Hind Foot Fractures And Dislocations

Front 1

aviator's astragalus

Back 1

hyperdorsiflexion injury resulting in fracture of the talar neck

Front 2

only blood supply that remains to talus after posteromedial dislocation

Back 2

through deltoid ligament
(arteries of tarsal sinus and tarsal canal disrupted)

Front 3

one of the most commonly missed injuries in the multiply injured patient

Back 3

foot injuries

Front 4

radiographic views of talus

Back 4

AP/lat/mortise ankle
Canale view
lat calcaneus
true lat of subtalar joint
oblique views

Front 5

Canale and Kelly view

Back 5

view of talar neck achieved by IR of foot placing the foot plantigrade on an x-ray film and angling the bear at 75 degrees to the perpendicular

Front 6

use of lateral view of calcaneus in talar fractures

Back 6

assess subtalar joint comminution and subluxation

Front 7

use of oblique views of talus

Back 7

diagnosing posterior process fractures

Front 8

most effective imaging for osteonecrosis of talus

Back 8

MRI

Front 9

most clinically useful general classification of talus fractures

Back 9

talar neck
talar body
talar processes

Front 10

most commonly used classification for talar neck fractures

Back 10

Hawkins with Canale and Kelly modifications

Front 11

Hawkins classification

Back 11

talar neck fractures:
I: nondisplaced (no assoc joint dislo)
II: assoc sublux and dislo of subtalar joint
III: dislo ankle and subtalar joint (posteromed is mc)
IV: assoc sublux/dislo talonavicular joint, but also can include comminuted

Front 12

most common type of talar neck fx-dislo

Back 12

II - may be amenable to closed reduction

Front 13

incidence of osteonecrosis in talar neck fx

Back 13

II: 40-50%
III: 100%
IV: 100%

Front 14

OTA talus fx

Back 14

A: avulsion/process/head fx (1: avulsion, 2: process, 3: head)
B: neck (1: nondisplaced, 2: displaced with sublux of subtalar joint, 3: displaced with subluxation of subtalar and ankle joints)
C: body (1: ankle joint/dome fx, 2: subtalar joint involvment, 3: ankle and subtalar joint involvement)

Front 15

Hawkins classification is predictive of...

Back 15

osteonecrosis

Front 16

important prognostic factor to talus fractures

Back 16

fracture comminution

Front 17

unique features of talus

Back 17

majority surface is articular cartilage
no muscles attach directly to it

Front 18

trochlea

Back 18

superior surface of talus
supports body weight
transmits load to inferior aspect of tibial plafond

Front 19

features of trochlea

Back 19

wider anteriorly compared to posterior

Front 20

neck of talus deviates medially how much?

Back 20

15-20 degrees

Front 21

spring ligament

Back 21

wraps around inferior aspect of talar head and deltoid ligament attaches to the medial aspect of the talar body

Front 22

what travels in groove between medial and lateral tubercle of talus

Back 22

flexor hallus longus

Front 23

% of os trigonum in normal feet

Back 23

50%

Front 24

OTA detailed classification

Back 24

A1: avulsion (1: anterior, 2: other)
A2: process (1: lateral, 2: posterior)
A3: head (1: noncommin, 2: commin)
B1: nondisplaced
B2: displaced with sublux subtalar joint (1: noncommin, 2: commin, 3: involves talar head)
B3: displaced with sublux subtalar and ankle joint (1: noncommin, 2: commin, 3: involves talar head)
C1: ankle joint, dome fx (1: noncommin, 2: commin)
C2: subtalar joint involvement (1: noncommin, 2: commin)
C3: ankle and subtalar joint involvement (1: noncommin, 2: commin)

Front 25

blood supply to talus

Back 25

via capsular and ligamentous attachments
vessels of tarsal sinus perforate inferior neck

Front 26

bounds of tarsal sinus

Back 26

calcaneus inferiorly
body of talus posteriorly
talar head and neck anteriorly

Front 27

bounds of tarsal canal

Back 27

talus and calcaneus just behind and below tip of the medial malleolus

Front 28

artery of the tarsal canal

Back 28

arises from posterior tibial artery just proximal to origin of medial and lateral plantar arteries

Front 29

deltoid branches

Back 29

arise from artery of the tarsal canal and supply medial third of talar body

Front 30

dorsal branches to talar neck

Back 30

from anterior tibial or dorsalis pedis artery

Front 31

peroneal artery supply to talus

Back 31

branches to posterior process
branch to form artery of sinus tarsi

Front 32

blood supply to talus

Back 32

anastomotic sling in tarsal canal/sinus
deltoid branches (posterior tib)
posterior process branches (peroneal)
dorsal branches (dorsalis pedis)

Front 33

complications of talar neck fractures

Back 33

osteonecrosis
osteoarthritis subtalar and ankle
delayed union
nonunion
malunion
infection

Front 34

technique for Hawkins II reduction

Back 34

knee flexed and foot plantarflexed

Front 35

technique for Hawkins III reduction

Back 35

plantar flexion and varus positioning of foot
transverse calc pin
direct pressure to talar body fragment

Front 36

radiographic diagnosis of osteonecrosis

Back 36

talar body demonstrates increased density compared with surrounding bone (which is vascularized and undergoing disuse atrophy)

Front 37

Hawkin's sign

Back 37

at 6-8 wks, presence of subchondral atrophy

Front 38

definitions of talar body fractures

Back 38

intraarticular injuries in which the articular surfaces of the tibiotalar and subtalar joints are involved
(fractures extending into or posterior to the lateral process of the talus are defined as talar body fractures, whereas fractures anterior to lateral process are defined as talar neck fractures)

Front 39

general classification of talar body fractures

Back 39

shearing-type
compression-type

Front 40

snowboarder's fracture

Back 40

talar lateral process fracture

Front 41

Hawkins division of talar lateral process fractures

Back 41

nonarticular chip
single large fragment involving talofib, subtalar joints
comminuted fx involving both articulations

Front 42

posterior talar process

Back 42

composed of medial and lateral tubercles

Front 43

characteristics of lateral tubercle

Back 43

larger
projects more posteriorly
seen on lat ankle view
attachment for posterior talofibular lig

Front 44

characteristics of medial tubercle

Back 44

medial and inferiorly from groove for FHL
attachment for posterior third of deltoid lig

Front 45

FHL runs...

Back 45

between lateral and medial tubercles in groove

Front 46

os trigonum

Back 46

accessory bone of the foot located just posterior to lateral tubercle of the posterior process

Front 47

Shepherd fracture

Back 47

fracture of lateral tubercle of the posterior process of the talus

Front 48

subtalar dislocation

Back 48

simultaneous dislocation of the distal articulations of the talus at the talocalcaneal and talonavicular joints

Front 49

basketball foot

Back 49

medial subtalar disloation
aka acquired clubfoot

Front 50

blocks to closed reduction of subtalar dislocations

Back 50

capsule of talonavicular joint
extensor retinaculum
extensor tendons
extensor digitorum brevis

Front 51

associated injuries with calcaneal fractures

Back 51

spine (10%)
other extremity fractures (26%)

Front 52

mechanism of fracture blisters

Back 52

cleavage at dermal-epidermal junction
represents sterile transudate

Front 53

when does fracture blister fluid become bloody

Back 53

when completey devoid of epidermal cells

Front 54

compartments within the foot

Back 54

medial
lateral
central
interosseus

Front 55

central compartment of foot

Back 55

superficial (flexor digitorum brevis)
deep or calcaneal (quadratus plantae, lateral plantar n)

Front 56

long term sequelae of unrecognized compartment syndrome

Back 56

clawtoe deformity
contracture
weakness
sensory disturbances

Front 57

radiograph eval of calcaneal fractures

Back 57

lat hindfoot
AP foot
Harris heel view
ankle series
lumbar xr

Front 58

indication for CT with calcaneal fracture

Back 58

intra-articular component

Front 59

tuber angle of Bohler

Back 59

line from highest part of anterior process to highest point of posterior facet and a line tangential to superior edge of tuberosity

Front 60

normal Bohler's angle

Back 60

20-40

Front 61

crucial angle of Gissane

Back 61

lateral margin of posterior facet and other extending anterior to beak of calc

Front 62

use of Harris view

Back 62

able to visualize:
loss of height
increase in width
angulation of tuberosity fragment

Front 63

Broden's view

Back 63

foot in neutral
leg internally rotated 30-40 deg
center beam at lat mal
angle to head of patient 40, 30, 20, and 10 deg
(mortise recreates)

Front 64

how CT obtained for calcaneal fx

Back 64

3-5 mm cuts
in axial, 30 deg semicoronal, sagittal planes

Front 65

Essex-Lopresti classification

Back 65

tongue type
joint-depression type

Front 66

Soeur and Remy classification

Back 66

(based on number of articular bony frag)
1st deg: nondisplaced shear-type with widening of joint
2nd deg: min 3 frag (2 fx lines), 2 included in articular surface
3rd deg: highly comminuted

Front 67

principles of Sanders classification

Back 67

based on images in coronal plane at widest undersurface of posterior facet of talus

Front 68

Sanders classification

Back 68

I: all nondisplaced (<2 mm)
II: 2 part fx of posterior facet
III: 3 part fx, usually with centrally depressed frag
IV: 4 part or highly comminuted

Front 69

characteristics of calcaneal superior surface

Back 69

3 articular facets - anterior, middle, posterior - all articulate with talus

Front 70

major weight bearing surface of calcaneus

Back 70

posterior facet - is also largest

Front 71

sustentaculum

Back 71

sits under talar neck, medial to calc body

Front 72

peroneal tendons

Back 72

run along lateral calc wall, peroneal tubercle separates

Front 73

origin of abductor digiti quinti minimi

Back 73

lateral process of posterior calc tuberosity

Front 74

characteristics of medial process of posterior calc tuberosity

Back 74

origin of abductor hallucis muscle
major weight bearing structure in hindfoot