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At least 19 recordsLinked to original sources
PubMed2000

Internal architecture of the calcaneus: implications for calcaneus fractures.

STUDY DESIGN: Fourteen cadaveri specimens were sectioned to analyze the internal architecture of the human calcaneus. We described the arrangement and orientation of trabecular patterns within the calcaneus and made multiple measurements of its cortical thickness. OBJECTIVE: To characterize the internal architecture of the calcaneus and correlate these findings with well-described patterns of calcaneus fracture in order to better understand the fracture mechanics of this common fracture. METHODS: Fourteen dry, frozen, human calcanei were sectioned using a saw. In each the coronal, sagittal and axial planes, we sectioned separate specimens into slices of 0.5 mm thickness. High-resolution radiographic images were taken of the sectioned specimens. The internal trabecular arrays were described and measurements of cortical thickness were recorded. The correlation between these findings and the known pattern of calcaneal fractures was analyzed. RESULTS: A dominant trabecular pattern running antero-posteriorly along the long axis of the calcaneus was observed. In the posterior tuberosity the trabeculae were arranged parallel to the posterior border. There was an area of sparse or absent mineralization in the anterior part of the calcaneus corresponding to the "neutral triangle" described by Wood and Harty 10, 23. The thickest sites of the calcaneal cortex were the lower pole of the posterior tuberosity, the upper surface at the angle of Gissane, and the lateral surface below the anterior portion of the posterior facet. CONCLUSION: The trabecular architecture of the calcaneus is created by applied stress in concordance with Wolff's law. The weakest plane of resistance to stress is parallel to these organized trabeculae or through areas lacking trabeculae. This study demonstrates that the primary and secondary fracture lines commonly encountered in calcaneus fractures correlates with the internal architectural map of the calcaneal trabecular patterns.

Aged↗
PubMed1998

[Therapy of dislocated calcaneus joint fracture with the AO calcaneus plate].

From August 1992 to March 1997, 66 patients with 71 displaced intraarticular calcaneal fractures were prospectively examined after an operative treatment using an extended lateral approach and the ASIF calcaneal plate followed by early functional postoperative treatment (mean follow-up 25 months, retrieval rate 96%). To classify the type of fracture and to verify the results of reduction and of retention CT scans in the coronal and transverse plane were performed pre- and postoperatively and on the day of assessment. The Zwipp Score was used for clinical evaluation. After fractures with 5 to 8 points according to the calcaneal fracture scale, 97% of the patients had an anatomical or near anatomical reduction of the posterior facet and the clinical outcome in 82% of the patients was graded as good or excellent. In 70% of patients with a fracture rated 9 to 10 points a good reduction was demonstrated and clinically there were 67% good or excellent results. But in the fractures with 11 to 12 points, despite 40% good reductions, the clinical outcome was graded as good in 10% of the patients only. However, if the post-operative displacement of the posterior facet was more than 2 mm no patient had a good result independent of the type of fracture. Due to restoration of the geometry of the most comminuted fracture types and the immediate partial weight bearing secondary soft tissue problems could be minimized without any loss of articular reduction. Anatomical reduction and stable internal fixation together with adequate physical therapy are apparently preconditions but not a guarantee for a good clinical result after displaced calcaneal fractures.

Adult↗
PubMed2000

[Resection of the calcaneus as a treatment option in osteitis following an open calcaneus fracture].

Surgical treatment of calcaneal fractures is demanding due to the poor musculocutaneous coverage. Infection with osteitis is a severe complication with open fractures. The appearance of osteitis requires aggressive surgical treatment including amputation in case of persistence, leading to considerable invalidism. We report the case of an 37-year-old mason with an grade III open calcaneal fracture caused by a fall. Osteitis appeared after primary osteosynthesis with open reduction and eventually--after several revisions--required a calcanectomy. By preservation of the forefoot and midfoot and thanks to sufficient orthosis treatment the patient was able to return to his profession after eight months.

Accidental Falls↗
PubMed2002

[Combined method of treating dislocated fractures of the calcaneus].

PURPOSE OF THE STUDY: The treatment of dislocated intraarticular fractures of calcaneus is still an unsolved chapter of traumatology. Our own poor long-term results of a purely conservative procedure has led us to develop a combined method of a direct and indirect reduction of calcaneus with the subsequent stabilization which we have been using since 1994. The basic principle of the method consists in the combination of a direct reduction of dislocated fragments of articular surfaces and indirect of calcaneus as a whole with the subsequent transfixation of calcaneus by K-wires. MATERIAL: In the period of 1994-2001 we have treated in total 261 patients with 302 fractures of calcaneus, of which 218 were men (83.5%) and 43 women (16.5%) in the age range from 13 to 82 years (average age 45.1 years). By our own surgical method we treated 213 patients with 248 fractures, of which 180 were men (84.5%) and 33 women (15.5%) in the age range of 13-79 years (average age 44.8 years). Conservatively handled were 54 fracture in 48 patients. In the long-term followed up group we included 160 patients with 187 fractures operated on by identical method observing a minimum two-year interval after the operation. Of them 134 were men (83.8%) and 26 women (16.2%) in the age range of 15-75 years (average age 44.3 years). Of 248 operated on fractures of calcaneus 159 were joint-depression type (64.1%), 61 tongue type (24.6%) and 28 comminuted (11.3%) types of fractures. The time interval between the injury and operation ranged between 6 hours and 3 weeks (average 18.5 hours), however most patients we operated on on the day of injury. METHODS: The basic principle of the method was a combination of a direct reduction of dislocated fragments of articular surfaces and indirect reduction of the calcaneus as a whole with a subsequent transfixation of the calcaneus by K-wires. After draping and setting of the image intensifier we proceeded to the actual surgery and divided the whole procedure of reduction and subsequent stabilization into 4 phases: Phase I--traction Phase II--elevation Phase III--compression Phase IV--transfixation In the first traction phase we inserted K-wire transversely through the distal-posterior edge of the calcaneus and connected it to the U-handle in order to achieve a proper effect of the traction. By traction distally along the long axis of the limb we restored the height and length of the calcaneus. Simultaneous pendular movements in eversion/inversion direction released the fragments and considerably facilitated the subsequent reduction. In the second, elevation phase the procedure differed according to individual types of fracture. In joint-depression type we inserted a blunt Steinmann pin or better a curved transpedicular elevator under the dislocated posterior articular surface through skin plantar stab incision and an ever-present primary transverse line of the fracture. In the tongue type of fracture we first introduced in the second phase a thick K-wire (3 mm) along the long axis of the tongue fragment and reduce the fragment by leverage elevation with a simultaneous continuous U-handle traction. After obtaining the desirable position we fixed the fragment by a K-wire vertically introduced from the upper part of calcaneal tuberosity (anteriorly and laterally from the origin of the Achilles tendon) towards the planta. If the medial part of the posterior articular surface remained dislocated we finished its reduction by means of elevator as in the preceding type of the fracture. The third and fourth phases of the surgical procedure was again identical for both types of fractures. In the third, compression phase we performed manually lateral compression of fragments under permanent traction. In the fourth, transfixation phase we first transfixed the reduced position of fragments formed by the primary longitudinal and transverse line. Under continuous radiograph checking in the lateral projection we inserted K-wires gradually from the lateral aspect, about 1.5 cm beneath the lateral malleolus into sustentacular fragment. Additional, mostly 2 K-wires we inserted under continuous traction and counter-traction along the long axis of the calcaneus and as the last step we drilled K-wires from the plantar side from calcaneal tuberosity into the fragments of the posterior articular surface. RESULTS: In the group of long-term followed up patients we evaluated the Creighton-Nebraska Health Foundation score in 160 patients who were on average 43.4 months after operation. The obtained values of the score ranged between 63-100 points with the average of 83.9 points. In 27 patients the result was very good (16.9%), in 89 patients good (55.6%), in 24 patients fair (15.0%) and in 20 patients the result was poor (12.5%). DISCUSSION: The first results of our method of 1998 have proved that it is necessary to combine the basic procedures of direct reduction of joint fragments, i.e. restoration of the calcaneus as a whole, namely in a strictly recommended sequence with a subsequent transfixation by K-wires. We do not use surgical procedures with open reduction and internal fixation (ORIF) differing mutually by the chosen surgical approach and the type of internal fixation used. As compared to ORIF our method has a significantly broader indication range. It can be used for the operation of patients regardless of the age, presence of associated diseases (diabetes, vascular affection) or local affection (a marked oedema, haematoma, non-infected skin blisters). The comparison of the general outcomes of the treatment in our group of patients, 72.5% of excellent and good results and only 12.5 of poor results, corresponds with the values of equally extensive foreign group of patients. In addition, as concerns the number of the incidence of deep infects in closed fractures (0.8%) the values in our group are in comparison several times lower and amputation of the limb was not necessary in any of the cases. It should be also noted that our group of patients has only a minimal indication limitation and operated on are also risk patients who never get in "filtered" groups treated by open method. Therefore it may be stated that the general results are in case of our method markedly better. CONCLUSION: The proposed method requires neither a specialist nor any expensive technical equipment and as a result it may be used both at orthopaedic and surgical departments and due to its undemanding nature and short hospitalization it is also very acceptable from the economic viewpoint.

Adolescent↗
PubMed1999

The effect of region of interest selection on dual energy X-ray absorptiometry measurements of the calcaneus in 55 post-menopausal women.

Bone mineral density (BMD) of the calcaneus was assessed by dual energy X-ray absorptiometry (DXA) in four different regions of the calcaneus in 20 pre-menopausal and 55 post-menopausal women, none of whom were on treatment or suffering from conditions affecting bone. The total body option in the small animal software package of a Lunar DPX-L bone densitometer was used. The precision of the technique (%CV) varied from 0.7 to 2.2% depending on the region scanned. For post-menopausal women, BMD results in the mid and posterior parts of the calcaneus varied by < 7% while BMD in the anterior region was about 20% lower. DXA of the calcaneus was compared with measurements at the spine (L2-L4) and hip (femoral neck) and changes with age were estimated from cross-sectional data. BMD of the calcaneus was significantly reduced in 28 post-menopausal women with low lumbar spine BMD (-2SD) compared with women with normal spine BMD. Calcaneal BMD was significantly correlated to axial BMD (r = 0.45-0.77) and to age (r = 0.45 to -0.63). For a subgroup of 33 post-menopausal women measured twice after approximately 1 year, calcaneus BMD decreased by between 1.2% and 2.5% while axial BMD showed no significant change. Unlike spine or femoral neck BMD, the decrease in calcaneus BMD was significantly greater in women with low spine BMD than in normal women, possibly indicating improved detection of skeletal changes. The optimum measurement sites for BMD in the calcaneus were within the mid or posterior part of the calcaneus or enclosing the whole posterior calcaneus. The calcaneus was shown to be a precise, sensitive and simple measurement site suitable for the assessment of osteoporosis, especially in the elderly where degenerative changes in the spine and hip can complicate BMD assessment.

Absorptiometry, Photon↗
PubMed1994

[Bone mineral measurement of the calcaneus by single X-ray absorptiometry].

The bone mineral content (BMC) of the calcaneus was evaluated using single X-ray absorptiometry (SXA) with respect to reproducibility of bone mineral measurement, age-related bone loss in healthy Japanese, the spine fracture threshold in osteoporotic women, and the effect of non-weight bearing on bone mass in patients after hip arthroplasty. The mean reproducibilities using this method in vitro and in vivo were 0.81% and 0.59%. In 264 healthy men aged between 21 and 79 years and 328 healthy women aged between 20 and 79 years, the calcaneus BMC reached a peak in their twenties and thereafter decreased linearly with age by 0.57% per year in men and 1.32% per year in women. Body height and weight were well correlated with the calcaneus BMC in healthy men and women (p < 0.001). The bone mineral density (BMD) of the lumbar spine was measured using dual X-ray absorptiometry (DXA) and was significantly correlated with the calcaneus BMC in both men (r = 0.727, p < 0.001) and women (r = 0.703, p < 0.001). The fracture threshold, defined as the 90th percentile for calcaneus BMC in a woman with a vertebral fracture, was 313.31 mg/cm2 and 70.2% of the peak bone mass in the calcaneus. In 30 patients with hip implant arthroplasty, the bone mass in the calcaneus, lumbar spine and the distal radius was evaluated longitudinally during a follow-up period of one year. Only the calcaneus BMC in the treated leg changed significantly during this period. In the first four months, the calcaneus BMC in the treated leg diminished by approximately 21%, but had recovered by one year after surgery. We concluded that bone mineral measurement in the calcaneus was useful for evaluating age-related bone mass changes in healthy men and women, bone loss in osteoporotic patients, and the effect of non-weight bearing on bone mass in patients after hip arthroplasty.

Absorptiometry, Photon↗
PubMed2004

Significance of intima-media thickness in femoral artery in the determination of calcaneus osteo-sono index but not of lumbar spine bone mass in healthy Japanese people.

The aim of this cross-sectional study was to investigate whether physical activity and local arterial thickening may affect bone metabolism. To analyze the effects of physical activity and atherosclerosis on bone in healthy Japanese people, health-related quality of life (HRQL) and local arterial thickening were assessed by means of the Medical( )Outcomes Study 36-item Short Form (SF-36), and intimal-medial thickness (IMT) in common carotid artery (CA) and femoral artery (FA), respectively. Bone mineral density (BMD) in lumbar spine was measured by dual X-ray absorptiometry and the osteo-sono assessment index (OSI) of the calcaneus by ultrasound. Healthy subjects (106 male and 154 female) were recruited from those who participated in a local health check program at the Osaka City University Hospital. A significant correlation existed between lumbar spine BMD and calcaneus OSI (r=0.551, P<0.0001). Among various scores in SF-36, only physical functioning score correlated weakly but significantly in a positive manner with lumbar spine BMD (rho=0.156, P=0.0147) and calcaneus OSI (rho=0.190, P=0.0024). Lumbar spine BMD correlated negatively with FA IMT (rho=-0.191, P=0.0027) whereas calcaneus OSI with FA IMT (rho=-0.199, P=0.0014). Multiple regression analyses revealed a significant association between FA IMT and calcaneus OSI, whereas lumbar spine BMD did not correlate significantly with FA or CA IMT. When subjects were restricted to female, FA IMT, but not CA IMT, still showed tendency against independent factors negatively associated with calcaneus OSI. Furthermore, lumbar spine BMD, but not calcaneus OSI, was weakly but significantly associated with increased physical functioning score independently. In conclusion, it was suggested that physical activity may affect bone strength in lumbar spine and calcaneus and that FA IMT might be a significant determinant of bone strength in calcaneus, but not in lumbar spine, in healthy Japanese subjects.

Arteriosclerosis↗
PubMed2002

Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures.

Treatment of displaced intra-articular calcaneus fractures has historically been controversial, but recent developments have led to resurgence in open reduction internal fixation (ORIF) for displaced calcaneus fractures. Recent functional outcome studies comparing operative to nonoperative treatment of unilateral calcaneus fractures has shown a trend towards improved function with ORIF. No studies have investigated the functional outcome of patients who have required operative treatment of bilateral displaced calcaneus fractures. The purpose of this study was to review our operative experience with bilateral displaced intra-articular calcaneal fractures. A retrospective review of medical charts indicated 13 patients had undergone ORIF for bilateral calcaneus fractures. Nine patients could be contacted and brought to the clinic for functional evaluation and radiographic CT studies. Functional outcome was assessed by the Musculoskeletal Functional Assessment Score (MFA) and the American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS). The average follow-up was 56 months. Over half of the patients required additional surgeries. The average MFA and AOFAS scores were 31.1 and 71.8, respectively. Functional outcome decreased for patients with multiple traumatic fractures and surgical procedures of the calcaneus. Our results show a diminished functional outcome for patients sustaining bilateral calcaneus fractures treated with ORIF when compared to patients managed surgically for unilateral calcaneus fractures, but better functional outcomes than patients who do not undergo ORIF for unilateral calcaneus fractures. This diminished function limits work capacity and ability to perform daily activities that require standing.

Adult↗
PubMed1994

Dual energy X-ray absorptiometry of the calcaneus: comparison with other techniques to assess bone density and value in predicting risk of spine fracture.

OBJECTIVE: The calcaneus has been proposed as an alternative site for assessment of bone mineral density (BMD) in women with osteoporosis. The objectives of this study were to evaluate the clinical usefulness of dual-energy X-ray absorptiometry (DXA) of the calcaneus for predicting spinal fracture and to compare the predictive value of assessment of BMD by DXA of the calcaneus, quantitative CT or DXA of the lumbar spine, and DXA of the most distal part of the radius. SUBJECTS AND METHODS: The study group consisted of 399 healthy volunteer women (aged 19-81 years) and 27 women (aged 44-85 years) who had osteoporosis. They had DXA of the calcaneus, quantitative CT and DXA of the lumbar spine, and DXA of the most distal part of the radius. T-score analyses were used to compare decreases in BMD in postmenopausal women with decreases in premenopausal women, and to compare decreases in women with and without osteoporosis. RESULTS: T-score analysis of age-related changes in BMD in the control subjects showed that densities in the calcaneus, the lumbar spine, and the most distal part of the radius decrease significantly with age in postmenopausal women. In women with osteoporosis (n = 27), BMDs in the calcaneus (DXA, p < .0002), L1-L3 (quantitative CT, p < .0001), L1-L4 (DXA, p < .0005), and the most distal part of the radius (DXA, p < .005) were significantly lower than those in healthy control subjects (n = 77). T-score analysis indicated that in women with osteoporosis, DXA of the calcaneus showed BMD losses greater than those shown by DXA of L1-L4 and the most distal part of the radius and similar to those shown by quantitative CT of L1-L3. Receiver-operating characteristic (ROC) analysis showed that findings on DXA of the calcaneus were as good a predictor of the risk of spinal fracture as findings on DXA of the lumbar spine and not as good as findings on quantitative CT of the lumbar spine. CONCLUSION: The results suggest that DXA assessment of BMD in the calcaneus is not a useful adjunct to other measurements. However, it can be used to predict the risk of fracture when better measures, such as quantitative CT, are unavailable.

Absorptiometry, Photon↗
PubMed2001

Reference data and predictive diagnostic models for calcaneus bone mineral density measured with single-energy X-ray absorptiometry in 7428 Chinese.

Calcaneus bone mineral density (BMD) of 7428 Chinese (4126 women, 3302 men; aged 22-94 years) was measured using single-energy X-ray absorptiometry (SXA). A reference range of calcaneus BMD values for healthy Chinese men and women was established and the usefulness of this method for screening and diagnosis in osteoporosis was evaluated. The peak BMD occurred at 20-24 years old and peak BMD in women was significantly lower than in men. BMD loss in the calcaneus started at the age of 35 years for women, and at 63 years in men. BMD loss rate was 1.2%/year for women and 0.56%/year for men after 50 years. The young normal reference for calcaneus BMD was 442.1+/-69.6 mg/cm2 for men and 388.3+/-61.7 mg/cm2 for women calculated from the mean BMD value of subjects whose age ranged from 20 to 49 years. The accumulated BMD loss in the calcaneus is similar to that of Ward's triangle. Multiple linear regression showed that both age and weight were important factors. The incidence of osteoporosis in older men and women (> or = 60 years) is 6.6% and 32.1% respectively. We conclude that calcaneus BMD measurement is useful and sensitive for the screening and diagnosis of osteoporosis. A predictive diagnostic model for osteoporosis based on the calcaneus was constructed using multiple linear regression and the WHO criteria for diagnosing osteoporosis can be applied to calcaneus BMD.

Absorptiometry, Photon↗
PubMed1999

Bone mass in the calcaneus after heavy loaded eccentric calf-muscle training in recreational athletes with chronic achilles tendinosis.

In an ongoing prospective study of 14 recreational athletes (12 males and 2 females, mean age 44.2 +/- 7.1 years) with unilateral chronic Achilles tendinosis, we investigated the effect of treatment with heavy-loaded eccentric calf-muscle training. Pain during activity (recorded on a VAS scale) and isokinetic concentric and eccentric calf-muscle strength (peak torque at 90 degrees /second and 225 degrees /second) on the injured and noninjured side were evaluated. In this group of patients, we examined areal bone mineral density (BMD) of the calcaneus after 9 months (range 6-14 months) of training. BMD of the injured side (subjected to heavy-loaded eccentric training) was compared with BMD of the noninjured side. Before onset of heavy-loaded eccentric training, all patients had Achilles tendon pain which prohibited running activity, and significantly lower concentric and eccentric plantar flexion peak torque on the injured compared with the noninjured side. The training program consisted of 12 weeks of daily, heavy-loaded, eccentric calf-muscle training; thereafter the training was continued for 2-3 days/week. The clinical results were excellent-all 14 patients were back at their preinjury level with full running activity at the 3 month follow-up. The concentric and eccentric plantar flexion peak torque had increased significantly and did not significantly differ from the noninjured side at the 3 and 9 month follow-up. There were no significant side-to-side differences in BMD of the calcaneus. There was no significant relationship between BMD of the calcaneus and calf-muscle strength. As a comparison group, we used 10 recreational athletes (5 males and 5 females) mean age 40.9 years (range 26-55 years), who were selected for surgical treatment of chronic Achilles tendinosis localized at the 2-6 cm level. Their duration of symptoms and severity of disease were the same as in the experimental group. There were no significant side-to-side differences in BMD of the calcaneus preoperatively, but 12 months postoperatively BMD of the calcaneus was 16.4% lower at the injured side compared with the noninjured side. Heavy-loaded eccentric calf-muscle training resulted in a fast recovery in all patients, equaled the side-to-side differences in muscle strength, and was not associated with side-to-side differences in BMD of the calcaneus. In this group of middle-aged recreational athletes, BMD of the calcaneus was not related to calf-muscle strength.

Achilles Tendon↗