Date: Mon, 19 Feb 2001 15:54:22 +0500

Subject: A foot injury

Hello Orthopaedic

A male 35 years after fall from 12 m height sustained the heel fracture (among other injuries). 2 weeks since injury. Xrays and CT are attached.

What type of exposure is best for the case? Any comments and sugesstions?

THX in advance!

Best regards,

Alexander N. Chelnokov,
Ural Scientific Institute of Traumatology and Orthopaedics
Ekaterinburg 620014 Russia

Date: Mon, 19 Feb 2001 10:34:43 -0800

From: bruce meinhard

Alex,

I usually like to have additional cuts perpendicular to the posterior facet, but two approaches could be used here. Knowing your proclivity to the Ilizarov type device, you could control length and correct varus with it then make an incision over the sinus tarsi to restore the extruded lateral wall and the posterior facet to anatomic position. Otherwise an extended L shaped incision to expose all and provide complete internal fixation with a plate thereby achieving the same goals as above. Of importance is to avoid smokers, diabetics, and the foot too swollen for surgery (no skin wrinkles).

BPM

Date: Tue, 20 Feb 2001 01:01:11 +0500

From: Alexander Chelnokov Hello bruce,

bm> I usually like to have additional cuts perpendicular to the posterior facet, but two approaches could be used here.

It is a patient of a colleague of mine, and he is going to go through a medial approach due to the main fragment of posterior facet displaced medially. Nobody in our unit has experience of such exposure so any comments are welcome.

Alexander N. Chelnokov,
Ural Scientific Institute of Traumatology and Orthopaedics
Ekaterinburg 620014 Russia

Date: Tue, 20 Feb 2001 13:26:29 -0800

From: Thomas A. DeCoster

The medial approach is fraught with problems including injury to sensory branches of tibial nerve and inability to adequately visualize and reduce the fractures. Be aware of those problems.

Tom DeCoster

Date: Wed, 21 Feb 2001 10:30:57 +0500

From: Alexander Chelnokov

Hello Thomas,

TAD> The medial approach is fraught with problems including injury to sensory branches of tibial nerve and inability to adequately visualize and reduce the fractures. Be aware of those problems.

I operated patella of the opposite limb at the same procedure, so was able to see the foot surgery too. Well, while your second statement was not confirmed on the table (visualization was quite enough, reduction see at the attached image), the first statement was more than right. Plantar branch of the a. tibialis posterior was passed away. At the moment no signs of foot ishaemia though... :-/

Alexander N. Chelnokov,
Ural Scientific Institute of Traumatology and Orthopaedics
Ekaterinburg 620014 Russia