APPROACH_TO_A_CASE_OF_SCOLIOSIS.ppt

1. Sunil Kumar Daha

9.  Fracture of neck:
◦ by violent hyperextension of ankle, neck forced against anterior
edge of tibia.
 Fracture of body:
◦ compression injury due to fall from a height.
◦ These are uncommon.

11. Fracture of neck of talus (Hawkins and Canale):
 Group 1: undisplaced
 Group 2: displaced, subtalar dislocation or
subluxation
 Group 3: displaced with dislocation of body of talus
from ankle joint
 Group 4: displaced vertical talar neck fracture with
associated talonavicular joint disruption

13.  Uncommon
 Often displaced
 May cause distortion of talocalcaneal joint.
 Deformity best visualized by three dimensional CT
reconstruction.

14.  Painful and swollen foot and ankle
 In displaced fracture
• Obvious deformity
• Skin may be tented or split which may be dangerous
sign
The pulses should be checked and compared

15.  X-ray AP, lateral and oblique view essential
 CT help to identify associated ankle and foot
injury
 Frequently missed (mostly undisplaced fracture)
because of overlapping of tarsal bones.

17.  Below the knee plaster and when swelling subsided
replaced by complete cast with foot planterflexed.

18.  Displaced fractures of neck
• If skin tight: urgent reduction
• For type II :Closed reduction under general anaesthesia
• If it fails: open reduction
• For type 3: urgent ORIF
 Displaced fracture of Body:
• Minimal displacement below knee non-weight bearing cast for 6-8
weeks
• Replaced by weight bearing cast for another 4 weeks
• If adjacent joints dislocated: ORIF

19. Fig: Fractures of the talus – treatment

21.  Displaced fracture of head:
◦ If large fragments: ORIF
◦ If much comminution – excise smaller fragments
 Displaced fracture of Talar process
◦ If fractures are large enough: ORIF, fixation with k-
wires or small screw

22.  Avascular necrosis and non –union
• Evetually osteoarthritis of ankle
 Secondary osteoarthritis
• avascular necrosis
• injury to its articular cartilage, lead to osteoarthritis of ankle
• Patient with osteoarthritis have complains of pain and stiffnes
 Treatment mostly by physiotherapy and in severe cases an ankle
arthrodesis may needed

24.  Maheshwari, Essential Orthopedics, 5th edition
 Apley’s System of Orthopedics and Fractures

25. NEXT  Fracture of CALCANEUM