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PubMedDate not supplied

Effects of hyaluronic acid on postoperative adhesion of tendo calcaneus surgery: an experimental study in rats.

Adhesions are a significant problem after tendon surgery. The effects of hyaluronic acid on adhesion formation of the tendo calcaneus were investigated in this study. Twenty Wistar rats were utilized. Both tendo calcanei were incised transversely, and then repaired. Hyaluronic acid (0.2 cc) was injected into peritendinous tissue on the right side, while the same amount of normal saline was injected to the left side as a control. The animals were sacrificed 40days after the experiment. Both the right and left tendon adhesions were evaluated both macroscopically and microscopically for the presence of adhesions (grading scale 0-4). Throughout the experimental period, there was no difference in range of motion of the ankle between the two groups. Macroscopically, there were fewer adhesions in the experimental group (mean 0.6 +/- 0.8) compared to the controls (mean 1.1 +/- 0.2). This difference was not statistically significant (p = .096). Histopathologically, these parameters were similar in both the experimental (mean 1.15 +/- 0.98) and the control groups (mean 1.9 +/- 1.25). This difference was significant (p = .043). Hyaluronic acid may be effective for prevention of adhesions in the tendo calcaneus though this effect could not be demonstrated experimentally.

Adjuvants, Immunologic↗
PubMedDate not supplied

Intraosseous lipoma of the calcaneus: a review and report of four cases.

Intraosseous lipomas have been reported as rare tumors in the lower extremity. They have been identified in the tibia, fibula, metatarsals, and calcaneus. They are frequently misdiagnosed as other tumors, especially unicameral bone cysts or aneutysmal bone cysts when found within the calcaneus. A detailed description of intraosseous calcaneal lipomas and their treatment is given. Surgical technique and four case reports are presented. One of the cases involved a pathologic calcaneal fracture, a finding to the authors' knowledge that has not been previously reported.

Adult↗
PubMedDate not supplied

Laboratory considerations in the surgical treatment of acute hematogenous osteomyelitis of the calcaneus.

Surgical treatment of acute hematogenous osteomyelitis of the calcaneus is uncommon in the literature. Laboratory considerations to aid diagnosis as well as methods of diagnosis, surgical intervention, and management with a review of the literature are presented. A case of a 10-year-old female with acute hematogenous osteomyelitis of the calcaneus treated by surgical drainage, bone biopsy, and management with 12-month follow-up is discussed.

Acute Disease↗
PubMed1998

Calcaneus as a site for the assessment of bone mass.

The calcaneus is a skeletal site frequently used for monitoring bone loss after spaceflight, because it is sensitive to microgravity-induced bone mineral loss and reflects the degree of demineralization in the vertebra and the femoral neck. In this article, methods for assessing the calcaneus are reviewed, and their potential applications and limitations as the monitoring site for bone loss in weightlessness are discussed. Currently, single or dual energy X-ray absorptiometry appears to be most sensitive for monitoring bone mineral loss in weightlessness. The results of recent studies suggest two- to threefold longer follow-up times required for ultrasound techniques. However, ultrasound devices can be designed to be portable, making them attractive for inflight use, and ultrasound techniques are expected to provide information related to bone quality. Additional investigations that assess new ultrasound techniques would be important to determine and utilize the full potential of this technology for monitoring bone loss in weightlessness.

Absorptiometry, Photon↗
PubMed1999

Ultrasonic measurement of the calcaneus in Polish normal and osteoporotic women and men.

In this cross-sectional study, 964 subjects (740 postmenopausal women and 224 men) who underwent ultrasound measurement of the calcaneus at the outpatient osteoporotic clinic in the years 1993-1996 were evaluated. The aim of the study was to compare the influence of age, years since menopause (YSM), and body size on ultrasound variables in normal and osteoporotic male and female populations as well as to assess the ability of quantitative ultrasound (qUS) to discriminate between healthy and osteoporotic individuals. The subjects were divided into four age-matched groups: normal women (n = 601, mean age 56.3 +/- 4.8 years); osteoporotic women (n = 139, mean age 56.5 +/- 4.8 years); normal men (n = 148, mean age 56.2 +/- 10.2 years); and osteoporotic men (n = 76, mean age 56.5 +/- 10.7 years). Persons with a history of a disease and/or medications known to affect bone metabolism were excluded. Broadband ultrasound attenuation (BUA, in decibels per megahertz) and speed of sound (SOS, in meters per second) were measured using Achilles device (Lunar, Madison, WI). Short- and long-term in vitro coefficients of variation (CVs) were: 1.23% and 0.54% for BUA and 0.12% and 0.14% for SOS, respectively. Short-term in vivo CVs were: in women, BUA 1.8% and SOS 0.22%; and, in men, 2.48% and 0.33%, respectively. SOS and BUA values were significantly higher in healthy men (1517.5 +/- 35.3 m/sec, 114.0 +/- 13.3 dB/MHz) than in healthy women (1511.1 +/- 25.6 m/sec, 108.7 +/- 9.5 dB/MHz) (p < 0.000001). The two ultrasound variables had higher values in osteoporotic men (SOS = 1492.6 +/- 24.6 m/sec, BUA = 106.1 +/- 11.6 dB/MHz) in comparison to osteoporotic women (SOS = 1490.4 +/- 19.5 m/sec, BUA = 103.2 +/- 8.6 dB/MHz), but the differences did not achieve significance. In both genders, ultrasound parameters were significantly lower in osteoporotic groups (p < 0.000001). The following age-adjusted odds ratios were obtained: in women, 1.7 (95% CI 1.42-2.03) for BUA, and 2.3 (95% CI 1.87-2.81) for SOS; in men, 1.05 (95% CI 0.03-2.07) for BUA, and 2.13 (95% CI 0.77-3.49) for SOS. ROC analyses performed in both genders showed the following area under the curve data: in women, 0.66 for BUA, and 0.74 for SOS; and, in men, 0.66 for BUA, and 0.71 for SOS. Multiple regression analysis showed age to be the main negative determinant of both ultrasound variables in healthy women, and YSM in osteoporotic women. In both genders, weight was found to have a positive influence on SOS and BUA values, whereas the effect of height was weaker and generally negative. It can be concluded that ultrasound measurement at the calcaneus is able to discriminate between normal male/female and osteoporotic male/female populations in a similar manner. Women had greater rates of decrease in BUA and SOS with age compared with rates in men, and the decrease was greater in normal individuals in both genders. Distinct gender-related differences were noted in regard to correlations of ultrasound parameters with body size.

Adult↗
PubMed2005

Quantitative ultrasound of the calcaneus in children and young adults with severe cerebral palsy.

Osteopenia is common in children, adolescents, and young adults with severe cerebral palsy (CP; spastic quadriplegia) living in residential care, and frequently results in atraumatic fractures. On clinical grounds 67 patients (34 males, 33 females) with severe CP (gross motor function classification system [GMFCS] levels IV or V) aged 5 to 25 years (median 20 y) were divided into three groups with increasing likelihood of severe impairment of bone quality: (1) patients without fractures and without anticonvulsant medication (n=13); (2) patients without fractures and with anticonvulsant medication (n=45); (3) patients with fractures and with anticonvulsant medication (n=9). Evaluation included measurements of quantitative ultrasound (QUS) of the calcaneus, multiple serum analyses, and determination of urinary bone-resorption markers. Values of the quantitative ultrasound index (QUI) were significantly different (p=0.001): group 1 (median 56.9; interquartile range 43.8-75.3); group 2 (49.9; 40.0-60.0); group 3 (35.6; 30.5-38.5). when comparing values of laboratory serum and urine in the three groups, we found significant differences in values of serum bone alkaline phosphatase (p=0.001), serum parathyroid hormone (PTH; p=0.002), serum albumin (p=0.020), and urinary deoxypyridinoline/creatinine ratio (p=0.004). In multiple regression analysis, no laboratory variable was found to be an independent predictor of QUI. QUS of the calcaneus may be a useful method to assess bone quality and fracture risk in children and young adults with severe cp living in residential care, independent of information from laboratory data.

Adolescent↗
PubMed1999

Comparison of quantitative ultrasound in the human calcaneus with mechanical failure loads of the hip and spine.

OBJECTIVE: Quantitative ultrasound of the calcaneus is used clinically for evaluating bone fracture risk, but its association with the mechanical properties at other skeletal sites is not well characterized. The objective was therefore to determine its predictive ability of the mechanical failure loads of the proximal femur and lumbar spine. METHOD: In 45 human cadavers (29 males and 16 females, aged 82.5 +/- 9.6 years), we determined the speed of sound, broadband ultrasonic attenuation (BUA) and the empirical stiffness index, using a commercial quantitative ultrasound scanner. The proximal femora and the fourth vertebral body were excised and loaded to failure in a testing machine. RESULTS: Femoral failure loads ranged from 933 to 7000 N and those of the vertebrae from 1000 to 7867 N, their correlation being 0.51 in females and -0.08 in males. Forty percent of the variability of femoral, but only 24% of the variability of the vertebral fracture loads could be predicted with calcaneal speed of sound. In the femur, a combination of speed of sound and BUA improved the prediction (r2 = 50-60%), but not in the spine. CONCLUSIONS: The study provides experimental evidence that calcaneal quantitative ultrasound is capable of predicting mechanical failure at other skeletal sites and has potential to identify patients at risk from osteoporotic fracture. The different association of quantitative ultrasound with femoral and vertebral failure may result from the influence of the cortical bone and a higher microstructure-related similarity of the calcaneus and the femur.

Aged↗
PubMedDate not supplied

A complete dislocation of the calcaneus: a case report.

Isolated dislocation of calcaneus from cuboid and talus is extremely rare. This is a report of a 40-year-old man who sustained an open dislocation of calcaneus from cuboid and talus with subluxation of the talonavicular joint. Immediate reduction and stabilization with Kirschner wires and an external fixator was performed. At 2-year follow-up, there was no evidence of infection or avascular necrosis of tarsal bones. However, osteoarthrosis of the calcaneocuboid joint was evident. The functional result after 2 years was satisfactory. This case illustrates that the diagnosis of concomitant injuries in the adjacent column of the foot and compliance with principles of management of multiple injuries in the midfoot are paramount in reducing morbidity, which is common in such injuries.

Adult↗
PubMed2002

Treatment of chondroblastoma of the calcaneus with a secondary aneurysmal bone cyst using endoscopic curettage without bone grafting.

Chondroblastoma is a relatively rare benign bone tumor. Approximately 7% of chondroblastomas occur in the calcaneus, and 17% of chondroblastoma associated with cystic lesions. We report a case of a chondroblastoma in the calcaneus with a secondary aneurysmal bone cyst treated successfully by endoscopic curettage without bone grafting. New bone formation is facilitated by minimal damage to the bone and soft tissue. The cosmetic results of this procedure are good. Two years later, the patient is asymptomatic with no radiographic evidence of recurrence. Endoscopic curettage without bone grafting is a promising new treatment for chondroblastoma.

Adult↗
PubMed1989

[Intra-articular juvenile calcaneus fractures in skiing].

Calcaneal fractures are extremely rare in children with intraarticular fractures occurring between 8 and 14 years. This report refers to two cases with displaced intraarticular fractures of the calcaneus sustained from skiing. Results of surgery were proven to be excellent. As essential prerogatives of successful treatment elaborate diagnostics including computerized tomography, experience in doing surgery on the calcaneus and knowledge about the special entities of the growing skeleton are mandatory.

Adolescent↗
PubMed1994

[Radiographic changes of the calcaneus in the framework of chronic polyarthritis].

Plain films of the calcaneus of 768 patients with confirmed rheumatoid arthritis were examined retrospectively with reference to inflammatory rheumatic changes. 42 patients (5.5%) showed an erosion of the posterior upper calcaneal margin related to an Achilles bursitis. In three patients there were additional plantar erosions. The Achilles bursitis was bilateral in 50% of cases, particularly in patients in stages 2 and 3 according to Steinbrocker. In the majority of bilateral cases (62%) the size or shape of the lesions was asymmetrical. Our observations indicate that involvement of the os calcis is not uncommon in rheumatoid arthritis; routine examination of this bone would appear to be indicated even in patients without symptoms. Since the defect is unilateral in half the patients, unilateral occurrence of an erosive lesion cannot be regarded as a criterion for a bacterial-inflammatory bursitis. Contrary to the symmetrical involvement of joints in the hands in rheumatoid arthritis, defects in the calcaneus are often unilateral or asymmetrical.

Achilles Tendon↗
PubMed1994

[Evidence of fluoride-induced effects on the calcaneus by measurements of broadband ultrasound attenuation (BUA)].

We measured broadband ultrasound attenuation (BUA) of the calcaneus as well as radial (RBD) and spinal bone density (SBD) in normal and osteoporotic females (n = 188) both before treatment and after long-term fluoride therapy. RBD was measured using single photon absorptiometry of the non-dominant distal forearm (SPA) and spinal bone density (SBD) was assessed using quantitative CT (QCT). In untreated osteoporotic patients (n = 62), BUA as well as the other densitometric methods showed significantly lower values (p < 0.05) when compared to age matched controls (n = 75). Females with osteoporosis and long-term treatment with fluoride (n = 51) had both significantly higher BUA values and higher spinal bone density when compared to women with untreated osteoporosis. BUA and SBD were correlated in the entire group (r = 0.5, r < 0.0001) as well as in the subgroups of untreated (r = 0.48, p < 0.001) and fluoride-treated patients with osteoporosis (r = 0.4, p < 0.05). These results suggest that BUA provides further evidence of an osteogenic response to fluoride at peripheral weight-bearing skeletal sites such as the calcaneus.

Absorptiometry, Photon↗
PubMed1989

[Pathologic changes in the hindfoot angle following fracture of the calcaneus].

Forty fractured calcanei (13 without and 27 with involvement of the joint) were examined by CT and the angle of the hind foot measured. Following a typical compression fracture there is a negative calcaneus-valgus angle, i.e. varus deformity of the tuberosity fragment. The sustentaculum angle is increased. There are changes in the talo-calcaneal and calcaneo-cuboidal angles. The length ratio of calcaneus to talus is reduced. Reproducible measurements make it possible to compare the results of operative correction and of changes in shape following conservative treatment, e.g. during weight-bearing.

Adult↗
PubMed2004

Outcome of surgically treated intraarticular calcaneus fractures--SF-36 compared with AOFAS and MFS.

BACKGROUND: There is no consensus as to which is the best treatment for intraarticular fractures of the calcaneus. Furthermore, few studies have assessed general health after calcaneus fractures. We therefore measured the state of general health after operation of calcaneal fractures and compared these data with usual foot-scores. PATIENTS AND METHODS: We compared the general health of 71 patients with surgically treated calcaneal fractures 2.5 years after injury, with the general health of 71 people from the standard German population (German National Health Survey, 1998) using the SF-36 form. We compared the results of the examination with results of AOFAS Ankle Hindfoot Scale and Maryland Foot Score in the treated patients. RESULTS: In patients with calcaneal fractures, there were significant limitations regarding general health in all 9 elements of the SF-36 form. Correlations between SF-36 and foot-scores were strong regarding function and pain scales, but moderate for all other scales. INTERPRETATION: Patients face significant limitations regarding general health after calcaneal fractures. The usual foot-scores measure only 2 dimensions of outcome: function and pain. To measure all dimensions of outcome, SF-36 is a better alternative.

Adult↗
PubMed2003

Association between polymorphisms of apolipoprotein E, bone mineral density of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in postmenopausal women with hip or lower forearm fracture.

A genetic contribution to the development of osteoporosis is well documented. Although the association between the common allelic variation of apolipoprotein E (APOE), fracture risk, bone loss and bone mineral density (BMD) has been examined in several studies, the results of these investigations are contradictory. The aim of this study was to examine the association between polymorphisms of APOE, BMD of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in a population of postmenopausal women with hip or lower forearm fractures admitted to a department of orthopaedic surgery and age-matched controls from the population register. The APOE genotypes of 327 women were studied: 73 with lower forearm fractures, 43 with hip fractures and 211 age-matched controls. The participants were not receiving antiosteoporotic treatment. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) was used to detect the APOE genotypes. Quantitative ultrasound was measured at the calcaneus. Bone mineral density (BMD) of the lower forearm was measured with dual-energy X-ray absorptiometry. The distributions of genotype frequencies in this study were: E2/E2: 0.3%; E2/E3: 16.5%; E2/E4: 2.5%; E3/E3: 54.7%; E3/E4: 24.2%; E4/E4: 1.8%. All subpopulations were in Hardy-Weinburg equilibrium. There was no association between bone mass parameters and the APOE allele groups. Logistic regression analysis did not show any association between fractures and APOE allele groups. In conclusion, this study showed no association between bone mass parameters (BMD, speed of sound (SOS), broadband ultrasound attenuation (BUA)), hip or lower forearm fracture and APOE genotypes in a population of postmenopausal women and age-matched controls.

Aged↗
PubMed1996

Ultrasonic assessment of calcaneus in inhabitants in a cadmium-polluted area.

We used ultrasound (US) transmission to evaluate the speed of sound (SOS) and broadband ultrasonic attenuation (BUA) in the calcaneus in 17 male and 18 female inhabitants of a Cd-polluted area and 23 men and 45 women living in a nonpolluted area. Significant decreases in SOS and stiffness (Stiff), which was an index empirically derived from SOS and BUA, were found in Cd-exposed women. To evaluate the usefulness of the US measurements for detecting bone abnormality in Cd-exposed people, we examined the associations with the bone measurements of metacarpus by the previously used microdensitometry (MD) method and the grade of renal tubular damage due to Cd exposure. Bone density estimated by MD, sigmaGS/D, was significantly correlated with BUA, SOS, and Stiff in the Cd-exposed men and with BUA and Stiff in the Cd-exposed women. Further, in the Cd-exposed women, the decreases in BUA and Stiff correlated significantly with the increases in urinary beta 2-microglobulin, while sigmaGS/D by the MD method did not. These results suggest that the measurement of the calcaneus using US is not only radiation free but also can be used as a tool for population surveys aiming to evaluate bone damage in people, especially women, showing renal tubular damage due to environmental Cd exposure.

Aged↗
PubMed2000

Calcaneus fractures with subluxation of the posterior facet. A surgical indication.

The charts and radiographs of 118 patients with 126 intraarticular fractures of the calcaneus were reviewed retrospectively. Eleven of 126 (8.7%) calcaneal fractures had injuries consisting of intraarticular calcaneal fracture, lateral subluxation or dislocation of the posterior facet, fracture extension into the calcaneocuboid joint, peroneal tendon subluxation, subluxation of the talus in the ankle mortise, and complete disruption of the anterior talofibular and calcaneal fibular ligaments or fracture of the lateral malleolus. There were six women and five men. The average age was 40 years (range, 17-65 years). The mechanism of injury was a motor vehicle accident in eight and a fall from a height in three. According to the classification of Sanders et al eight fractures were Type II, one was Type III, and two were Type IV. Followup at an average of 26 months (range, 14-38 months) showed that eight of 11 patients (72.7%) had either good or excellent results. When lateral subluxation of the posterior facet of the calcaneus is identified with a preoperative computed tomography scan, operative management is indicated, and the surgeon should search for associated injuries that should be addressed at the time of surgery.

Adolescent↗
PubMed1996

Open reduction and internal fixation of the calcaneus using minifragment plates.

During a 4-year period, 35 nonconsecutive intraarticular fractures of the calcaneus were fixed with 2.7-mm minifragment plates and 3.5-mm small fragment screws through an extended lateral approach. There were 25 type II and 10 type III fractures by the classification system of Sanders. The reduction of the facet was anatomic in 91%. The reduction of the tuberosity was acceptable (< or = 5 degrees of angulation) in all cases. Early motion was begun in the ankle, subtalar, and midfoot joints in all cases. Two patients had minor edge necrosis amenable to local treatment. There were no deep infections. Using the Maryland foot score, there were 77% good or excellent results. The small size of the minifragment plates allows for their application to a wide variety of fracture patterns. They are also low profile and are therefore easy to cover. Multiple plates were used in many cases without steric interference. They provided rigid enough fixation to allow aggressive early motion exercises without loss of reduction or hardware failure in any case. Minifragment plates with small fragment screws are effective for the fixation of intraarticular calcaneus fractures through an extended lateral approach.

Adolescent↗