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Abstract Aims Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT’s primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes. Methods Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler’s and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p = 0.001). STA’s operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p

BackgroundThe calcaneal enthesis, an osseous footprint where the Achilles tendon seamlessly integrates with the bone, represents a complex interface crucial for effective force transmission. Bone adapts to mechanical stress and remodels based on the applied internal and external forces. This study explores the relationship between the elasticity of the Achilles tendon enthesis and the bone microstructure in the calcaneal crescent.MethodsIn total, 19 calcaneal-enthesis sections, harvested from 10 fresh-frozen human cadaveric foot-ankle specimens (73.8 ± 6.0 years old, seven female), were used in this study. Indentation tests were performed at the enthesis region, and Hayes' elastic modulus was calculated for each specimen. Micro-CT scanning was performed at 50-micron voxel size to assess trabecular bone microstructure within six regions of interest (ROIs) and the cortical bone thickness along the calcaneal crescent.ResultsSignificant Spearman correlations were observed between the enthesis elastic modulus and trabecular bone thickness in the distal entheseal (ROI 3) and proximal plantar (ROI 4) regions (R = 0.786 and 0.518, respectively).ConclusionThis study highlights the potential impacts of Achilles tendon enthesis on calcaneal bone microstructure, which was pronounced in the distal calcaneal enthesis, suggesting regional differences in load transfer mechanism that require further investigation.

YouTube contains videos that provide information about many health conditions. Patients and healthcare professionals frequently use YouTube to obtain information. The calcaneal spur (heel spur) is a bony outgrowth of the calcaneal tuberosity in the form of osteophytes. In this study, we aimed to determine the quality and reliability of YouTube videos about the calcaneal spur, whose prevalence increases with age and is more common in those with osteoarthritis. Search was made with the keywords 'Calcaneal spur' and 'heel spur'. Of the 300 videos reviewed, 104 were included in the study. The number of days since the videos were uploaded, the number of views, likes, dislikes, comments and the duration of the videos were recorded. The DISCERN tool and the Global Quality Scale (GQS) were used to evaluate the reliability and quality of the videos. Most of the video presenters were healthcare professionals (79.80%). In 65.4%, the target audience was patients. 61.4% of the videos were low quality, 32.69% medium quality, 5.77% high quality. There was no difference between health professionals and non-health professionals in terms of quality and reliability. This study showed that most of the information provided by YouTube videos about the calcaneal spur is not reliable and inconsistent. YouTube should consider collaborating with database platforms, which is constantly updated and equipped with evidence-based information, to provide reliable health information on many health issues, including the calcaneal spur.

Background: The calcaneal enthesis, an osseous footprint where the Achilles tendon seamlessly integrates with the bone, represents a complex interface crucial for effective force transmission. Bone adapts to mechanical stress and remodels based on the applied internal and external forces. This study explores the relationship between the elasticity of the Achilles tendon enthesis and the bone microstructure in the calcaneal crescent. Methods: In total, 19 calcaneal-enthesis sections, harvested from 10 fresh-frozen human cadaveric foot-ankle specimens (73.8 ± 6.0 years old, seven female), were used in this study. Indentation tests were performed at the enthesis region, and Hayes’ elastic modulus was calculated for each specimen. Micro-CT scanning was performed at 50-micron voxel size to assess trabecular bone microstructure within six regions of interest (ROIs) and the cortical bone thickness along the calcaneal crescent. Results: Significant Spearman correlations were observed between the enthesis elastic modulus and trabecular bone thickness in the distal entheseal (ROI 3) and proximal plantar (ROI 4) regions (R = 0.786 and 0.518, respectively). Conclusion: This study highlights the potential impacts of Achilles tendon enthesis on calcaneal bone microstructure, which was pronounced in the distal calcaneal enthesis, suggesting regional differences in load transfer mechanism that require further investigation.

For lengthening irregular bones, such as calcaneus, there are few reports in the literature. This study aimed to introduce the treatment strategy and preliminary outcomes for calcaneus shortening using calcaneal body lengthening. From January 2017 to January 2022, calcaneal lengthening was conducted for three patients (two males and one female) who suffered from traumatic calcaneal shortening. The Achilles tendon was lengthened in one patient. After osteotomy of the calcaneus, an Ilizarov frame was used to gradually (1 mm/day) distract the calcaneal fragment. The lengthening procedure was stopped when the calcaneal height and length were restored based on radiography. The fixator was removed after bone union. The average follow‐up length was 18 months (range, 14–24 months). X‐ray was used for radiological assessments. Patients reported satisfaction using the 100‐mm visual analog scale (VAS). Clinical outcome was evaluated following the American Orthopedic Foot and Ankle score. All data were assessed by two physicians blind to clinical assessments. The wound healed primarily in three cases. The bone got solid union without refracture and malunion. The distraction time was 30 days (range, 25–45 days). The fixation time was 113.3 days (average, 80–150 days). Calcaneal lengthening was 26 mm (range, 15–43 mm). The height and length of the calcaneus were restored nearly to the same as the opposite foot. The mean preoperative calcaneal pitch angle increased from 2.6 degrees to an average of 19.0 degrees after the surgery. The AOFAS score increased from 60.0 to 86.0. One patient experienced pin infection. The infection healed after changing the dressing. Calcaneal lengthening using an Ilizarov external fixator is a preferable technique to restore the length and height of the calcaneus and can achieve satisfactory foot function.

The treatment of calcaneal osteomyelitis is challenging, and no effective treatment has been confirmed. In particular, Pseudomonas aeruginosa is resistant to many treatments and is associated with a high risk of amputation. The induced membrane technique has recently shown efficacy in treating osteomyelitis. In this paper, we present two cases of calcaneal osteomyelitis with Pseudomonas aeruginosa infection treated by the Masquelet technique combined with a fibular free flap. Case 1 involved a 25-year-old woman who developed calcaneal osteomyelitis following a calcaneal open fracture. Case 2 involved a 46-year-old man with paraplegia who developed calcaneal osteomyelitis secondary to a chronic skin ulcer. In the first stage of surgery, the necrotic bone and soft tissue were debrided, and a polymethylmethacrylate cement spacer was implanted into the bone defect. In the second stage of surgery, a free fibula flap was transplanted to the bone defect, and the peroneal artery and vein were anastomosed to the dorsal artery and saphenous vein. In Cases 1 and 2, the C-reactive protein concentration had decreased to normal by 21 and 36 days after surgery, respectively. Both patients showed no recurrence of osteomyelitis for >3 years of follow-up. The Masquelet technique involves the use of an induced membrane with neovascularization around the cement spacer. Drug delivery to the calcaneal region is considered to increase through this membrane, contributing to the suppression of Pseudomonas aeruginosa. The blood circulation in the free fibular flap is stable, contributing to wound healing.

Talar neck fractures, though rare, pose significant challenges in treatment due to their complex nature and potential for severe complications. Despite the fact that most of talar fractures are treated operatively, there is scarcity of clear recommendations concerning appropriate surgical technique and care. Historically, conservative management was favored, but open reduction and internal fixation (ORIF) have become the standard of care. However, merely restoring rotation, axis, and length is insufficient; restoring the articulating surface in an anatomical manner is essential for long-term joint health. Surgical access to the fracture site via anteromedial and anterolateral approaches provides visualization, but risks compromising the sensitive, partly retrograde blood supply to the talar body. While being biomechanically superior, screws inserted from a posterior to anterior direction pose challenges in soft tissue preservation and accurate placement. Despite widespread usage of this technique, postoperative outcomes remain suboptimal with considerable rates of malunion, osteonecrosis and osteoarthritis. An overlooked technique in the literature is the use of a distractor, commonly employed in minimally-invasive surgical calcaneal fracture treatment in order to maintain length, alignment and joint reposition during fixation. With the potential to reduce soft tissue damage and preserve the blood supply minimally invasive techniques present a promising advancement in fracture management of talar neck fractures.