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At least 55 records · Page 3Linked to original sources
PubMed1993

Intra-articular fractures of the calcaneum. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach.

The classification of intra-articular fractures of the calcaneum described in part I is related to an operative approach which allows accurate reduction and stable fixation of the fracture fragments. An extended lateral incision is used to avoid sural nerve damage and problems of soft-tissue healing. In type 3 fractures, access to the lateral joint fragment requires an osteotomy of the lateral wall, but after this the lateral joint fragment can be rotated out of the subtalar joint to allow transcalcaneal reduction of the medial wall. Reduction of the body fragment and lateral joint fragment on to the sustentacular fragment allows the three fragments to be stabilised by a 3.5 mm Y-shaped reconstruction plate. Our early results have been successful in terms of fracture reduction and the restoration of heel shape and joint congruity, but extended follow-up will be necessary to define the indications for this difficult procedure.

Adolescent↗
PubMed1993

Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study.

We report a prospective trial of 66 patients with intraarticular fractures of the calcaneum. All fractures were assessed by CT. Patients with displaced fractures were randomised to receive either conservative (n = 31) or operative treatment (n = 25). Undisplaced fractures (n = 10) were treated conservatively. Operation involved open reduction of the posterior subtalar joint, and fixation with Kirschner wires. All 66 patients were reviewed at a minimum of one year (mean 23 months). After conservative treatment the undisplaced fractures had slightly better results than the displaced fractures. There was no significant difference in outcome between the operatively and the conservatively treated displaced fractures. We have also documented prospectively the natural history of the injury, which is of use in assessing prognosis for both clinical and medicolegal purposes.

Adolescent↗
PubMed2006

External fixation for displaced intra-articular fractures of the calcaneum.

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders' type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler's angle was 6.98 degrees (5.95 degrees to 19.86 degrees), whereas after surgery the mean value was 21.94 degrees (12.58 degrees to 31.30 degrees) (p < 0.01). Excellent results on CT scanning were demonstrated in 24 cases (44.4%), good in 25 (46.3%), fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing. The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique.

Adult↗
PubMed1999

The vascularization of the os calcaneum and the clinical consequences.

This study was conducted to analyze extraosseous and intraosseous vascularization of the os calcaneum and to elucidate possible clinical manifestations. The arteries of 13 lower leg and foot specimens of human cadavers were injected with a polymer and subjected to maceration or were embedded in plastic. The examination revealed that 45% of the bone is vascularized via medial arteries and 45% via lateral arteries, whereas the remaining 10% is supplied by the sinus tarsi artery. From the medial side, two or three vessels branch off the posterior tibial artery, penetrate the calcaneus below the sustentaculum, and supply the medial part of the posterior joint. The lateral calcaneal artery normally is a branch from the posterior tibial artery. In two of 13 specimens, this lateral supply comes from the peroneal artery. The medial and lateral intraosseous arterial supply for the calcaneus is equal. Inside the bone there is a water-shed zone where the medial and lateral arterial supply meet in the midline. Only 10% of the blood flow is supplied by vessels in the sinus tarsi. Clinically, interruption of the lateral calcaneal artery during the conventional lateral surgical approach for a calcaneus fracture may result in ischemic bone necrosis. The lateral calcaneal artery could supply a local microvascular flap to cover soft tissue defects of the heel. A compartment syndrome after a calcaneus fracture may be caused by bleeding from the medial calcaneal arteries into the quadratus plantae compartment.

Adult↗
PubMedDate not supplied

[Articular fractures of the calcaneum. Therapeutic indications based on a series of 105 cases].

The authors have treated 105 articular fractures of the calcaneum. Three methods were tested: open reduction and fixation, conservative treatment with early mobilization, primary subtalar arthrodesis. The final results were satisfactory in 85% of the cases. However the three above groups were hardly comparable. Details on the radiological study of these fractures are given. The authors conclude that when osteosynthesis obtained a perfect anatomical reduction, functional results were good. But perfect reduction was rarely obtained. Final results could be improved by a better selection of the surgical cases and a better surgical technique.

Adult↗
PubMed1987

Fractures of the calcaneum: when and how to operate.

Between the years 1967 to 1984, 307 fractures of the calcaneum were treated by different methods, 148 of which were available for long-term review. These have been studied in three groups; those treated conservatively (42), those treated by the Essex-Lopresti method (34) and the present group of 72 cases treated by a variety of surgical methods. These have been analysed with a view to ascertaining whether it is possible to propose a best type of operative treatment related to the type of fracture according to the AO system of classification. From a detailed review of the failures, it emerges that the greatest problem is posed by fractures involving the posterior articular surface with downward displacement of one of the fragments, and by burst fractures of B3 types 1, 2 and 3 (AO classification). From this review, it emerges that the best methods of treatment are as follows: for B3.2 fractures characterised by vertical sinking, the open or closed Essex-Lopresti method of repositioning; for B3.2 fractures characterised by horizontal sinking, open repositioning and osteosynthesis; for B3.3 fractures, in which there is complete disruption of the articular surface, arthrodesis by the Stulz method in the best position obtainable.

Calcaneus↗
PubMed1978

Open lateral wedge osteotomy of the calcaneum for severe postural pes valgus in children.

Conservative treatment for postural pes valgus in children is, on occasions, unsuccessful in the more severe cases. Where adequate conservative treatment had failed, it was decided to correct the deformity by performing an open lateral wedge osteotomy of the calcaneum, as advocated by Dwyer. When the Achilles tendon was short, an open elongation of the tendon was added to the procedure. In this series, 10 patients from 5 to 14 years of age with marked postural pes valgus were treated. Satisfactory results are reported after an average follow-up period of 9 years. A possible explanation for the success of the operation is discussed.

Adolescent↗
PubMed1986

A survey of osteoporosis using the calcaneum as an index.

Two hundred radiographs of the calcaneum and 200 radiographs of the femoral neck from 100 persons were compared. A system of calcaneal grading, different from that earlier reported, was evolved which correlated significantly with the Singh Index. We found that resorption of secondary tensile and compressive trabeculae occurred before resorption of the primary trabeculae. Interruption of primary compressive trabeculae, which was previously described, is an inconstant feature. Our system using six grades is easier to correlate with the Singh Index. We found that osteoporosis increased progressively with age and was three times more common in females than males.

Adult↗
PubMed1978

[Functional treatment of fractures of the calcaneum (author's transl)].

62 fractures of the calcaneum treated by functional therapy have been reviewed. Good results were observed in 63 per cent of the cases, whereas 37 per cent showed satisfactory results. Fractures of the Typ A and B and those of Typ C without other injuries demonstrated good results. Therefore functional therapy can be recommended. Although Typ C fractures combined with other injuries have poor end-results, operative therapy should be delayed because of the over-all risk of the patient. A trial of functional therapy should be initially instituted.

Calcaneus↗
PubMed1994

Fractures of the calcaneum: the anterolateral fragment.

Our previous reports on the pathological anatomy and operative treatment of intra-articular fractures of the calcaneum failed to take account of the fracture pattern anterior to the posterior facet of the subtalar joint. We have reviewed our experience of 63 operative cases and have studied fractures with axial and coronal CT scans reconstructed onto plastic model bones. A constant anterolateral fragment exists, which is displaced by an extended lateral approach to the fracture. If it is unrecognised and unreduced, union in a displaced position may limit hindfoot eversion and disrupt the calcaneocuboid joint. We describe techniques for reduction and fixation of the fragment.

Bone Plates↗
PubMed1996

[Analysis of processes of elevating calcaneum bone stiffness in young women--from the view point of their life-style].

Calcaneum bone stiffness in 222 young women was investigated by using an ultra-sound bone densitometer (Achilles). Their exercise experiences, amounts of dairy products (including foods which contain a lot of calcium) consumed and 24 questions on their eating attitudes were also analysed. Stiffness showed a significant (p < 0.05) positive correlation with age, BMI and the onset of menarche by polynomial (2) regressions. Using these three variables, expected stiffness was calculated by multiple regression, and according to the differences between the real and expected stiffness, the subjects were divided into three subgroups. Group H which showed higher stiffness, showed significantly (p < 0.05) higher exercise experiences and had the habit of consuming more dairy products and small fish than the other two groups. In all of the subjects, the most important variable which increased the stiffness was the exercise experience at junior high school and the next was the habit of eating small fish. The subjects who customarily ate their meals with their families were more likely to eat small fish. These findings suggest that family eating habits should be noticed not only in post-menopausal women, but also in young girls.

Adolescent↗
PubMed1997

Clinics in diagnostic imaging (21). Intraosseous lipoma of the calcaneum.

A 50-year-old woman presented with plantar foot pain. Radiographs and computed tomography demonstrated an intraosseous lipoma of the calcaneum. Curettage and packing were performed. The imaging features, including the magnetic resonance appearances, of intraosseous lipomas are described.

Bone Neoplasms↗
PubMed1998

[3-dimensional imaging of thalamic fractures of the calcaneum. Validation of classifying fractures into 3 forms].

UNLABELLED: Three dimensional CT scans enables to visualize the calcaneum and to follow the fracture pattern without any risk of errors. PURPOSE OF THE STUDY: This technique has been used to validate our previous classification (using three forms: vertical, horizontal, and mixed) which resulted from a two dimensional tomodensitometric study. MATERIAL: The study was based on a series of 74 fractures, all of them studied with 3D CT and 71 of which were operated. METHOD: The previous classification relied on correlation between lateral radiographs and position on coronal CT plane of the Palmer's fracture line. This we called the Fundamental Line (FL); so the vertical form had medial fundamental line, with thalamic verticalization; and so that the horizontal form with thalamic horizontalization had a lateral FL; the mixed form had a medio thalamic FL with double contoured image. RESULTS: In vertical fractures (16 cases, i.e. 20 per cent), the FL was seen denting the thalamus inwards, continuing forward and damaging the forward facet in about two thirds of cases. The thalamic fragment tilted on its axes frequently, with a great rotation movement; in about half cases, it extended backwards (propagated variation). This lateral fragment, called "cortico thalamic" (CT) explained the vertical thalamic x-ray image. In the horizontal fractures (15 cases, i.e. 20 per cent), the FL dents the thalamus outwards, the medial fragment, pushed downwards, explaining the horizontal image. In the mixed cases (40 cases i.e. 55 per cent) the FL was medio thalamic; the two fragments, downed medially and tilted laterally, are of equivalent importance, hence the double contoured image. In half cases, an accessory line separates the sustentaculum tali, creating the two lined mixed form (14 cases i.e. 35 per cent of the mixed). In those cases, the medial thalamic fragment is unsoldered, when in 50 per cent of cases (i.e. 7 out of 14), the pre-thalamic line, following the sinus tarsi, separates it from the forward part and completely isolates it. Therefore, the initial classification in three forms was in fact confirmed. Moreover, the fundamental line appears in all three forms, being the boundary between the lateral thalamic fragment (always tilted) and the medial fragment (always pushed downside). The anterior of cuboidian joint facets are frequently damaged by the forward prolongation of the Fundamental Line according to studied cases. DISCUSSION: This three form classification emphasizes the role of the Fundamental Line, which in effect acts as a boundary between the two typical displacements of this fracture: downward or rotation movement of the thalamic fragments (since it is there that the main displacements occur). A comparison with the Eastwood and Sanders classifications has been carried out. CONCLUSION: This three dimensional CT approach validates, visualizes and completes the three form classification. This will help us to understand fracture displacements in different forms, and therefore, the particular fracture reduction and osteosynthesis best suited for each case.

Calcaneus↗