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Wheeless' Textbook of Orthopaedics

Wheeless' Textbook of Orthopaedics

C.R. Wheeless MD

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Wheeless' Textbook of Orthopaedics

Foot Inclusion for External Fixators:

- Indications: - temporary fixation of foot to eliminate ankle & soft tissue motion at frx site may be needed w/ open frx treated w/ external fixators; - patient w/ concurrent head injury or severe soft tissue wounds involving muscles that control ankle or foot motion; - foot inclusion prevents plantar skin break down & equinus deformities; - Calcaneal Pin Insertion: - Insertion of Talar Pins: - pins are usually inserted from the medial side to avoid N/V structures; - mark a line joining the points from the medial malleolus to the navicular; - insertion of pins anterior to this line should safely avoid the N/V bundle; - using flouroscopy, insert a horizontally directed pin into the talar neck, just proximal to the head and midway between the dorsal and plantar surfaces of the talus; - the pin should be perpendicular to the talar neck as seen on the AP view; - Insertion Technique for Ilizarov: - half ring must be elongated w/ plates to accommodate obliquely inserted transfixation wires; - at the distal edge of the plate, another half ring is attached at right angles to the floor; - hindfoot: - is stabilized w/ 2 to 3 crossed transfixation pins placed thru posterior calcaneal tuberosity; - see: calcaneal pin insertion: - midfoot and forefoot: - two 4 mm half pins inserted into subcutaneous border of first metatarsal; - fifth metatarsal can be used similarly; - alternatively, a single transfixation pin can be placed transversely thru the midfoot between dorsal & plantar neurovascular & tendinous structures; - or, transfixation wires can be inserted thru the necks of the first and fifth metatarsal necks, passing underneath the central metatarsals; - or, the surgeon's hand can be used to flatten out the forefoot arch, when then allows a tranfixation wire to be directed across all 5 metatarsals; - Frame: - two half rings are used to construct the foot frame; - the half rings are the same size as the tibial rings; - Insertion Technique for EBI: - see EBI insertion technique: - options include: - two distal pins placed into the talus via the "T clamp": - both screws are inserted from the medial side; - usually cortical screws work best; - one screw in talus and one screw in calcaneus: - the talar screw is inserted medially in the talar neck, parallel to the dome of the talus;

Foot Inclusion for External Fixators:

- Indications: - temporary fixation of foot to eliminate ankle & soft tissue motion at frx site may be needed w/ open frx treated w/ external fixators; - patient w/ concurrent head injury or severe soft tissue wounds involving muscles that control ankle or foot motion; - foot inclusion prevents plantar skin break down & equinus deformities; - Calcaneal Pin Insertion: - Insertion of Talar Pins: - pins are usually inserted from the medial side to avoid N/V structures; - mark a line joining the points from the medial malleolus to the navicular; - insertion of pins anterior to this line should safely avoid the N/V bundle; - using flouroscopy, insert a horizontally directed pin into the talar neck, just proximal to the head and midway between the dorsal and plantar surfaces of the talus; - the pin should be perpendicular to the talar neck as seen on the AP view; - Insertion Technique for Ilizarov: - half ring must be elongated w/ plates to accommodate obliquely inserted transfixation wires; - at the distal edge of the plate, another half ring is attached at right angles to the floor; - hindfoot: - is stabilized w/ 2 to 3 crossed transfixation pins placed thru posterior calcaneal tuberosity; - see: calcaneal pin insertion: - midfoot and forefoot: - two 4 mm half pins inserted into subcutaneous border of first metatarsal; - fifth metatarsal can be used similarly; - alternatively, a single transfixation pin can be placed transversely thru the midfoot between dorsal & plantar neurovascular & tendinous structures; - or, transfixation wires can be inserted thru the necks of the first and fifth metatarsal necks, passing underneath the central metatarsals; - or, the surgeon's hand can be used to flatten out the forefoot arch, when then allows a tranfixation wire to be directed across all 5 metatarsals; - Frame: - two half rings are used to construct the foot frame; - the half rings are the same size as the tibial rings; - Insertion Technique for EBI: - see EBI insertion technique: - options include: - two distal pins placed into the talus via the "T clamp": - both screws are inserted from the medial side; - usually cortical screws work best; - one screw in talus and one screw in calcaneus: - the talar screw is inserted medially in the talar neck, parallel to the dome of the talus;
 
 
 
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