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PubMed1985

The structure of the trabeculae of cancellous bone. 1. The calcaneus.

87 either cylindroid or laminar trabeculae, isolated from the perpendicular or inferior bundles of the human calcaneus, were embedded in methylmatecrylate and serially cut along longitudinal and transversal planes with a rotatory-blade saw. The microscopical study of the sections showed that in 83% of the samples secondary osteons run along the longitudinal axis of the trabeculae and their lumina either form a continuous channel network throughout each trabecula (37% of cases) or are restricted to discrete segments (46% of cases). The trabeculae entirely devoid of osteons (17%) are the thinnest, never exceeding 400 microns in thickness. This value is not even exceeded by the segments devoid of osteons in the trabeculae in which the Haversian canals occur only intermittently; conversely, the segments containing Haversian canals can reach and exceed 600 microns in thickness. The maximum distance of the osteocytic lacunae from filtering surfaces--i.e. outer surface of the trabeculae or inner surface of the Haversian canals--was found to be almost the same in the segments of the trabeculae that enclose or not osteons, even though the average trabecular thickness is greater in the former than in the latter regions. On the basis of these findings the formation of endotrabecular osteons may be viewed as a device that indirectly favours the metabolic exchange of deep-seated osteocytes while increasing the free surface area available for bone tissue reconstruction. It remains doubtful whether the Haversian systems may also contribute to improve the mechanical properties of the trabeculae. The arrangement of the collagen fibrils, which differs between cylindroid and laminar trabeculae, is apparently well suited to ensure the resistance of the trabeculae to mechanical loading through the use of the least amount of building material, in accordance with Wolff's law.

Adult↗
PubMed1979

[Fractures of the calcaneus. Orthopaedicotechnical management and long-term results following surgical or conservative first treatment (author's transl)].

75 fractures of the calcaneus were followed up in a long-term study in 64 patients. 27 of these patients were older than 10 years. 22 were operated (or reoperated) later. 16 of these received a double arthrodesis. The early and late results were compared. There was no difference between the results obtained with the surgically treated and the conservatively treated patients (functional or closed repositioning and plaster cast). The late operations are discussed. Emphasis is given to the orthopaedicotechnical possibilities which, in the authors' opinion, should be utilised more often.

Arthrodesis↗
PubMed1984

[Late results of our treatment method in calcaneus fractures].

The authors treated their patients, who had fractures of the calcaneus body in association with dislocation, by means of a new method: repositioning was effected by means of a special apparatus, retention via percutaneous screw osteosynthesis. Previously, they had used a Kirschner wire drilled from the tuber calcanei. The types of fracture differ very widely; the authors subdivide them into three groups, taking into consideration the involvement of the posterior talocalcaneal joint surfaces. The patients were subsequently followed up, and the results of 182 fractures of the calcaneum were evaluated, taking numerous different aspects into consideration. The authors were thus able to establish that the results of the treatment are greatly improved by accurate repositioning followed by percutaneous screw osteosynthesis.

Bone Screws↗
PubMed1982

[Screwed-plate osteosynthesis and reconstruction of fractures of the calcaneus].

The authors have treated 182 fractures of the calcaneus. Ninety-nine of these were operated on and plated. The results were studied in 75 cases with a follow up of 1 to 6 years. The technique used a lateral approach; a plate was always used, sometimes with a heterogeneous bone graft (Kiel bone). The operation was followed by 3 weeks of plaster cast fixation followed by mobilisation of the foot. A good functional result was obtained in 82 p. 100 of cases, but a satisfactory anatomical reduction in only 73 p. 100. Some mobility of the subtalar joint was conserved in 73 p. 100 of cases. The indications are described. This type of operation should be performed in displaced fractures with 2, 3 or 4 fragments. In more comminuted fractures the authors consider that primary arthrodesis is advisable. Conservative treatment is indicated in slightly displaced fractures or when local conditions make operation inadvisable.

Adolescent↗
PubMed1982

Surgical excision for anterior-process fractures of the calcaneus.

Most fractures of the anterior process of the calcaneus are successfully treated with cast immobilization. Eighteen of the twenty-five patients in this study were so treated successfully, although their symptoms persisted for variable periods after removal of the cast. Seven of the twenty-five patients had excision of the fracture fragment, two of whom were not relieved of their symptoms after excision. Both of these patients had had a missed diagnosis and no prior treatment of a fracture that had gone on to non-union. This suggests that the correct initial diagnosis and treatment are important, particularly if the fracture fragment is large, and that early excision of the fragment is usually not necessary or advisable.

Adolescent↗
PubMed1982

[Morphologic and functional structure of talar articular surfaces of the calcaneus].

The shape of the talar articular surfaces of calcaneus are described. The structure of articular cartilage is examined by means of the split line method. Comparing the split line patterns with the trajectorial patterns found in the photoelastic experiments the functional structure of the articular cartilage can be demonstrated. In the case of the facies articularis talaris posterior the stress increases to the centre of the articular surface. It is the first description of this type of stress distribution.

Aged↗
PubMedDate not supplied

Neonatal osteomyelitis of the calcaneus following a heel pad puncture: a case report.

Osteomyelitis of the calcaneus developed in a 6-day-old girl subsequent to heel pad puncture for taking blood samples. A review of the literature indicates that as a complication, osteomyelitis is very rare, considering the thousands of punctures performed. There is no mention in the orthopedic literature of such cases being treated in neonatal units. The present case, like others reported thus far, is characterized by the benign course of the disease. Theoretically, it is possible that infectious process could spread from the heel primary site to other bones or joints. Some difficulty in early diagnosis may be encountered in the incipient stages of the disease because of the benign course and lack of radiologic findings. In such cases, when local findings and the history of heel pad punctures suggest an infectious process involving the bone, a bone scan is helpful inasmuch as it is positive before the radiologic signs become manifest. An adequate course of antibiotic therapy, immediately administered, is usually successful, with normal X-ray of the healed os calcis being evident after two to three months. Nevertheless, prophylactic therapy is strongly recommended.

Anti-Bacterial Agents↗
PubMed1995

Intraarticular fracture of the calcaneus.

The treatment of displaced intraarticular fractures of the calcaneus continues to challenge the orthopaedic community. The recent development of prognostic classification systems based on computerized tomography has clarified the roles of non-operative and operative treatment. It has also opened the door for further prospective study of the appropriate treatment of this injury and comparison of operative methods. Based on current literature and our experience, we recommend CT evaluation of all intraarticular fractures of the os calcis in patients who are operative candidates with treatment guided by fracture classification.

Ankle Injuries↗
PubMed1995

[Classification and osteosynthesis technique of calcaneus fractures. External fixator as temporary distractor].

In the treatment of fractures of the calcaneus, the particularly intricate local anatomy, complicated fracture forms and associated soft tissue damage often prejudice operative, anatomical reconstruction. We propose a simplified classification that is based on the Regazzoni classification of 1993 and has six grades of severity. It can be helpful in the selection of operative treatment and, above all, make it possible to recognize whether operative reconstruction is possible and appropriate. When operative reconstruction is indicated we find the secondary operation important; it is also important to diagnose and treat compartment syndrome if present and otherwise to take steps to prevent it. In the first phase, in special cases we use an external fixator without reconstruction of the full length. The operative technique is largely standardized as as the fixator is placed only temporarily. Correct positioning allows easy correction of shortening or varus deformation, and joint surface reconstruction is also feasible. Autologous bone grafting is possible. The definitive fixation is achieved with internal plate stabilization by a lateral approach and removal of the fixator. Contraindications for this procedure are burst fractures with total destruction of the joint surfaces and cartilage. Out of 54 fractures we used the fixator to aid reduction in 45. In 71% of these we had very good and good results according to the Merle d'Aubigné scoring system.

Adult↗
PubMed1995

[Abductor digiti minimi-plasty: a local muscle flap for treatment of calcaneus fractures with limited soft tissue injuries].

Wound healing complications and osteitis following calcaneus fractures are common problems due to compromised local soft-tissue perfusion. Transposition of the M. abductor digiti minimi was successfully performed in 12 cases. The problem of soft tissue coverage could be solved by this procedure. Up to now, no negative influence on the myo-osseous architecture of the feet could be observed.

Adult↗
PubMed1995

Operative treatment of intra-articular fractures of the calcaneus.

Displaced intra-articular fractures of the calcaneus remain a diagnostic and therapeutic dilemma. The classification of these fractures has been frustrated in the past by limitations of radiographic technique. Because of our need to consistently analyze our results, a CT scan classification was developed, based on the number and location of articular fracture fragments. The authors have treated displaced intra-articular calcaneal fractures according to an operative protocol using a modified lateral approach, a new plate and lag screws, all without the use of bone graft. This article will discuss in depth the treatment options available as well as the controversies that surround them.

Arthritis↗
PubMed1993

[Tibio-calcaneus fusion].

From January 1977 to August 1992 22 tibiocalcaneal fusions were performed at the Co-Operative Trade Association Hospital for Accidents, at Tübingen, Germany. 21 of these fusions healed both clinically and roentgenologically, the quality of the effected healing being stable. In more than two-thirds of the cases the indication for performing the fusion had been a fracture of the talus of the Weber/Marti IV or Hawkins III type with its associated complications. Hence, bony fusion between tibia and calcaneus is a commendably reliable treatment possibility in severe diseases of the talus and its adjacent articulations. The result can of course be only as good as the indication arrived at by the physician. In traumatology, this indication is mainly prompted by aseptic necrosis of the talus following talus fractures of maximum severity. A large number of relevant publications mentions an almost 100 per cent rate of necrosis associated with this lesion. This raises the very important question whether in case of such most severe forms of talus fracture it would not be better to aim at a primary tibio-calcaneal fusion straightway to save the patient the trouble of an otherwise prolonged course of the disease with doubtful outcome.

Adult↗
PubMed1995

Monostotic Paget's disease involving the calcaneus. Diagnostic and therapeutic problems. Two case-reports.

The authors report the cases of two patients who had chronic incapacitating heel pain unresponsive to standard therapy. They were both found to have Paget's disease of the calcaneus. The diagnosis was difficult because the typical roentgenological changes required time to develop and because no other sites were involved. Local corticosteroid injections, elimination of weight-bearing, and standard analgesic therapy were ineffective. Bisphosphonate therapy (pamidronate) given as intravenous infusions ensured prompt lasting pain relief, making ambulation possible.

Calcaneus↗
PubMed1993

[Ultrasound attenuation in calcaneus and bone density].

Broadband ultrasound attenuation (BUA) is a new technique for investigating bone status. We evaluated its use in osteoporosis. To assess in vivo reproducibility, we determined the coefficient of variation (cv) on the basis of five measurements (with repositioning) of the same foot in 50 women. The cv was 2.8 +/- 1.7%. BUA values were similar in the right feet and left foot and were correlated with bone density in the calcaneal area investigated (r = 0.8, p < 10(-4). BUA of the calcaneus was correlated with bone density in the lumbar spine, femur, and forearm in 240 healthy postmenopausal women (correlation coefficients 0.36 to 0.55; p < 10(-4)). BUA decreased with age, with a sharper drop during the first years following menopause. Mean broadband ultrasonic attenuation in 37 females with osteoporosis (58.92 +/- 11.59 dB/MHz) is lower than controls (66.10 +/- 15.29 dB/MHz, p = 0.04). Areas under receiver operating characteristic curves, used to evaluate the discriminating value of BUA in osteoporosis and osteopenia, were 0.79 and 0.72, respectively. The kappa coefficient of concordance between BUA and spinal density was 0.59. These data demonstrate that BUA cannot replace bone density measurements. Prospective studies are needed to investigate the potential role of this technique for identifying women at high risk for osteoporotic fractures.

Adult↗