3 - Mini-invasive approach
for subtalar avivement
3
Tylos
TM
TALOCRURAL APPROACH
In certain exceptional cases, and providing that the surgeon is used to it, this
approach may be done through an arthroscopic procedure. In most cases,
the recommended procedure a standard anterior approach made between
the tendons of the anterior tibial and the common extensor tendons after
sectioning the retinaculum of the extensors, whilst respecting the foot’s dor-
sal pedicle
(Fig. 2)
.
After arthrotomy, the joint is approached for freshening of the articular sur-
faces, respecting as much as possible their geometry and insisting on the
malleolar sulci using a drill and a set of curettes of increasing size.
Depending on whether there is loss of bone substance, fi lling by means of an
autograft and/or bone substitute is of course possible. It is also recommended
that any axis deformity be corrected as the nail will only be introduced into a
hindfoot with a normal axis.
SUBTALAR APPROACH
This is indispensable. It is perfectly do-able using a mini-invasive approach via
the lateral orifi ce made in the projection of the tarsal sinus
(Fig. 3)
.
The cartilage of the subtalar joint can be freshened in the same way, using a
set of curettes of increasing sizes and a drill, under fl uoroscopic control.
After these two procedures, it must be possible to realign the hindfoot easily.
PLANTAR APPROACH
(Point of introduction of the nail)
By means of a short approach made in the axis of the 4th radius,
just before the heel strike, the inferior face of the calcaneus is
approached
(Fig. 4)
.
To be sure to be in the right position on the plantar cortical
(which is not very wide) of the calcaneus, it is recommen-
ded that it be palpated. The cannulated obturator
(
ref. 253258
) placed in the soft tissue
protector (
ref. 253247
) is put into
position in contact with the
bone to make it possible to
insert the threaded tip pin
(
ref. 253244
)
in place.
2 - Approach – Talocrural and anterior exposure
4 – Introduction point – Using the trocar point
