- The Sanders classification — how it is built
- Sanders Types I–IV and what they mean
- Sanders type predicts the outcome
Assessing the Injured Foot
Looking beyond the heel, watching the soft tissue, and choosing the right images
- Look beyond the heel
- Compartment syndrome of the foot
- The skin wrinkle test
- Soft tissue decides when you operate
- High-risk patients and revealing signs
- Radiographic views of the calcaneus
- Plain radiographs — still useful
- Axial and Broden projection angles
- Getting the special views right
- CT assessment of calcaneal fractures
- CT — the map for surgery
Surgical Indications and Goals
When to operate, who benefits, and exactly what a good reduction must restore
- When to operate — the timing rules
- Indications for surgery
- The goals — what surgery must restore
- Evidence and who benefits most
Fixation via the Lateral Approach
Positioning, the extensile L-incision, the no-touch flap, and rebuilding the bone
- Lateral decubitus positioning for ORIF
- Positioning and preparation
- The extensile lateral L-shaped incision
- The extensile L-shaped incision
- Raising the full-thickness no-touch flap
- The no-touch, full-thickness flap
- Reduction sequence and restoring heel height
- Reduction principles and regaining height
- Reducing and pinning the posterior facet
- Rebuilding the joint surface
- Anterior and lateral fragments last
- Types of calcaneal plates
- Final fixation: plates and screws
- Screw danger zones on the medial side
- Screw safety — mind the medial side
- Case: Sanders IIA fracture, ORIF and follow-up
- Case: Sanders IIIAB fracture, reduction and fixation
- Two-layer tension-free incision closure
- Closing without tension
- Wound negative-pressure therapy (VSD)
- Postoperative management
- Experience and lessons
Minimally Invasive Fixation
Percutaneous treatment of tongue-type fractures and repair of Achilles-avulsion fractures
- Minimally invasive fixation of a tongue-type fracture
- Tongue-type fractures: the percutaneous route
- Closed reduction of a tongue-type fracture
- Reducing and pinning it closed
- Suture repair of a tuberosity avulsion
- Fixing tuberosity avulsion fractures
Complications and Malunion
Wound problems, the anatomy of a badly healed heel, and how to classify and treat it
- Wound complications and infection
- Case: open comminuted fracture with flap coverage
- Malunion 1: loss of height
- Case: Sanders III fracture, late reduction loss
- Malunion 2: widening and inversion
- Post-traumatic arthritis
- Stephens–Sanders classification of malunion
- Classifying and treating malunion
- Case: bilateral malunion, subtalar arthrodesis
- Peroneal tendon impingement
Bringing It Together
The three ideas that run through every step
- Three ideas to carry away
- Key takeaways
- References (1/6)
- References (2/6)
- References (3/6)
- References (4/6)
- References (5/6)
- References (6/6)
- Orthopaedic Trauma Surgery — Volume 2: Lower Extremity