第一页，共二十九页。Preoplateraldemonstratingjointdepressiontypeoffracturewithdisplacementofatuberosityandextensionintothecalcanealcuboidjoint.第二页，共二十九页。The30degreesemi-coronalandaxialCATscansofthefracture.TALUSDISPLACEDPOSTERIORFACETINTACTPOSTERIORFACETSECONDARYFRACTURELINETUBEROSITYANTEROLATERALFRAGMENTTHALAMIC(SUSTENTACULAR)FRAGMENTDISPLACEDPOSTERIORFACET第三页，共二十九页。Thepatientispositionedcarefullyinthelateraldecubituspositionwithpadsundertheaxillaanddownsideperonealnerve.Thedownlegisplacedforwardagainstandparallelwiththeanterioredgeofthebed.第四页，共二十九页。Pillowsareplacedbetweenthelegsandenoughsheetsbehindthedownlegsuchthattheoperativelegliesparallelwiththegroundandatthelevelofthepatient’ship.第五页，共二十九页。Thewrinkletest,asdescribedbySanders,involvesdorsiflexingthefootfromaplantar-fixedpositionandlookingfornormalskinturgor,asevidencedbywrinklingoftheskinalongtheareaofthelateralpartofthefoot.第六页，共二十九页。ANTERIORACHILLESBORDERINCISIONPERONEALTENDONSFIFTHMETATARSALTheincisionisslightlycurvedandL-shaped,beginningjustanteriortotheAchilles,curvingattheleveloftheskincolorchange,runningparallelwiththesoleofthefootandthencurvingslightlyupanteriorlyatitsdistalextent.FIBULA第七页，共二十九页。Withthetourniquetinflated,thecorneroftheincisionisbroughtdirectlydowntobone.第八页，共二十九页。ABDUCTORFASCIATowardthedistalextentoftheincisionthefasciaoftheabductorshouldbeidentifiedanddissectionshouldbeperformedsuperficiallytothissoasnottodevascularizethemusclelayer.第九页，共二十九页。Inordertodissectdirectlyonthecalcaneusinasubperiostealmanner,significanttensionshouldbedevelopedbyholdingtheheelinvertedwiththethumbandpullingdirectlylaterallyawayfromthefootwithasharpretractorhelddeepintheflap.第十页，共二十九页。TENSIONThetensionasdevelopedallowsforeasydissectioninasubperiostealmanner,withaknifethatisheldessentiallyparallelwiththebone.Many#15bladeswillbenecessaryinordertodissectouttheentirecalcaneus.第十一页，共二十九页。PERONEALTENDONSAftertheflapiscompletelyelevated,theperonealtendonsarevisibleatthedistalextentoftheflap.Caremustbetakennottodamagethesetendonsasthedissectionprogressesdistally.第十二页，共二十九页。LATERALPROCESSOFTALUSCloseupviewdemonstratingthatwithflapelevationthelateralprocessandposteriorfacetofthetalusisidentified.AK-wireisplacedintothetalarbodyfromthelateralprocessandusedtoretracttheflap.第十三页，共二十九页。PININFIBULAPININTALUSDISPLACEDPOSTERIORFACETThelateralwallanddisplacedportionoftheposteriorfacetofthecalcaneususremoved.第十四页，共二十九页。TUBEROSITYINTACTPOSTERIORFACETOFCALCANEUSPOSTERIORFACETTALUSDISPLACEDPOSTERIORFACETAbonehookcanbeusedtopullthetuberositydowntoitsnormalposition;thisreductionisnecessarytoallowforreductionoftheposteriorfacetwithoutstericinterference.第十五页，共二十九页。TUBEROSITYINTACTPOSTERIORFACETOFCALCANEUSPOSTERIORFACETTALUSDISPLACEDPOSTERIORFACETInthisfigure,theposteriorfacetofthetalusisvisiblewiththeintactmedialportionoftheposteriorfacetofthecalcaneusremaininginitsreducedposition.Thefracturedlateralportionofthefacetisvisibleasitisbeingremoved.第十六页，共二十九页。K-WIREFREERELEVATORAftercleaningthefragment,theposteriorfacetisreducedanatomicallywiththeaidofaFreerelevatorinpalpatingthereduction,whichissometimesverydifficulttosee.ThisisheldinplacewithaK-wire第十七页，共二十九页。K-WIREFREERELEVA...
