classification -...
TRANSCRIPT
![Page 1: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/1.jpg)
![Page 2: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/2.jpg)
Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow
Type I non displaced fractures
Type II 1 joint dislocation
○ Subtalar
Type III 2 joint dislocation
○ Subtalar
○ Ankle
Type IV 3 joint dislocation
○ Subtalar
○ Ankle
○ Talo-navicular
*Hawkins LG: JBJS 1970; 52-A
![Page 3: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/3.jpg)
Classification – Talar Body Fracture
Type C1
Partial
Type C2
Complete, simple
Type C3
Complete, comminuted
![Page 4: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/4.jpg)
Avascular necrosis
J.J. Halvorson et al. / The Journal of Foot & Ankle Surgery 52 (2013) 56–61
33.30%
![Page 5: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/5.jpg)
Undisplaced?
![Page 6: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/6.jpg)
CT scan Always CT scan
![Page 7: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/7.jpg)
Indirect Reduction Internal
Fixation
Simple fractures that can be
reduced anatomically closed
Prone position
Incision just lateral to
Achilles tendon
Palpate and reduce subtalar
joint
Fix with two screws
![Page 8: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/8.jpg)
![Page 9: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/9.jpg)
Anterolateral Approach Anteromedial Approach
All other fractures needs ORIF
![Page 10: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/10.jpg)
Mainly screws in differrent
size and shape
![Page 11: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/11.jpg)
![Page 12: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/12.jpg)
Reduction is urgent – fixation is not
Reduce joints – not fracture
Analyse x-ray
Dislocated joint(s)
Direction
Position
GA + Relax
![Page 13: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/13.jpg)
Reduction is urgent – fixation is not
Ankle and subtalar joint
Mainly dorsal dislocation
Prone position
Traction + dorsal fleksion foot
Direct push postero-lateral
![Page 14: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/14.jpg)
Reduction is urgent – fixation is not
Ankle and subtalar joint
Prone position
Dorsal fleksion foot
Direct push postero-lateral
Closed reduction
External fixation
![Page 15: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/15.jpg)
Talo-navicular joint
+ ?
![Page 16: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/16.jpg)
One big + one small fragment (+bits)
All joints dislocated
![Page 17: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/17.jpg)
Mainly anterior and lateral
![Page 18: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/18.jpg)
Supine
Ankle and subtalar
reduced
Hintermann distractor in
talus and cuneiforme
med.
Transfixing K-wires
![Page 19: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/19.jpg)
Take Home Message
Talus fracture
Reduction is urgent – not fixation
○ Plan your reduction
Talus neck – talus body – three joints
All except truly undisplaced need operation
Highly specialised - transfer
![Page 20: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/20.jpg)
Calcaneal fractures
![Page 21: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/21.jpg)
Extra
Articular
![Page 22: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/22.jpg)
Treatment
![Page 23: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/23.jpg)
Intra-articular
Sanders classification - CT scan
![Page 24: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/24.jpg)
Bøhler angle
![Page 25: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/25.jpg)
Negative Böhler angle
![Page 26: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/26.jpg)
Postoperative Böhler’ s angle parameters
were found to have a significant correlation
with the functional recovery
![Page 27: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/27.jpg)
![Page 28: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/28.jpg)
Broad/short/varus
![Page 29: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/29.jpg)
Complications to surgery
Hardware
OIF (experience)
Malposition of screws 5%
Loss of fixation (böhler)
Infection
Superficial 15% / Deep 2%
Sural nerve 10%
Compartment syndrome
1-5% or more ?
![Page 30: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/30.jpg)
![Page 31: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/31.jpg)
2006 patients
151 patients
![Page 32: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/32.jpg)
27 surgeons across the 22 centres.
Median number of operations per surgeon was two with a maximum of six
All fractures in one pot
![Page 33: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/33.jpg)
Who needs operation?
Sanders II + dislocation
Sanders III +
1 fragment undisplaced
positive negative
Undisplaced
Smoker
Alcohol abuse
Age > 70 years
Sanders III + dislocation
Sanders IV
Böhler angle neg.
Short/broad hindfoot
Comorbidity eg. IDDM Varus hindfoot
![Page 34: Classification - ao-danmark.dkao-danmark.dk/wp-content/uploads/2018/05/6-TalusCalcAONordic2018... · Classification – talar neck fracture Hawkins*--Prognostic Based on Blood Flow](https://reader031.vdocuments.net/reader031/viewer/2022022804/5c98722e09d3f2f43c8bb385/html5/thumbnails/34.jpg)
Take Home Message
Calcaneus
Sanders classification
Few need surgery
Displacement
○ Böhler angle
○ Broad, short, varus
Comorbidity