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5th Metatarsal
Fractures
BLOOD SUPPLY
CLASSIFICATION
• ZONE 1: Tuberosity (AVUSLION) Fractures
• ZONE 2: MD Junction (JONES) Fractures
• ZONE 3: Diaphyseal (STRESS) Fractures
AVULSION
FRACTURES
• Cast
JONES FRACTURE
• INDICATIONS FOR SURGERY:
• Athlete
• Patient Demand (wants to go back to work quickly,
not willing to take risk of Nonunion)
• Nonunion, Refracture
• Cavovarus hind foot
TECHNIQUE
Entry Point
COMPLICATIONS OF
SURGERY
• nonunion
• hardware breakage, prominent hardware
• peroneal tendon irritation
• sural nerve injury
Nonunion of 5th MT
• Debridement
• Bone Grafting
• Compression
• Immobilization
DIABETIC ANKLE
FRACTURES
• How they are different?
ISSUES
• Impaired Vascularity (Co existing PVD)
• Neuromuscular Imbalance
• Absence of Pain, “Protective Sensations”
• Delayed Healing of Bones
• Obesity
DIABETIC FOOT
• Neuropathic Foot: Identify by sensory examination
• Non Neuropathic Foot.
Diabetic but non neuropathic
• Routine fracture care, Better to err on extra fixation
Neuropathic Foot
• Augment Fixation
• 2 Methods
Manoli’s techniqueWashington Uni
Post op
• Double NWB time (3 months for ankle fracture)
• Cautious WT bearing, regular check X-rays.
SYNDESMOSIS
INJURY
DIAGNOSIS
• HISTORY: Mechanism of Injury
• EXAMINATION : squeeze test, stress test
DIAGNOSIS
• Medial
clear space
• T/F Interval
• T/F Overlap
Intraop Assessment
• Cotton’s Test
• Ballotment
TREATMENTScrews Tight Rope(Fiber, Button)
Q1)When to remove syndesmosis screws?
• If restricted Dorsiflexion at 3 months, then remove otherwise don’t. Broken
screws means it has self dynamised.
Q2)Advantage of Tight Rope?
• physiological motion and stability
Q3) Unicortical or bicortical?
• Bicortical
Q4) Position of ankle while tightening of screws?
• Neutral, no hyperdorsiflexion.
LISFRANC INJURIES
• TMT joint is the Lisfranc Joint
• LISFRANC INJURIES is an Umbrella term
MISSED LISFRANC
• Collapse of arch, Broadening
• Pain
• Arthritis
DIAGNOSIS
• Plantar Ecchymosis
DIAGNOSIS
• Wt Bearing both feet X-ray
• AP, Lat, Medial Oblique(True AP)
DIAGNOSIS
TREATMENT
• Rigid Fixation, Immobilization
ACUTE TA RUPTURE
• Indications for Surgery
• Athlete
• Young age, wants to return to normal activities early
TA RUPTURE
• Myotendinous junction tears is a contraindication for
Repair.
MIS
• Diabetics
• PVD
Achillon
CALCANEAL FRACTURE
ORIF
• GOALS:
• Height
• Neutral alignment (No Varus Valgus)
• Articular congruity
• Correction of Broadening.
• Step 1: Flip the lateral wall/ Remove it.
STEPS OF CALCANEAL
FRACTURE ORIF
• Step 2: Correct Heel Varus, Height
• Step 3: Reconstruct Anterior Calcaneus
• Step 4: Reduce the Posterior Facet
• Step 5: Replace the lateral wall, Fix it.
• Allgower Donati Sutures
“Bag Of Bones” Type
Fracture
• Get Height, Width
SMALL TOPICS
ANKLE SPRAINS
Treatment is Conservative for All.
COMPARTMENT
SYNDROME
• No role after 24 Hours
• Never elevate above Heart level.
THANK YOU