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PubMedDate not supplied

Occult fracture of the calcaneus in toddlers.

Five children 14-33 months of age were treated for calcaneal fractures. All had a history of trauma with limping or refusal to walk. Physical examination could not localize the fracture. Initial radiographs were negative. There were no signs of systemic illness. They were treated with long-leg casts. Radiographs after 2 weeks revealed an arc of sclerosis across the tuberosity of the calcaneus. In no case was a bone scan instrumental in making the diagnosis. Awareness of calcaneal fractures in the child younger than 36 months can prevent the routine use of bone scans to make the diagnosis.

Calcaneus↗
PubMed1992

Tibio-talo-calcaneal fusion with a free vascularized fibular graft in comminuted open fractures of the talus and the calcaneus.

An operation is described in which a free vascularized fibular graft with a peroneal cutaneous flap is used for tibio-talo-calcaneal fusion and simultaneous skin coverage in treatment of comminuted open fractures of the talus and the calcaneus involving large skin loss. Nine months postoperatively, the tibio-talo-calcaneal arthrodesis was successful, with good coverage of the skin defect on the medial aspect of the sole. One year 7 months postoperatively, the patient is free of pain and able to walk with full weightbearing on the foot.

Arthrodesis↗
PubMed1995

Internal fixation of calcaneus fractures: an anatomical study of structures at risk.

This study examines the risk of injury to medial soft-tissue structures during the fixation of calcaneal fractures performed through a lateral approach. An L-shaped lateral incision was performed on 10 fresh cadaver feet. The calcaneus was divided into three zones for study. Ten K-wires were inserted in a standard configuration from a lateral starting point extending through the medial cortex. The feet were dissected medially to measure the distance from each exiting K-wire to the medial and lateral plantar vessels, the calcaneal branch of the posterior tibial nerve, and the tendons of the flexor hallucis longus, flexor digitorum longus, and posterior tibialis. The mean risk of injury to these medial structures was calculated for each lateral insertion site. Wires placed in the subchondral bone of the posterior facet or anterior to the critical angle of Gissane were determined to be at high risk of injury to the medial soft tissues. Structures at risk included the medial and lateral plantar nerves and vessels and the flexor hallucis longus tendon. Caution should be exercised when inserting K-wires, drills, and screws into high-risk areas to avoid iatrogenic injury to the medial structures.

Bone Wires↗
PubMed1996

Irreducible fracture of the calcaneus due to flexor hallucis longus tendon interposition.

An unusual fracture-dislocation of the calcaneus is presented in which tendinous interposition in the subtalar joint prevented the possibility of closed reduction. This situation has been reported in the literature in only five previous patients. The position of the flexor hallucis tendon in the joint could be visualized on the preoperative computed tomographic scan. The patient was treated operatively with reduction through a lateral approach without a supplemental medial incision.

Adult↗
PubMed1997

Avulsion fracture of the calcaneus: report of a case using a new tension band technique.

We report a case of avulsion fracture of the calcaneus in an 83-year-old woman. Nonoperative treatment was not considered satisfactory. However, the os calcis was osteoporotic, and internal fixation therefore was performed with a transverse Kirschner pin through the os calcis, securing a figure-of-8 metal tension band wiring to the fragment. We suggest that this technique provides a strong internal fixation in selected cases.

Aged↗
PubMed1997

Evaluation of fracture predilection in the calcaneus after external fixator pin removal.

OBJECTIVES/HYPOTHESIS: External fixators have been advocated for the treatment of intra-articular fractures of the distal tibia, so-called "pilon" or "plafond" fractures. Current recommendations include placement of external fixator pins, which vary in diameters up to six millimeters, in the talus and calcaneus. Removal of a relatively large pin may create a large defect in the bone, theoretically increasing fracture predilection with weight bearing. The objective was to compare the compressive load at failure of intact and formerly instrumented calcanei. It was hypothesized that the pin hole defect would not lead to a clinically significant difference in compressive load at failure. STUDY DESIGN: A biomechanical evaluation of randomized matched pairs of cadaveric calcanei. METHODS: Fresh human calcanei were harvested, embedded in casting compound, and tested pairwise. Among pairs of calcanei, one served as the control, and the other was drilled with a 6.0-mm pin in the posterior portion. The pin was removed before biomechanical evaluation. Testing was performed in compression under displacement control on a hydraulic materials testing system. RESULTS: There was a 22% reduction in compressive load at failure (p = 0.021) of the drilled versus intact specimens. Compared with intact calcanei, defect calcanei had a compressive failure load much closer to forces that might be encountered with walking and running. CONCLUSIONS: The six-millimeter-pin defect is a significant stress riser, and protected, progressive weight bearing after pin removal should be recommended.

Aged↗
PubMed1998

Operative treatment of displaced intra-articular fractures of the calcaneus using absorbable internal fixation: a prospective study of twenty-five fractures.

OBJECTIVE: To document the use of absorbable implants in the operative treatment of displaced intra-articular fractures of the calcaneus. DESIGN: Prospective clinical study. SETTING: Level one trauma center, university hospital. PATIENTS: Twenty-five displaced intra-articular calcaneal fractures in twenty-one patients. INTERVENTION: The fractures were reduced operatively and fixed with absorbable self-reinforced polyglycolide rods. MAIN OUTCOME MEASUREMENTS: Reduction, healing, and stability of fixation were assessed on radiographs. The functional result was scored using the method of Crosby and Fitzgibbons. Patient satisfaction was recorded. RESULTS: The mean Böhler angle was -12 degrees (standard deviation 22 degrees) preoperatively and 20 degrees (standard deviation 13 degrees) postoperatively. After a two-year follow-up, seven patients had excellent, five good, three fair, and six poor functional results. Subjectively, fifteen patients were satisfied and six were dissatisfied. Twelve patients returned to work within one year, three were unemployed, two were retired prior to the accident, and four were unable to work because of the calcaneal fracture. The postoperative Böhler angle and later the appearance or absence of posttraumatic subtalar arthritis were significant prognostic factors. CONCLUSIONS: Results with absorbable implants are similar to those with other operative methods. Advantages include the absence of secondary procedures for implant removal and undisturbed computed tomography scans postoperatively.

Absorbable Implants↗
PubMed1988

Operative treatment of displaced intra-articular fractures of the calcaneus.

Thirty-five patients with 41 calcaneus fractures, seen at Cook County Hospital over a 3 1/2-year period, underwent an open reduction and internal fixation of their fractures through a sinus tarsi incision. Bohler's angle averaged 6 degrees preoperatively and 26 degrees postoperatively. An additional measurement, the critical angle, was defined. This angle is a measurement of the congruency of the posterior facet. It facilitated the selection of patients for an open reduction as well as allowed a determination of the adequacy of restoration of the joint surfaces postoperatively. In this series the critical angle averaged 26 degrees preoperatively and 1 degree postoperatively. Followup was possible in 73% of the patients. Almost all of the patients exhibited some degree of limitation of motion of the subtalar joint, but the reduction of the fracture fragments was maintained in all cases and secondary deformity and complaints did not develop.

Adult↗
PubMed1995

Ten-year follow-up after operative treatment for intra-articular fractures of the calcaneus.

Our first 16 patients with intra-articular calcaneal fractures that were managed by open reduction and internal fixation were originally reviewed on average 3 years after operation. We looked at the same patients again on average more than 10 years after surgery using the same evaluation system by the same physician. Seventy-five percent of the patients showed an excellent or good functional result. In no case was there an indication for a secondary arthrodesis. In spite of the fact that radiologically most patients showed a slowly progressing posttraumatic subtalar osteoarthritis, the subjective results (pain, capacity to work, and/or sports) at 10 years were clearly better than 3 years after surgery. These results may allow the conclusion that radiologic findings are only of limited value in the assessment of long-term results after operative treatment of calcaneal fractures. From a functional point of view and on the long-term follow-up most patients with intra-articular fractures of the calcaneus seem to profit from open reduction and internal fixation.

Adolescent↗
PubMed2006

Bilateral Paget disease of the calcaneus diagnosed by conventional bone scintigraphy.

An 85-year-old woman who had an invasive ductal carcinoma of the breast and elevated alkaline phosphatases (420 U/L) was referred for Tc-99m MDP bone scintigraphy for initial evaluation of skeletal metastases. Bone symptoms were limited to chronic pain in both knees. A bone scan revealed pagetoid findings in both calcanei. Feet and toes on plain x-rays of the calcaneus were unremarkable. Findings were stable in the 2-year follow up, excluding other potential diagnosis as extensive metastases or stress fractures.

Aged, 80 and over↗
PubMedDate not supplied

The value of computed tomography in the early assessment of comminuted fractures of the calcaneus: a review of three patients.

Computed tomography (CT) was performed within 4-8 days of injury in three patients with five fractures of the calcaneus. Three of the fractures were comminuted, and CT gave graphic additional information to the plain radiographs. Three fractures were undisplaced and were managed conservatively. In the other two, there was displacement of bony fragments, and these were treated operatively. In these, CT gave valuable preoperative information regarding the size and location of fracture fragments and helped the surgeon determine the site of incision and type of surgery required. The CT findings were confirmed at operation. CT therefore provides useful information for the management of these difficult fractures.

Adolescent↗
PubMedDate not supplied

Subtalar posterior displacement osteotomy of the calcaneus: a preliminary report of seven cases.

A preliminary report of a new posterior displacement osteotomy of the calcaneus is presented. Seven calcaneocavus feet in six patients ranging in age from 10 to 18 years were operated on with a follow-up of 2-4 years. The osteotomy was performed just below the subtalar joint after a complete plantar release. The posterior shift obtained was limited only by skin tension. The cavus deformity was corrected, and gait improvement was evident. The geometric study of postoperative lateral radiographs showed an expected 30-50% increase in tendo-Achilles strength.

Adolescent↗
PubMedDate not supplied

Calcaneus deformity in spina bifida: results of anterolateral release.

We reviewed a group of patients with 76 feet treated operatively for a calcaneus or a calcaneovalgus deformity by a simple anterior (tenotomy of the tibialis anterior, extensor digitorum communis and extensor hallucis longus), or anterolateral (associated tenotomy of the peroneus longus and brevis) release. The results were assessed considering bracing and shoewear problems or presence of pressure sores. The mean follow-up time was 4.66 years, and a good result was achieved in 62 feet (81.5%), with 14 poor results in 18.5%. Among the 14 poor results, six deformities have recurred and were operatively treated by the same technique and eight feet developed an equinus deformity requiring a heel cord release.

Adolescent↗
PubMed2001

Ultrasonic attenuation in human calcaneus from 0.2 to 1.7 MHz.

Ultrasonic attenuation has been demonstrated to be a useful measurement in the diagnosis of osteoporosis. Most studies have employed ultrasound in a range of frequencies from about 200 kHz-300 kHz to 600 kHz-1 MHz, and many have assumed a linear dependence of attenuation on frequency. In order to investigate the attenuation properties of human calcaneus at higher frequencies, 16 defatted human calcanea were interrogated in vitro using two matched pairs of transducers with center frequencies of 500 kHz and 2.25 MHz. The linear dependence of attenuation on frequency seems to extend up to at least 1.7 MHz. The correlation between attenuation coefficient and frequency from 400 kHz to 1.7 MHz was r = 0.999 (95% confidence interval, CI, = 0.998-1.00). The measurements suggest that some deviations from linear frequency dependence of attenuation may occur at lower frequencies (below 400 kHz), however.

Biomedical Engineering↗
PubMed2003

The dependence of ultrasonic backscatter on trabecular thickness in human calcaneus: theoretical and experimental results.

Trabecular thickness within cancellous bone is an important determinant of osteoporotic fracture risk. Noninvasive assessment of trabecular thickness potentially could yield useful diagnostic information. Faran's theory of elastic scattering from a cylindrical object immersed in a fluid has been used to predict the dependence of ultrasonic backscatter on trabecular thickness. The theory predicts that, in the range of morphological and material properties expected for trabecular bone, the backscatter coefficient at 500 kHz should be approximately proportional to trabecular thickness to the power of 2.9. Experimental measurements of backscatter coefficient were performed on 43 human calcaneus samples in vitro. Mean trabecular thicknesses on the 43 samples were assessed using micro computed tomography (CT). A power law fit to the data showed that the backscatter coefficient empirically varied as trabecular thickness to the 2.8 power. The 95% confidence interval for this exponent was 1.7 to 3.9. The square of the correlation coefficient for the linear regression to the log transformed data was 0.40. This suggests that 40% of variations in backscatter may be attributed to variations in trabecular thickness. These results reinforce previous studies that offered validation for the Faran cylinder model for prediction of scattering properties of cancellous bone, and provide added evidence for the potential diagnostic utility of the backscatter measurement.

Calcaneus↗
PubMed2005

Osseous lesion of the calcaneus following the use of shock wave therapy in a horse.

An 8-year-old Dutch warmblood gelding was presented with a mechanical lameness (2/10) because of the presence of a soft tissue injury on the top of the right tuber calcanei. Plain radiographs of the tarsus demonstrated the presence of soft tissue swelling caudal to the right tuber calcanei, without osseous involvement, and ultrasonography revealed excessive scar tissue within and around the superficial digital flexor tendon. Extra-corporeal shock wave therapy was applied on the right hock to decrease the amount of scar tissue. One month after the therapy the lameness was greater (3/10) and a marginal increase in the size of the swelling was found. Periosteal new bone formation associated with an ill-defined radiolucent area and two bony fragments were detected radiographically at the caudo-proximal aspect of the right tuber calcanei. A blister containing oil of croton, camphor, pine and thyme, turpentine and cantharides was applied on the right calcaneus. Twenty days after blister application, the size of the swelling had been reduced by 50% and the degree of lameness had also been decreased (1/10). On clinical re-evaluation 6 months after treatment, the degree of lameness was stable (1/10) and flexion test of the limb was negative.

Animals↗
PubMed2005

Skin to calcaneus distance in the neonate.

BACKGROUND: Current recommendations for obtaining blood from neonates advise avoidance of the midline area of the heel and are based on postmortem studies. OBJECTIVE: Because of the potential pain and tissue damage from repeated heel pricking in the same area, to investigate using ultrasonography whether the distance from skin to calcaneus is less at the midline than at the borders. METHODS: One hundred consecutive healthy preterm and 105 consecutive healthy term neonates were studied 48-72 hours after delivery. The skin to perichondrium distance (SPD) was measured on two occasions by ultrasound at the external, midline, and internal areas of the heel. FINDINGS: Mean SPD was 0.2 mm less at the midline than at the other sites. The proportion of measurements <3 mm at any of the three sites was the same. Depth was <3 mm in less than 3% of the term and approximately 20% of the preterm infants. The SPD correlated only with gestational age. Of children <33 weeks gestational age, 38% had an SPD <3 mm compared with 8% of older preterm infants. The proportions of preterm infants of > or = 33 weeks gestation and term infants with an SPD <3 mm were similar (8% v 3%). INTERPRETATION: With the use of automated lancets of 2.2 mm length or less, the whole heel plantar surface is safe for obtaining blood in term and preterm infants of > or = 33 weeks gestation. This means that soft tissue damage and pain from repeated pricking in the same area can be reduced.

Anthropometry↗
PubMed2001

Quantitative US of the calcaneus: cutoff levels for the distinction of healthy and osteoporotic individuals.

PURPOSE: To calculate cutoff levels for quantitative ultrasonography (US) performed to distinguish healthy individuals and those with osteoporosis identified with dual x-ray absorptiometry. MATERIALS AND METHODS: In 1,357 patients (856 females, aged 55.1 years +/- 15.4 [mean +/- SD]; 501 males, aged 50.4 years +/- 15), bone mineral density measurements of the lumbar spine (posteroanterior, L1 through L4) and femoral neck were obtained, and quantitative US was performed to determine the stiffness of the calcaneus. Individuals with a T score less than -2.5 (osteoporotic) at the spine and femur were identified, and upper T-score cutoff values (3 SDs from the mean) in the groups of male and female patients with osteoporosis were identified. RESULTS: Females with dual x-ray absorptiometric values that were indicative of osteoporosis of the spine had an upper T-score cutoff value of -1.0 (males, -0.2). Females who had femoral osteoporosis showed an upper quantitative US T-score cutoff value of -0.6 (males, 0). CONCLUSION: Cutoff values may permit the use of quantitative US to screen for the presence of osteoporosis in the spine and femur. Quantitative US will help to prevent unnecessary dual x-ray absorptiometric and conventional radiographic examinations.

Absorptiometry, Photon↗