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At least 37 records · Page 2Linked to original sources
PubMed2003

Hip fracture discrimination study: QUS of the radius and the calcaneum.

As an emerging alternative to current radiation-based bone densitometry techniques, there is a growing interest in the use of quantitative ultrasound (QUS) measurements for the noninvasive assessment of fracture risk in the management of osteoporosis. However, there are also a multiplicity of technologically different QUS devices available on the market and, so far, no study has compared heel and radius QUS device for the discrimination of subjects with hip fractures. Our study evaluated the ability of three QUS devices (one calcaneal gel-coupled system, one calcaneal water-coupled system, and one radius system) to discriminate osteoporotic from controls subjects, using the same population. We also checked if the combination of two different skeletal sites (i.e., calcaneum and radius) improve the discriminatory ability of the QUS devices. Forty-five women aged 79.1+/-7.1 yr with hip fractures within the last 4 d were used as the hip-fracture group and compared to 40 healthy controls from 65-87 yr. In addition, 47 young controls, aged 20-40 yr, were used as reference population to express some of the results as T-scores. QUS measurements were performed with the Hologic Sahara, Ge-Lunar Achilles+, and Sunlight Omnisense devices according to the manufacturer's recommendations. Adjusted odds ratio results showed that a decrease in Omnisense SOS of 1 standard deviation (SD) was associated with a significant increase in fracture risk (OR adj.=2.83) comparable with Sahara BUA (OR adj.=2.42) and Achilles BUA (OR adj.=3.29). However, given the large overlap between the 95% intervals of each odds ratio, no significant difference was found between the devices. Similarly, comparison between the areas under ROC curves did not show any significant difference between all the parameters. Considering the parameters provided per default by each QUS device, the Sahara, Achilles, and Omnisense devices classified correctly 70, 67.5, and 62.5% of the subjects, respectively. Although the OR of the combination of radius and calcaneum is improved (3.62 to 4.74) compared with either one of the single skeletal site, the large confidence intervals do not allow to claim a significant difference. The three QUS technologies tested against hip fractures seem to show the same discriminatory ability. However, there is some differences in the definition of the diagnostic threshold underlying the nonusability of the World Health Organization (WHO) osteoporosis definition. Finally the combination of several site using two different devices is not clinically relevant. Potential interest could be seen in combining several sites using the same device, supposing that such device would measure differently active bone.

Aged↗
PubMed1989

The surgical treatment of valgus flat foot in the adolescent by osteotomy of calcaneum associated with tenodesis of tibialis anterior and posterior.

In the treatment of valgus flat foot in adolescent patients, when growth has nearly ceased (about 13 years in the female and 15 in the male) the operation of choice is varus osteotomy of the calcaneum, stabilised by a homoplastic bone wedge, together with tenodesis of tibialis anterior and posterior. At this age, skeletal growth is not sufficient to guarantee corrective evolution of the deformity after repositioning of the calcaneo-talar joint by any surgical technique. Varising osteotomy of the calcaneum offers the advantage of avoiding sacrifice of the calcaneo-talar joint, as in the Grice-Green arthrodesis, which although indicated for the paralytic valgus flat foot, is not appropriate in the idiopathic variety.

Adolescent↗
PubMed1986

Osteotomy of the calcaneum in the treatment of idiopathic valgus foot.

In the rare cases of idiopathic valgus foot that fail to respond to conservative treatment surgery is indicated. The author describes an oblique osteotomy of the calcaneum extending from the pre-Achilles region to the inferior margin of the calcaneo-cuboid joint whereby the whole plantar surface of the calcaneum is rotated around its longitudinal axis. This reduces the sliding plane of the talo-calcaneal joint and changes the direction of the Achilles tendon and tibialis posterior so that they exert a more favourable action on the forefoot and tend to actively stabilise the correction. The results in 9 patients (11 feet) aged from 8 to 10 years are most encouraging and the operation preserves the dynamics of the hindfoot in every aspect. The case material is necessarily small because the indications for surgery in this condition are very rare.

Adolescent↗
PubMed2005

Evaluation and development of automatic two-dimensional measurements of histomorphometric parameters reflecting trabecular bone connectivity: correlations with dual-energy x-ray absorptiometry and quantitative ultrasound in human calcaneum.

In osteoporosis, bone fragility results from both bone loss and changes in trabecular microarchitecture, which can be quantified by bone histomorphometric parameters. Twenty human calcaneum were collected after necropsy. All measurements were performed at the same anatomical location. Bone histomorphometric parameters were measured on histological slides with an automatic image analyzer. The aims of our study were (1) to develop automatic measurements of four additional parameters reflecting trabecular network connectivity and complexity, i.e., trabecular bone pattern factor (TBPf), Euler number/tissue volume (Euler) according to the three definitions previously reported and to a fourth one established in the laboratory (Euler(strut.cavity)), marrow star volume, and interconnectivity index, and to determine their usefulness in microarchitecture characterization; and (2) to validate these parameters by evaluating their relationship with dual-energy X-ray absorptiometry and quantitative ultrasound (QUS) measurements performed on the same samples. The statistical analysis showed that TBPf and Euler(strut.cavity) appeared to be the most significant connectivity parameters, independently of bone quantity (bone mineral density, apparent density, cancellous bone volume). For QUS, after adjustment for bone quantity, only speed of sound (SOS) was significantly and negatively correlated to Euler(strut.cavity). Broadband ultrasound attenuation depends only on bone quantity. In conclusion, TBPf (a strut analysis parameter extrapolable in three dimensions) and Euler(strut.cavity) (the only bone connectivity parameter reflecting SOS) are two valid bone microarchitecture parameters. These new parameters were significantly correlated to the established trabecular structure parameters: trabecular thickness or trabecular spacing, being weakly correlated with SOS.

Absorptiometry, Photon↗
PubMed1976

Intra-articular fractures of the calcaneum.

A method of reducing deformity of displaced, intra-articular fractures of the calcaneum is described, together with a programme of management aimed at restoring a painless and mobile foot. The clinical and radiographic results are presented in 41 patients treated over a 10-year-period, with a minimum follow-up of 2 years. The complications, none of which were serious, are described. The results are compared with a group of 52 patients whose fractures were treated over the same period by early movements without any attempt at reduction. Although disabling pain was not a notable feature in either group, more patients in the reduced group had resumed work of a heavy nature entailing climbing or walking on rough ground. Analysis of the figures suggests that this is related to the better function regained in the subtalar joint by this group.

Calcaneus↗
PubMed1994

The use of the axial CT scan in intra-articular fractures of the calcaneum.

The axial CT scan has become part of our routine management of os calcis fractures. This investigation helps distinguish between tongue and joint depression type fractures, gives important information regarding the fracture pattern in the anterior calcaneum and the degree of comminution of the sustentaculum tali and the subtalar joints. The scan is also useful in determining direction of movement of the body fragment.

Calcaneus↗
PubMed2001

The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol.

The management of intra-articular calcaneal fractures remains controversial with strong arguments supporting both conservative and operative management. This study assesses the results of open reduction and internal fixation (ORIF) of displaced intra-articular fractures of the calcaneum in two independent centres where the indications for operative management had been strictly defined.Forty-seven patients (51 fractures) who had sustained such injuries underwent an ORIF performed by one of the senior surgeons using the technique described by Eastwood et al. [JBJS 75-B(1993)189] All of the fractures were assessed by plain X-ray and CT scan and graded according to the Sanders classification [Clin. Orthop. 290(1993)97]. Patients were assessed at a minimum of 2 years post-surgery both clinically and with a standardised questionnaire based on that described by Kerr et al. [Injury 27(1996)35]. The mean age at operation was 42 and 50 years for the two centres, and the mean follow-up was 44 months. Seventy-six per cent of the patients were male. Eighty-eight per cent of the injuries were due to a fall from a height. Fifteen patients had contralateral foot/ankle injuries. Thirty-four of 46 patients were in employment at the time of the injury, 24 of these were in physical jobs and 20 sustained their injury whilst at work.Overall, the satisfaction rate was 90%. Ninety-four per cent of patients in work returned to work at a median of 6 months. Bilateral injuries were associated with a significantly poorer outcome as were those with heel pad pain. Delay to operation greater than 14 days was associated with a higher infection rate. Smoking was not related to infection rate.

Accidental Falls↗
PubMedDate not supplied

[Bony involvement of the calcaneum in sarcoidosis. A case report].

Bone lesions of sarcoidosis occur in 10 to 15% of the cases, most often involving the extremities. These frequently corticosteroid-dependent lesions worsen the prognosis of the disease. We report a case of sarcoidosis of 14 years duration in a 58-year old woman who presented with a bone lesion strictly localized to the calcaneum. To our knowledge, such lesion has not previously been reported.

Bone Diseases↗
PubMed1997

Osteonecrosis of the calcaneum in a heart transplant recipient.

Avascular necrosis affects 3% of transplant recipients. In the lower limb, the femoral heads or condyles may be involved. We report the hitherto unrecorded complication of avascular necrosis of the calcaneum. Conservative management resulted in resolution without long-term complications.

Adrenal Cortex Hormones↗
PubMed1980

Unfavourable radiological signs in fractures of the calcaneum.

Although 28 radiological signs in both primary and late radiographs were analysed for 67 patients with 86 fractures of the calcaneum. The fracture type is correlated with the clinical late result in Table 1. The radiological signs which predict or correlate with a poor late result are presented in Table 2. The operative reduction is mainly directed to improve the architecture of the posterior talocalcaneal joint: in our series the improvement was observed in half of the postoperative radiographs. However, this improvement was not usually followed by a favourable late result; mainly because the operated patients had also the most severe injuries.

Adolescent↗
PubMed1996

Comparison between broad-band ultrasound attenuation of the calcaneum and total body bone mineral density in children.

We measured broad-band ultrasound attenuation (BUA) in the calcaneum using the prototype Paediatric Contact Ultrasound Bone Analyser (CUBA) and total body bone mineral density (TBBMD) using dual-energy X-ray absorptiometry (DXA) (Hologic QDR-1000W) in 58, 7-17-year-old healthy children and adolescents. Calcaneal BUA was significantly related to TBBMD (r = 0.74, p < 0.001), and both the calcaneal BUA and TBBMD were significantly correlated with age and body weight. We conclude that calcaneal BUA reflects bone mineral density (BMD) in healthy children and adolescents; however, BMD measured by CUBA appears to be less sensitive than that measured by DXA. Since BUA reflects structural properties of bone, as well as density, it may complement radiological techniques of bone density measurement in the assessment of paediatric conditions associated with fracture risk.

Absorptiometry, Photon↗
PubMed1987

Chondrosarcoma of the calcaneum and massive soft tissue calcification in a patient with hereditary and acquired connective tissue diseases.

We describe the first case of the coexistence of the hereditary connective tissue disorder multiple exostoses (HME) and an acquired connective tissue disorder manifest by the overlap of dermatomyositis (DM), scleroderma (PSS), high titre speckled pattern antinuclear antibodies, and increased antibodies to double stranded deoxyribonucleic acid (DNA). Furthermore this patient developed chondrosarcoma of the calcaneum (an unusual site for this malignancy) and massive soft tissue calcification (an unusual feature of PSS, adult DM, and systemic lupus erythematosus (SLE)).

Bone Neoplasms↗
PubMed1998

The calcaneum as a site for intraosseous infusion.

Intraosseous infusion has been recommended as a rapid and effective form of circulatory access in the collapsed child. Recognised sites for insertion include the tibia, femur, iliac crest, sternum, and clavicle. The case of a 3 year old collapsed child is described who was successfully resuscitated with the use of an intraosseous needle placed in the calcaneum; the method of needle insertion is also detailed.

Calcaneus↗
PubMed1999

Ultrasound study of heel to calcaneum depth in neonates.

AIM: To investigate whether it would be safe to extend the currently recommended area of sampling to the whole heel in neonates. METHODS: Eighty newborn infants were studied, weight range 0.56 to 4.34 kg, gestation 24 to 42 weeks. Ultrasound scanning was used to measure the shortest distance between the skin and the perichondrium of the calcaneum. RESULTS: The shortest depth of perichondrium was in the centre of the heel and ranged from 3 to 8 mm. In 78 of the 80 infants the distance was 4 mm or more. There was a small but significant positive correlation with weight. CONCLUSIONS: Standard automated lancets for preterm use that puncture to a depth of 2.4 mm may be safely used anywhere over the plantar surface of the heel. The posterior aspect of the heel should be avoided. Reducing the density of heel pricks should reduce the associated pain.

Blood Specimen Collection↗
PubMed2005

Modified calcaneal index: a new screening tool for osteoporosis based on plain radiographs of the calcaneum.

PURPOSES: To assess osteoporosis using plain radiography of the calcaneum by studying the performance characteristics of the modified calcaneal index through inter- and intra-observer agreement. To study the correlation of the modified calcaneal index to quantitative ultrasound of the calcaneus and bone mineral density (BMD) of the femoral neck and distal radius. METHODS: Lateral calcaneal radiographs of 252 women who participated in a clinical trial for osteoporosis were reviewed. The BMD of the hip and distal radius was measured and the calcanea were assessed using ultrasound. The calcaneal radiographs were graded by 3 clinicians according to a previously described 5-grade calcaneal index. A modified 3-grade calcaneal index was then developed. RESULTS: The highest scores of intra- and inter-observer reliability of the modified calcaneal index were 0.45 and 0.40, respectively, which were higher than those of the 5-grade calcaneal index. The correlation of the modified calcaneal index with other measures was significant (hip BMD, r=0.31; distal radius BMD, r=0.28; calcaneal speed of sound, r=0.20; broadband ultrasound attenuation, r=0.36) [p<0.005]. There were significant differences in hip BMD, distal radial BMD, calcaneal speed of sound, and broadband ultrasound attenuation between the 3 grades of the modified calcaneal index (Kruskal-Wallis 1-way ANOVA; p<0.0001). CONCLUSION: The modified calcaneal index can be used to measure bone structure and skeletal strength and is a suitable screening tool for osteoporosis in places where advanced approaches to bone-status assessment are not available.

Absorptiometry, Photon↗
PubMed1983

The trabecular pattern of the calcaneum as an index of osteoporosis.

Radiographs of the foot and hip in 61 patients with fractures of the upper end of femur have been studied, noting the progressive loss of bone trabeculae with age. The trabecular pattern in the calcaneum (expressed as the calcaneal index) closely parallels that in the upper end of the femur (Singh's index) and is easier to assess. Both indices have a significant correlation with age.

Adult↗
PubMed1992

The ossific nuclei and the cartilage anlage of the talus and calcaneum.

We studied the ossific nuclei on radiographs of the feet of three stillborn infants, two with club feet, relating the size, position and alignment of each nucleus to the cartilaginous talus or calcaneum in which it lay. Anteroposterior projections of the nucleus of the talus show deformity of that bone as well as subtalar malalignment. Lateral projections of the calcaneal nucleus may underestimate the degree of hindfoot equinus.

Calcaneus↗
PubMed1992

Osteomyelitis of the calcaneum.

We reviewed 52 cases of osteomyelitis of the calcaneum. The clinical symptoms and signs were well defined, but different and less dramatic than those of long-bone osteomyelitis. Blood cultures were positive in 41% of cases and tissue cultures in 91%. Routine haematological tests were of little value, and radiological changes were often delayed, and were absent in 12%. With early diagnosis, treatment with antibiotics alone was usually effective, but complications and chronic disease were more likely if there was delay. Early diagnosis is the key to successful treatment. We describe a new physical sign and consider that diagnosis is almost always possible by clinical methods.

Adolescent↗