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PubMed1993

Ultrasonic velocity measurements through the calcaneus: which velocity should be measured?

The assessment of skeletal integrity by the measurement of ultrasonic velocity through the calcaneus has only recently become widely available and is usually made in conjunction with the measurement of broadband ultrasonic attenuation. Using data obtained with a contact ultrasonic bone analyser (CUBA) system, this report examines whether ultrasonic studies of the heel require the measurement of true velocity of sound in the calcaneus (Vbone), or whether heel velocity (Vheel, defined as the mean velocity through bone and soft tissue) or time of flight velocity (Vtof, defined as the mean velocity between the two transducers) are adequate surrogates. The populations selected for study were 15 healthy young women (group 1, mean age 26 years), 231 healthy peri- and postmenopausal women (group 2, mean age 52 years) and 33 osteoporotic women with confirmed vertebral fracture (group 3, mean age 66 years). Precision was studied by performing 10 repeated scans on the subjects in group 1 and duplicate scans on 144 women randomly selected in groups 2 and 3. Precision was expressed as the percentage coefficient of variation (CV). Both precision studies yielded similar results. The precisions (and 5% to 95% ranges) for all groups combined were: Vbone 2.71% (1465-1809 m/s); Vheel, 1.10% (1511-1646 m/s): Vtof, 0.70% (1349-1425 m/s). Although the precision data suggest Vtof should be preferred, when the range of clinical values is taken into account the smaller CV is exactly cancelled by the narrower range.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Broadband ultrasound attenuation of the calcaneus predicts lumbar and femoral neck density in Caucasian women: a preliminary study.

Recent studies have demonstrated the ability of ultrasound techniques to differentiate normal and osteoporotic women. To define the ability of broadband ultrasound attenuation (BUA) of the calcaneus to predict axial bone mass, the ultrasound value was correlated with lumbar vertebral and femoral neck density in 22 Caucasian women. The three measures of bone mass inversely correlated with age: lumbar density (r = 0.54), femoral neck density (r = 0.65), and BUA (r = 0.73). BUA correlated with lumbar (r = 0.83) and femoral neck (r = 0.87) density. Lumbar vertebral density predicted femoral neck density with a standard error of estimate (SEE) of 0.07 g/cm2, and femoral neck density predicted lumbar density with a SEE of 0.09 g/cm2. BUA of the calcaneus was as effective as either axial bone mass measure in predicting the other value: the SEE for lumbar density was 0.09 g/cm2 while that for femoral neck density was only 0.06 g/cm2. The results of this preliminary study indicate that this rapid, radiation-free technique can accurately predict axial bone mass, and may be of value as an initial procedure to discriminate those women warranting more extensive radiologic evaluations.

Aged↗
PubMed1994

Bone density of the calcaneus and fractures in 75- and 80-year-old men and women.

Bone mineral density of the calcaneus in relation to fractures was studied both retrospectively and prospectively among the 75- and 80-year-old men and women resident in the city of Jyväskylä, Finland, in 1989 and 1990, respectively. The bone measurements were performed at the calcaneus by 125I-photon absorption. Retrospective fracture (RF) history after age 50 was collected by questionnaire and interview, and reported fractures were checked from medical records. In the retrospective study, in the 75-year-olds a fracture was found in 22% (n = 22) of men and in 45% (n = 84) of women. The corresponding figures for the 80-year-olds were 16% (n = 9) and 35% (n = 48). Over half of the fractures were of the wrist/hand or ankle/leg. Prospective fractures (PF) were recorded over periods of 29-34 months. Twenty of the 75-year-olds and 16 of the 80-year-olds sustained a fracture during the follow-up period. In the 75-year-olds, the results showed that both RF and PF women, together with the RF men, had lower bone area density (BMDa) and volume density (BMDv) than the non-fracture (NF) subjects (p = 0.001-0.011). In the 80-year-olds, significantly lower BMDa was found in the RF women (p = 0.008) and lower BMDv in the PF women (p = 0.024) compared with the NF subjects. During the follow-up period there were no fractures in either of the sex or age groups among those with BMDa and BMDv values greater than 1 SD above the mean. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Occult fracture of the calcaneus--another toddler's fracture.

Fractures of the calcaneus have been considered rare among children. We feel this may be erroneous since in the last 12 months we have seen 10 such fractures among children, 19 and 41 months of age, who presented with acute limping. The fractures were detected with bone imaging which was performed when initial radiographs were noncontributory. Subsequent radiographs of the calcaneus were positive for fracture in 4 of 10 while follow up radiographs confirmed healing fractures in the two children so evaluated. The sensitivity of bone imaging for the detection of occult fractures in toddlers is emphasized.

Bone and Bones↗
PubMed1996

[The "low contact plate" for stabilizing the dislocated intra-articular calcaneus fractures].

Open reduction and internal fixation of intraarticular calcaneus fractures have been increasingly emphasized in recent years. Operation of most of these fractures is via an extended lateral approach. Different implants are used to stabilize the often complex fractures. We have developed a low contact plate that is specially designed for calcaneal fractures. Because the design is based on the anatomy of the calcaneus, all types of fractures can be treated. The plate has a large number of holes to accommodate screw fixation. Our results in 36 cases were comparable to those of other series using open reduction and internal fixation with plates and the demands on the plate were fulfilled.

Adolescent↗
PubMed2006

[The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery].

We compared in a prospective study including 82 patients treated with ORIF of an intraarticular calcaneus fracture the quality of fluoroscopy, intraoperatively Iso-C(3D) and postoperative CT-scans. Therefore the posterior facet of the calcaneus (PFOC) was divided into three sectors. Joint steps and fracture gaps were detected by two independent investigators and statistically analysed. Another focus was to evaluate if the findings due to intraoperatively Iso-C(3D) assessment performed by the surgeon were correct and subsequently influenced the surgical procedure. There were no statistically differences between the Iso-C(3D)- and CT findings concerning joint steps or fracture gaps in PFOC sectors I-III. With fluoroscopy an assessment of the PFOC sectors I and II was not possible. In six cases (7.3%), intraoperative reduction was redone after performing an Iso-C(3D) scan. In ten cases, 12 malpositioned screws were replaced (12.2%/14.6%). These results suggest that intraoperative 3D Iso-C(3D) imaging provides a high diagnostic reliability. By careful assessment of the images the surgeons receive information which could lead to a change of the operative strategy.

Algorithms↗
PubMed2007

[The calcaneus as the site of manifestation for osteoporosis-associated fractures: age- and sex-specific changes in calcaneal morphology correlate with the incidence and severity of intra-articular calcaneal fractures].

BACKGROUND: While it is recognized that trauma energy at the time of injury is an important factor in the pathogenesis and severity of calcaneal fractures, the possible role of changes in calcaneal microarchitecture remains largely undefined. The purpose of this study was to determine whether the calcaneal bone structure changes with age and to address if local bone mass is of clinical relevance in respect to the occurrence and complexity of calcaneal fractures. MATERIAL AND METHODS: The radiographic and clinical data of 182 patients with intra-articular calcaneal fractures were analyzed to provide correlative clinical evidence for a relation between local bone mass and fractures of the calcaneus. To measure bone mass, 60 calcanei were harvested from 30 age- and gender-matched patients at autopsy. RESULTS: The average age at the time of fracture was higher in females (46.0+/-18.3 years) than in males (39.9+/-13.9 years). Furthermore, the relative frequency of fractures during aging shifted from males to females and the frequency of compound fractures was higher in females (65%) than in males (48%). The calcaneal bone mass was significantly reduced by 19% in older females (female symbol 20-40 years: 292 mg/cm(3); female symbol 61-80 years: 237 mg/cm(3); p<0.05). CONCLUSION: The calcaneus displayed age- and gender-related changes in its microarchitecture that are known to reduce the biomechanical stability of trabecular bone. These results suggest that bone mass and structure are risk factors in respect to the occurrence and severity of calcaneal fractures.

Adult↗
PubMed2003

Effect of daily walking steps on ultrasound parameters of the calcaneus in elderly Japanese women.

In this cross-sectional study, we investigated the effect of daily walking steps on ultrasound parameters of the calcaneus in elderly Japanese women. The subjects were 143 community-dwelling elderly women aged 61-87 years (mean age 71.4+/-5.5 years). The speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (Stiffness) of the calcaneus were measured. Walking steps were recorded using a pedometer for 7 consecutive days as an outcome measure of physical activity. In univariate analyses, steps/day significantly decreased with aging. SOS, BUA and Stiffness showed negative correlations with age and positive correlations with weight. Linear relationships were not seen between any of the ultrasound parameters and daily walking steps. Then, the ultrasound parameters were adjusted for age and/or weight using multiple regression models, and the relationships between the adjusted ultrasound measurements and walking steps were examined using quadratic regression models. Walking activity up to approximately 12,000 steps/day was positively associated with the adjusted ultrasound measurements, above which additional walking steps had no positive effect. We conclude that daily walking steps may be suitable for evaluating the relationship between ultrasound parameters and physical activity in elderly women, but further research is needed to confirm the effect of daily walking steps on the rate of bone loss.

Age Factors↗
PubMed2003

Quantitative ultrasound of the calcaneus and dual X-ray absorptiometry of the lumbar spine in assessment and follow-up of skeletal status in patients after kidney transplantation.

Bone loss after kidney transplantation is a significant complication of immunosuppressive treatment leading to a high prevalence of bone fracture in these patients. The purpose of this study was to determine the usefulness of quantitative ultrasound (QUS) of the calcaneus in comparison with dual X-ray absorptiometry (DXA) of the lumbar spine in determining bone status and mineral changes in patients in the first 6 months after transplantation. Forty-six patients participated in the study (25 men and 21 women; age range 26-62 years, 102+/-66 months previously on dialysis). They were treated with cyclosporine, methylprednisolone, mycophenolate mofetil, and basiliximab. The 6-month cumulative steroid dose was 24.9+/-3.7 mg/kg body weight. Calcaneal QUS (Sahara, Hologic, Waltham, Mass.) and DXA (Hologic QDR 4500) of the lumbar spine were done in all patients within 3 weeks after transplantation and 6 months thereafter. Bone mineral density (BMD) of the lumbar spine measured by DXA decreased from 0.892+/-0.137 to 0.837+/-0.126 g/cm2 (p<0.0001) and the T score decreased from 1.84+/-1.29 standard deviation (SD) to 2.35+/-1.19 SD (p<0.0001) in the first 6 months after transplantation. The QUS parameters of the calcaneus were broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound index (QUI). The QUS parameters did not change significantly after the first 6 months. All QUS parameters correlated significantly with DXA BMD of the lumbar spine immediately after transplantation and 6 months thereafter. Significant decrease of the lumbar spine BMD in the first 6 months after transplantation was not accompanied by significant changes of calcaneal QUS parameters. The calcaneal QUS does not reflect bone mineral changes occurring in the lumbar spine and could not be a substitute for a direct-site DXA of the lumbar spine in the early period after kidney transplantation.

Absorptiometry, Photon↗
PubMed2004

Smoking and quantitative ultrasound parameters in the calcaneus in 36-year-old men and women.

Little is known regarding the association between smoking and quantitative ultrasound (QUS) parameters. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) are believed to provide information on bone quality besides information on bone mineral density (BMD). The aim of this study was to investigate (1) current tobacco smoking; (2) lifetime tobacco smoking; and (3) years since smoking cessation, in relation to QUS and BMD parameters in 36-year-old men and women. Data came from the ninth measurement of the Amsterdam Growth and Health Longitudinal Study (AGAHLS), in which 165 men (36 smokers and 129 nonsmokers) and 178 women (33 smokers and 145 nonsmokers) participated, with an average age of 36 years (SD = 0.7). BUA (dB/MHz) and SOS (m/s) of the calcaneus were assessed by using the CUBA Clinical instrument. BMD of the lumbar spine (L1-L4), total hip, and total body were measured with dual-energy X-ray absorptiometry (DXA). We used multiple linear regression analyses with correction for body weight, physical activity, calcium intake, and alcohol consumption. We found no significant associations between smoking and any of the BMD parameters in 36-year-old men and women. However, both current and lifetime tobacco smoking were significantly and negatively associated with BUA in women but not in men. Lifetime tobacco smoking was significantly and negatively associated with SOS in both sexes. The latter association was independent of body weight, calcium intake, physical activity, and alcohol consumption in women, but not in men. Our results suggest that both current and lifetime tobacco smoking are associated with a deterioration in bone quality but not with a reduction in BMD. However, since BMD parameters and QUS parameters were not measured at the same sites, our results may also simply suggest that the calcaneus is affected by smoking at an earlier stage than the lumbar spine, hip, and total body.

Adult↗
PubMed2004

The influence of corticosteroids on quantitative ultrasound parameters of the calcaneus in the 1st year after renal transplantation.

Steroid-related bone loss is a recognized complication after renal transplantation. Quantitative ultrasound (QUS) of bone measures bone structure besides bone mass. We investigated the influence of corticosteroid therapy on QUS parameters in the 1st year after renal transplantation. A total of 119 renal transplant recipients were randomized to receive either a steroid-free regimen or a regimen with prednisone during 4 months. In 96 patients (steroid-free n=49, steroids n=47), dual-energy X-ray absorptiometry (DXA) parameters of the lumbar spine and the right hip, and QUS parameters of the right calcaneus were measured at baseline, 3, and 12 months after transplantation. Despite a significant difference in steroid use between the two groups, there was no statistically significant difference between the two groups in DXA and QUS parameters at any time point. BMD of the lumbar spine decreased at 3 months and recovered hereafter to the baseline value. BMD of the femoral trochanter decreased at 3 months and remained stable hereafter. The QUS parameter broadband ultrasound attenuation (BUA) was significantly lower at 12 months after transplantation compared with baseline (steroid-free -4.1+/-1.5%, steroids -2.6+/-1.5%). In contrast to the DXA parameters, BUA continued to decrease (P<0.05) between 3 and 12 months after transplantation in both groups. It is concluded, that the usage of a moderate dose of steroids during 4 months after renal transplantation had no important influence on QUS parameters of the calcaneus. While BMD remained stable or improved between 3 and 12 months after transplantation, the decrease in BUA seems to reflect a continuing change in bone structure in this population with preexistent renal osteodystrophy.

Absorptiometry, Photon↗
PubMed1998

Comparison of quantitative ultrasound measurements in calcaneus with DXA and SXA at other skeletal sites: a population-based study on 280 children aged 11-16 years.

We performed ultrasound measurements (QUS) of the calcaneus in a population-based setting on 280 healthy children, aged 11-16 years, from a small urban area in southern Sweden. The results are compared with dual-energy X-ray absorptiometry (DXA) measurements in the total body, the lumbar spine and the hip, as well as single-energy X-ray absorptiometry (SXA) of the forearm. Normative data and correlations between the three different techniques were determined. We found significant correlations between QUS and age (r = 0.34-0.54), height (r = 0.13-0.56) and weight (r = 0.30-0.60), and between QUS and bone mineral density (BMD) measurements (r = 0.44-0.70). Boys increased all their bone mineral variables with age, whereas girls showed a decreasing trend from age 15 years. QUS had a significantly higher increase in standardized value with age than Ward's triangle BMD, but a significantly lower increase in standardized value with age than distal radius (cortical site) BMD. At other BMD sites we did not find any significant differences compared with QUS regarding changes with age. The measurements obtained by QUS, DXA and SXA, respectively, were divided into, quartiles. Of all subjects in the lowest quartile for QUS measurements, only 34-50% were also in the lowest quartiles for DXA and SXA measurements. In conclusion, QUS measurements of the calcaneus in children show similar results as for adult regarding the correlation with DXA and SXA; they also have a significant correlation with anthropometric data. QUS did not identify the same individuals with low bone mass as the X-ray techniques.

Absorptiometry, Photon↗
PubMed1999

Quantitative ultrasound measurements of the tibia and calcaneus in comparison with DXA measurements at various skeletal sites.

The performance of quantitative ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly people (age range 65-87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation (CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual-energy X-ray absorptiometry (DXA). Calcaneal QUS correlated better with BMD at various skeletal sites than tibial QUS. Calcaneal BUA showed higher correlations with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r = 0.48-0.64, r = 0.30-0.47, r = 0.35-0.47, respectively; p < 0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values. After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests that correction for body weight is important and could add to the predictive value of QUS measurements.

Aged↗
PubMed1998

Effect of region of interest location on ultrasound measurements of the calcaneus.

Ultrasound (US) measurements of the calcaneus are usually carried out in a region of interest (ROI) at a fixed site relative to a footplate. Recently, US transmission systems have been developed with imaging capability that enable selection of the position of ROI; the region of measurement is always the area of minimum attenuation in the posterior part of the calcaneus. This study compares measurements of broadband ultrasound attenuation (BUA) and speed of sound (SOS) at the variable ROI of minimum attenuation (ROIv) and at fixed coordinates (ROIf). Ultrasound variables were estimated at ROIv and ROIf in 212 female subjects, including 26 patients with osteoporotic fractures. Among the 186 women without fractures, 63 were classified as having osteoporosis on the basis of their vertebral bone density. Precision of BUA and SOS were better at ROIv than at ROIf. BUA was more highly correlated with bone mineral density (BMD) at the lumbar spine and femoral neck at ROIv than ROIf (r = 0.64 for lumbar spine and 0.68 for femoral neck at ROIv versus 0.50 for lumbar spine and 0.54 for femoral neck at ROIf, P < 0.05 for both comparisons). There were no significant differences between the correlations of SOS with axial BMD at ROIv compared with ROIf. Significant difference was found between the areas under the ROC curve for each ultrasound variable at ROIv and ROIf for both groups of patients, subjects with osteoporosis (area under curve = 0.87 for BUA at ROIv versus 0.82 at ROIf, P < 0.05; area under curve = 0.85 for SOS at ROIv versus 0.81 at ROIf, P < 0. 05), and women with fractures (area under curve = 0.93 for BUA at ROIv versus 0.86 at ROIf, P < 0.05; area under curve = 0.91 for SOS at ROIv versus 0.82 at ROIf, P < 0.05). Ultrasound variables measured at ROIv enable improved reproducibility and significantly better differentiation of diseased subjects from healthy individuals as compared with measurements at ROIf.

Aged↗
PubMed2003

Multimodality imaging features of primary xanthoma of the calcaneus.

Secondary xanthomatous features are histologically observed in various bone lesions, but primary xanthoma of bone is rare. We present a primary xanthoma of the right calcaneus in a 51-year-old woman who had no aberrant lipid metabolism. Roentgenograms showed a small osteolytic lesion in the calcaneal triangle, partially surrounded by bone sclerosis. Computed tomographic scans of the calcaneus showed multiple osteolytic areas, with an irregular trabecular pattern in the surrounding sclerotic bone. T1-weighted magnetic resonance images showed a lesion with central low signal intensity, surrounded by a peripheral ring with high signal intensity. The entire lesion showed high signal intensity on T2-weighted images, partially surrounded by areas with low signal intensity, concordant with reactive bone sclerosis. Histologically, the lesion consisted of numerous lipid-laden histiocytes arranged in sheets, scattered multinucleated giant cells and lymphocytes, and granulation tissues. There was no evidence of pre-existing lesions. Total excision of the tumor was curative.

Bone Diseases↗
PubMed2006

Results in the treatment of paralytic calcaneus-valgus feet with the Westin technique.

Between 1988 and 2003, 23 patients with paralytic calcaneus-valgus feet were submitted to the Westin procedure and 17 patients (25 feet) were re-evaluated. Nine patients were male and eight were female. The mean age at the surgical procedure was 8+/-5 years. The aetiology of paralysis was sequelae of poliomyelitis in 6 patients (8 feet) and of myelomeningocele in 11 patients (17 feet). The mean follow-up period was 6+/-6 years. The results were analysed clinically and radiographically considering the decrease of the retropulsion, the patient's satisfaction, and the increase of the lateral tibiocalcaneal angle. Results were considered satisfactory when the patients showed a decrease of the retropulsion during gait, improvement of the gait pattern, and an increase of the tibiocalcaneal angle. As an overall result, 16 patients (94.2%) were satisfied and 1 patient (two feet) dissatisfied with the outcome. The increase of the tibiocalcaneal angle was significant for the myelomeningocele patients (P=0.001), but not for poliomyelitis (P=0.053). No statistical relation between the follow-up period and the increase of the tibiocalcaneal angle was found (r=0.04). The authors concluded that the Westin procedure is a good technique for the treatment of paralytic calcaneus valgus feet with myelomeningocele.

Adolescent↗
PubMed2004

Anterior process of the calcaneus: a clinical-radiological contribution to anatomical vocabulary.

The anterior portion of the calcaneus is not explicitly described as a bony landmark in contemporary textbooks of human anatomy. However, it may be involved in all types of fractures of the largest tarsal bone. Both surgeons and radiologists are aware of the anterolateral extension of traumatic lesions of the calcaneus. Thus, the anterior portion of the bone should be referred to uniformly as the processus anterior calcanei.

Anatomy, Comparative↗
PubMed2001

Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures.

The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 microm(2)). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters ( p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status.

Absorptiometry, Photon↗