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At least 757 records · Page 42Linked to original sources
PubMed1984

The long-term results of conservative management of severely displaced fractures of the calcaneus.

A subjective, objective and radiographic study of 21 patients with comminuted calcaneal fractures showing severe involvement of the subtalar joint is reported. The average follow-up was 14.6 years (range 8 to 29 years). Only patients with unilateral closed fractures and no associated injuries to either lower limb were admitted to the study. All were treated by early active mobilisation of the ankle, and the subtalar and the midtarsal joints. Seventy-six per cent of the patients achieved a good result with minor symptoms which did not interfere with their occupation or leisure requirements. Although two-thirds of the patients reached a point of maximal recovery at two to three years, 24% continued to improve for six years. None of the patients experienced any deterioration after this time. Neither the degree of clinical stiffness nor the degeneration of the subtalar joint, assessed radiographically, correlated with the severity of symptoms or functional disability. The role of the soft tissues in the aetiology of residual symptoms is discussed.

Adult↗
PubMed2003

Community-based survey of low quantitative ultrasound values of calcaneus in Taiwan.

This study investigated prevalence and associated-factors of low quantitative ultrasound (QUS) values by screening calcaneal QUS parameters--broadband ultrasound attenuation (BUA) and speed of sound (SOS)--in population samples of three different Taiwanese communities. The study included 6,322 subjects (2,631 male and 3,691 female), aged 31 yr old or more in Shih-Pai (a metropolitan area in northern Taiwan),Yu-Chi (a mountain area in central Taiwan), and A-Lein (a seaside area in southern Taiwan). The overall response rate was 50.2%. The correlation between BUA and SOS was 0.684, p<0.001. From those who responded, we selected 403 subjects aged 31-40 yr as the reference (the young group), and their BUA was 65.34+/-7.91 dB/MHz. The t-score was calculated from the BUA data of our reference group. The percentile of -2.5<t-score<-1.0 and t-score< or =-2.5 in male subjects was 21.4 and 2.9%, respectively, and in female subjects 24.2 and 14.1%, respectively. The BUA of urban area subjects was higher than that of rural area subjects in almost all age-strata, and overweight was noted to be a protective factor. The effect of age-adjusted odds ratio (AOR) on low QUS values in females was significantly increased every 10 yr from 1.55, 5.13, 13.81, 34.29, to 38.14. This survey showed that age-related decreases in calcaneal ultrasonometry, indicating prevalence of low QUS values, were more obvious in female than male subjects. Overall 38.3% of the female Taiwanese had low QUS values, and this is approximately equivalent to the lifetime risk of fracture at the hip, spine, or distal forearm in Caucasian women. The specific t-score designation, as World Health Organization (WHO) criteria, applied to calcaneal QUS are reasonable when the reference group is selected from the same population.

Adult↗
PubMed2004

Quantitative ultrasound of the calcaneus as a screening tool to detect osteoporosis: different reference ranges for caucasian women, african american women, and caucasian men.

The interpretation of results measured by quantitative ultrasound (QUS) of the heel depends on the population studied. We measured estimated bone mineral density (BMD) of the heel using the Hologic Sahara sonometer. People were studied at county fairs, health fairs, and churches. Subjects were not on treatments that would affect bone density, other than calcium supplementation. This included 823 Caucasian women, 131 African American women, and 301 Caucasian men. In contrast to women, for Caucasian men the squared term for age was not significant, and a straight line of decline was the best fit for estimated BMD. African American women had a standard deviation larger than that reported by Hologic for Caucasian women. We compared a history of self-reported fractures with a subject's estimated BMD. An estimated BMD of 0.57 gm/cm2 included 75% of all fractures. This cutoff point was associated with increased fracture prevalence in subjects over age 50, relative risk of 1.4. This result corresponds to the Hologic data T-score of -0.2. When used as a screening tool for osteoporosis fracture risk, an estimated BMD of 0.57 gm/cm2 seems reasonable in those subjects over age 50.

Adult↗
PubMed2001

Stiffness index of the calcaneus measured by quantitative ultrasound and menopause among Japanese women: The Hizen-Oshima Study.

Quantitative ultrasound (QUS) is a recently developed technique for evaluating fracture risk that can assess both bone mass and architecture. Although numerous studies have shown that menopause is associated with accelerated loss of bone mineral density, there are only a few studies on the association of QUS parameter (stiffness index) with menopausal status, especially among Japanese population. We examined age-specific changes in stiffness index, and relation with age, body mass index (BMI) and menopausal status among 506 community-dwelling Japanese women aged 40-89 years. Mean age at menopause (standard deviation) among 459 women with natural menopause was 49.4 (4.0) years. Stiffness index significantly decreased with increasing age. Stiffness index among 80-89 years age group was 40% lower, compared with that of 40-49 years age group. The greatest decline among adjacent ten-year age groups in stiffness index (15%) was found between 40-49 and 50-59 years of age. Multiple regression analysis showed that menopause related with decreased stiffness index, independent of age and BMI. Our findings indicate that menopause influences loss of bone mass and induces deterioration of bone trabecular microstructure.

Adult↗
PubMed1993

Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors.

Forty-four patients who had had fifty-two calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between four and fourteen years after the operation, with use of an evaluation system for the hindfoot and with plain radiographs. The characteristics of the patients that were associated with an unsatisfactory outcome were an age of more than fifty years, a greater body weight, work involving strenuous labor, and increased time missed from work due to the injury. Other prognostic variables associated with an unsatisfactory result included subtalar incongruity, osteoarthrosis of the talonavicular joint and the ankle, an increased heel width, a decreased fibulocalcaneal space, and a decreased Böhler-angle ratio of the fractured to the normal side. The heel height, fat-pad height, arch angle, talocalcaneal angle, and length of the Achilles-tendon fulcrum were not related to the outcome. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. Comminution of tongue and large central-depression fractures was associated with a worse prognosis. The most common most painful area in the patients who had a satisfactory outcome was the lateral aspect of the hindfoot, while in those who had an unsatisfactory result, it was the heel pad.

Absenteeism↗
PubMed1998

Pathoanatomy of intra-articular fractures of the calcaneus.

Radiographs of 220 calcaneal fractures (205 patients) were reviewed retrospectively. One hundred and sixty-three fractures were intra-articular; thirty (18 per cent) of the 163 fractures were a tongue-type injury, and 133 (82 per cent) were a joint-depression injury. Plain radiographs and computerized tomography scans in the coronal and axial planes were available for 116 intra-articular fractures (106 patients). These studies were reviewed, and the 116 fractures were grouped according to the Sanders classification of calcaneal fractures and the anterior extension of the primary fracture line was evaluated. Sixty-two primary fracture lines (53 per cent) extended into one articular surface; twenty-three (20 per cent), into two articular surfaces; twenty-three (20 per cent), into a periarticular location; and eight (7 per cent), into a medial or lateral location. Sixty-seven (58 per cent) involved the calcaneocuboid joint, thirty-one (27 per cent) involved the anterior facet of the talocalcaneal joint, and ten (9 per cent) involved the middle facet of the talocalcaneal joint. A distinct anterolateral fragment was identified in 108 fractures (93 per cent). Plain radiographs failed to demonstrate the anterior extension of fifty-one (47 per cent) of the primary fracture lines. The prevalence of involvement of the anterior facet was significantly greater in Sanders type-III fractures (sixteen of thirty-five; 46 per cent) than in the other types (p < 0.01). The prevalence of involvement of the calcaneocuboid joint and the middle facet was evenly distributed among the fracture types. The primary fracture line typically extends anterior to the angle of Gissane, creating a relatively consistent anterolateral fracture fragment. The primary fracture line cannot be reliably seen on plain radiographs and is better visualized on computerized tomographic scans.

Calcaneus↗
PubMed1992

Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis.

The prognosis of intraarticular calcaneal fractures is variable, ranging from severe functional impairment and pain to complete return of normal function. Clinical assessment and CT scanning were performed 1-11 years after fracture in 45 patients (51 fractures) to determine the relationship between the CT findings and clinical status. Conservatively treated (n = 18) and surgically treated (n = 33) fractures were assessed. Clinical assessment included evaluation of subjective parameters (pain, activity, gait, and use of orthotics) and objective measurement of subtalar motion. CT evaluation included assessment of abnormalities in the posterior subtalar joint, loss of calcaneal height, tendon abnormalities, and calcaneocuboid joint abnormalities. A poor clinical outcome, caused by loss of subtalar motion, was more common when CT showed incongruity or degeneration of the posterior facet (p = .04) and when Bohler's angle was decreased (p = .0006). Other CT findings, such as loss of calcaneal height and tendon abnormalities, did not correlate with clinical outcome. An unexpected finding was that surgical screws were intraarticular in eight (24%) of 33 surgically treated patients; however, this finding was not significantly associated with poor clinical outcome. Our findings indicate that the CT findings of degenerative change and incongruity of the posterior subtalar joint correlate significantly with poor clinical outcome.

Adolescent↗