Chapter 31 - Rearfoot

TN fusion

• -resect MTJ (CC then TN) this allows access to STJ
• -resect STJ
• -temporarily fixate STJ
• -temporarily fixate MTJ (TN then CC)
• -check with C-arm
• -fixate STJ
• -fixate MTJ

• 1. Anterior medial portal: medial to ATT and lateral to medial mal.
• 2. Anterior lateral portal: Lateral to Peroneus tertius tendon and medial to lateral mal
• 3. Anterior central portal: lateral to EHL tendon and medial to EDL tendon
• 4. Posterior medial portal: medial to Achilles, lateral to tarsal canal. Avoid the PT artery and tibial nerve
• 5. Posterior lateral portal - lateral to achilles and medial to fibular malleolus

Within 4 hours or wait 7-10 days until swelling has subsided. Perform ORIF within 2 weeks.

• Essex Lopresti:
• Joint depression and Tongue type

• A, B, C, D.
• A is superior medial fragment
• B is anterolateral fragment
• C Lateral fragment in joint depression type (semilunar fragment, but with tongue type it's termed thalamic or comet fragement.
• D Tuberosity

• Rowe:
• Type 1A: medial tuberosity fx
• Type 1B: sustentaculum Tali fx
• Type 1C: Anterior process fx
• Type IIA: Posterior beak fx (no achilles involvement)
• Type IIB: Posterior beak fx (achilles involved).
• Type III: Extraarticular body fx
• Type IV - Intraarticular body fx without depression
• Type V - Intraarticular body fx with depression (comminution).

Sander's Classification:

• Type I - any nondisplaced intraarticular fracture
• Type II - 1 fracture through posterior facet (creating 2 fragments)
• Type III - 2 fracture through posterior facet (creating 3 fragments)
• Type IV - 3 or more intraarticular fracture lines (comminution).

ABC are lines on the posterior calcaneus: A is most lateral and C is most medial.