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Minimal invasive surgery of intra-articular calcaneus fractures final 31jan2018 c_rodemund

It is essential to

It is essential to insert the second PIN perpendicular to the angulated axis of the tuber fragment. Otherwise, correction of the varus malalignment is not possible and the reduction will not succeed! Fig. 114 calcaneal PIN insertion exactly 90 degrees to the varus angulated axis of the tuber calcanei. This has to be measured through the axial view Fig. 115 significant convergence of the PINs on the medial side Fig. 116 – 117 manual reduction oft he varus afterwards montage oft he medial distraction device Mounting of the lateral distraction device. Fig. 118 to avoid slipping of the distraction devices, bending of the K-Wires is recommended. Afterwards you can shorten the PIN`s Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 22 of 34

Extension is applied alternately medial and lateral while using the lateral and axial view until adequate reduction of the length is completed. As indicated by the bending of the K-wires, significant traction is needed to successfully reduce the fracture. Without adequate distraction (respectively wrong positioning of the pins) it is not possible to anatomically reduce the central joint fragments. Hint: If you have problems for reduction of central fragments, you normally have less extension. Fig. 119 - 120 Significant bending of the pin during reduction of the varus and length Screw fixation should be achieved during the already mounted distraction devices after the reduction and fixation of the central joint fragments (depending on case possibly decrease extension) Although we use an angle-stable 2-point distraction device, the tension of the ligaments of the foot (particularly the plantar fascia) can help to raise the longitudinal arch – via ligamentotaxis as calcaneal length is restored. This is a big aid to correct Boehler’s angle. Fig. 121 Extension between the talus and the calcaneus causes raising of the foot arch through tension of the plantar fascia Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 23 of 34

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