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PubMed2002

Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus fractures.

BACKGROUND: The development of major and minor wound complications is a major concern in the open reduction and internal fixation of displaced intra-articular calcaneus fractures. Percutaneous, arthroscopically assisted screw osteosynthesis was developed to minimize the surgical approach without risking inadequate reduction of the subtalar joint. The method was applied in selected cases of displaced intra-articular calcaneus fractures with one fracture line crossing the posterior calcaneal facet (Sanders type II fractures). METHODS: Between March 1998 and July 2000, 15 patients were treated with that method. Percutaneous leverage was carried out with a Schanz screw introduced into the tuberosity fragment (the Westhues maneuver) under direct arthroscopic and fluoroscopic control. After anatomic reduction was achieved, the fragments were fixed with three to six cancellous screws introduced via stab incisions. RESULTS: The functional results of 10 patients at a minimum of 1 year follow-up are good to excellent, with an average AOFAS ankle-hindfoot score of 93.7 (range 87-100) and an average Maryland Foot Score of 95.8 (range 93-100). Overall patient comfort and satisfaction were superior to open reduction for similar fracture patterns, and the in-hospital time could be reduced. CONCLUSIONS: Percutaneous, arthroscopically assisted osteosynthesis offers exact assessment of the articular surface and allows anatomical reduction while adhering to the principles of minimally invasive surgery. The short-term results are excellent, while long-term results with greater patient cohorts are awaited.

Adult↗
PubMed2001

Imaging features of intraosseous lipomas of the calcaneus.

We report two cases of intraosseous lipoma arising in the calcaneus of a 36-year-old and a 22-year-old women complaining of heel pain. Plain radiographs and computed tomography scans revealed cystic lesions in the calcaneus triangle. On magnetic resonance images, the lesions had high signal intensities on both T1-weighted and T2-weighted images, corresponding to adipose tissue. Histological examination revealed mature fat cells with small bone fragments. Curettage and bone grafting were performed. There was no recurrence identified on plain radiographs 2 years following the surgery.

Adolescent↗
PubMed1988

The clinical relevance of calcaneus bone mineral measurements: a review.

The use of bone mineral content (BMC) measurements to assist in the management of osteoporosis has received increasing emphasis in recent years. Although the calcaneus, an essentially trabecular bone (90-95%), has been used extensively in the NASA experiments, few data relating to primary osteoporosis have appeared in the literature until recently. This paper is a review of the methods of measurement, their precision and methods of calibration, and the relationship of calcaneal mineral content to age, height, weight, other bone sites, degree of spinal osteoporosis, metabolic bone disease and the effects of therapeutic drugs. Prospectively, calcaneal BMC relates as well as spinal BMC to osteoporotic fracture risk. It is this use of BMC measurements which has the most promise for the future. The data indicate that osteoporosis is a systemic disease and trabecular bone losses are reflected in the calcaneus as well as in the spine itself.

Absorptiometry, Photon↗
PubMed1995

Interruption of disuse by short duration walking exercise does not prevent bone loss in the sheep calcaneus.

The effect on calcaneal bone loss of interrupting immobilization by daily periods of normal walking was investigated in adult female sheep. The left calcaneus of 28 sheep was protected from normal loading by placing an external fixator across the hock joint, from the tibia to the metatarsus. In vivo strain gauge recordings from 3 animals showed that, at a test location on the calcaneus, this resulted in a significant reduction in principal strain magnitude during walking at 1.5 m s-1 from a peak of -228 x 10(-6) before application of the fixator, to 71 x 10(-6) with the fixator in place. In addition to reducing peak strains during normal activity, the fixator also abolished the high magnitude transient strains (peak -1147 x 10(-6)) normally experienced when the sheep made sudden movements. Thirteen animals (group 1) had fixators applied, and were given no further treatment. In a further 6 animals (group 2), the fixator was removed for 20 min per day, during which they walked on a motorized treadmill at 1.5 m s-1. In the remaining 6 sheep (group 3), incomplete fixator bars were applied to allow uninterrupted joint movement. Over the 12-week period of the experiment, dual photon absorptiometric scans showed that the bone mineral content (BMC) of the calcanei of group 1 fell by 22%. In group 2, where immobilization was interrupted by daily walking, the BMC fell by 21%. In group 3, with incomplete bars, there was no significant reduction in BMC.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed2006

Arthroscopic resection of the calcaneonavicular coalition or the "too long" anterior process of the calcaneus.

Calcaneonavicular coalition and the "too long" anterior process (TLAP) of the calcaneus can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprain. Surgical resection of the bone bar is frequently required. We present here an arthroscopic approach that can be used to accurately assess pathoanatomy and resect the bone bar. A portal is established slightly dorsal to the angle of Gissane. This is the primary visualization portal. The working portal, which is identified under an image intensifier, is located at the space between the talonavicular and calcaneocuboid joints, directly over the TLAP or the calcaneonavicular coalition. With the 2.7-mm 30 degrees arthroscope placed at the primary visualization portal, soft tissue around the TLAP or the calcaneonavicular coalition is cleared up with the use of an arthroscopic shaver at the working portal. After the TLAP or the calcaneonavicular coalition is clearly visualized, it can be resected with an arthroscopic burr through the working portal. The bone bar is resected proximally until the medial side of the calcaneocuboid joint, the lateral side of the taloavicular joint, and the plantar-lateral aspect of the talar head are clearly seen. Inversion stress should then be applied to the foot to prevent further impingement of the anteromedial process of the calcaneus to the plantar-lateral part of the talar head.

Arthroscopy↗
PubMed2004

Discrimination of hip fractures by quantitative ultrasound of the phalanges and the calcaneus and dual X-ray absorptiometry.

The aim of the current study was to evaluate the ability of different techniques used for the assessment of bone status to discriminate between postmenopausal women with and without hip fracture. Fifty-one postmenopausal women (mean age 64.5 +/- 6.5) who had sustained a low energy hip fracture and 51 age-matched controls (mean age 64.6 +/- 6.0) were studied. Quantitative ultrasound (QUS) assessment was carried out using the Ubis 3000 device capable of measuring broadband ultrasound attenuation (BUA) and speed of sound at the calcaneus (SOSC) and the Sunlight Omnisense device capable of estimating speed of sound at the phalanges (SOSP). Femoral neck bone mineral density (BMD) was assessed using dual X-ray absorptiometry. Correlations between QUS variables ranged from r = 0.35 to 0.72 and between QUS variables and BMD from r = 0.30 to 0.36. BMD was the best discriminator of hip fractures (odds ratio = 3.61, area under curve = 0.824). All QUS variables were significant discriminators of hip fractures with odds ratios ranging from 1.88 to 2.63 and areas under the ROC curves ranging from 0.663 to 0.740. Among the QUS variables, the SOSP showed the best odds ratio and area under curve. Comparison between the areas under the ROC curve did not show any significant difference between SOSP, BUA and BMD. On the contrary, the difference between SOSC and BMD was significant (P < 0.05). In conclusion, BMD and QUS variables investigated in the current study were significant discriminators of hip fractures. The differentiation of the hip fractures by BMD was significantly better than that of BUA measured at the calcaneus. Moreover, BMD discriminated fractured patients better than BUA and SOS(P), although the difference did not reach statistical significance.

Absorptiometry, Photon↗
PubMed2006

Sex determination from the talus and calcaneus measurements.

Several studies have demonstrated that discriminant function equations used to determine the sex of a skeleton are population-specific. The purpose of the present research was to develop discriminant function equations for sex determination on the basis of 18 variables on the right and left talus and calcaneus in a modern northern Italian sample. The sample consisted of 118 skeletons (62 males and 56 females) from the Frassetto Collection (University of Bologna). The ages of the individuals ranged from 19 to 70 years. The results indicated that metric traits of the talus (in particular) and calcaneus are good indicators of sexual dimorphism. The percentage of correct classification was high (87.9-95.7%). In view of the differences among current Italian populations, we tested the validity of the discriminant function equations in an independent sample of individuals of different origin (northern and southern Italy). The accuracy of classification was high only for the northern Italians. Most southern Italian males were misclassified as females, confirming the population-specificity of discriminant function equations.

Adult↗
PubMed2004

Calcaneus fractures: facts, controversies and recent developments.

The management of calcaneus fractures and their associated soft tissue injuries are challenging tasks for the surgeon. Open reduction and stable internal fixation with a lateral plate and without joint transfixation has been established as a standard therapy for displaced intra-articular fractures with good to excellent results in two-thirds to three-quarters of cases in larger clinical series. Bone grafting appears not useful in the vast majority of cases. Anatomical reduction of joint congruity and the overall shape of the calcaneus are important prognostic factors. The quality of joint reduction should be reliably proven intra-operatively either with Brodén views, high-resolution fluoroscopy or open subtalar arthroscopy. Treatment results are adversely affected by open fractures, delayed reduction after more than 14 days and individual risk factors such as high body mass index and smoking. The extended lateral approach respects the neurovascular supply to the heel and allows a good exposure of the fractured lateral wall, and the subtalar and calcaneocuboid joints in most fractures. In selected fracture patterns percutaneous screw fixation, possibly with arthroscopic control, is a good alternative. Open fractures, compartment syndrome and fractures with severe soft tissue compromise are treated as emergency cases. Early, stable soft tissue coverage appears promising in treating complex open fractures. The benefits of newly developed plate designs and subtalar arthrolysis at the time of hardware removal remains to be proven in further studies. Calcaneal malunions after conservative therapy of displaced fractures are disabling conditions that can be treated successfully with a staged protocol according to the type of deformity. Treatment options include lateral wall decompression, subtalar in situ, or corrective, arthrodesis and calcaneal osteotomy along the former fracture line.

Biomechanical Phenomena↗
PubMed2006

Intrinsic mechanical properties of trabecular calcaneus determined by finite-element models using 3D synchrotron microtomography.

To determine intrinsic mechanical properties (elastic and failure) of trabecular calcaneus bone, chosen as a good predictor of hip fracture, we looked for the influence of image's size on a numerical simulation. One cubic sample of cancellous bone (9 x 9 x 9 mm(3)) was removed from the body of the calcaneus (6 females, 6 males, 79+/-9 yr). These samples were tested under compressive loading. Before compressive testing, these samples were imaged at 10.13 microm resolution using a 3D microcomputed tomography (muCT) (ESRF, France). The muCT images were converted to finite-element models. Depending on the bone density values (BV/TV), we compared two different finite element models: a linear hexahedral and a linear beam finite element models. Apparent experimental Young's modulus (E(app)(exp)) and maximum apparent experimental compressive stress (sigma(max)(exp)) were significantly correlated with bone density obtained by Archimedes's test (E(app)(exp)=236+/-231 MPa [19-742 MPa], sigma(max)(exp)=2.61+/-1.97 MPa [0.28-5.81 MPa], r>0.80, p<0.001). Under threshold at 40 microm, the size of the numerical samples (5.18(3) and 6.68(3)mm(3)) seems to be an important parameter on the accuracy of the results. The numerical trabecular Young's modulus was widely higher (E(trabecular)(num)=34,182+/-22,830 MPa [9700-87,211 MPa]) for the larger numerical samples and high BV/TV than those found classically by other techniques (4700-15,000 MPa). For rod-like bone samples (BV/TV<12%, n=7), Young's modulus, using linear beam element (E(trabecular)(num-skeleton): 10,305+/-5500 MPa), were closer to the Young's modulus found by other techniques. Those results show the limitation of hexahedral finite elements at 40 microm, mostly used, for thin trabecular structures.

Aged↗
PubMed2005

Bone status in primary hyperparathyroidism assessed by regional bone mineral density from the whole body scan and QUS imaging at calcaneus.

To assess the bone mineral density status in primary hyperparathyroidism (PHPT), we studied 64 females with PHPT and 17 healthy women. Regional BMD (arms, trunk, legs) from the whole body scan and conventional sites (lumbar spine, femur, radius) were assessed by DXA. Quantitative ultrasound (QUS) imaging measurements were performed at calcaneus. Sixteen women had history of renal lithiasis, 11 had low impact fracture and 37 women had neither renal lithiasis nor fracture. In the entire group, the mean Z-scores were significantly decreased at all sites (lumbar spine, femur, radius). In all clinical subgroups, the mean Z-scores were significantly decreased at radius. The mean Z-scores in premenopausal women were significantly decreased comparatively to postmenopausal women at lumbar spine and femur. In a group of PHPT females matched to controls for age and BMI, only BMD values at radius were lower in PHPT patients than in control (P < 0.03). However, from the whole body scan data, all sites but no trunk were significantly involved in PHPT patients (P < 0.04). Using QUS measurements at calcaneus, the BUA but not SOS in PHPT females was significantly lower (P = 0.03) than in controls. Our results suggest that low BMD at lumbar spine and femur is encountered preferentially in premenopausal women. The BMD decrease predominates at limbs in PHPT with presumably a gradient from proximal to distal part of the limbs. Indeed, the distal part of the limbs are the most affected areas in PHPT whatever the amount of cortical or trabecular bone.

Absorptiometry, Photon↗
PubMedDate not supplied

Radial forearm free flap for coverage of postoperative lateral heel wounds after open reduction and internal fixation of the calcaneus.

For intraarticular calcaneus fractures, open reduction and internal fixation has become commonplace for the reduction of morbidity of postinjury arthritis. Despite adequate surgical results, there are often associated postoperative wound complications. The purpose of this study was to describe a unique application of the radial forearm free flap for coverage of lateral postoperative heel defects seen after calcaneal fixation. Seven lateral heel wounds after open reduction of calcaneal fractures in 6 patients were covered with radial forearm free flaps. The technique used involved passage of the pedicle of the laterally placed flap anteriorly to the Achilles tendon so that it can be anastomosed to the posterior tibial artery. Flap application was 100% successful, with good functional and cosmetic results in all patients. The radial forearm free flap provides a quick, reliable, and easily harvested source of coverage for lateral heel wounds seen after open reduction and internal fixation of the calcaneus. Tunneling of the flap pedicle anterior to the Achilles tendon is simple and provides the additional advantages of access to reliable vessels, reduced scarring, and avoidance of further wound problems often seen with incisions used to access the anterior tibial artery.

Adult↗
PubMed2005

Measurements of acoustic dispersion on calcaneus using spilt spectrum processing technique.

The speed of sound (SOS) has become a useful tool in osteoporosis assessment, since it represents a combination of density and compressibility of bone tissue and should provide better information on bone quality and an estimate the fracture risk. In general, the speed of sound on dispersive material, such as bone tissue, depends strongly on frequency. Therefore, a measurement of velocity dispersion magnitude (VDM) might provide more important bone structure information than measurements of bone mineral density (BMD), SOS or broadband ultrasound attenuation (BUA). To obtain the velocity dispersion magnitude requires a sequence of pulses that have a frequency that is different from that used in conventional approaches. The measurement is complicated by the fact that pulse waveform will distort as the pulses propagate through the frequency-dependent medium. Alternatively, the phase velocity and velocity dispersion measurements also can be obtained on frequency-domain processing. However, the accuracy of those techniques is affected by the 2mpi ambiguity in the phase unwrapping process in frequency domain. And the spectrum approach is highly dependent on the gating window selection in time domain signals. The time-domain split spectrum processing (SSP) technique is proposed here to measure the phase velocity and the VDM. The SSP technique is also used to measure the SOS and VDM of two commercial calcaneus phantoms. Simulation results are in good agreement with the preset parameters of a model-based signal obtained using the SSP technique. In addition, in vitro SSP measurements agree with the manufacturer's specifications for two commercial calcaneus phantoms. The negative dispersion is also found in in vivo measurements on human heel. Finally, an approach based on the time domain SSP technique has potential clinical applications for osteoporosis diagnosis.

Algorithms↗
PubMed2004

Influence of age and osteoporosis on calcaneus trabecular bone structure: a preliminary in vivo MRI study by quantitative texture analysis.

Recent developments in high-resolution MR imaging techniques have opened up new perspectives for structural characterization of trabecular bone by non-invasive methods. In this study, 3-D MR imaging was performed on 17 healthy volunteers and 6 osteoporotic patients. Two different MR sequences were used to evaluate the impact on MR acquisition on texture analysis results. Images were analyzed with four automated methods of texture analysis (grey level histogram, cooccurrence, runlength and gradient matrices) enabling quantitative analysis of grey level intensity and distribution within three different regions of interest (ROI). Texture analysis is not very frequently used since the interpretation of the large number of calculated parameters is difficult. We applied multiparametric data analyses such as principal component analysis (CFA) and hierarchical ascending classification (HAC) to determine the relevant parameters to differentiate between three sets of images (healthy young volunteers, healthy postmenopaused and osteoporotic patients). The results suggest that relevant texture information (depending on the ROI localization in the calcaneus) can be extracted from calcaneus MR images to evaluate osteoporosis and age effects on trabecular bone structure if strictly the same acquisition sequences are used for all patients' examination.

Adult↗
PubMed1999

Adaptation of the human calcaneus to variations of impact forces during running.

OBJECTIVE: The influence of varied forces under the heel induced by changes in midsole hardness on adaptations of the human calcaneus during running training was investigated. DESIGN: A longitudinal study was conducted over a period of 20 weeks with subjects training for 50 km per week on average. BACKGROUND: The skeletal systems' metabolism acts highly dynamic, governed by mechanical factors. The amount of running training has been shown to increase the bone mineral density in the calcaneus. Mechanical factors have not been controlled in former investigations. METHODS: Bone quality parameters were determined before and after the training by use of an ultrasound system and quantitative MRI while the mechanics of foot-ground contact were controlled. The total group of 26 subjects was divided into three subgroups based upon different magnitude of forces under the heel inside the shoe. RESULTS: The biomechanical testing demonstrate no relationship between midsole hardness and external or in-shoe impacts. Bone parameters showed specific differences for all groups which are pronounced in runners with intermediate impacts. CONCLUSIONS: The observed variations reflect metabolic changes in bone marrow which appear to be effected by the impact magnitude and cannot be characterised as negative. RELEVANCE: The current data imply that no negative changes of impacts on calcaneal bone were produced by high amounts of training in distance running. The mechanical testing indicates that the potential of modifying calcaneal adaptation directly by varying midsole hardness is limited.

Adaptation, Physiological↗
PubMed2001

Quantitative ultrasound (QUS) at the calcaneus and hand phalanges in Polish healthy postmenopausal women.

In a cross-sectional study, 109 postmenopausal, healthy women, mean age 58.8 years, were studied. The aim of the study was to compare quantitative ultrasound (QUS) performed at two measurement sites of the same persons (correlations between parameters studied, age, and years since menopause (YSM)-related changes, influence of body size). Bone status was established using measurements at the calcaneus by Achilles (Lunar, USA), which measures speed of sound (SOS [m/s], CV% = 0.22%), broadband ultrasound attenuation (BUA [dB/MHz], CV% = 1.8%), stiffness index (SI [%], CV% = 1.3%), and by DBM Sonic 1200 (Igea, Italy), which measures amplitude-dependent speed of sound (Ad-SoS [m/s], CV% = 0.64%) at the hand phalanges. Mean and SD values were: SOS = 1498 +/- 24.8 m/s, BUA = 104.6 +/- 9.4 dB/MHz, SI = 69.2 +/- 12.3%, Ad-SoS = 1879 +/- 90.1 m/s. Age- and YSM-related changes were as follows: age-SOS r = -0.37, p < 0.0001, age-BUA r = -0.33, p < 0.001, age-SI r = -0.36, p < 0.001, age-Ad-SoS r = -0.62, p < 0.00001, YSM-SOS r = -0.27, p < 0.01, YSM-BUA r = -0.32, p < 0.001, YSM-Ad-SoS r = -0.44, p < 0.00001, YSM-SI r = -0.29, p < 0.01. In stepwise, multiple regression analyses of ultrasound parameters on age, YSM, height, and weight, the following equations were obtained: SOS [m/s] = 1564.9 - 1.1 x age [y], r = -0.37, p < 0.0001; BUA [dB/MHz] = 88.7 + 0.28 x weight [kg] - 0.36 x YSM [y], r = -0.51, p < 0.00001; SI [%]) = 79.2 - 0.5 x age [y] + 0.28 x weight [kg], r = -0.47, p < 0.00001; Ad-SoS [m/s] = 2287 to 6.9 x age [y], r = -0.62, p < 0.00001. In conclusion, QUS at the calcaneus and hand phalanges express similar trends in skeletal changes due to aging and the postmenopausal period, although measurements at the phalanges seem to be more sensitive for detecting bone changes, due to faster decrease rate of the Ad-SoS value than calcaneal measurements.

Body Constitution↗
PubMed2002

Quantitative ultrasound of the hand phalanges and calcaneus revealed skeletal abnormalities due to primary hyperparathyroidism: a case report.

Primary hyperparathyroidism (PHPT) is a common disease causing bone loss in elderly patients. We report a case study of a 36-year-old woman with PHPT. Quantitative ultrasound (QUS) assessment of the phalanges and calcaneus revealed significantly lower than normal values for age. This observation was confirmed by measuring bone mineral density in different skeletal sites using dual-energy X-ray absorptiometry (DXA). Subsequent parathyroid adenoma surgery normalized calcium metabolism, resulting in a progressive increase of BMD and ultrasound (US) parameters. This report has shown an ability of peripheral QUS examinations (phalanges and calcaneus) in early detection of bone alterations caused by PHPT in a young woman. Skeletal changes after surgery could be evaluated by QUS in a similar manner to that used in DXA.

Absorptiometry, Photon↗
PubMed2000

Prevalence and risk factors of low quantitative ultrasound values of calcaneus in Korean elderly women.

Quantitative ultrasound (QUS) of bone is a new radiation-free, low-cost method that measures both bone mass and bone quality. This study was performed to establish the normative data of QUS for Korean women and to determine the prevalence and risk factors of low quantitative ultrasound values in a Korean elderly population. We studied 238 healthy women aged 20-29 years working at a hospital, and 552 women over 50 years of age living in six villages of Chung-Up district, a rural area of South Korea, using QUS measurement of bone. Broadband ultrasound attenuation and speed of sound were measured at the calcaneus, and an index combining these factors (stiffness index) was calculated. T-score was calculated from the data of young normal subjects. Of the 552 elderly women, 34.2% had T-scores between -1.0 and -2.5, and 11.8% had T-scores below -2.5. The prevalence of low quantitative ultrasound values increased with older age, longer duration following menopause, lower body mass index, younger age at menopause and smoking. In multiple logistic regression analysis, age (odds ratio = 1.40 per 5 years, P < 0.05), duration following menopause (odds ratio = 1.35 per 5 years, P < 0.05) and body mass index (odds ratio = 0.78 per quartile, P < 0.05) were independently associated with low quantitative ultrasound values. These results suggested that quantitative ultrasound measurement of the calcaneus could be a useful tool for epidemiological surveys of bone mass.

Adult↗
PubMed1999

Effect of methamphetamine abuse on the bone quality of the calcaneus.

BACKGROUND: Methamphetamine, a derivative of amphetamine, has been said to cause mainly mental dependency in humans, but only little is known about its physical dependency. Like other narcotics, it may have chronic effects on the human body, so, this study was planned to evaluate it by examining the bone quality of the skeletal system. METHOD: Among the convicts serving in Fuchu Prison, two groups of people were chosen according to their methamphetamine experience. The bone quality of the calcaneus of both abusers (n = 59, ages 41 +/- 11 years) and controls (n = 50, aged 45 +/- 13 years) was examined with an Achilles ultrasound bone densitometer. SOS (speed of sound) and BUA (broadband ultrasound attenuation), both of which were obtained from the measurement and are an indicator of the strength of bone, were compared between the two groups. RESULTS: The SOS of the abuser group was 1559 +/- 24 (mean +/- SD) m/s and this was significantly lower than that of the control group, 1570 +/- 27 (mean +/- SD) m/s (p = 0.017). The BUAs of the abuser group and the control group were 108 +/- 10 and 110 +/- 10 (mean +/- SD) dB/MHz, respectively, and there was no significant difference between them (p = 0.181). CONCLUSION: There was loss of SOS of the calcaneus in methamphetamine abusers.

Adult↗