Search

Background: Calcaneal fractures are not uncommon, accounting for 2% and 60.0% of all adult and tarsal fractures, respectively. Its treatment is still controversial. Aim of the work: To assess results and complications of calcaneal fractures treatment by fixation with calcaneal plate on clinical and radiological basis. Patients and Methods: A convenient sample of 20 patients, with calcaneal fractures and treated by calcaneal plate fixation were included. They were assessed in preoperative period in a systematic manner. Then, treated with a locking plate. Postoperatively, immediate X-rays, examination of the neurovascular status had been done. Anti-edematous, pain therapy, intravenous antibiotics and anticoagulation medication were administered. All patients had been followed up at 8, 16 weeks after operation and assessed for functional and anatomical state. RESULTS: According to the American Orthopedic Foot Ankle Society [AOFAS] Ankle-Hindfoot Score, the outcome was excellent [30.0%], good [40.0%], fair [20.0%] and poor [10.0%]. At the last follow‑up, Bohler’s angle was restored to normal [20°-40°] in 17 feet [85 %] while 3 feet [15 %] was less than normal. Wound infection was seen in [10%], each of varus heel deformity and flexion deformity of big toe was found in one patient [5.0%] and two case had reflex sympathetic dystrophy.Finally, there was no association between fracture type and subtalar arthritis. However, patients with subtalar arthritis had significantly lower AOFAS score when compared to patients with no subtalar arthritis [76.22±6.24 vs 87.0±6.05 respectively, p < 0.001]. Conclusion: Displaced calcaneal fractures treated surgically are associated with a relatively better functional outcome, provided that, Bohler's angle was restored to its normal or near normal values.

Management of unicondylar femoral fractures is mainly done by open reduction and internal fixation. Anatomic reduction in the articular surface is paramount in this type of lesion. Medial condyle fractures lack specific osteosynthesis material for fixation.We report a case resolved with the sparsely documented technique using calcaneal plate fixation.

Background Three-dimensional (3D) printing technology has developed rapidly in orthopaedic surgery and effectively achieves precise and personalized surgery. The purpose of this meta-analysis was to assess the efficacy of 3D printing technology in the management of displaced intra-articular calcaneal fractures (DICFs) by extended lateral approach (ELA). Methods We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and VANFUN databases were searched up to October 2020. All clinical studies comparing traditional surgery and 3D printing-assisted surgery in the management of DICFs were obtained, evaluating the quality of the included studies and extracting data. For each study, we assessed odds ratios (ORs), standard mean difference (SMD), and 95% confidence interval (95% CI) to assess and synthesize the outcomes. Results Three RCTs and nine retrospective studies involving 732 patients were included met our inclusion criteria with 366 patients in the 3D group and 366 patients in the conventional group. The meta-analysis showed that there were significant differences of the operative time in the 3D group [SMD = − 1.86, 95% CI (− 2.23, − 1.40), P P P P P Conclusion The current study indicates that 3D printing-assisted ELA surgery showed a better rate of excellent and good outcome, shorter operation time, less intraoperative blood loss, fewer intraoperative fluoroscopies, fewer complications. Besides, there is still a need for large-sample, high-quality, long-term randomized controlled trials to confirm the conclusion.

Purpose There are multiple skeletal maturity grading systems, but none of them utilizes the phalanges of the foot. To minimize radiation, it would be ideal if one could assess the skeletal maturity of a foot based on bones seen on routine foot radiographs, if guided growth is being considered as a treatment option. We developed a system that correlates changes of the appearance of the foot phalanges to peak height velocity (PHV) and the recently described calcaneal apophyseal ossification grading system. Methods We selected 94 children from the Bolton-Brush study, each with consecutive radiographs from age ten to 15 years old. Using the anteroposterior view, we analyzed the ossification patterns of the phalanges and developed a six-stage system. We then determined the PHV for each subject and defined its relationship with our system. Our system was then compared with the previously established calcaneal system. Results We calculated an Intraclass correlation coefficient (ICC) range of 0.957 to 0.985 with a mean of 0.975 and interclass reliability coefficient of 0.993 indicating that this method is reliable and consistent. Our system showed no significant difference between gender with respect to PHV, which makes it a reliable surrogate for determining bone age in paediatric and adolescent patients. Conclusions Our system has a strong association with the calcaneal system. It is a simple six-stage system that is reliable and correlated more strongly with PHV than chronological age. The system requires knowledge of the ossification markers used for each stage but is easily used in a clinical setting.

The calcaneal fat pad is a major load bearing component of the human foot due to daily gait activities such as standing, walking, and running. Heel and arch pain pathologies such as plantar fasciitis, which over one third of the world population suffers from, is a consequent effect of calcaneal fat pad damage. Also, fat pad stiffening and ulceration has been observed due to diabetes mellitus. To date, the biomechanics of fat pad damage is poorly understood due to the unavailability of live human models (because of ethical and biosafety issues) or biofidelic surrogates for testing. This also precludes the study of the effectiveness of preventive custom orthotics for foot pain pathologies caused due to fat pad damage. The current work addresses this key gap in the literature with the development of novel biofidelic surrogates， which simulate the in vivo and in vitro compressive mechanical properties of a healthy calcaneal fat pad. Also, surrogates were developed to simulate the in vivo mechanical behavior of the fat pad due to plantar fasciitis and diabetes. A four-part elastomeric material system was used to fabricate the surrogates, and their mechanical properties were characterized using dynamic and cyclic load testing. Different strain (or displacement) rates were tested to understand surrogate behavior due to high impact loads. These surrogates can be integrated with a prosthetic foot model and mechanically tested to characterize the shock absorption in different simulated gait activities, and due to varying fat pad material property in foot pain pathologies (i.e., plantar fasciitis, diabetes, and injury). Additionally, such a foot surrogate model, fitted with a custom orthotic and footwear, can be used for the experimental testing of shock absorption characteristics of preventive orthoses.

Objectives: The complications associated with iliac crest bone-graft harvest have resulted in the development of alternative harvest sites. Lower extremity alternative sites that have been reported for foot and ankle procedures include greater trochanter, proximal tibia, distal tibia, and calcaneus. These sites have been studied in terms of complications, postoperative pain, and quality of the harvested bone. The long-term effect of the harvest on the bone of the calcaneus has not been reported. Methods: Case report on incidental CT imaging 4 years after bone graft harvest from the calcaneus. Results: This case demonstrates the failure of the calcaneal trabecular bone to regenerate after harvesting cancellous bone graft for foot fusion procedure. Conclusions: The calcaneal graft site should not be used for a repeat bone-graft harvest without advanced imaging to confirm reconstitution of the harvest bed.

Background: The aim of this study was to compare the postoperative pain levels in patients undergoing osteosynthesis of the calcaneus with either a popliteal nerve block or an ankle block. Methods: A retrospective analysis of all consecutive patients undergoing operative fixation of a calcaneal fracture via a sinus tarsi approach between August 2012 and April 2017 in a single foot/ankle specialized center was performed. Single-shot popliteal blocks were placed using ultrasound guidance by an anesthesiologist while ankle blocks were placed by a foot/ankle specialized surgeon. Pain levels were measured through the numerical rating scale (NRS). In total, 83 patients were included in this study; 33 received a popliteal block, and 50 received an ankle block. No statistically significant differences were present in baseline characteristics between the 2 groups. Results: Comparable postoperative pain levels were observed in both groups. There was no statistically significant difference in amount of morphine used between the 2 groups. Conclusion: No differences were found in postoperative pain levels between patients receiving a single-shot popliteal block and patients who received a single-shot ankle block following calcaneal fracture surgery. Level of Evidence: III, comparative series.

Introduction The diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient. Case presentation A 9-year-old white boy presented to our institution with heel pain and an inability to weight bear. There was a 10-day delay in diagnosis of calcaneal osteomyelitis, with a total of three presentations to our emergency department. The condition was misdiagnosed as Sever’s disease on two separate occasions with discharge home. On his third presentation the diagnosis was finally clinched when he developed more definitive signs and symptoms, with pyrexia and signs of lymphangitis. Magnetic resonance imaging revealed diffuse osteomyelitis of his calcaneum. He underwent surgery and 2 weeks of antibiotics administered intravenously, followed by 4 weeks of oral therapy. We are happy to report a good recovery without any complications at his 12-month follow up. Conclusions Physicians should include calcaneal osteomyelitis as a differential in any child presenting with heel pain. Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest.

Background Previous studies on the relationship between bone health and metabolic syndrome (MS) have revealed heterogeneous results. There are limited studies employing bone quantitative ultrasonometry in evaluating this relationship. This study aimed to determine the relationship between MS and bone health in a group of Malaysian middle-aged and elderly men using bone quantitative ultrasonometry. Methods This cross-sectional study recruited 309 free living Chinese and Malay men aged 40 years and above residing in Klang Valley, Malaysia. Their demographic and anthropometric data were collected. Their calcaneal speed of sound (SOS) was measured using a CM-200 bone ultrasonometer. Their blood was collected for the evaluation of lipid profile, total testosterone and sex hormone-binding globulin. The joint interim MS definition was used for the classification of subjects. Multiple linear regression analysis was used to assess the association between SOS and indicators of MS and the presence of MS, with suitable adjustment for confounders. Results There was no significant difference in SOS value between MS and non-MS subjects (p > 0.05). The SOS values among subjects with different MS scores did not differ significantly (p > 0.05). There were no significant associations between SOS values and indicators of MS or the presence of MS (p > 0.05). Conclusions The relationship between bone health and MS is not significant in Malaysian middle-aged and elderly men. A longitudinal study should be conducted to evaluate the association between bone loss and MS to confirm this finding.

O presente estudo teve o objetivo de oferecer uma avaliação clínica, radiográfica e biomecânica de pacientes com fratura intraarticular de calcâneo, submetidos à redução aberta e fixação interna. A amostra consistiu em 22 pacientes, 20 do sexo masculino e dois do sexo feminino, com idade média de 40,95 (± 11,63) anos. Os autores realizaram avaliações radiográficas do ângulo de Böhler e Gissane, no pré e no pós-operatório, além de utilizarem a tomografia computadorizada para avaliação da classificação de Sanders. A avaliação da Distribuição da Pressão Plantar foi realizada pelo sistema F-scan. Os resultados clínicos encontrados foram satisfatórios apresentando, pontuação média de 75,5 no critério da AOFAS.. A redução cirúrgica resultou em uma melhora dos ângulos de Böhler e Gissane. O estudo mostrou diferenças estatisticamente significantes entre o antepé o retropé fraturados no que tange sobre a área de contato, pressão e força de reação do solo. Os valores encontrados para estes parâmetros foram maiores no retropé que no antepé fraturados. A trajetória de Pressão (COP) foi menor no pé fraturado que no pé normal. Encontrou-se correlação entre o Ângulo de Gissane após a redução e o Segundo Pico de Força, indicando que quanto melhor a redução deste ângulo , melhor a impulsão. Também encontrou-se a correlação entre a pontuação AOFAS e o Primeiro Pico de Força, mostrando que quanto melhor o resultado clínico melhor o apoio do retropé. The present study had an objective to perfom a clinical, radiographic and biomechanical evaluation in patients with calcaneal fractures submitted to open reduction with internal fixation. The sample consisted of 22 patients - 20 male and 2 female with an average age of 40,95 (±11,63) years old. The authors have done radiographic evaluation of the pre and post operatory of Böchler and Gissane angles; furthermore, they used a CT scanning for Sander's classification of calcaneal fractures. The plantar pressure distribution was analyzed with F-scanning system. The results of the intra-articular calcaneal fractures were clinically satisfactory, showed average punctuation with 75,5 in AOFAS criterion. The surgical reduction in a better angle of Böchler and Gissane. The study showed statistical differences between the forefoot and rearfoot concerning the the contact area, average preassure and strength in the injured foot. The figures found to this parameter were bigger in the rearfoot than the forefoot. The trajectory of pressure (COP) was shorter in the fractured foot than in the normal foot. The correlation between the angle of Gissane after the reduction and the second peak of force was found, showing as better as the reduction of this angle, the better is the impulsion. It was also found the correlation between the punctuation between AOFAS and the first peak of force, showing as better is the clinical result the better is the foot supporter.