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Bilateral unicameral bone cysts of the calcaneus are extremely uncommon. A sixteen-year-old female presented with bilateral heel pain. Conventional radiographs and computed tomography showed cystic lesions and cameral cystic formation. Curettage and bone grafting were performed. The patient had no complaints in the postoperative 38th month. Radiologically, no recurrence was observed.
OBJECTIVES: We evaluated the midterm results of surgical treatment for intraarticular calcaneal fractures. METHODS: This study included 19 feet of 14 patients with intraarticular fractures of the calcaneus. Twelve patients were males and two were females (mean age 28.3 years; range 17 to 54 years). The fractures were bilateral in five patients. In one patient the contralateral foot was treated conservatively. Anteroposterior, lateral, and tangential radiographs and computed tomography (CT) scans were obtained in all patients preoperatively. According to the Sanders CT classification, there were 10 type II, five type III, and four type IV fractures. An extensile lateral incision was performed in all patients but one to provide an anatomic reduction with the use of Sherman plates, screws, and staples. The patients were followed-up by radiographs and CT. The results were evaluated using the Maryland Foot Score. The mean follow-up was 32.7 months (range 24 to 43 months). RESULTS: Radiographs and CT scans obtained in the early postoperative period showed that a complete anatomic reduction was achieved in 13 feet. According to the Maryland Foot Score, the results were excellent in five, good in eight, fair in four, and poor in two feet. None of the patients required a subsequent operation due to surgery-associated causes. CONCLUSION: The success of surgical treatment of intraarticular calcaneal fractures depends only on the achievement of an anatomic reduction and on maintaining it with a stable osteosynthesis using appropriate strength hardware.
Fifty-one adult patients with 54 intra-articular fractures of the calcaneus have been reviewed from one to 11 years after the injury. Treatment consisted in immediate active exercises of the foot without any attempt at reduction or immobilization. The patients resumed full weight-bearing, on the average, three months after injury. The overall results were excellent in 19, good in 24 and unsatisfactory, objectively and subjectively, in 11 feet. In this consecutive series, the majority of the fractures had a marked degree of displacement. Excluding undisplaced fractures which had a good result, no clear cut relation between the type and degree of displacement and the final result could be found. However, there were more unsatisfactory results in fractures in which the tuber-joint angle was equal to or less than 10 degrees.
Intra-articular fractures of the calcaneus have always represented a controversial subject; numerous surgical methods involving synthesis have been proposed, but none of these is without complications. The authors describe the use of new multiple-hole Tra.Ma plate in 25 patients between 1997 and 1999; all of the fractures were classified based on routine CT scan and X-ray evaluation and the Bohler, DeLangre and Preiss preoperative angles were measured 2 and 4 months later. All of the patients were also evaluated clinically and each of them underwent gait analysis using an electronic baropodometer. The Tra.Ma plate allows us to obtain satisfactory results both clinically and radiographically, also reducing the local complications related to the cumbersome nature of previous instrumentation; gait analysis also revealed the distribution of load comparable to that of the contralateral limb.
Double-power X-ray absorptiometry of the axial skeleton and ultrasound densitometry of the calcaneus were used to examine 3 groups of patients: 58 with chronic renal failure (CRF), 73 with senile osteoporosis, and 78 with diabetes mellitus (DM). The examination has indicated that X-ray absorptiometry is the most informative method in diagnosing osteoporosis in patients with CRF and DM. Ultrasound densitometry is of informative value only in patients with senile osteoporosis and it may be used as a screening tool in this category of patients.
A treatment without plaster cast is presented of intra-articular fractures of calcaneus. In nine patients after fracture reduction by the Westhues method or by operation, the fragments were united by means of divergent bundle of Kirschner wires, introduced from the side of calcaneal tuber. The obtained stabilization made possible an early rehabilitation treatment. In no case a secondary displacement of fragments occurred after removal of uniting wires. Poor result was noted only after surgical treatment complicated with osteitis.
Intraosseous lipomas of the calcaneus are an extremely rare entity and appear radiographically very similar to many other lesions affecting the foot. A case report followed by a brief discussion of the etiology, clinical, pathologic, and radiologic findings is presented. The authors emphasize the importance of magnetic resonance studies as a definitive noninvasive diagnostic modality.
The authors have observed four cases of a rare condition of fracture-dislocation of the calcaneus. The fracture line was in the sagittal plane and there were only two fragments. An anterior and medial fragment maintained its normal relationship with the talus whilst the posterior and lateral fragment became dislocated laterally underneath the fibular malleolus. Treatment should always be surgical by open reduction and screw fixation. Two cases out of four were not operated upon and these have poor results.
Painful enlargement of the entire posterior aspect of the calcaneus can be difficult to effectively treat and must be differentiated from a classical Haglund's deformity. Clinical, radiographic, and surgical treatments of this deformity will be discussed. An illustrative case presentation is also included.
Osteotomy of the calcaneus (Dwyer procedure) was performed in 14 children (26 feet) aged between 5 and 15 years. On four occasions it was associated with an osteotomy of the first metatarsal and on three occasions with tarsectomy. The technique is described and the results are analysed. The authors conclude that the results were good in children under the age of 10 whilst the feet were still supple. In children over the age of 10, in whom the feet were more rigid, the gait was improved but the cavus deformity was not improved. The best age for operation is between 6 and 10 years.
The diagnosis of osteoid osteoma, in usual localizations, is generally simple. In iuxta-articular localizations this tumor may be unrecognized and the diagnosis delayed. Injury has been sometimes correlated with the onset of symptoms and this can make the diagnosis even more difficult. We present a case of osteoid osteoma of the calcaneus iuxta-articular to the subtalar joint in a 17-year-old basketball player. He had a history of initial injury, ankle sprain during training, followed by pain and swelling. He was initially treated for lateral ligament lesion of the ankle with unsatisfactory results. After acute trauma the pain changed becoming chronic and mostly nocturnal disappearing when rofecoxib was taken. Standard x-ray didn't show the lesion. Nuclear Magnetic Resonance (NMR) and scintigraphic results were not well interpreted but these clinical changes and Computed Tomography (CT) images supported the diagnosis of osteoid osteoma. The complete resection of the bone lesion resolved all the symptoms and the histological report confirmed the suspected diagnosis.
The author describes a scale of rating for the evaluation of the results of fractures of the calcaneus, similar to that used for the evaluation of hip function. Five points are given for walking ability, pain, mobility and triceps power. The last point is considered to be essential. This evaluation was tested on 232 cases. A close correlation was established between the four criteria.
We resected eight calcaneus-navicular bars in six children. The average age at the surgery was fifteen years, and the average follow up period was four years. In all cases the extensor digitorum brevis was interposed into the gap created by an excision of the bar. On the follow up three feet were painfree and four were occasionally painful. In one case a coalition recurred, and the pain did not improve. The ankle range of motion was normal in all cases, whereas the subtalar motion was limited in three feet, and normal in the remaining five.
OBJECTIVE: To evaluate the results of intra-articular calcaneal fractures treated with open reduction and internal fixation. METHODS: Thirty-five displaced intra-articular calcaneal fractures in 34 patients were treated with open reduction and internal fixation from August 2001 to April 2003. Fracture classification was based on Sanders classification. Extended lateral approach, and fixed the fractures with AO titanium plate for calcaneus were performed. Bone graft was used in selected patients. Thirty-five fractures in thirty-four patients were evaluated using radiographic examinations and ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS). Average follow-up was 18.3 months (range from 12 to 32 months). RESULTS: There were 30 type II fractures and 5 type III fractures. Average Böhler's angle was 5.6 degrees preoperatively and 28.2 degrees finally. Roentgenographic evaluation of calcaneal body dimensions showed restoration of heel height (97.7%) to virtually normal. Anatomic or near anatomic reductions were obtained in 80% of the cases. The average score was 88.1 for type II fractures, and 78.8 for type III fractures. Excellent or good clinical results occurred in 82.8% type II fractures, and 60.0% type III fractures. The overall excellent or good rate was 79.4%. CONCLUSION: From the results, open reduction and internal fixation for Sanders type II and type III fractures are recommended.
Severs disease (calcaneal apophysitis) is a self-limiting condition seen in physically active children. Although there is controversy about the radiographic appearance, some reports propose the importance of fragmentation of the secondary nucleus in the diagnosis of Severs disease. We studied secondary nucleus of the calcaneus with ultrasonography. Twenty-one symptomatic heels of 14 children were examined. All these heels showed fragmentation of the secondary nucleus on both conventional radiograph and sonography. Ultrasonographic examination also showed 2 retrocalcaneal bursitis. Our initial data showed that sonography may be valuable in the diagnosis of Severs disease.
41 displaced intraarticular fractures of the calcaneus were treated with open reduction, limited internal screw fixation, bone grafting and percutaneous pinning, using an extensile postero-lateral approach. Despite early functional after treatment all fractures healed without secondary displacement in an average time of 8 weeks. At follow-up (average 4.2 years) there was a strict correlation between the clinical results and the severity of articular comminution. A satisfactory outcome seems to depend on the ability to restore the best possible articular congruency and extra-articular alignment of the os calcis. Results and advantages of our method are discussed.
OBJECTIVE: To provide a scientific basis for the diagnosis and prevention of osteoporosis in Chinese populations. METHODS: The stiffness index (STI) of the calcaneus was measured with the Achilles Express ultrasound apparatus made in USA among 2769 healthy persons, 1262 males and 1507 females, aged 10 to over 60, in Zhejiang province. The relationships between the STI and sex and age were analyzed. RESULTS: The peak STI appeared in the age 20 - 24 among the males, and appeared in the age 15 - 19 among the females. Beyond these age periods the STI decreased along with the age. The STI values of the males aged over 54 were significantly higher than those of the females the same age. The speed of STI decrease of the females aged over 55 was higher than the males of the same age (P < 0.01). The prevalence of osteoporosis was higher in the females than in the males. The STI was negatively correlated with age, and positively correlated with height and body weight in both sexes. The practically measured T values were mostly significantly lower than the instrument' T values (with young adult Japanese as reference population). CONCLUSION: There are significant relationships between STI and age, height, and body weight in both males and females. The distribution of bone mineral density of the reference population for the imported instrument does not completely accord with that of Chinese. It is necessary to establish a standard adaptable to the specific condition of Chinese.
Bone mineral content (BMC/W) and density (BMD) were studied in 70- to 81-yr-old active male endurance-trained (long-distance runners, cross-country skiers, N = 67), strength-trained (throwers, weight-lifters, N = 14), and speed-trained (sprinters, jumpers, N = 16) athletes. A population sample of similar age (N = 42) served as a control group. The measurements were performed at the calcaneus by single-energy photon absorption. The endurance-trained athletes had higher bone width and depth, and the strength and speed-trained athletes higher bone depth than the control subjects. The three groups of athletes showed 19-28% higher BMC (g.cm-1) and BMC/W (g.cm-2) than the control group (P less than 0.01-0.001). When the results were corrected for bone depth by assessing BMD (g.cm-3), the mean differences between the athletes and controls were 11-16% (P less than 0.05-0.01, not significant for the strength group). The highest BMD values were associated with moderate training for running and cross-country skiing. BMD did not correlate with serum total testosterone, but there was a negative correlation between BMD and sex hormone binding globulin and a positive correlation between BMD and the free androgen index in the endurance group. The results indicate that athletes having a long-term training history and being still active at over 70 yr of age preserve superior trabecular bone mass compared with the average male population of the same age.