Sterile Instruments/Equipment

• Small pointed bone reduction clamps (Weber clamps)
  
• Shoulder hook, dental picks, and Freer elevators
  
• Finger traps and Mastasol for traction
  
• Implants
  
  
  
  • 0.062 inch K-wires
    
  • Mini-fragment plates and screws (2.0 and 2.4 mm)
  
  
• K-wire driver/drill

Positioning

• Supine on radiolucent table.
  
• Place a small bump under ipsilateral hip so that the patella faces anteriorly.
  
• Use tibial nailing triangle turned long-side down to get good AP and oblique views of midfoot.
  
• C-arm should enter from opposite side of the table.
  
• Alternatively, flex knee to 90 degrees over a tibial nailing triangle. With the fluoroscopic beam perpendicular to floor, five folded towels under the forefoot gives a good view and a stable platform for reduction and pin placement (Fig. 24-1).

Figure 24-1. Five folded towels under the forefoot with the fluoroscopic beam perpendicular to the floor gives good visualization of the forefoot.

• The C-arm angle is often best determined on a lateral view so that the beam for AP and oblique images are oriented perpendicular to the metatarsal necks and shafts.
  
• Roll the foot between AP and oblique views to determine both mediolateral and dorsal-plantar K-wire vectors.

Surgical Approaches

• Percutaneous reduction and pinning
  
  
  
  • Strategically placed small incisions for reduction instruments and K-wires.

Reduction and Implant Techniques

• Pull toe axially, and manipulate medially or laterally depending on the fracture obliquity and displacement (Fig. 24-2).

Figure 24-2

Related posts:

Intertrochanteric Femur Fractures Distal Radius Fractures Ankle-Spanning External Fixation Distal Humerus Fractures Distal Femur Fractures Tibial Plateau Fractures

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