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  1. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    Science.gov (United States)

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. Copyright 2016, SLACK Incorporated.

  2. A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

    Directory of Open Access Journals (Sweden)

    Radwane Faroug

    2013-01-01

    Full Text Available Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF. Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome.

  3. Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures

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    Kai Wu

    2014-01-01

    Full Text Available Background: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the effectiveness of clinical intervention is assessed. Materials and Methods: A review of medical records was conducted of 209 patients (239 calcaneal fractures surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might influence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical significance. Results: Twenty-one fractures (8.79% involved surgical incision complications, including 8 (3.35% cases of wound dehiscence, 7 (2.93% of flap margin necrosis, 5 (2.09% of hematoma, and 1 (0.42% of osteomyelitis. Five factors were statistically significant : t0 he time from injury to surgery, operative duration, post-operative drainage, retraction of skin flap, bone grafting, and patients′ smoking habits. The results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time > 1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. The post-operative duration of antibiotics and bone grafting made no significant difference. Conclusion: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin flaps gently and for as short a time as possible, and prohibiting smoking.

  4. Pediatric calcaneal fractures

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    Hobie Summers

    2009-07-01

    Full Text Available Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular and severity (displaced vs. nondisplaced have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was -5° (range: -35 - +35 compared to 31° (range: +22 - +47 on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30-4.3 years. Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 - +49. We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.

  5. Calcaneal fractures • In children

    African Journals Online (AJOL)

    1989-07-15

    Jul 15, 1989 ... Eight patients with 9 calcaneal fractures were reviewed. Of the fractures 6 were intra-articular and 3 extra-articular but in children this distinction appears to have little relevan~e to treatment or prognosis. While these fractures are relatively uncommon in children, clinical suspicion is important in making the ...

  6. Complications in calcaneal fracture surgery and implant removal

    NARCIS (Netherlands)

    Backes, M.

    2017-01-01

    This thesis focuses on postoperative wound complications in calcaneal fracture surgery and implant removal. The extended lateral approach (ELA) in calcaneal fracture surgery is hampered with high rates of postoperative wound infection (POWI) of up to 25%. No placement of a closed suction drain is

  7. Percutaneous Fixation of Displaced Calcaneal Fracture

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    Yeung Yip-Kan

    2011-06-01

    Conclusion: Percutaneous fixation of displaced tongue-type calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay, minimal skin complications, and quick recovery.

  8. Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation

    NARCIS (Netherlands)

    Tomesen, T.; Biert, J.; Frolke, J.P.M.

    2011-01-01

    BACKGROUND: Surgical treatment of displaced intra-articular fractures of the calcaneus is a standard procedure in many institutions. To avoid soft-tissue complications, several minimally invasive procedures have recently been introduced. The aim of this study was to assess the percutaneous treatment

  9. Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment

    National Research Council Canada - National Science Library

    Gwak, Heui-Chul; Kim, Jeon-Gyo; Kim, Jung-Han; Roh, Sang-Myung

    2015-01-01

    ...) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital...

  10. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

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    Jain Saurabh

    2013-12-01

    Full Text Available 【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of com- minution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiologi- cal assessment was done by Bohler’s angle and Gissane’s angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Or- thopaedics Foot and Ankle Society (AOFAS scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97, with 86% having excellent to good results and 2 (7.7% and 1 (3.7% having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler’s angle, mean Gissane’s angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap ne- crosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and

  11. The new intra-articular calcaneal fracture classification system in term of sustentacular fragment configurations and incorporation of posterior calcaneal facet fractures with fracture components of the calcaneal body

    National Research Council Canada - National Science Library

    Harnroongroj, Thossart; Harnroongroj, Thos; Suntharapa, Thongchai; Arunakul, Marut

    2016-01-01

    Objective: The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. Methods...

  12. Computed tomography of calcaneal fractures

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    Heger, L.; Wulff, K.; Seddiqi, M.S.A.

    1985-07-01

    Computed tomography (CT) of 25 fractured calcanei was performed to investigate the potential of CT in evaluating the pattern and biomechanics of these fractures. The characteristic findings of typical fractures are presented, including the number and type of principal fragments, size and dislocation of the sustentacular fragment, and involvement of the anterior and posterior facets of the subtalar joint. In 17 cases, the calcaneus consisted of four or more fragments. Furthermore, in 17 cases the sustentacular fragment included all or part of the posterior facet joint. In 18 of the 25 cases, the sustentacular fragment was displaced. It is concluded that well performed CT is an invaluable adjunct in understanding the fracture mechanism and in detecting pain-provoking impingement between the fibular malleolus and the tuberosity fragment.

  13. The role of multidetector CT in evaluation of calcaneal fractures

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    Kareem Mohsen Moussa

    2015-06-01

    Conclusion: The study showed that multidetector computed tomography is the best method for assessing and classifying calcaneal fractures, as well as delineating the fracture fragments and helping in making the pre-operative planning.

  14. Ultrasonographic diagnostics and evaluation of calcaneal fracture: case report

    National Research Council Canada - National Science Library

    Lukac, Damir; Milenović, Natasa; Drapsin, Miodrag; Kecojević, Vaso; Sekulić, Slobodan; Klasnja, Aleksandar

    2013-01-01

    Radiography is the standard tool in the diagnostics of bone fractures. This paper presents a case of calcaneal fracture diagnosed by ultrasonography that was also used in the follow-up of recovery progress...

  15. Sinus Tarsi Approach (STA) versus Extensile Lateral Approach (ELA) for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures (DIACF): a meta-analysis.

    Science.gov (United States)

    Bai, L; Hou, Y; Lin, G-H; Zhang, X; Liu, G-Q; Yu, B

    2018-02-01

    Our aim was to compare the effect of Sinus Tarsi Approach (STA) vs Extensile Lateral Approach(ELA) for Treatment of Closed Displaced Intra-Articular Calcaneal Fractures (DIACF.) is still being debated, MATERIALS AND METHODS: A thorough research was carried out in the MEDLINE, EMBASE, and Cochrane library databases from inception to December 2016. Only prospective or retrospective comparative studies was selected in this meta-analysis. Two independent reviewers conducted literature search, data extraction, and quality assessment. The primary outcomes were anatomical restoration and prevalence of complications. Secondary outcomes included operation time and functional recovery. Four randomized controlled trials involving 326 patients and three cohort studies involving 206 patients were included. STA technique for DIACFs led to a decline in both operation time and incidence of complications. There were no significant differences between the groups in American Orthopaedic Foot and Ankle Society scores, nor changes in Böhler angle. This meta-analysis suggests that STA technique may reduce the operation time and incidence of complications. In conclusion, STA technique is reasonably an optimal choice for DIACF. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  16. Calcaneal fractures • In children

    African Journals Online (AJOL)

    1989-07-15

    Jul 15, 1989 ... pointed our that this reported incidence is possibly erroneously low in view of the subtle clinical and radiographic presentation of this injury. A history of trauma may not be forthcoming, and furthermore, the blow required to produce a fracture of calcaneum, especially in the younger child, may be surprisingly.

  17. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

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    Rak Vaclav

    2009-01-01

    Full Text Available Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17% in group A and 1/34 (3% in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Bφhler´s angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55% in group A and in 30/34 (85% in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the

  18. TREATMENT OPTIONS FOR DISPLACED FRACTURE OF THE CALCANEAL TUBEROSITY

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    Siva G. Prasad

    2016-12-01

    Full Text Available BACKGROUND The aim of the study is to compare the outcome following conservative or surgical treatment for displaced fracture of the medial process of the calcaneal tuberosity. MATERIALS AND METHODS 14 men and 4 women aged 20 to 44 years chose to undergo conservative (9 feet or surgical (10 feet treatment by a single surgeon for closed displaced fracture of the medial process of the calcaneal tuberosity. The injury mechanism was a fall from a height of <1.5 m; the mean time from injury to treatment was 3 (range 1-7 days. Conservative treatment comprised immobilisation in a plaster cast. Surgical treatment involved fixation with a half thread cannulated screw for large fragments (in 6 feet or a mini-plate for comminuted fragments (in 4 feet. At the final follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS ankle and hind foot score was evaluated. RESULTS The conservative and surgery groups were comparable in terms of age, gender and fracture displacement. The mean follow-up duration was 20 (range, 14-24 months. All patients had bone union; none had implant loosening or breakage. One patient with surgical treatment developed skin numbness at the medial aspect of the heel that resolved following neurotrophic drug treatment for 3 months. The surgery group achieved earlier full weight bearing (5.8 vs. 7.5 weeks, p<0.001 and return to work (5.9 vs. 8.2 weeks, p=0.048, but comparable AOFAS score (89.0 vs. 88.2, p=0.4. CONCLUSION Surgery for displaced fracture of the medial process of the calcaneal tuberosity enabled earlier full weight bearing and return to work, but comparable AOFAS score.

  19. Radiologic aspects of calcaneal fractures in childhood and adolescence

    Energy Technology Data Exchange (ETDEWEB)

    Rasmussen, F.; Schantz, K.

    One hundred and forty-three calcaneal fractures in 140 patients under the age of19 years were reviewed. Of the total number, 75% were in males. Eighty fractures were seen in females under 13 years of age and in males under 16 years of age. Fifteen (19%) of these fractures were initially not recognized. Four projections were available in the majority of the cases, and were reviewed: lateral, axial, straight dorsoplantar and oblique dorsoplantar views. The various types of fractures had different courses and localizations. The optimum demonstration of a fracture in a certain projection will therefore be dependent on the type of fracture present. It is clinically difficult to foresee a specific type of calcaneal fracture, and consequently it is recommended that all four views should be obtained routinely following trauma to the calcaneal region in patients of the pertinent age groups.

  20. Helical CT of calcaneal fractures: technique and imaging features

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    Wechsler, R.J.; Schweitzer, M.E.; Karasick, D.; Deely, D.M.; Morrison, W. [Thomas Jefferson University Hospital, Department of Radiology, 111 South 11th Street, Philadelphia, PA 19107 (United States)

    1998-01-01

    Since the degree of comminution, fracture alignment, and articular congruity of intra-articular calcaneal fractures are important determinants in surgical treatment and patient prognosis, we review helical computed tomographic (CT) technique and features for detecting and assessing the extent of acute calcaneal fractures. Helical CT can be used to classify these fractures and facilitate the surgeon`s understanding of the anatomy and position of the fracture components in all orthogonal planes independently of the patient`s condition, foot placement in the CT gantry, or other injuries. (orig.) With 13 figs., 13 refs.

  1. Calcaneal fractures in children | De V. de Beer | South African ...

    African Journals Online (AJOL)

    Eight patients with 9 calcaneal fractures were reviewed. Of the fractures 6 were intra articular and 3 extra-articular but in children this distinction appears to have little relevance to treatment or prognosis. While these fractures are relatively uncommon in children, clinical suspicion is important in making the diagnosis, since ...

  2. Computed tomography of calcaneal fractures. Comparison with conventional radiography

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    Ishino, Youichi; Oono, Masato; Uchino, Akira; Satou, Yoshiyuki; Nakata, Hajime.

    1989-03-01

    Computed tomography (CT) and conventional radiography were compared in 52 calcaneal fractures. As for CT, direct coronal imagings were performed in all and direct axial imagings were added in 27 of them. Conventional radiography included lateral, axial, and Anthonsen (oblique) views. Overall CT detected 7 more of the incongruity of the posterior facet, 9 more of the bulging of the lateral wall, and 6 more of the fracture of the sustentaculum tali than conventional radiography. In addition the entrapment of the peroneal tendons between the calcaneal body and the fibular malleolus could be evaluated only with CT. These informations are indispensable for the proper treatment of the fractures and we conclude that CT is useful in evaluating calcaneal fractures. (author).

  3. Management of Intraarticular Calcaneal Fractures by Minimally Invasive Sinus Tarsi Approach-Early Results

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    Meraj A

    2012-03-01

    Full Text Available The operative treatment of displaced intraarticular calcaneal fractures has been a controversial topic. Soft tissue conditions and concomitant disease must be considered in these patients. The minimally invasive sinus tarsi approach is a valid therapeutic solution that guarantees stability, anatomic reduction of the fracture and soft tissue preservation. Twenty-five closed calcaneal fractures in 20 patients were treated with open reduction and internal fixation using the sinus tarsi approach (including fixation with cannulated screws. All fractures healed by the time of final follow-up at 18 months. The time to union judged both clinically and radiographically, averaged 3 months. Mean Maryland foot scores were: 95 in type II; 91 in type III; and 83 in type IV fractures. Advantages offered by this new approach include a less invasive incision while still permitting good visualization and anatomic reduction of articular surfaces and with few complications.

  4. Subtalar versus triple arthrodesis after intra-articular calcaneal fractures

    NARCIS (Netherlands)

    Schepers, Tim; Kieboom, Brenda C. T.; Bessems, Gert H. J. M.; Vogels, Lucas M. M.; van Lieshout, Esther M. M.; Patka, Peter

    2010-01-01

    Depending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients with 37

  5. Subtalar versus triple arthrodesis after intra-articular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); B.C.T. Kieboom (Brenda); J.H.J.M. Bessems (Gert); L.M.M. Vogels (Lucas); E.M.M. van Lieshout (Esther); P. Patka (Peter)

    2010-01-01

    textabstractDepending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients

  6. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    Energy Technology Data Exchange (ETDEWEB)

    Petrover, David [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Hopital Beaujon, Service de Radiologie, Paris (France); Schweitzer, Mark E. [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Laredo, J.D. [Hopital Lariboisiere, Service de Radiologie, Paris (France)

    2007-07-15

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  7. Intra-articualr calcaneal fractures: Computed tomographic analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rosenberg, Z.S.; Feldman, F.; Singson, R.D.

    1987-02-01

    Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases. CT proved superior to plain films by consistently demonstrating additional fracture components within each major category suggesting subclassifications which have potential prognostic value. CT allowed more expeditious handling of acutely injured patients, and improved preoperative planning, postoperative follow-up, and detailed analysis of causes for chronic residual pain. CT further identified significant soft tissue injuries such as peroneal tendon displacement which cannot be delineated on plain films.

  8. Calcaneal Fractures and Böhler’s Angle

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    Lindsey Spiegelman

    2017-01-01

    Full Text Available History of present illness: 40-year-old male presents to the emergency department after falling off a ladder. He was repairing a window when he fell, landing on the ground 12 feet below. The patient landed onto his feet bilaterally and then fell backwards onto his buttocks. On arrival, the patient had bilateral foot pain. He denied any back pain, headache, or loss of consciousness. Significant findings: The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow in addition to fracture fragments along the heel pad margin (blue arrow. The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow. There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle. Discussion: Calcaneal fractures occur typically in adults who have undergone significant axial load on their feet secondary to a fall from high height.2,3 There are two broad types of calcaneal fractures: intraarticular and extraarticular.2 The intraarticular fractures are colloquially referred to as a “Lover’s Fracture” as they have been known to occur in those jumping out of a tall window to escape the wrath of a lover’s spouse.1 Calcaneal fractures are best diagnosed with a CT scan or with lateral x-ray by measuring Böhler’s angle.2,3 This is the angle formed by the intersection of two lines demonstrated on a normal lateral ankle radiograph. The first line is drawn between the superior aspect of the anterior process of the calcaneus (point A and the superior edge of the posterior articular facet (point B. The second line is drawn between the superior aspect of the posterior calcaneal tuberosity (point C and point B.2

  9. [Operative treatment of displaced intra-articular calcaneal fractures].

    Science.gov (United States)

    Zwipp, H; Rammelt, S; Amlang, M; Pompach, M; Dürr, C

    2013-12-01

    Anatomic reduction of displaced intra-articular calcaneal fractures with restoration of height, length, and axial alignment and reconstruction of the subtalar and calcaneocuboid joints. Displaced intra-articular calcaneal fractures with incongruity of the posterior facet of the subtalar joint, loss of height, and axial malalignment. High perioperative risk, soft tissue infection, advanced peripheral arterial disease (stage III), neurogenic osteoarthropathy, poor patient compliance (e. g., substance abuse). Extended lateral approach with the patient placed on the uninjured side. Reduction of the anatomic shape and joint surfaces according to the preoperative CT-based planning. Reduction of the medial wall and step-wise reconstruction of the posterior facet from medial to lateral. Reduction of the tuberosity and anterior process fragments to the posterior joint block and temporary fixation with Kirschner wires. Internal fixation with an anatomic lateral plate in a locking or nonlocking mode. Alternatively less invasive internal fixation with a calcaneus nail over a sinus tarsi approach for less severe fracture types. The lower leg is immobilized in a brace until the wound is healed. Range of motion exercises of the ankle and subtalar joints are initiated on the second postoperative day. Patients are mobilized in their own shoe with partial weight bearing of 20 kg for 6-12 weeks depending on fracture severity and bone quality. Over a 4-year period, 163 patients with 184 displaced, intra-articular calcaneal fractures were treated with a lateral plate via an extended approach. In all, 102 patients with 116 fractures were followed for a mean of 8 years. A surgical revision was necessary in 4 cases (3.4%) of postoperative hematoma, 2 (1.7%) superficial and 5 (4.3%) deep infections. Of the latter, 2 patients needed a free flap for definite wound coverage, no calcanectomy or amputation was needed. Secondary subtalar fusion for symptomatic posttraumatic arthritis was

  10. Operative compared to non-operative treatment of displaced intra-articular calcaneal fractures

    Directory of Open Access Journals (Sweden)

    Mohammad Hadi Nouraei

    2011-01-01

    Full Text Available Background: The aim of this study was to compare outcomes of open reduction and rigid internal fixation of dis-placed calcaneal fractures with that of non operative treatment. Methods: Seventy two consecutive patients with displaced intra-articular calcaneal fractures were selected regarding inclusive and exclusive criteria and then were randomly allocated to surgical and non surgical groups. First group un-derwent open reduction and internal fixation with reconstruction plate and screws fixation and the other group were treated with closed reduction and cast immobilization. Data were collected by clinical observation and a check list. Data was analyzed by chi-square and student′s t-test. Results: The results showed significant difference between outcomes of surgical treatment and nonsurgical me-thod (p = 0.001. There were some differences between two methods in terms of decreasing pain [Odd Ratio (OR: 6.72, p = 0.001], swelling (OR: 6.80, p = 0.001, increased range of motion of the joints (p = 0.001, decreased late osteoarthritis (OR: 2.33, p = 0.22 in favor of surgical group. Conclusions: Open reduction and internal fixation of displaced calcaneal fractures in absence of open fracture, severe osteoporosis, or comminution, poor general condition may be the preferred method of treatment.

  11. Clinical efficacy and prognosis factors of open calcaneal fracture: a retrospective study

    Science.gov (United States)

    Zhang, Xuebin; Liu, Yueju; Peng, Aqin; Wang, Haili; Zhang, Yingze

    2015-01-01

    Background: Treatment of open calcaneal fractures remains to be a challenge for orthopaedic surgeons. The aim of this study is to assess factors affecting the treatment results of open calcaneal fractures. Methods: A total of 98 patients who have 101 open calcaneal fractures were recruited in our hospital, they were all treated with a standard protocol based on the appearance of the traumatic wound. Data on mechanism of injury, location and size of wound, classification, fixation methods and subsequent soft-tissue complications were collected and evaluated. AOFAS Ankle-Hindfoot Survey and physical examinations were performed to access outcomes. Results: No statistical difference was found in complication and AOFAS score in open calcaneal fractures treated with different fixation, and no statistical difference was found in AOFAS between gustilo I and II type open calcaneal fractures (P > 0.05). There was significant difference between gustilo I and III type or gustilo II and III type fractures (P < 0.05). The more serious soft tissue injury of open calcaneal fracture lead to the worse outcome and higher incidence of complications obtained. Conclusion: Open calcaneal fractures have a high propensity for soft-tissue complications no matter which fixation method was chose. There was no significant difference between patients who had been treated with different fixations in complication rates. Soft-tissue injury played an important role in outcomes of open calcaneal fractures. Deep infections and osteomyelitis were rare by means of emergency debridement and following repeated debridement. PMID:26064282

  12. Ultrasonographic diagnostics and evaluation of calcaneal fracture: Case report

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    Lukač Damir

    2013-01-01

    Full Text Available Introduction. Radiography is the standard tool in the diagnostics of bone fractures. This paper presents a case of calcaneal fracture diagnosed by ultrasonography that was also used in the follow-up of recovery progress. Case Outline. A 68-year-old male patient was diagnosed avulsion fracture of the calcaneus by ultra-sonography (US examination using a multi-frequency linear probe (7-15 MHz and confirmed by X-ray findings; US also provided insight into the dynamics of the reparatory processes. Control examinations were performed on day 14, 21, 30, 60 and 300 (10 months after the occurrence of the fracture. During this time rehabilitation process was carried out. The diameters of the wedge defect of the calcaneus were measured by US for the follow-up of the healing process of the injured bone. Postero-anterior (PA or longitudinal diameter and latero-medial or medio-lateral or transverse diameter were measured. Conclusion. Study results indicate a possible use of US in the diagnostics of fractures and monitoring of calcaneal healing.

  13. Demographics of extra-articular calcaneal fractures: Including a review of the literature on treatment and outcome

    NARCIS (Netherlands)

    T. Schepers (Tim); A.Z. Ginai (Abida); E.M.M. van Lieshout (Esther); P. Patka (Peter)

    2008-01-01

    textabstractIntroduction: Extra-articular calcaneal fractures represent 25-40% of all calcaneal fractures and an even higher percentage of up to 60% is seen in children. A disproportionately small part of the literature on calcaneal fractures involves the extra-articular type. The aim of this study

  14. Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: Current concepts' review

    NARCIS (Netherlands)

    T. Schepers (Tim); P. Patka (Peter)

    2009-01-01

    textabstractIntroduction: A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different

  15. The effect of fracture type and angular deterioration on the functional outcome of calcaneal fractures

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    Atilla Polat

    2011-03-01

    Full Text Available The aim of this study was to determine the effect of fracture type and angular deterioration on the outcome of calcaneal fractures.Materials and methods: Thirty-two patients (23 males, 9 females; mean age 45 years with calcaneus fractures retrospectively reviewed. Twenty-four fractures were closed, and eight fractures were open. Böhler and Gissane angles were measured using patient’s before, and after reduction X-ray films. According to the Essex-Lopresti classification there were three type I, 14 type II, and 15 type III fractures. Five patients were treated with casting (Group I, 19 patients with closed reduction K-wire application (Group II, and 8 patients with plate fixation. Final clinical outcome were assessed by Maryland Foot Score. Mean follow-up period was 109 weeks.Results: Mean Böhler and Gissane angles were 7°, 85° before reduction, and 20°, 100° after reduction, respectively. The mean Maryland Foot Score was 62 (range 55-72 in Group I, 68 (range 40-90, and 66 (range 58-79 in group II.The Maryland Foot score in Type I fracture was higher than Type III (p=0.025, and Typ II (p=0.094, respectively. In terms of last radiologic examination, the Maryland Foot Score was higher in those angle’s were in normal border than whose angle’s were abnormal (p=0.027 and p=0.02, respectively. Mean correction of angles in Group III were more than Group I, and Gruop II (p<0.05.Conclusion: Severe calcaneus fracture was related to poor functional outcome. Böhler and Gissane angle can be more corrected with plate fixation method, but has similar functional outcome.

  16. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach.

    Science.gov (United States)

    Backes, Manouk; Schepers, Tim; Beerekamp, M Suzan H; Luitse, Jan S K; Goslings, J Carel; Schep, Niels W L

    2014-04-01

    Post-operative wound infections (PWI) following calcaneal fracture surgery can lead to prolonged hospital stay and additional treatment with antibiotics, surgical debridement or implant removal. Our aim was to determine the incidence of superficial and deep PWI and to identify risk factors (RF). This study is a retrospective case series. All consecutive patients from 2000 to 2010 with a closed unilateral calcaneal fracture treated with open reduction and internal fixation (ORIF) by an extended lateral approach were included. Patient, fracture, trauma and peri-operative characteristics were collected, including RF such as smoking, diabetes mellitus, time to operation, pre-operative in- or outpatient management and wound closure technique. The primary end point was a PWI as defined by the US Centers for Disease Control and Prevention. A total of 191 patients were included of which 47 patients (24.6%) had a PWI; 21 (11.0%) and 26 (13.6%) patients had a superficial and deep wound infection, respectively. American Society of Anesthesiologists (ASA) classification higher than ASA 1 was associated with an increased risk. Placement of a closed suction drain at the end of surgery was associated with less PWI (35% vs 15%, p = 0.002). In this study, none of the previously reported RF were associated with an increased risk for PWI. ORIF of displaced calcaneal fractures is associated with a high rate of PWI of 25%. Factors that were associated with an increased risk were ASA classification other than 1 and absence of a closed suction drain placement. A closed suction drain may be a protective measure to avoid wound complications.

  17. FUNCTIONAL OUTCOME OF INTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURE

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    Saket Jati

    2016-12-01

    Full Text Available BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation. The purpose of this research, the relationship exists between Bohler’s angle and the injury severity of displaced calcaneal fractures and between surgical improvement of Bohler’s angle and its practical outcome. MATERIALS AND METHODS Patients were treated surgically for unilateral closed displaced intra-articular calcaneal fractures from May 2014 to October 2016 were identified. The Bohler’s angles of bilateral calcaneus were measured and was compared to the dimension of the uninjured foot was used as its normal control. The difference in the value of Bohler’s angle measured preoperatively or after surgery between the angle of the damaged foot and that of the contralateral calcaneus was calculated, respectively. The change in Bohler’s angle by ratio was calculated by dividing the variation in the value of Bohler’s angle between bilateral calcaneus by its typical control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot and Ankle Society hindfoot scores. RESULTS 30 patients were included into the study with a mean follow-up duration of 30 months. According to Sanders classification, the fracture pattern included 12 type II, 10 type III and 8 type IV fractures. According to American Orthopaedic Foot and Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 10, 8, 4 and 2 patients, respectively. The preoperative Bohler’s angle, difference value of Bohler’s angle between bilateral calcaneus and change in Bohler’s angle by ratio each has a significant relationship with Sanders classification (P=0.003; P=0.004; P=0.005, respectively, however, is not correlated with

  18. FUNCTIONAL OUTCOME OF INTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURE

    National Research Council Canada - National Science Library

    Saket Jati; Dev Padia

    2016-01-01

    BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation...

  19. The role of computed tomography in the diagnosis and treatment of calcaneal fractures

    National Research Council Canada - National Science Library

    Bica, F

    2014-01-01

    .... In a retrospective audit of patients hospitalized in our clinic, I tried to identify the opportunity of the CT scan as a preoperative investigation protocol in calcaneal fractures, the results...

  20. Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate

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    Luiz Carlos Almeida da Silva

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the clinical results of surgical treatment of intraarticular fractures of the calcaneus, comparing the use of calcaneal plate and flat plate. METHODS: This was a retrospective study assessing the postoperative results of 25 patients between 2013 and 2015. Patients undergoing surgical treatment of intraarticular fractures of the calcaneus without concomitant surgical lesions were included. Patients who did not complete appropriate follow-up after surgery were excluded from the study. RESULTS: The unavailability of calcaneal plates at resource-limited settings, associated with the availability and lower cost of flat plates, may have been a confounding factor in the present study. However, there was no statistical difference between the outcomes of fractures treated with calcaneal plates or flat plates. CONCLUSION: Statistical inference shows that, when calcaneal plates are not available, it is possible to use flat plates with similar clinical outcomes.

  1. Intra-articular calcaneal fracture in a 14-year-old competing skier: case report.

    Science.gov (United States)

    Tudor, Anton; Sestan, Branko; Nemec, Boris; Prpic, Tomislav; Rubinic, Dusan

    2003-12-01

    Intra-articular calcaneal fracture as a skiing injury in children is extremely rare. We report on what we believe is a unique and previously unreported mechanism of a skiing injury, which caused intra-articular calcaneal fracture in a young competing skier, a member of the Croatian national ski team. This 14-year-old boy sustained a heel injury while training for giant slalom. There was no fall on the heel or obvious axial force that could have caused this type of calcaneal fracture. The skier had sophisticated equipment and used carving skies. We speculated that, when the skier tried to establish the lost balance during the fall, a violent contraction of triceps muscle occurred. Instead of an injury of a well-protected tuber or Achilles tendon, the strong pulling force of the Achilles tendon was transmitted more distally and anteriorly, generating axial compression force, which caused an intra-articular fracture of the calcaneus bone. Obviously, the existing ski boot did not sufficiently protect the calcaneus bone. We postulate that the calcaneal tuber and Achilles tendon were protected on the expense of the intra-articular calcaneal fracture. Our case warns of the possibility of a serious foot injury in young top skiers in spite of extensive improvement in the ski equipment. Sophisticated carving skis could be a contributing factor to an injury.

  2. Current concepts in the treatment of intra-articular calcaneal fractures: Results of a nationwide survey

    NARCIS (Netherlands)

    T. Schepers (Tim); E.M.M. van Lieshout (Esther); T.M. van Ginhoven (Tessa); M.J. Heetveld (Martin); P. Patka (Peter)

    2008-01-01

    textabstractThe treatment of intra-articular calcaneal fractures is controversial and randomised clinical trials are scarce. Moreover, the socio-economic cost remains unclear. The aim of this study was to estimate the incidence, treatment preferences and socio-economic cost of this complex fracture

  3. Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey

    NARCIS (Netherlands)

    Schepers, T.; van Lieshout, E. M. M.; van Ginhoven, T. M.; Heetveld, M. J.; Patka, P.

    2008-01-01

    The treatment of intra-articular calcaneal fractures is controversial and randomised clinical trials are scarce. Moreover, the socio-economic cost remains unclear. The aim of this study was to estimate the incidence, treatment preferences and socio-economic cost of this complex fracture in the

  4. Conservative Management of Calcaneal Fractures. A Retrospective Review of Treatment Outcome

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    HY Wong

    2008-04-01

    Full Text Available INTRODUCTION: Treatment of calcaneal fracture is still controversial and indication for surgery is not well established. We are reporting the mid term outcome of calcanel fractures treated conservatively. MATERIALS AND METHODS: Patients admitted with calcaneal fractures from 1st November 2002 till 31st December 2004 and were treated conservatively were included in this study. The fractures were grouped according to Essex-Lopresti classification and their outcomes were assessed with the Maryland foot score. We also looked at time to weight bearing and returning to occupational activity. RESULTS: Forty-four patients were included for evaluation. Patients with extraarticular calcaneal fractures had significantly higher rating scores compared to those with intraarticular fractures (98.2 and 88.8 respectively, with a p value = 0.0001. Generally, both group of patients had a good clinical outcome. 18 of the 44 patients (41% started partial weight bearing before or at 6 weeks and 31 patients (72% were able to start full weight bearing by 12 weeks. 31 patients (72% were back to work 12 weeks after the injury. CONCLUSION: Conservative management for calcaneal fractures is an acceptable mode of treatment with satisfactory functional outcome.

  5. Plantar pressure analysis after percutaneous repair of displaced intra-articular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); A. van der Stoep (Arjan); H. van der Avert (Hans); E.M.M. van Lieshout (Esther); P. Patka (Peter)

    2008-01-01

    textabstractBackground: Clinical results for the treatment of displaced intra-articular calcaneal fractures are mainly expressed using disease-specific outcome scores, physical examination and radiographs. We hypothesized that plantar pressure and foot position analysis is a valuable tool in

  6. The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: A systematic review

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2013-01-01

    textabstractIntroduction: The late complications following a displaced intra-articular calcaneal fractures includes painful arthrosis for which a subtalar fusion might be considered. In case of malalignment due to loss of height and varus deformity a reconstructive arthrodesis is necessary. The

  7. Health-related quality of life in trauma patients who sustained a calcaneal fracture

    NARCIS (Netherlands)

    Alexandridis, G.; Gunning, A. C.; Leenen, L. P. H.

    Background Calcaneal fractures are known to cause a considerable long-term disability; disability influences the public health negatively in terms of personal suffering and monetary losses. Health-related quality of life (HRQoL) in general is influenced by various patient-specific factors, and

  8. Radiographic evaluation of calcaneal fractures: To measure or not to measure

    NARCIS (Netherlands)

    T. Schepers (Tim); A.Z. Ginai (Abida); P.G.H. Mulder (Paul); P. Patka (Peter)

    2007-01-01

    textabstractObjective: The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture with plain radiography. Design: The design was a prognostic study of a retrospective cohort with concurrent follow-up. Patients: A total of 33

  9. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2011-01-01

    textabstractPurpose: Although open reduction and internal fixation is currently considered the gold standard in surgical treatment of displaced intra-articular calcaneal fractures, various different approaches exist including the limited lateral approach. The aim of this systematic review was to

  10. The heel of achilles: calcaneal avulsion fracture from a gunshot wound.

    Science.gov (United States)

    Cooper, D E; Heckman, J D

    1989-02-01

    Greek mythology relates that the legendary warrior Achilles was made invincible by his mother Thetis, who dipped him in the River Styx while holding him by his heel. Because his heel was never immersed, it remained his one area of vulnerability. After the fall of Troy, Achilles met his demise when he was shot in the heel by Paris, whose arrow was guided by the Greek god Apollo. This is the derivation of the term "Achilles tendon." Avulsion fractures of the tuberosity of the calcaneus are rare injuries. Schonbauer reviewed a series of 870,000 accident cases treated at the Vienna Trauma Hospital and found only four such cases in addition to 151 cases of subcutaneous Achilles tendon rupture. In Bohler's series of 182 calcaneal fractures, avulsion of the calcaneal tuberosity accounted for less than 1% of these injuries. Rowe reported four Achilles avulsion fractures in his series of 154 calcaneal fractures. Three basic mechanisms of injury have been described: (1) dorsiflexion violence against the maximally plantarflexed foot, typically occurring in a fall from a height; (2) powerful contraction of the triceps surae muscle with simultaneous extension of the knee such as when a person is about to sprint in a race; (3) a direct blunt blow to the hindfoot. We are describing a case of avulsion of the calcaneal tuberosity due to direct penetrating trauma from a gunshot wound, a mechanism not previously reported.

  11. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

    NARCIS (Netherlands)

    Backes, Manouk; Schepers, Tim; Beerekamp, M. Suzan H.; Luitse, Jan S. K.; Goslings, J. Carel; Schep, Niels W. L.

    2014-01-01

    Post-operative wound infections (PWI) following calcaneal fracture surgery can lead to prolonged hospital stay and additional treatment with antibiotics, surgical debridement or implant removal. Our aim was to determine the incidence of superficial and deep PWI and to identify risk factors (RF).

  12. Percutaneous reduction and fixation of intraarticular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); L.M.M. Vogels (Lucas); I.B. Schipper (Inger); P. Patka (Peter)

    2008-01-01

    textabstractObjective: Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to

  13. Calcaneal Fractures in Non-Racing Dogs and Cats: Complications, Outcome, and Associated Risk Factors.

    Science.gov (United States)

    Perry, Karen L; Adams, Robert J; Woods, Samantha; Bruce, Mieghan

    2017-01-01

    To estimate the prevalence of complications and describe the outcome associated with calcaneal fractures in non-racing dogs and in cats. Retrospective multicenter clinical cohort study. Medical records of client-owned dogs and cats (2004-2013). Medical records were searched and 50 animals with calcaneal fractures were included for analysis. Complications were recorded and an outcome score applied to each fracture. Associations between putative risk factors and both major complications, and final outcome scores were explored. Complications occurred in 27/50 fractures (61%) including 23 major and 4 minor complications. At final follow-up, 4 animals (10%) were sound, 27 (64%) had either intermittent or consistent mild weight-bearing lameness, 7 (17%) had moderate weight-bearing lameness, and 1 (2%) had severe weight-bearing lameness. Fractures managed using plates and screws had a lower risk of complications than fractures managed using pin and tension band wire, lag or positional screws or a combination of these techniques (Relative risk 0.16, 95% CI 0.02-1.02, P=.052). Non-sighthounds had reduced odds of a poorer outcome score than sighthounds (Odds ratio 0.11, 95% CI 0.02-0.50, P=.005) and fractures with major complications had 13 times the odds of a poorer outcome score (Odds ratio 13.4, 95% CI 3.6-59.5, Pdogs and in cats, and a poorer outcome score was more likely in animals with complications. A more guarded prognosis should be given to owners of non-racing dogs or cats with calcaneal fractures than previously applied to racing Greyhounds with calcaneal fractures. © 2016 The American College of Veterinary Surgeons.

  14. Percutaneous reduction and fixation of an intra-articular calcaneal fracture using an inflatable bone tamp: description of a novel and safe technique

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    Mauffrey Cyril

    2012-03-01

    Full Text Available Abstract Calcaneal fractures are common injuries involving the hind foot and often a source of significant long-term morbidity. Treatment options have changed throughout the ages from periods of preferred nonoperative management to closed reduction with a mallet, and more recently, open reduction and anatomic internal fixation. The current treatment of choice; however, is often debated, as open management of these fractures carries many risks to include wound breakdown and infection. A less invasive form of surgical management through small incisions, while maintaining the ability to obtain joint congruency, anatomic alignment, and restore calcaneal height and width would be ideal. We propose a novel form of fracture reduction using an inflatable bone tamp and percutaneous fracture fixation. Preoperative planning and experienced fluoroscopy is crucial to successful management using this method. Although we achieved successful radiographic outcome in this case, long-term functional outcome of this technique are yet to be published.

  15. Surgical treatment of sanders type 2 calcaneal fractures using a sinus tarsi approach

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    Chul Hyun Park

    2017-01-01

    Full Text Available Background: Calcaneum is the most commonly fractured tarsal bone. The optimal treatment for displaced calcaneus fractures involving the posterior facet is surgical. The extensile lateral approach is commonly preferred because it provides sufficient exposure of the subtalar facet. However, this technique has the risk of complications such as wound necrosis and sural nerve injury. Various minimally invasive approaches, such as sinus tarsi approach, limited posterior approach, and percutaneous approach, have been introduced to reduce possible complications. This study was prospectively performed to evaluate the results of the sinus tarsi approach for Sanders Type 2 calcaneal fractures using postoperative computed tomography (CT. Materials and Methods: Between October 2012 and December 2013, 20 Sanders Type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach and checked using CT preoperatively, immediately postoperatively, and at 12 months after surgery. Clinical evaluations were performed using the visual analog scale (VAS and the ankle-hindfoot score developed by the American Orthopaedic Foot and Ankle Society (AOFAS. Radiographic evaluations were performed using calcaneus lateral and axial radiographs, hindfoot alignment radiograph, and CT. Changes in Böhler's angles and calcaneal widths were evaluated both preoperatively and at last followup. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT. Results: VAS and AOFAS scores were significantly improved at 1 year after surgery but did not improve further. Böhler's angles and calcaneal widths were significantly improved after surgery. Böhler's angle was significantly smaller at the last followup than immediately after surgery, whereas calcaneal width was maintained. Reduction of the posterior facet was graded excellent in five feet (25%, good in ten (50%, and fair in five (25% on immediately

  16. Absolute fracture-risk prediction by a combination of calcaneal quantitative ultrasound and bone mineral density.

    Science.gov (United States)

    Chan, Mei Y; Nguyen, Nguyen D; Center, Jacqueline R; Eisman, John A; Nguyen, Tuan V

    2012-02-01

    Quantitative ultrasound measurement (QUS) and bone mineral density (BMD) have each been shown to predict fracture risk in women. The present study examined whether a combination of QUS and BMD could improve the predictive accuracy of fracture risk. This is a population-based prospective study which involved 454 women and 445 men aged 62-89 years. Femoral neck BMD (FNBMD) was measured by DXA and calcaneal QUS was measured as broadband ultrasound attenuation (BUA) by a CUBA sonometer. Fragility fracture was ascertained by X-ray reports during the follow-up period, which took place between mid-1989 and 2009. During the follow-up period (median 13 years, range 11-15), 75 men and 154 women sustained a fragility fracture. In women, the model with FNBMD and BUA had a higher AUC compared to that without BUA (0.73 vs. 0.71 for any fracture, 0.81 vs. 0.77 for hip fracture, and 0.72 vs. 0.70 for vertebral fracture). Reclassification analysis yielded a total net reclassification improvement of 7.3%, 11.1%, and 5.2% for any, hip, and vertebral fractures, respectively. For men, the addition of BUA to FNBMD did not improve the predictive power for any, hip, or vertebral fracture. These results suggest that calcaneal QUS is an independent predictor of fracture risk and that a combination of QUS and BMD measurement could improve the predictive accuracy of fracture risk in elderly women.

  17. Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment

    Energy Technology Data Exchange (ETDEWEB)

    Linsenmaier, Ulrich; Schoening, Alexander; Rieger, Johannes; Kroetz, Michael; Pfeifer, Klaus Juergen; Reiser, Maximilian [Department of Radiology, Klinikum der Universitaet Muenchen, Nussbaumstrasse 20, 80336, Munich (Germany); Brunner, Ulrich [Department of Surgery, Klinikum der Universitaet, Nussbaumstrasse 20, 80336, Munich (Germany); Department of Surgery, Krankenhaus Agatharied, St.-Agatha-Strasse 1, 83734, Hausham (Germany); Mutschler, Wolf [Department of Surgery, Klinikum der Universitaet, Nussbaumstrasse 20, 80336, Munich (Germany)

    2003-10-01

    The purpose of this study was to evaluate spiral computed tomography and multislice CT (SCT/MSCT) with multiplanar reconstructions (MPR) in the classification of calcaneal fractures according to a modified CT classification and to quantify fragment displacement to guide surgical treatment. Forty-eight calcaneal fractures were examined by spiral CT (1- to 2-mm slice thickness, pitch=1.5) with multiplanar reconstructions (MPR). Fractures were grouped according to a modified Munich classification scheme, differentiating six categories of fractures by joint involvement, number of fragments in the posterior facet, and the presence and extent of displacement. A qualitative and quantitative statement was made for the presence of clinical relevant displacement of the posterior articular facet (A: >2 mm), widening of the heel (B: crossing fibular reference line), reduction in calcaneal height (C: >10%), and axis shift of the calcaneocuboid angle (D: >10 ). Treatment recommendations resulting from the CT classification were retrospectively compared with the treatment given by examining the patients' files. There were 10 extra-articular and 38 intra-articular fractures; 8 were in class I (extra-articular, nondisplaced), 2 in class II (extra-articular, displaced), 1 in class III (intra-articular, nondisplaced), 20 in class IV (two fragments), 9 in class V (three fragments), and 8 in class VI (>4 fragments), one of the latter being uncertain; 34 showed displacement of the articular facet, 35 widening of the heel, 35 reduction in calcaneal height, and 20 a shift of the axis. In 94% of the cases the procedure recommended by the Munich system of classification was followed; there was disagreement in 1 case in class I and 1 in class IV. Spiral CT allowed fracture classification and quantification of relevant displacement of fragments by radiologists. The implemented recommendations for treatment were adopted by surgeons in most cases. (orig.)

  18. Radiographic evaluation of calcaneal fractures: to measure or not to measure

    Energy Technology Data Exchange (ETDEWEB)

    Schepers, T.; Patka, P. [Erasmus MC, University Medical Centre Rotterdam, Department of General Surgery-Traumatology, Room H-974, P.O. Box 2040, Rotterdam (Netherlands); Ginai, A.Z. [Erasmus MC, University Medical Centre Rotterdam, Department of Radiology, Rotterdam (Netherlands); Mulder, P.G.H. [Erasmus University Rotterdam, Department of Epidemiology and Biostatistics, Rotterdam (Netherlands)

    2007-09-15

    The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture with plain radiography. The design was a prognostic study of a retrospective cohort with concurrent follow-up. A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Patients filled in three disease-specific questionnaires, graded their satisfaction and the indication for an arthrodesis was noted. Standardised radiographs were made of the previously injured side and the normal (control) side. Different angles and distances were measured on these radiographs and compared with values described in the literature. The differences in values in angles and distances between the injured and uninjured (control) foot were correlated with the outcome of the questionnaires, and the indication for an arthrodesis. None of the angles correlated with the disease-specific outcome scores. Of the angles only the tibiotalar angle correlated with the VAS (r = 0.35, p = 0.045) and only the absolute foot height correlated with the indication for an arthrodesis (odds = 0.70, CI = 0.50-0.99). In this study the radiographic evaluation correlated poorly with the final outcome. Measurements on plain radiographs seem not to be useful in determining outcome after intra-articular calcaneal fractures. (orig.)

  19. Correlation between Parameters of Calcaneal Quantitative Ultrasound and Hip Structural Analysis in Osteoporotic Fracture Patients.

    Directory of Open Access Journals (Sweden)

    Licheng Zhang

    Full Text Available Calcaneal quantitative ultrasound (QUS, which is used in the evaluation of osteoporosis, is believed to be intimately associated with the characteristics of the proximal femur. However, the specific associations of calcaneal QUS with characteristics of the hip sub-regions remain unclear.A cross-sectional assessment of 53 osteoporotic patients was performed for the skeletal status of the heel and hip.We prospectively enrolled 53 female osteoporotic patients with femoral fractures. Calcaneal QUS, dual energy X-ray absorptiometry (DXA, and hip structural analysis (HSA were performed for each patient. Femoral heads were obtained during the surgery, and principal compressive trabeculae (PCT were extracted by a three-dimensional printing technique-assisted method. Pearson's correlation between QUS measurement with DXA, HSA-derived parameters and Young's modulus were calculated in order to evaluate the specific association of QUS with the parameters for the hip sub-regions, including the femoral neck, trochanteric and Ward's areas, and the femoral shaft, respectively.Significant correlations were found between estimated BMD (Est.BMD and BMD of different sub-regions of proximal femur. However, the correlation coefficient of trochanteric area (r = 0.356, p = 0.009 was higher than that of the neck area (r = 0.297, p = 0.031 and total proximal femur (r = 0.291, p = 0.034. Furthermore, the quantitative ultrasound index (QUI was significantly correlated with the HSA-derived parameters of the trochanteric area (r value: 0.315-0.356, all p<0.05 as well as with the Young's modulus of PCT from the femoral head (r = 0.589, p<0.001.The calcaneal bone had an intimate association with the trochanteric cancellous bone. To a certain extent, the parameters of the calcaneal QUS can reflect the characteristics of the trochanteric area of the proximal hip, although not specifically reflective of those of the femoral neck or shaft.

  20. Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients

    National Research Council Canada - National Science Library

    Li, Lian-Hua; Guo, Yong-Zhi; Wang, Hao; Sang, Qing-Hua; Zhang, Jian-Zheng; Liu, Zhi; Sun, Tian-Sheng

    2016-01-01

    ... intraarticular calcaneal fractures. Between January 2009 and January 2014, patients with displaced intraarticular calcaneal fracture were randomly assigned to receive surgical treatment by the sinus tarsi approach or the extended...

  1. Spontaneously Healed Pathologic Fracture over a Critical-Size Calcaneal Cyst

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    Nikolaos G. Lasanianos

    2011-01-01

    Full Text Available Simple bone cysts are nonsymptomatic lesions. They typically involve the medullary cavity, but they can also be found in nonlong bones such as the calcaneum. Their treatment remains controversial varying from observation and conservative healing to irritating injections or bone grafting. In the case of a pathologic fracture, surgical treatment seems most appropriate especially when the cyst is situated on a weight-bearing bone. We present herein the rare case of a spontaneously healed pathological fracture over a critical-size calcaneal cyst of a patient reluctant to undergo surgical treatment. An interpretation of the healing procedure as well as a review of the literature is presented.

  2. Bilaretal Complex Regional Pain Syndrome After Bilateral Calcaneal Fractures: Case Report

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    Özcan Hız

    2010-08-01

    Full Text Available Summary Complex regional pain syndrome (CRPS is a painful complication of a fracture, surgery, or other type of injury. Currently KBAS is categorized as CRPS-1 when no clear nerve injury is defined, and CRPS -2 when associated with clear nevre injury. Central and peripheral theory have been reported in etiopathogenesis of CRPS -1. Generally, it occurs in the injured limb but, it may ocur in the opposite extremities. İn this article, we have presented a case developing bilateral CRPS -1 after bilateral calcaneal fracture. (Osteoporoz Dünyasından 2010;16:38-40

  3. IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS

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    N. S. Konovalchuk

    2017-01-01

    Full Text Available Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of

  4. SUBSTANTIATION OF THE NEW METHOD OF CLOSED REDUCTION OF FRACTURE CALCANEUS

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    M. E. Kupitman

    2012-01-01

    Full Text Available The authors presented the results of analysis of surgical treatment 52 patients with calcaneal fractures in the trauma department of Magnitogorsk city hospital N 3 from 2007 to 2009. On the basis of these results a new classification of calcaneal fractures was created, which determined the tactics of closed reduction. The author’s method of minimally invasive reposition in patients with calcaneal fractures n is described. The results of applying this technique in 25 patients were evaluated. According to the authors, the closed reduction technique is simple and can be applied in any trauma department in the presence of X-ray control. This technique has a very good cosmetic results and the small number of postoperative complications.

  5. Outcome Determining Factors for displaced Intra-articular Calcaneal Fractures treated operatively

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    Nawfar SA

    2015-11-01

    Full Text Available Introduction: Calcaneal fractures are caused by high energy trauma and mostly are intra-articular fractures. Nondisplaced intra-articular calcaneal fracture (IACF can be treated non-operatively. However, displaced intra-articular need to be reduced and fixed anatomically to facilitate early ankle rehabilitation and minimize functional impairment. This study was done to find out the outcome of the IACF patients who underwent operative treatment. Methods: 62 patients with IACF were selected in this study and had been followed up from June 2009 to May 2013. They were placed into two groups; the operative treated and non-operative treated groups. Bilateral ankle lateral view plain radiographs were taken for comparison of the Bohler and Gissane angles. Both groups of patients were assessed by the Maryland Foot Score (MFS and the SF-36v2 general health survey questionnaire. The ability of the patients to perform activity of daily living (ADL and /or return to work (RTW was assessed as well. Results: The operative treatment group of displaced IACF patients achieved no significant better scores in the mean MFS and SF-36v2 mean scores as compared to non operated cases. There was no difference in RTW between the 2 groups, but earlier ADL was recorded in the operated group. However, this study had found 5 associated factors which causes major effect to the patients’ outcome to treatment. Conclusions: The patient’s compliance with post-operative rehabilitation regimen were found to be significantly related with the outcomes

  6. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

    LENUS (Irish Health Repository)

    Kennedy, J G

    2012-02-03

    Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

  7. [Manipulative reduction and external fixation with cardboard splint for the treatment of calcaneal fractures: a 60-case report].

    Science.gov (United States)

    Hao, Bo-Chuan; Xie, Ke-Bo

    2014-07-01

    To investigate the therapeutic effects of manipulative reduction for calcaneal fractures. From January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus. All cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor. Manipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.

  8. Ligamentotaxis for complex calcaneal fractures using Joshi′s external stabilization system

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    Singh Ajai

    2008-01-01

    Full Text Available Background: Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi′s external stabilization system (JESS for its efficacy. Materials and Methods: Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition fractures of the calcaneum, who were treated by external fixator (JESS based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9% patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months. Results: Forty-two (93.4% of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4% complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8% patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients. On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity. Conclusion: We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures.

  9. Calcaneal stress fracture: an adverse event following total hip and total knee arthroplasty: a report of five cases.

    Science.gov (United States)

    Miki, Takaaki; Miki, Takahito; Nishiyama, Akihiro

    2014-01-15

    Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the English-language literature. Most orthopaedic surgeons are not familiar with calcaneal stress fractures that may occur in elderly patients after a total knee or total hip arthroplasty. We retrospectively reviewed the clinical features, imaging findings, and bone mineral content of the proximal part of the femur and the distal end of the radius in five patients who had a calcaneal stress fracture after a total knee or total hip arthroplasty. All patients were women with a mean age of 76.8 years. All fractures occurred in the calcaneus on the same side as the arthroplasty. The fracture appeared at a mean of 10.2 weeks postoperatively. All patients reported heel pain on walking. Swelling and local heat were found in four and three patients, respectively. Pain was elicited by squeezing the calcaneus in all patients. Early radiographs had normal findings in two patients, and an irregular sclerotic line appeared later in the radiographs of all patients. All fractures were treated conservatively. Four fractures healed uneventfully, but one fracture displaced. All patients had osteoporosis. Calcaneal stress fractures during the postoperative period following total knee or total hip arthroplasty may not be as rare as previously thought. Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. Magnetic resonance imaging or repeated radiographs may be necessary to make the correct diagnosis when no abnormality is apparent on the initial radiograph.

  10. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

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    Pedro José Labronici

    2016-04-01

    Full Text Available OBJECTIVE: To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. METHOD: 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. RESULTS: All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2 were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. CONCLUSION: The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

  11. Effects of intra-operative fluoroscopic 3D-imaging on peri-operative imaging strategy in calcaneal fracture surgery

    NARCIS (Netherlands)

    M.S.H. Beerekamp (Suzan); Backes, M. (M.); N.W.L. Schep (Niels); D.T. Ubbink (Dirk); J.S.K. Luitse; T. Schepers (Tim); J.C. Goslings (Carel)

    2017-01-01

    textabstractIntroduction: Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby

  12. Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture : A systematic review

    NARCIS (Netherlands)

    Alexandridis, G.; Gunning, A. C.; Leenen, L. P H

    2015-01-01

    Background: A displaced intra-articular calcaneal fracture (DIACF) is known for having a negative influence on the daily activities of patients. A health-related quality of life (HRQoL) outcome instrument is used to quantify the impact of DIACF. It seems that these studies used restrictive inclusion

  13. Complications following the extended lateral approach for calcaneal fractures do not influence mid- to long-term outcome.

    NARCIS (Netherlands)

    Groot, R. de; Frima, A.J.; Schepers, T.; Roerdink, W.H.

    2013-01-01

    BACKGROUND AND AIM: Open reduction and internal fixation (ORIF) of intra-articular calcaneal fractures through an extended lateral approach is frequently accompanied by a high complication rate. However, ORIF currently provides the best long-term clinical results. The aim of this study was twofold:

  14. Functional Outcome and Patient Satisfaction after Displaced Intra-articular Calcaneal Fractures: A Comparison Among Open, Percutaneous, and Nonoperative Treatment

    NARCIS (Netherlands)

    A.S. de Boer (Annette ); E.M.M. van Lieshout (Esther); D. den Hartog (Dennis); B. Weerts (Bas); M.H.J. Verhofstad (Michiel); T. Schepers (Tim)

    2014-01-01

    textabstractThe aim of the present study was to compare the outcomes of patients with a displaced calcaneal fracture treated by open reduction and internal fixation (ORIF), percutaneous treatment, or nonoperative methods. A retrospective cohort study was conducted at a level I trauma center of

  15. Extended Lateral Approach for Intra-articular Calcaneal Fractures: An Inverse Relationship between Surgeon Experience and Wound Complications

    NARCIS (Netherlands)

    T. Schepers (Tim); D. den Hartog (Dennis); L.M.M. Vogels (Lucas); E.M.M. van Lieshout (Esther)

    2013-01-01

    textabstractThe current reference standard for the treatment of displaced intra-articular calcaneal fractures is open reduction and internal fixation using an extended lateral approach. In the present retrospective study, we evaluated the results of a consecutive series of patients treated in the

  16. Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study.

    Science.gov (United States)

    Chen, Ching-Hsuan; Hung, Chinghua; Hsu, Yu-Chun; Chen, Chen-Sheng; Chiang, Chao-Ching

    2017-10-01

    Calcaneal fractures are the most common fractures of the tarsal bones. The stability of fixation is an important factor for successful reconstruction of calcaneal fractures. The purpose of this study was to analyze the biomechanical influence of plate fixation with different combinations of locking and nonlocking screws during early weight-bearing phase. A three-dimensional FE foot model was established using ANSYS software, which comprised bones, cartilages, plantar fascia, and soft tissue. Calcaneal plate was fixed with whole locking (WLS), whole nonlocking (WNS), and hybrid screw configurations for FE analysis. The WNS generated a 6.1° and 2.2° Bohler angle decrease compared with the intact model and WLS (WNS: 18.9; WLS: 21.1; intact: 25.0°). Some hybrid screw configurations (Bohler angle: 21.5° and 21.2°) generated stability similar to WLS. The FE results showed that the fragments at the posterior facet and the posterior tuberosity sustained more stress. This study recommends that the hybrid screw configuration with at least four locking screws, two at the posterior facet fragment and two at the posterior tuberosity fragment, is the optimal choice for the fixation of Sanders type IIB calcaneal fractures.

  17. The surgical dilemma of the malunited calcaneal joint depression fracture: the VAMC Miami experience.

    Science.gov (United States)

    Cohen, M

    1996-01-01

    During the period of October 1985 through March 1995, 25 patients presented to the Veterans Affairs Medical Center, Miami with a chief complaint of chronic pain status post calcaneal joint depression fracture. Their acute injury was treated conservatively at this and various other institutions. Nine patients were managed conservatively with orthotics, University of California Biomechanics Laboratory braces (UCBLs), shoe modification, or prosthetics. Sixteen patients underwent hindfoot fusions. Good to excellent results were obtained in 15 of the 16 fusions. The remaining patient, having an isolated subtalar fusion, was later diagnosed with multiple sclerosis. Proper evaluation of the chronic pain patient is critical when mapping out an appropriate treatment plan. Hindfoot arthrodesis with soft tissue decompression is a successful tool in eliminating chronic pain due to malunited depression fractures.

  18. Operative treatment of calcaneal fractures: improved outcomes and low complications rates with a strict management protocol.

    Science.gov (United States)

    Vasukutty, N; Kumar, V; Diab, M; Moussa, W

    2017-04-01

    This is a retrospective review of 80 intra-articular calcaneal fractures treated with open reduction and internal fixation by a specialist team under supervision of a single surgeon in a tertiary centre between 2005 and 2014. The fractures were evaluated with plain radiography and computed tomography, and graded using the Eastwood-Atkins classification. A lateral approach was used and all fractures were fixed with calcaneal plates. All patients had clinical and radiological follow-up. Clinical assessment included foot and ankle disability index, SF-36 ® and Kerr-Atkins scores. The mean follow-up duration was 72 months (range: 12-130 months). The mean age of patients was 49 years (range: 17-73 years). There were three open fractures and eight patients had other injuries. The mean Bohler's angle improved from 6° preoperatively to 26° postoperatively. The mean foot and ankle disability index score was 78.62, the mean SF-36 ® scores were 45.5 (physical component) and 52.6 (mental component), and the mean Kerr-Atkins score was 72 (range: 36-100). Early complications included one case of screw protrusion in the subtalar joint (which warranted a repeat procedure), one sural nerve injury and one wound breakdown, which healed with non-operative measures. Twelve patients had symptomatic subtalar joint osteoarthritis. Four of these had subtalar fusion. We believe that our strict protocols of patient selection, intraoperative and postoperative management produced long-term results comparable with those in the peer reviewed literature.

  19. Cement Calcaneoplasty: An Innovative Method for Treating Nonunion in Calcaneal Insufficiency Fracture.

    Science.gov (United States)

    Godavitarne, Charles; Fawzy, Ernest; Giancola, Giorgio; Louette, Luc

    2016-01-01

    Insufficiency type stress fractures are common in older patients with osteoporosis. Persistent pain after nonunion of these fractures can be disabling, with the management options often limited. We aimed to assess the suitability of fluoroscopic-guided injection of bone cement into a persistently symptomatic nonuniting calcaneal insufficiency fracture. To the best of our knowledge, this technique has not previously been described in the published data. After local subcutaneous anesthesia, the midpoint of the fracture site was accessed by trocar insertion under radiographic guidance, and bone cement was injected directly into the site. A preprocedure visual analog scale pain score of 90 of 100 was recorded. This had improved to 0 of 100 at the 12-month follow-up point after the procedure. The aim of the present case report was to raise awareness of percutaneous calcaneoplasty, which we believe to be a safe and well-tolerated technique for the management of osteoporotic insufficiency fracture of the calcaneus. We propose that this technique be considered when conservative methods aimed at promoting fracture healing have failed. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  20. [Positions of Sustentacular Screw in Osteosynthesis of Calcaneal Fractures: Clinical and Radiographic Study].

    Science.gov (United States)

    Pazour, J; Křivohlávek, M; Lukáš, R

    2016-01-01

    talocalcaneal joint. Therefore, it will be useful to seek methods allowing for safer screw insertion and elimination of risks associated with screw misplacement. The technique of sustentacular screw insertion by means of a compression-based device, described by the authors, designated to allow for screw placement in distal humerus fractures is one of the options. CONCLUSIONS Optimisation of techniques for sustentacular screw insertion in the osteosynthesis of calcaneal fractures should contribute to reduction of risks related to screw malposition. The assessment of effects which the position of a screw may have on delayed failure of fracture reduction should be based on a thorough biomechanical study. sustentacular screw, calcaneal fracture, insertion, malposition.

  1. Surgical Management of Calcaneal Malunion

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    Guang-Rong Yu

    2013-06-01

    Full Text Available Calcaneal malunion is a common complication after conservative treatment or incorrect surgical treatment of calcaneal fracture. The typical pathoanatomies of calcaneal malunion are subtalar joint incongruity, loss of calcaneal height, arch collapse, varus or valgus deformity of the calcaneus, heel widening and so on. Calcaneal malunion often needs to be treated surgically. The classification of calcaneal malunion and the detailed clinical and radiographical assessment play important roles for surgical option. The main surgical methods include in situ subtalar arthrodesis, reconstruction of calcaneal thalamus and subtalar arthrodesis, calcaneal osteotomy with subtalar arthrodesis, corrective calcaneal osteotomy without subtalar arthrodesis. Each option has its different indications, advantages and disadvantages. Thus, the surgical treatment should be individualised.

  2. Comparison of the Conventional Surgery and the Surgery Assisted by 3d Printing Technology in the Treatment of Calcaneal Fractures.

    Science.gov (United States)

    Zheng, Wenhao; Tao, Zhenyu; Lou, Yiting; Feng, Zhenhua; Li, Hang; Cheng, Liang; Zhang, Hui; Wang, Jianshun; Guo, Xiaoshan; Chen, Hua

    2017-09-19

    This study was aimed to compare conventional surgery and surgery assisted by 3D printing technology in the treatment of calcaneal fractures. In addition, we also investigated the effect of 3D printing technology on the communication between doctors and patients. we enrolled 75 patients with calcaneal fracture from April 2014 to August 2016. They were divided randomly into two groups: 35 cases of 3D printing group, 40 cases of conventional group. The individual models were used to simulate the surgical procedures and carry out the surgery according to plan in 3D printing group. Operation duration, blood loss volume during the surgery, number of intraoperative fluoroscopy and fracture union time were recorded. The radiographic outcomes Böhler angle, Gissane angle, calcaneal width and calcaneal height and final functional outcomes including VAS and AOFAS score as well as the complications were also evaluated. Besides, we made a simple questionnaire to verify the effectiveness of the 3D-printed model for both doctors and patients. The operation duration, blood loss volume and number of intraoperative fluoroscopy for 3D printing group was 71.4 ± 6.8 minutes, 226.1 ± 22.6 ml and 5.6 ± 1.9 times, and for conventional group was 91.3 ± 11.2 minutes, 288.7 ± 34.8 ml and 8.6 ± 2.7 times respectively. There was statistically significant difference between the conventional group and 3D printing group (p 3D printing group achieved significantly better radiographic results than conventional group both postoperatively and at the final follow-up (p 3D printing model. This study suggested the clinical feasibility of 3D printing technology in treatment of calcaneal fractures.

  3. Percutaneous poking reduction and fixation versus open reduction and fixation in the treatment of displaced calcaneal fractures for Chinese patients: A systematic review and meta-analysis

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    Xiao-Jian Wang

    2016-12-01

    Conclusion: For the treatment of calcaneal fractures, percutaneous poking reduction and fixation is superior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.

  4. Effect of Intraoperative Three-Dimensional Imaging During the Reduction and Fixation of Displaced Calcaneal Fractures on Articular Congruence and Implant Fixation

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Marianne

    2015-01-01

    BACKGROUND: Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures......, resulting in improved articular congruence and implant positioning. METHOD: Sixty-two displaced calcaneal fractures were operated on using standard fluoroscopic views. When the surgeon had achieved a satisfactory reduction, an intraoperative 3D scan was conducted, malreductions or implant imperfections were......: Intraoperative 3D imaging improved the articular reduction of the posterior facet and secured optimal implant position in displaced calcaneal fractures. Radiation dose to the patient was less than that of a normal foot computed tomography scan. LEVEL OF EVIDENCE: Level IV, case series....

  5. Subtalar arthrodesis for late sequelae of calcaneal fractures: fusion in situ versus fusion with sliding corrective osteotomy.

    Science.gov (United States)

    Huang, P J; Fu, Y C; Cheng, Y M; Lin, S Y

    1999-03-01

    Primary subtalar arthritis is not common. In most cases, it is the late sequela of intra-articular calcaneal fracture. Subtalar arthrodesis is mostly used for the treatment of traumatic subtalar arthritis in our clinics. We have compared our early cases of in-situ subtalar fusion with our recent cases of fusion with sliding corrective osteotomy in this clinical report. From 1989 to 1992, 15 feet of 13 patients were treated with subtalar arthrodeses for subtalar arthritis caused by malunion of calcaneal fractures. Fusion in situ was done by Ollier's approach, and resection of bony protrusion was done if there was lateral entrapment syndrome. From 1992 to 1995, 13 feet of 12 patients also received subtalar arthrodeses to salvage their calcaneal fractures, but the subtalar fusion was done by wide lateral approach, calcaneal sliding corrective osteotomy, and sometimes (11 of 13 feet) with Achilles tendon lengthening to restore the calcaneal height and width. Patients of both groups experienced obvious clinical improvement in subtalar pain relief, but there was no difference with walking distance, running, or jumping. The group undergoing fusion with sliding corrective osteotomy was more satisfied with regard to cosmetic results and shoe wear. The overall satisfactory rate in the group who underwent fusion with sliding corrective osteotomy (92%) was superior to the group who underwent fusion in situ (77%). Though our method of sliding corrective osteotomy does not provide much improvement to the talus declination angle, it is suitable for those patients with a "banana"-shaped calcaneus malunion. If the patient has prominent anterior ankle pain caused by tibiotalar impingement, we believe that a distraction subtalar arthrodesis would be more appropriate.

  6. Diagnosis and classification of calcaneal fractures in computed tomography; Diagnostik und Klassifikation von Kalkaneusfrakturen in der Computertomographie

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    Herold, T.; Grabbe, E.; Funke, M. [Klinikum der Georg-August-Univ. Goettingen (Germany). Abt. Diagnostische Radiologie; Folwaczny, E.K.; Stuermer, K.M. [Klinikum der Georg-August-Univ. Goettingen (Germany). Klinik fuer Unfall-, Plastische und Wiederherstellungschirurgie

    2004-09-01

    Purpose: To compare image quality of single-slice spiral CT (SSCT) and multislice spiral CT (MSCT) in the diagnosis and classification of calcaneal fractures and to present a rapid and precise algorithm for the classification system of Stuermer. Materials and Methods: In 102 patients with 124 calcaneal fractures, spiral CT was performed, in 82 cases as SSCT with a slice thickness (SD) of 3 mm, a table speed (TS) of 3-4 mm/rot and an increment of 1.5 mm. In 42 cases, patients were scanned using MSCT (SD of 1.25 mm, increment 0.8 mm). For these examinations, 2 different scan protocols were used, with a TS of 3.75 mm/rot in one group(n=21) and a TS of 7.5 mm/rot in the other group (n=21). The image quality of axial sections and reconstructed images was assessed on a scale from 1 to 5 (1=very good; 5=insufficient). The fractures were evaluated using a classification system according to Stuermer, which assigns three main groups (A/B/C) and three subtypes (1/2/3). Results: MSCT had substantial advantages over SSCT with respect to scan time and image quality, especially for multiplanar reformatting (median 1.5 versus 4.0). TS showed no significant influence on the image quality. The standardized evaluation of the images enabled a classification of fractures within 5 minutes. All fractures could be assigned to the different types and subtypes. This classification system takes into account the severity of the fracture and the therapeutic approach. The most common type (90 of 124 fractures) were 'joint depression' fractures (type C), which were treated by surgery in 92%. Type A fractures were treated conservatively in 72%. (orig.)

  7. Treatment of displaced intraarticular calcaneal fractures with or without bone grafts: A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Yunfeng Yang

    2012-01-01

    Full Text Available Background: The necessity of bone grafts in the treatment of intraarticular calcaneal fractures continues to be one of the most debated topics in foot and ankle surgery. The purpose of this study was to determine whether there are sufficient objective cumulative data in the literature to compare the two methods and if the bone graft was needed in surgical treatment of intraarticular calcaneal fractures. Materials and Methods: A comprehensive search of all relevant articles from 1990 to 2010 was conducted. Two reviewers evaluated each study to determine its suitability for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two treatment methods. Results: The systematic review identified 32 primary studies with 1281 fractures, which contained 4 comparative studies, 13 with bone grafts, and 15 without bone grafts in treatment methods. The infection rate in bone graft group was higher through statistically insignificant than in non-graft group (8.3% vs. 6.3% No significant difference was found between good reduction rate, postoperative osteoarthritis rate, and subtalar fusion rate. The average full weight-bearing time in bone graft group was significantly lower (5.4 months than in non-graft group (10.5 months. The mean postoperative Böhler′s angle was significantly higher in bone graft group (lose due to collapse was significancy less. For the efficacy outcomes, the bone graft group had a lower American Orthopaedic Foot and Ankle Society Score (AOFAS (71.4 points vs. 80.5 points but a higher Creighton score (89.9 points vs. 81.0 points compared with non-graft group. Pooled mean results showed 35% of the patients in bone graft group had an excellent result, 40% had a good result, 21% had a fair result, and 4% had a poor result. In the non-graft group, the corresponding values were 34, 42, 14, and 10%, respectively. Conclusions: The operative treatment of intraarticular

  8. The fate of Bohler's angle in conservatively-treated displaced intra-articular calcaneal fractures

    NARCIS (Netherlands)

    Bakker, Berdine; Halm, Jens A.; van Lieshout, Esther M. M.; Schepers, Tim

    2012-01-01

    Purpose Although the predictive value of Bohler's angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Bohler's angle during follow-up are frequently reported following surgical treatment of displaced intra-articular calcaneal

  9. Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Missa Takasaka

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. METHODS: This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1 open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2 open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3 open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. RESULTS: Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. CONCLUSION: Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeon's experience with the surgical technique chosen.

  10. The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study.

    Science.gov (United States)

    Esmaeilzadeh, Sina; Cesme, Fatih; Oral, Aydan; Yaliman, Ayse; Sindel, Dilsad

    2016-08-01

    Dual-energy X-ray absorptiometry (DXA) is considered the "gold standard" in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case-control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX® (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. This case-control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX® 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. While all DXA BMD, and QUS variables and FRAX® fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX® major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. It can be concluded that QUS variables, particularly BUA, and FRAX® major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures.

  11. Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion: longitudinal approach versus sinus tarsi approach.

    Science.gov (United States)

    Zhang, Tao; Su, Yanling; Chen, Wei; Zhang, Qi; Wu, Zhanpo; Zhang, Yingze

    2014-02-19

    The optimal treatment for displaced intra-articular fractures of the calcaneus remains controversial. This study aims to assess the clinical outcomes of a minimally invasive longitudinal approach compared with the sinus tarsi approach in the surgical treatment of these fractures. Patients with a displaced intra-articular fracture of the calcaneus who were admitted to the trauma center of our hospital from September 2009 through April 2010 were randomly assigned to treatment using one of these two surgical techniques. All patients underwent the same standardized postoperative rehabilitation protocol. Functional outcome was assessed by using the American Orthopaedic Foot & Ankle Society scores. Linear regression analysis was performed to identify the potential influencing factors for functional outcomes. One hundred and sixty-seven patients who met the inclusion criteria were included in the study. Thirty-seven patients were lost to follow-up for various reasons, and the remaining 130 patients were followed for an average of twenty-seven months. Sixty-nine fractures in sixty-three patients were treated using a minimally invasive longitudinal approach (the MILA group), and seventy-two feet in sixty-seven patients were treated with a sinus tarsi approach (the STA group). The two groups were comparable in terms of age, sex, fracture type, and time from injury to operation. The operative time in the MILA group was significantly shorter than that in STA group (p 0.05). The good and excellent results in the two groups were comparable for the Sanders type-II and III calcaneal fractures (p > 0.05), but the good to excellent rate in the STA group was significantly higher for the Sanders type-IV fractures (p influence on functional outcomes. Outcomes are similar for the minimally invasive longitudinal and sinus tarsi surgical approaches in the treatment of Sanders type-II and III displaced intra-articular fractures of the calcaneus, with the benefit of a lower complication

  12. Effects of intra-operative fluoroscopic 3D-imaging on peri-operative imaging strategy in calcaneal fracture surgery.

    Science.gov (United States)

    Beerekamp, M S H; Backes, M; Schep, N W L; Ubbink, D T; Luitse, J S; Schepers, T; Goslings, J C

    2017-12-01

    Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby neglecting corrections after intra-operative fluoroscopic 2D-imaging (2D-imaging). The aim of this study was to assess the effects of additional 3D-imaging on intra-operative corrections, peri-operative imaging used, and patient-relevant outcomes compared to 2D-imaging alone. In this before-after study, data of adult patients who underwent open reduction and internal fixation (ORIF) of a calcaneal fracture between 2000 and 2014 in our level-I Trauma center were collected. 3D-imaging (BV Pulsera with 3D-RX, Philips Healthcare, Best, The Netherlands) was available as of 2007 at the surgeons' discretion. Patient and fracture characteristics, peri-operative imaging, intra-operative corrections and patient-relevant outcomes were collected from the hospital databases. Patients in whom additional 3D-imaging was applied were compared to those undergoing 2D-imaging alone. A total of 231 patients were included of whom 107 (46%) were operated with the use of 3D-imaging. No significant differences were found in baseline characteristics. The median duration of surgery was significantly longer when using 3D-imaging (2:08 vs. 1:54 h; p = 0.002). Corrections after additional 3D-imaging were performed in 53% of the patients. However, significantly fewer corrections were made after 2D-imaging when 3D-imaging was available (Risk difference (RD) -15%; 95% Confidence interval (CI) -29 to -2). Peri-operative imaging, besides intra-operative 3D-imaging, and patient-relevant outcomes were similar between groups. Intra-operative 3D-imaging provides additional information resulting in additional corrections. Moreover, 3D-imaging probably changed the surgeons' attitude to rely more on 3D-imaging, hence a 15%-decrease of

  13. Minimally Invasive Sinus Tarsi Approach With Cannulated Screw Fixation Combined With Vacuum-Assisted Closure for Treatment of Severe Open Calcaneal Fractures With Medial Wounds.

    Science.gov (United States)

    Zhang, Taiyuan; Yan, Yan; Xie, Xinmin; Mu, Weidong

    2016-01-01

    The aim of our prospective study was to investigate the clinical results and advantages of a minimally invasive sinus tarsi approach with cannulated screw fixation combined with vacuum-assisted closure for the treatment of severe open calcaneal fractures with medial wounds. A total of 31 patients (32 feet) with open calcaneal fractures who were admitted to our hospital from January 2008 to May 2013 were selected for the study and randomly divided into 2 groups: the cannulated screw group (n = 16 patients, 16 feet) and the plate group (n = 15 patients, 16 feet). The Böhler and Gissane angles were compared before and after surgery. The clinical results were evaluated using according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the rate of infection. The follow-up duration for all patients ranged from 10 to 36 (mean 24) months. No statistically significant differences were found in the radiologic indicators, incidence of early postoperative complications, or American Orthopaedic Foot and Ankle Society ankle-hindfoot scores (p > .05) between the 2 groups. However, a statistically significant difference was seen in the duration of hospitalization (p vacuum-assisted closure is an effective method for the treatment of severe open calcaneal fractures with medial wounds. It provides good reduction and requires fewer days of hospitalization. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures.

    Science.gov (United States)

    Zhou, Hai-Chao; Yu, Tao; Ren, Hao-Yang; Li, Bing; Chen, Kai; Zhao, You-Guang; Yang, Yun-Feng

    2017-02-01

    To study and compare the clinical outcomes of open reduction and internal fixation via extensile L-shape incision and limited open reduction via the sinus tarsi approach using the medial distraction technique for intra-articular calcaneal fractures. We performed a retrospective review of 65 intra-articular calcaneal fractures treated operatively between March 2012 and February 2015. Patients were divided into two groups: 28 were in the sinus tarsi approach group and 37 were in the extensile lateral approach group. All patients were asked to return for a research visit that included radiography and clinical evaluation. The postoperative function was evaluated using the ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and the visual analogue scale (VAS). No significant difference was found in demographics between the two groups. The corrected value of the calcaneal varus angle between the two groups is statistically significant (P approach group had developed hindfoot varus deformity at last follow-up. At the last follow-up, the average AOFAS ankle and the hindfoot score of the minimal group was 88.4 ± 6.6, and the VAS score was 1.9 ± 0.7, while that of the extensile lateral approach group was 83.2 ± 5.6 and 2.3 ± 1.0, respectively. Limited open reduction via the sinus tarsi approach for intra-articular calcaneal fractures could reduce the incidence of wound complications effectively, and the medial distraction technique is helpful for correcting the calcaneus varus deformity. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  15. Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance

    Energy Technology Data Exchange (ETDEWEB)

    Guyer, B.H.; Levinsohn, E.M.; Fredrickson, B.E.; Bailey, G.L.; Formikell, M.

    1985-11-01

    Eighteen CT examinations were performed in 10 patients for the evaluation of acute intraarticular fractures and their follow-up. Fractures comparable to those in the patients were created in cadavers. The normal anatomy and the traumatically altered anatomy of the calcaneus in the axial, coronal, and sagittal planes are demonstrated by CT and corresponding anatomic sections. Scanning was performed in the axial plane, with subsequent reconstruction in the coronal and sagittal planes. The axial scans show disruption of the inferior part of the posterior facet, calcaneocuboid joint involvement, and widening of the calcaneus. The coronal scans show disruption of the superior part of the posterior facet, sustentaculum tali depression (involvement of middle and anterior facets), peroneal and flexor hallucis longus tendon impingement, and widening and height loss of the calcaneus. The sagittal scans show disruption of the posterior facet, calcaneocuboid joint involvement, and height loss of the calcaneus and allow the evaluation of Boehler's and Gissane's angles. All three planes show the position of major fracture fragments. Radiation dose to the foot was measured to be 0.1 rad (0.001 Gy) for plain film radiography (five exposures), 18 rad (0.18 Gy) for conventional tomography (20 cuts), and 2.6 rad (0.026 Gy) for axial CT examination.

  16. Operative results of closed tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    Mathur Hitin

    2005-01-01

    Full Text Available Background: Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. Comparison of operative results in recent reports has been difficult due to a lack of standard fracture classification scheme and uniform standardized objective criteria for evaluating results. Methods: Between August 1998 to December 2002, 27 closed tibial plateau fractures were treated operatively using methods and principles advocated by AO/ASIF and followed up for an average of 35.74 months (range 24-68 months. Fractures were classified according to Schatzker′s staging system and results evaluated using Rasmussen′s 30-point clinical grading system and Rasmussen′s radiological evaluation of the knee at a minimum follow up of 2 years. Results: Type II was the most common fracture type (9 cases followed by type I (6 cases. There were 37% excellent and 51.85% good functional results with only 3 patients having unacceptable results. The mean Rasmussen′s functional score was 25.062 (range 15-30. Minimal fixation in comminuted or depressed fractures as compared to rigid fixation was the cause of unacceptable results. Loss of knee range of motion in a few cases was attributed to delayed knee mobilization in these cases. Using Rasmussen′s radiological grading, 2 patients had excellent results and 81.48 % patients had good results. Only 3 patients had poor radiological results. The mean Rasmussen′s radiological score was 15.33 (range 10-18. Moreover, clinical evaluation did not correlate with the follow up radiograph. Conclusion: Anatomic reduction and rigid internal fixation followed by early knee motion and partial weight bearing during bone healing are the cornerstones in the treatment of tibial plateau fractures. Standard fracture classification, uniform reporting and evaluating criteria, along with detailed analysis of uniform treatment methods, has helped us

  17. Fracture union in closed interlocking nail in humeral shaft fractures.

    Science.gov (United States)

    Sahu, Ramji Lal; Ranjan, Rajni; Lal, Ajay

    2015-06-05

    Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Out of 78 patients, 69 patients underwent union in 90-150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  18. Fracture Union in Closed Interlocking Nail in Femoral Fracture

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    R L Sahu

    2010-09-01

    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  19. Calcaneal nonunion: Three cases and a review of the literature

    NARCIS (Netherlands)

    T. Schepers (Tim); P. Patka (Peter)

    2008-01-01

    textabstractThe long-term follow-up of intra-articular calcaneal fractures is often accompanied by complications. Frequently occurring are arthrosis, arthrofibrosis of the subtalar joint, and malunion. Uncommon is the calcaneal nonunion. A total of three cases is presented in this report, including

  20. Outcomes of The Isolated Closed Tibial Shaft Fractures Treated Nonsurgically

    OpenAIRE

    Dawood Jafari; Pouya Nozarnejad

    2011-01-01

    Background: Fractures of the tibia are important for their commonness and controversy in their management. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization.The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures.Me...

  1. Measurement technique of calcaneal varus from axial view radiograph

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    Thossart Harnroongroj

    2015-01-01

    Full Text Available Background: Medial displaced posterior calcaneal tubercle creates varus deformity of an intraarticular calcaneal fracture. The fracture involves posterior calcaneal facet and the calcaneal body so we developed a measurement technique representing the angle between posterior facet and long axis of calcaneus using lateral malleolus and longitudinal bone trabeculae of posterior calcaneal tubercle as references to obtain calcaneal varus angle. Materials and Methods: 52 axial view calcaneal radiographs of 26 volunteers were studied. Angles between posterior facet and long axis of calcaneus were measured using the measurements 1 and 2. Angle of measurement 1, as gold standard, was obtained from long axis and posterior facet of calcaneus whereas measurement 2 was obtained from a line, perpendicular to apex curve of lateral cortex of the lateral malleolus and a line parallel to the longitudinal bone trabeculae of posterior calcaneal tubercle. No more than 3° of difference in the angle of both measurements was accepted. Reliability of the measurement 2 was statistically tested. Results: Angles of measurement 1 and 2 were 90.04° ± 4.00° and 90.58° ± 3.78°. Mean of different degrees of both measurements was 0.54° ± 2.31° with 95% of confidence interval: 0.10°-1.88°. The statistical analysis of measurement 1 and 2 showed more than 0.75 of ICC and 0.826 of Pearson correlation coefficient. Conclusion: Technique of measurement 2 using lateral malleolus and longitudinal bone trabeculae of posterior calcaneal tubercle as references has strong reliability for representing the angle between long axis and posterior facet of calcaneus to achieve calcaneal varus angle.

  2. Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients.

    Science.gov (United States)

    Li, Lian-Hua; Guo, Yong-Zhi; Wang, Hao; Sang, Qing-Hua; Zhang, Jian-Zheng; Liu, Zhi; Sun, Tian-Sheng

    2016-09-01

    We conducted a prospective randomized clinical trial to compare the clinical and radiological outcomes of the sinus tarsi and extended lateral approaches for the surgical treatment of displaced intraarticular calcaneal fractures. Between January 2009 and January 2014, patients with displaced intraarticular calcaneal fracture were randomly assigned to receive surgical treatment by the sinus tarsi approach or the extended lateral approach using block randomization. We recorded and analyzed data on demographics, time to surgery, wound complications, Böhler angles pre- and postoperatively, and American Orthopedic Foot & Ankle Society score. Sixty-four patients met the inclusion criteria and were randomly assigned to the 2 groups: 32 patients underwent sinus tarsi approach, and 32 patients the extended lateral approach. Baseline characteristics of both groups were similar. The time to surgery in the sinus tarsi approach group was significantly shorter than in the extended lateral approach group (P = 0.04). The wound complication rates were 6.3% and 31.2% in the sinus tarsi approach and extended lateral approach groups, respectively, which was significantly different (P = 0.01). Regarding the clinical outcomes, the groups did not differ significantly on walking visual analogue scale or American Orthopedic Foot & Ankle Society scores at 6 months and 1 year postoperatively. No significant differences existed between groups regarding the Böhler angle at different times and reduction quality of the articular surface and the medial wall. Compared with the extended lateral approach, the sinus tarsi approach decreased wound complications and preoperative waiting time, and achieved similar functional and radiological outcomes for displaced intraarticular calcaneal fractures.

  3. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Ramji Lal Sahu

    2015-01-01

    Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  4. Evaluation of the normal calcaneal angles in Egyptian population ...

    African Journals Online (AJOL)

    Introduction: The calcaneus is the largest and strongest tarsal bone. It is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. The importance of the calcaneal angles in assessing the fractures of calcaneus and planning treatment has been highlighted. Aim: The purpose of this study was to ...

  5. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial.

    Science.gov (United States)

    Feng, Yongzeng; Shui, Xiaolong; Wang, Jianshun; Cai, Leyi; Yu, Yang; Ying, Xiaozhou; Kong, Jianzhong; Hong, Jianjun

    2016-07-15

    The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC (N = 42) or MISTA (N = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded. The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group (p < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group (p < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group (p < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures (p < 0.05). The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own

  6. Calcaneal varus angle change in normal calcaneus: a three-dimensional finite element analysis.

    Science.gov (United States)

    Zhang, Xue-Bin; Wu, Hao; Zhang, Li-Guo; Zhao, Ji-Tang; Zhang, Ying-Ze

    2017-03-01

    The objective of the study was to investigate the stress changes in the posterior articular surface of the calcaneus following alternation of the calcaneal varus angle in normal calcaneus and discuss the clinical significance of the calcaneal varus angle. Axial view radiographs of 165 volunteers were obtained to measure the calcaneal varus angle of normal calcaneus. A calcaneal model with different varus angle changes (including +2°, +4°, +6°, -2°, -4°, and -6°) was established using Creo 2.0 software. Stress changes at different calcaneal varus angles in the posterior articular surface of the calcaneus under a load of 100 N were measured. Stressed areas in posterior articular facets were slightly fewer following +2°, +4°, and +6° changes in varus angle than in normal varus angles with stress concentering regions moving to the anteromedial aspect of the posterior calcaneal facet. However, stress concentering areas in posterior calcaneal facets following -4° and -6° changes in varus angle obviously moved to the anterior and posterior medial side of posterior calcaneal facets. Stress distribution in the posterior articular surface of the calcaneus varies with the calcaneal varus angle. The decrease in calcaneal varus angle following operative treatment of calcaneal fractures should be controlled within 2°.

  7. Ulnar nerve palsy after closed forearm fracture: a case report

    Directory of Open Access Journals (Sweden)

    Levent Kucuk

    2012-04-01

    Full Text Available Closed double bone forearm fractures are among the most common fractures of childhood. These fractures often heal without problems with closed reduction and casting. The leading complications are known as malunion and compartment syndrome. The reports about nerve injuries related with these fractures are very limited. We present an eight years old boy who admitted to our hospital with ulnar nerve palsy symptomps three months after his initial trauma. His initial trauma was a simple fall which caused radius and ulna fractures. Radiological assessment showed proper union of the fractures. We performed surgical exploration to the ulnar nerve. We found a trapped and damaged nerve in the fracture region. Even though the rate of complications about nerve injuries are extremely rare in forearm fractures, neurologic examinations should be performed before and after the reduction maneuvers. Neurologic examination will be not only a guide for fracture management but also an important point for medicolegal problems. [Hand Microsurg 2012; 1(1.000: 30-32

  8. Particle Swarms in Fractures: Open Versus Partially Closed Systems

    Science.gov (United States)

    Boomsma, E.; Pyrak-Nolte, L. J.

    2014-12-01

    In the field, fractures may be isolated or connected to fluid reservoirs anywhere along the perimeter of a fracture. These boundaries affect fluid circulation, flow paths and communication with external reservoirs. The transport of drop like collections of colloidal-sized particles (particle swarms) in open and partially closed systems was studied. A uniform aperture synthetic fracture was constructed using two blocks (100 x 100 x 50 mm) of transparent acrylic placed parallel to each other. The fracture was fully submerged a tank filled with 100cSt silicone oil. Fracture apertures were varied from 5-80 mm. Partially closed systems were created by sealing the sides of the fracture with plastic film. The four boundary conditions study were: (Case 1) open, (Case 2) closed on the sides, (Case 3) closed on the bottom, and (Case 4) closed on both the sides and bottom of the fracture. A 15 μL dilute suspension of soda-lime glass particles in oil (2% by mass) were released into the fracture. Particle swarms were illuminated using a green (525 nm) LED array and imaged with a CCD camera. The presence of the additional boundaries modified the speed of the particle swarms (see figure). In Case 1, enhanced swarm transport was observed for a range of apertures, traveling faster than either very small or very large apertures. In Case 2, swarm velocities were enhanced over a larger range of fracture apertures than in any of the other cases. Case 3 shifted the enhanced transport regime to lower apertures and also reduced swarm speed when compared to Case 2. Finally, Case 4 eliminated the enhanced transport regime entirely. Communication between the fluid in the fracture and an external fluid reservoir resulted in enhanced swarm transport in Cases 1-3. The non-rigid nature of a swarm enables drag from the fracture walls to modify the swarm geometry. The particles composing a swarm reorganize in response to the fracture, elongating the swarm and maintaining its density. Unlike a

  9. The Lottes nail in the closed treatment of tibia fractures.

    Science.gov (United States)

    Sedlin, E D; Zitner, D T

    1985-01-01

    The effectiveness of the Lottes nail was evaluated in 63 consecutive cases of tibia fractures treated by closed intramedullary fixation with image intensification. The procedure was offered to all adults except those with Gustillo and Anderson Type III open wounds and with fractures less than 10 cm from the knee or 5 cm from the ankle. The operations were generally performed within a few days in closed fractures and somewhat later in open fractures. Patellar-tendon-bearing casts were applied five to ten days after operation, and weight-bearing to tolerance was emphasized. All fractures united. Bridging callus was generally seen by seven or eight weeks. Complications not necessarily peculiar to the procedure included one each of delayed wound infection, peroneal neurapraxia, compartment syndrome, heel decubitus, and shortening of more than 2 cm. Technical failures included malunion of fracture, loss of fixation by the nail, backing out of the nail, and penetration into the ankle joint. Most of the complications and technical failures could be remedied and did not influence the ultimate result. The authors recommended the Lottes nail and closed intramedullary nail fixation as the preferred method of treatment of diaphyseal fractures of the tibia in adults.

  10. Fracture of open- and closed-cell metal foams

    NARCIS (Netherlands)

    Onck, P; van Merkerk, R.; Raaijmakers, A; De Hosson, JTM

    2005-01-01

    Two closed cell aluminium foams and one open cell nickel-chromium foam were subjected to microstructural characterization, in situ fracture tests and fractography. The failure process of the open cell foam was observed to be rather ductile, while that of the closed cell foams was found to be

  11. Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base.

    Science.gov (United States)

    Yao, Hui; Liang, Tangzhao; Xu, Yichun; Hou, Gang; Lv, Lulu; Zhang, Junbin

    2017-03-14

    The extensile lateral approach (ELA) has been widely performed for displaced intra-articular calcaneal fractures (DIACFs), and wound complications remain a significant problem. As a minimal incision technique, the sinus tarsi approach (STA) was designed to overcome this disadvantage. There were already many reports about this approach but the conclusions were not completely consistent. Based on the current evidence, we performed this meta-analysis to compare the STA with ELA in the management of DIACF and expected to draw a certain and meaningful conclusion. All potentially relevant randomized controlled trials (RCTs) and cohort studies (CSs) were searched in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrial.gov. The desirable outcomes including wound complications, excellent and good rate, secondary surgery rate and Böhler's angle were extracted. RCT studies were assessed using the Risk of Bias Tool recommended by the Cochrane Collaboration, and cohort studies were evaluated using the Newcastle-Ottawa Scale. The data of RCTs and cohorts were pooled respectively using the fixed-effect model or random-effect model. Mean differences with 95% confidence intervals (CIs) were calculated for continuous data, and relative risks (RRs) with 95% CIs were calculated for dichotomous data. Statistical heterogeneity was assessed with the Q test and I 2 . Sensitivity analysis was developed to assess the reliability of pooled results. Seven studies including two RCTs and five CSs were eligible for the meta-analysis. No matter RCTs or CSs, the pooled data all showed that STA group had a lower incidence of wound complications than that in the ELA group and no significant difference was found in excellent and good rate and the recovery of Böhler's angle between the two groups. The CSs also showed that the STA group had a lower incidence of secondary surgeries than that in the ELA group. Through a STA, we not only can reduce

  12. Clinical usefulness of calcaneal measurements using dual energy x-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Kohno, Jun [Nagasaki Saiseikai Hospital (Japan); Nakata, Tomoko; Ito, Masako

    1999-07-01

    To investigate the clinical usefulness of calcaneal measurement using dual-energy x-ray absorptiometry (DXA), the ability to detect bone loss and fracture risk were evaluated in comparison with spinal bone mineral density (BMD) measured using DXA and quantitative CT (QCT) and with calcaneal quantitative ultrasound (QUS). Furthermore, to investigate the region in calcaneus in which to detect bone change sensitively, the ability to detect bone loss and fracture risk were also evaluated using new regions of interest (ROIs) that were manually defined. The subjects were 165 healthy women, and 188 female patients with fracture, estrogen deficiency, and steroid-induced osteoporosis. Calcaneal BMD with some manually defined ROIs showed lower precision and less sensitivity in detecting bone loss than BMD measured with automatically defined ROIs. Calcaneal DXA, spinal DXA, and QCT demonstrated significant age-related bone loss, and all measurements could discriminate fracture cases from non-fracture cases. Calcaneal DXA could discriminate the bone loss associated with estrogen deficiency as well as spinal DXA. Furthermore, calcaneal measurements showed a greater ability to detect steroid-induced bone loss than spinal DXA, probably because this group included subjects of advanced age with spondylosis. In conclusion, calcaneal DXA is useful to assess BMD in subjects who are not suitable for spinal measurement, although the ability to detect age-related bone loss in calcaneal DXA is less than in spinal measurements. (author)

  13. [Clinical practice guideline on closed tibial plateau fractures in adulthood].

    Science.gov (United States)

    Ocegueda-Sosa, Miguel Ángel; Valenzuela-Flores, Adriana Abigail; Aldaco-García, Víctor Daniel; Flores-Aguilar, Sergio; Manilla-Lezama, Nicolás; Pérez-Hernández, Jorge

    2013-01-01

    Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture. The mechanism of production of this fracture is through large varus or valgus deformation to which is added a factor of axial load. The trauma may be direct or indirect. The degree of displacement, fragmentation and involvement of soft tissues like ligaments, menisci, vascular and nerve structures are determined by the magnitude of the force exerted. Any intra-articular fracture treatment can lead to an erroneous instability, deformity and limitation of motion with subsequent arthritic changes, leading to joint incongruity, limiting activity and significantly altering the quality of life. Open reduction and internal fixation with anatomic restitution is the method used in this type of fracture. However, the results of numerous publications can be questioned due to the inclusion in the same study of fractures treated with very different methods.

  14. Closed reduction of zygomatic tripod fractures using a towel clip.

    Science.gov (United States)

    Cinpolat, Anı; Ozkan, Ozlenen; Bektas, Gamze; Ozkan, Omer

    2017-08-01

    The zygomatic bone constitutes the prominence of the cheek. Fractures of the zygomatic bone are the second most treatment of zygomatic bone fractures and can be examined under two headings, open and closed reductions. This paper describes a new technique in the closed reduction of tripod fractures using a towel clip. Seventeen consecutive patients (three females, 14 males) with a mean age of 35.5 years (range = 18-66 years) with zygomatic tripod fracture were treated using the towel clip technique between December 2011 and February 2014. Patients were assessed in the first and 6 months postoperatively, by physical examination and computed tomography. Preoperatively, nine patients had paresthesia in the infraorbital nerve region. Three of these cases regressed postoperatively. Persistent collapse of the zygomatic projection was present in one patient. Non-comminuted zygomatic tripod fractures can be easily treated percutaneously with the towel clip method in the absence of preoperative ocular problems such as diplopia, enophthalmos, or restricted eye movements. The technique is economical, fast, and safe. The possibility of persistent zygoma collapse after reduction should be kept in mind, and preoperatively the team should be warned of the possibility of progression to open reduction during surgery.

  15. Biomechanics – Elastic Foundation Applied in Modelling of Calcaneal Nails

    Directory of Open Access Journals (Sweden)

    Sejda František

    2015-12-01

    Full Text Available This paper presents a strength analysis of a calcaneal nail (material Ti6Al4V and stainless steel which is used to treat complex heel fractures. The application focuses on a unique calcaneal nail, the C-NAIL, produced by Medin a.s. (Nové Město na Moravě, Czech Republic. The paper first presents an analysis of fracture types, treatment methods and loading of the calcaneus. It then presents an analysis of limit conditions and loading. Calculations (displacement and stress are performed for 6 and 7 fixing screws using FEM (Ansys Workbench 14 software. The calculation involves a new, original application of an elastic foundation, which effectively replaces the complex interaction of the calcaneal nail and the heel bone.

  16. Desenho de placa em forma de borboleta para tratamento de fraturas do calcâneo Design of butterfly-shaped plate and its application in treatment for calcaneal fractures

    Directory of Open Access Journals (Sweden)

    Guangrong Yu

    2012-12-01

    Full Text Available OBJETIVO: Apresentar um desenho de placa em forma de borboleta e sua aplicação no tratamento de fraturas do calcâneo e discutir suas indicações clínicas, vantagens e desvantagens. MÉTODOS: De fevereiro de 2008 a abril de 2010, 22 pacientes com 26 fraturas intra-articulares do calcâneo foram tratados com redução a céu aberto e fixação interna com placa em forma de borboleta. Dezesseis pacientes eram homens e 6 eram mulheres, com média de idade de 36,8 anos. Onze eram pés esquerdos e 15, direitos. De acordo com a classificação de Sanders, 12 eram fraturas de calcâneo Tipo II (inclusive 3 Tipo IIa, 7 Tipo IIb e 2 Tipo IIc e 14 eram Tipo III (inclusive cinco do Tipo IIIab, 7 Tipo IIIac e duas do Tipo IIIbc. RESULTADOS: Dezessete pacientes (21 pés foram submetidos a acompanhamento por em média 19,2 meses. Os desfechos funcionais foram avaliados com o sistema Maryland Foot Score. Entre os nove pés com fraturas Tipo II, sete receberam escore excelente e dois, bom. Entre as 12 fraturas Tipo III, seis tiveram escore excelente, cinco, bom e uma, razoável. CONCLUSÃO: A placa em forma de borboleta é aplicável ao tratamento de fraturas do calcâneo do Tipo II e Tipo III de Sanders, com a vantagem de garantir fixação confiável, facilitar a cirurgia, produzir menos complicações pós-operatórias e produzir melhores desfechos clínicos gerais. Nível de Evidência IV, Série de casos.OBJECTIVE: To introduce the design of butterfly-shaped plate and its application in treatment for calcaneal fractures, and to discuss its clinical indications, advantages and disadvantages. METHODS: From February 2008 to April 2010, 22 patients with 26 intra-articular calcaneal fractures were treated by open reduction and internal fixation with butterfly-shape plate. Sixteen patients were male and 6 patients were female, with a mean age of 36.8 years. Eleven were left feet and 15, right. According to Sanders classification, 12 were Type II (including 3

  17. Function impairment and pain after closed treatment of fractures of the mandibular condyle

    NARCIS (Netherlands)

    Dijkstra, P.U.; Stegenga, B.; de Bont, L.G.; Bos, R.R.

    Background: To determine the prognosis of fractures of the mandibular condyle after closed treatment. Methods: Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on

  18. Closed total dislocation of talus without any accompanying fractures.

    Science.gov (United States)

    Gursu, Sarper; Sahin, Vedat; Demir, Bilal; Yildirim, Timur

    2013-01-01

    Total talar dislocation, ie, disruption of the talus from the calcaneus, navicula, and tibia, is a rare and severe injury. We present a case of closed peritalar dislocation without any accompanying fractures and, thus, discuss the conflicts encountered in this rare injury. A 25-year-old male patient presented with severe pain, swelling, and deformity in his right ankle within 30 minutes of a fall from a height. There were no wounds around the ankle. Radiographs revealed that the talus was disrupted from the calcaneus, navicula, and tibia moving in the anterolateral direction. No accompanying fractures were seen in the talus or in surrounding bones. After an unsuccessful closed reduction attempt, a further decision was open reduction. It was seen that the interposed joint capsula was preventing reduction. After reduction, stability of the ankle was checked and found to be satisfactory, so no fixation material was used. It has been 2 years since the first injury, and the patient is functioning well, with no pain. The ankle has the same range of motion as the unaffected side. No sign of an avascular necrosis or sclerosis is seen on the final radiographs. Closed total dislocation of the talus without any accompanying fractures is a rare entity. The injury is open to various important complications, such as avascular necrosis, infection in patients with open wounds, and arthritic changes. To achieve a good outcome, early reduction of the dislocation has key importance.

  19. Evaluation of the normal calcaneal angles in Egyptian population

    African Journals Online (AJOL)

    Fahmy Anwar Shoukry

    2012-02-01

    Feb 1, 2012 ... The importance of the cal- caneal angles in assessing the fractures of calcaneus and planning treatment has been highlighted. Aim: The purpose of this study was to evaluate the normal calcaneal angles in the Egyptian pop- .... ulae groups which increases with osteoporosis and disrupted in comminuted ...

  20. Complex calcaneal defect reconstruction with osteotomized free fibula-flexor hallucis longus osteomuscular flap.

    Science.gov (United States)

    Lykoudis, Efstathios G; Gantsos, Apostolos; Dimou, Apostolos Od

    2013-01-01

    Complex calcaneal defects represent a reconstructive challenge since calcaneous plays a key role in standing and gait. We report the case of a 35-year-old patient with a complex calcaneal defect due to chronic osteomyelitis after a high energy Gustillo type IIIB calcaneal fracture that was reconstructed with a free fibula-flexor hallucis longus osteomuscular flap. The fibula was osteotomized into two segments, which were used to reconstruct the bone defect, and the muscular component of the flap was used for coverage of the reconstructed calcaneal skeleton. Fifteen days later permanent skin coverage was ensured with a local random pattern rhomboid skin flap. Early and late postoperative periods were uneventful. Bone maturation was radiographically evident at a follow up of 12 weeks, and complete bone incorporation at 3 years. Full weight bearing was possible at 6 months postop. Final follow up, at 3 years postop, verified a very good functional and aesthetic outcome. Copyright © 2012 Wiley Periodicals, Inc.

  1. Avulsion fracture of the posterosuperior tuberosity of the calcaneus managed with lag screw fixation.

    Science.gov (United States)

    Lui, T H

    2018-02-01

    To review the efficacy of lag screw fixation in management of avulsion fracture of the posterosuperior tuberosity of the calcaneus. Since 2002, thirteen patients with displaced fracture of the posterior tuberosity of the calcaneus were treated with emergency reduction of the fracture and lag screw fixation. The medical records and radiographs of the patients were reviewed and the patients were assessed according to the Kerr calcaneal fracture scoring system during the latest follow up. There was no skin necrosis, but one wound dehisced in a patient with unstable diabetes and hypothyroidism. All fractures healed, but two had separation of the fracture fragments after the plaster was removed, both of them were elderly osteoporotic patients. The overall average calcaneal score was 93 (range, 77-100). The average calcaneal score of the patients with closed reduction was 91 (range, 77-100). The average calcaneal score of the patients with open reduction was 94 (range, 79-100). Complications occurred in seven patients (54%). Percutaneous or open reduction of the avulsion fracture of the posterosuperior tuberosity of the calcaneus together with lag screw fixation and equinus short leg cast immobilization can provide good results without skin necrosis. The surgeon should pay attention of the details of the operation and the rehabilitation program in order to minimize the complications. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  2. Increased exercise after stable closed fracture fixation does not affect fracture healing in mice.

    Science.gov (United States)

    Holstein, J H; Becker, S C; Fiedler, M; Scheuer, C; Garcia, P; Histing, T; Klein, M; Menger, M D; Pohlemann, T

    2012-04-30

    The aim of the present study was to evaluate the systemic biological effect of increased exercise on bone repair after stable fracture fixation. Two groups of SKH-1h mice were studied. Animals of the first group (n=36) were housed in cages supplied with a running wheel, while mice of the second group (n=37) were housed in standard cages for control. Using a closed femur fracture model, bone repair was analysed by histomorphometry and biomechanical testing at 2 and 5 weeks. At 2 weeks, we additionally evaluated the expression of the proliferation marker PCNA (proliferating cell nuclear antigen) and the angiogenic and osteogenic growth factor VEGF (vascular endothelial growth factor). To standardise the mechanical conditions in the fracture gap, we used an intramedullary compression screw for stable fracture fixation. Each mouse of the exercise group run a mean total distance of 23.5 km after 2 weeks and 104.3 km after 5 weeks. Histomorphometric analysis of the size and tissue composition of the callus could not reveal significant differences between mice undergoing exercise and controls. Accordingly, biomechanical testing showed a comparable torsional stiffness, peak rotation angle, and load at failure of the healing bones in the two groups. The expression of PCNA and VEGF did also not differ between mice of the exercise group and controls. We conclude that increased exercise does not affect bone repair after stable fracture fixation. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. The Use of the String of Pearls Locking Plate System in the Stabilisation of a Comminuted Calcaneal Fracture in a Giant Breed Dog

    Directory of Open Access Journals (Sweden)

    A. B. Scrimgeour

    2011-01-01

    Full Text Available An eight-year-old male Pyrenean mountain dog was presented with a comminuted fracture of the right calcaneus following motor vehicle trauma. The fracture was stabilised with a plate-rod construct, using the String of Pearls locking plate system and an intramedullary pin. Healing was uncomplicated.

  4. [Surgical treatment of calcaneal spurs].

    Science.gov (United States)

    Benvenuti, R; Orlandi, S; Pellegrini, F

    1982-01-01

    74 operations for the removal of calcaneal spurs at the "G. Pini" Orthopaedic Clinic in Milan over the post 20 years have been examined. After a brief summary of the main aetiopathogenetic theories, the symptomatological picture and various surgical techniques, and the data on the cases encountered are analysed. A high percentage of failures is reported. It is hoped that all cases of talalgia due to calcaneal spur will initially be given conservative therapy. Only if this fails should surgery be considered.

  5. Myogenic progenitors contribute to open but not closed fracture repair

    Directory of Open Access Journals (Sweden)

    Liu Renjing

    2011-12-01

    Full Text Available Abstract Background Bone repair is dependent on the presence of osteocompetent progenitors that are able to differentiate and generate new bone. Muscle is found in close association with orthopaedic injury, however its capacity to make a cellular contribution to bone repair remains ambiguous. We hypothesized that myogenic cells of the MyoD-lineage are able to contribute to bone repair. Methods We employed a MyoD-Cre+:Z/AP+ conditional reporter mouse in which all cells of the MyoD-lineage are permanently labeled with a human alkaline phosphatase (hAP reporter. We tracked the contribution of MyoD-lineage cells in mouse models of tibial bone healing. Results In the absence of musculoskeletal trauma, MyoD-expressing cells are limited to skeletal muscle and the presence of reporter-positive cells in non-muscle tissues is negligible. In a closed tibial fracture model, there was no significant contribution of hAP+ cells to the healing callus. In contrast, open tibial fractures featuring periosteal stripping and muscle fenestration had up to 50% of hAP+ cells detected in the open fracture callus. At early stages of repair, many hAP+ cells exhibited a chondrocyte morphology, with lesser numbers of osteoblast-like hAP+ cells present at the later stages. Serial sections stained for hAP and type II and type I collagen showed that MyoD-lineage cells were surrounded by cartilaginous or bony matrix, suggestive of a functional role in the repair process. To exclude the prospect that osteoprogenitors spontaneously express MyoD during bone repair, we created a metaphyseal drill hole defect in the tibia. No hAP+ staining was observed in this model suggesting that the expression of MyoD is not a normal event for endogenous osteoprogenitors. Conclusions These data document for the first time that muscle cells can play a significant secondary role in bone repair and this knowledge may lead to important translational applications in orthopaedic surgery. Please see

  6. Tratamento cirúrgico de fraturas intra-articulares de calcâneo sanders II e III: revisão sistemática Surgical treatment of intraarticular calcaneous fractures of sanders' types II and III: systematic review

    Directory of Open Access Journals (Sweden)

    Adriano Augusto Antoniazzi Pelliccioni

    2012-01-01

    Based Medicine. References of studies accessed were also consulted. The keywords used Boolean logic (AND and OR: "calcaneus fracture, calcaneous, calcaneal; surgical treatment, management; open Reduction, minimally invasive, percutaneous reduction; internal fixation, external fixation. RESULTS: We identified just three randomized comparative studies. Each Study compared a different technique (external fixation, percutaneous fixation with Kirchner wires and cannulated screws fixation to the open reduction with internal fixation using plate and screws (named standard technique. CONCLUSION: Comparing the series, percutaneous fixation using Kirschner wires achieved the best results, however we will need more data in order to conclude what is the most effective surgical technique.

  7. Fraturas intra-articulares do calcâneo: análise clínica e biomecânica Intraarticular calcaneal fracture: a clinical and biomechanical analysis

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2009-01-01

    Full Text Available OBJETIVO: Verificar as variáveis de distribuição da pressão plantar de pacientes submetidos a tratamento cirúrgico de fratura de calcâneo e correlacioná-las com duas diferentes vias de acesso cirúrgico. Métodos: Os autores estudaram 15 pacientes com idade entre 20 e 53 anos (média de 40,06 anos que apresentaram fraturas intra-articulares do calcâneo, submetidos ao tratamento cirúrgico por duas vias de acesso cirúrgico, a via lateral e a via do seio do tarso. Avaliaram a distribuição da pressão plantar, correlacionando essas variáveis com as duas vias de acesso. A avaliação da distribuição da pressão plantar foi rea-lizada através do sistema Pedar (Novel, GmbH, Munique, Alemanha, verificando o pico máximo de pressão do retropé e do antepé do lado fraturado e do lado normal. RESULTADOS: A média das pressões máximas dos plantigramas do retropé dos pés operados pela via de acesso lateral e pela via curta não apresentou diferença estatística entre as duas vias de acesso (t = 0,11; p = 0,91, bem como a média das pressões máximas dos plantigramas do antepé também não mostrou diferença estatística significativa (t = -0,48; p = 0,64. CONCLUSÃO: Os autores concluíram que não houve diferença estatística entre as médias dos picos máximos de pressão do retropé e do antepé do lado operado, comparados com o lado normal, bem como não houve diferença estatística dessas variáveis comparadas com a via de acesso cirúrgico utilizada.OBJECTIVE: Verify the variables of plantar pressure distribution of patients submitted to surgical procedure for calcaneal fracture, and correlate them with two different surgical approaches. Method: The authors studied 15 patients between 20 and 53 years of age (average 40.06 yrs. who had intra-joint calcaneal fractures, submitted to surgical treatment by means of two different approaches: the lateral and the sinus tarsi. The authors checked the plantar pressure distribution by

  8. Intranasal midazolam for anxiolysis in closed reduction of nasal fractures in children.

    Science.gov (United States)

    Plum, Ann W; Harris, Tucker M

    2015-07-01

    Nasal fractures can result in obstruction of the nasal airflow and cosmetic deformities, and are treated either with observation, closed reduction, or a delayed rhinoplasty. In the pediatric patient, closed reduction is challenging due to anxiety and poor patient cooperation. Here, we describe the unique topical use of intranasal midazolam for anxiolysis in two pediatric patients at the time of closed reduction of nasal fractures, which has not been previously described. Retrospective case series. In this case series, intranasal midazolam was used in two pediatric patients with isolated nasal fractures during closed reduction for anxiolysis in the Emergency department at a single academic medical institution between 2012 and 2013. There were no adverse outcomes and anxiolysis was achieved in both patients. Intranasal midazolam can provide effective anxiolysis for pediatric patients during closed reduction of nasal fractures. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Are frequent radiographs necessary in the management of closed forearm fractures in children?

    Science.gov (United States)

    Bochang, Chen; Katz, Kalman; Weigl, Daniel; Jie, Yang; Zhigang, Wang; Bar-On, Elhanan

    2008-06-01

    A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China. The sample consisted of 202 consecutive children (mean age 7 years; range 3-12 years) with closed forearm fractures treated nonoperatively. Children with open, growth-plate fractures or fractures associated with dislocation of the nearby joint (i.e., monteggia fractures) were excluded. In 28 children who had torus fractures, radiographic examination was performed at the time of cast removal, 3 weeks after the start of treatment. In 63 children who had stable fractures that did not require reduction (undisplaced or minimally displaced, complete or greenstick), radiographic examination was performed 1 week after the start of treatment and again at cast removal 4-6 weeks later. In the remaining 111 children with complete, displaced, or greenstick fractures (all with angulation of more than 15 degrees ) who underwent closed reduction, an additional X-ray was taken 2 weeks after cast placement. All children (except those with torus fractures) were followed clinically, without further radiographic examination, for 3 months after cast removal. Radiographs at cast removal showed good union in all stable fractures, indicating that additional X-rays on cast removal would have had no added value. In the children with unstable fractures, only 9 showed redisplacement with angulation of more than 15 degrees on repeated X-rays during the first 2 weeks after cast placement. All 9 underwent successful re-reduction. On clinical evaluation 3 months after cast removal, all patients in the sample had full range of elbow and forearm motion. Repeated fracture did not occur in any of the patients. On the basis of these results, radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures. At the time of cast removal, if clinical

  10. 450 closed fractures of the distal third of the tibia treated with a functional brace.

    Science.gov (United States)

    Sarmiento, Augusto; Latta, Loren L

    2004-11-01

    Four hundred fifty closed fractures of the distal third of the tibial diaphysis, treated with a functional brace, are the subject of this study. Four (0.9%) of the fractures resulted in nonunion. The average healing time was 16.6 +/- 5.6 weeks, with a range from 10-40 weeks. The average final shortening was 5.1 +/- 4.8 mm with a range from 0-25 mm. Four hundred twenty four (94.2%) fractures healed with nails. It seems that functional bracing is an effective method of treatment of a selected group of tibial fractures.

  11. Shanz Screws for Closed Reduction of Femoral Shaft Fractures during Intramedullary Nailing

    Directory of Open Access Journals (Sweden)

    A. Sedighy

    2008-01-01

    Full Text Available Introduction & Objective: Closed intramedullary nailing has become the standard treatment for femoral shaft fractures, but because the existing closed reduction methods are difficult and demanding, in the most trauma centers these fractures usually are treated by open reduction method. Our objective was close reduction of these difficult fractures by a simple but effective method using Schanz screws for manipulating fracture fragments on a radiolucent table.Materials & Methods: In this prospective study, 30 patients whose femoral shaft fractures required reduction were operated on a radiolucent table in the lateral position and their fractures reduced closed by Schanz pins and fixed with IM Rod. The patients were followed-up 1 year. Results: We obtained reduction in 93% of patients. Average time of reduction in the first 48 hours was 9.23minutes and after 48 hours it was 19.7minutes (p<0.05. Also time to reduction was dependent on amount of preoperative traction .When the amount of preoperative traction was 5kg, that time was 19.16minutes but in maximal amount of traction it was 10.29minutes. Time to reduction also was shorter in Winquist-Hansen type III and IV fractures than in type I and II fractures. There was 13% valgus deformity (5-10 o, 33% external malrotation (5-15 o and 37% shortening (up to 1-3 cm. But we had no infection and no need for blood transfusion or bone grafting.Conclusion: Schanz screws provide a very effective method for close reduction of femoral shaft fractures. Complications of this method are the same or even in some parts are less than other close reduction methods. The method is more successful if performed in the first 48 hours, or if the weight of preoperative skeletal traction is near to the maximum (15% of body weight.

  12. C-arm guided closed reduction of zygomatic arch fracture

    Energy Technology Data Exchange (ETDEWEB)

    Eo, Yoon Ki; Lee, Dong Kun [College of Medicine, Wonkwang Univ., Iksan (Korea, Republic of); Kim, Jeong Sam; Jang, Young Il [Kwangyang College, Kwangyang (Korea, Republic of)

    1999-04-01

    The zygomatic arch is structurally protruded and is easily fractured. The classic management of zygomatic arch fracture has been mentioned the Keen, Lothrop, Dingman and Alling and threaded K-wire. All of the above methods have advantages and disadvantages. To minimize the disadvantages, we performed threaded K-wire for the first time using C-arm image intensifier. The subjects were 16 patients with Knight North group II (Zygomatic arch fracture). Among them the C-arm was used in 12 patients and the operator used sensitivity general method in 4 patients and confirmed the operation by mobile X-ray equipment. In conclusion, both groups were satisfied surgically and cosmetically. Using the C-arm, actual image at the time operation was clear and satisfied, the surrounding tissue damage was minimized and at was more accurately completed. The operation time was shortened by 30 to 60 minutes proving it to be an efficient method. We suggest though that further studies be needed to evaluate the radiation effect on these patients.

  13. A review of 100 closed head injuries associated with facial fractures.

    Science.gov (United States)

    Haug, R H; Savage, J D; Likavec, M J; Conforti, P J

    1992-03-01

    One hundred closed head injuries associated with facial fractures treated over a 78-month period at a level I trauma center in Northeast Ohio were reviewed. The incidence of closed head injury in patients with facial fractures was 17.5%. Males suffered closed head injuries four times more often than females, and sustained severe intracranial injuries eight times as often. The 16- to 30-year age group predominated (59%). Although motor vehicle accidents were the most frequent cause of injury (61%), motorcycle accidents were associated with the most severe head injury. The mandible/midface fracture ratio (1.3:1) was almost half that of the non-head-injured population (2.1:1). Facial fracture complications were found to have a similar incidence (14%) as in the non-head-injured population, but were associated with more severe intracranial injuries.

  14. Fractures of the calcaneus in racing greyhounds.

    Science.gov (United States)

    Ost, P C; Dee, J F; Dee, L G; Hohn, R B

    1987-01-01

    Fifty-one calcaneus fractures associated with (41) or without (10) central tarsal bone (Tc) fractures in racing greyhounds were evaluated and categorized. All calcaneal fractures with no Tc fractures had a plantar proximal intertarsal subluxation. No subluxations were found in dogs with both calcaneal and central tarsal fractures. The calcaneal fractures were treated either with coaptation splints or surgical repair. Surgical techniques included a Steinmann pin with a figure eight tension band device or screw or plate fixation as primary techniques supplemented by Kirschner wires and cerclage wires. In all calcaneal fractures associated with plantar proximal intertarsal subluxation, an arthrodesis of the calcaneoquartal joint was performed. All 22 surgically repaired fractures in dogs available for physical and radiographic reexamination had healed within 1 to 6 months. Eight dogs with fractures of the calcaneus associated with fractures of Tc returned to a racing career. None of the dogs with plantar proximal intertarsal subluxation raced again. Based on the orientation of the fracture lines and on dissection of two tarsi with calcaneal fractures, a hypothesis on the pathogenesis of calcaneal fractures in racing greyhounds was formulated.

  15. OUTCOMES IN CLOSED REAMED INTERLOCKING NAIL IN FRACTURES OF SHAFT OF FEMUR.

    Science.gov (United States)

    Mohammad, Taj; Khan, Alamzeb; Sawati, Alamzeb; Ahmed, Ashfaq; Awan, Abdus Saboor; Saboor, Abdus; Siddique

    2015-01-01

    Femoral shaft fracture is one of the common fractures seen in accident and emergency department of our hospital. Violent forces are required to break this and strongest of human bones. There are various treatment modalities for femoral shaft fractures in adults like traction, brace, platting, intramedullary nail (IMN), external fixators and inter locking nails. The study was done with an objective to evaluate the results of closed reamed interlocking nail in fractures of shaft of femur. A prospective study of 114 cases of femoral shaft fractures was carried out at orthopaedic unit of Ayub Teaching Hospital Abbottabad during 1 year. All these cases were treated with statically locked nails under spinal or general anaesthesia. These cases were followed up for up to one year and Results of the interlocking nail were observed in terms of union and complications. Out of 114 patients, 95 underwent union in 90-150 days with a mean of 110.68 days. Ten patients had dynamization within six weeks because of obvious fracture gap in radiograph. There were 3 patients who had non-union, and 6 patients had delayed union which was treated with dynamization. Close reamed interlocking intramedullary nail in femoral shaft fractures is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and fracture healing response is good.

  16. Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

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    Kang-Young Choi

    2012-07-01

    Full Text Available In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.

  17. Functional outcome of closed fractures of proximal humerus managed by Joshi′s external stabilizing system

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    Anil Kumar Gupta

    2012-01-01

    Full Text Available Background: Proximal humeral fractures account for 4-5% of all fractures; most of them involving elderly and osteoporotic people. 1 51% of such fractures are displaced. Two Fractures with minimal displacement, regardless of the number of fracture lines, can be treated with closed reduction and early mobilization, but anatomical reduction in displaced fractures is difficult to obtain and the incidence of pseudarthrosis is high 3-5. We evaluated the functional results of closed Neer′s 2- and 3-part proximal humerus fractures treated by Joshi′s external stabilizing system. Materials and Methods: Sixteen patients with proximal humeral fractures were managed from 2008 to 2010 by Joshi′s stabilizing external fixation. They were 10 males and 6 females, with a mean age of 57.5 years. Based on Neer′s classification, there were eleven 3-part fractures and five 2-part fractures. The mechanism of injuries included seven road traffic accidents and nine fall. Shoulder mobilization exercises were started within 1 week after stabilization with JESS. External fixation was removed after the evidence of union (6-8 weeks. Pain was evaluated by visual analogue scale (VAS and shoulder range of motion was evaluated by Constant Scoring System. Followup was done at 4 weeks, 8 weeks, 12 weeks, and then at every 4 weeks. Results: Mean followup was of 20.5 months (range 9-30 months. Postoperative mean VAS score and Constant Score of patients was 2.1 (±0.73 and 78.1 (±9.61 at an average followup of 6 months. Mean duration for union was 6.5 (±1.18 weeks. One case of K-wire loosening and one case of pin tract infection were the complications noted. Conclusion: External fixation by JESS is an alternative option to treat Neer′s 2 and 3 part proximal humerus fractures with good results.

  18. Objective Outcomes of Closed Reduction According to the Type of Nasal Bone Fracture

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    Kang, Chang Min

    2017-01-01

    Background Nasal fractures have a tendency of resulting in structural or functional complications, and the results can vary according to the type of nasal bone fracture. The aim of this study was to evaluate the objective postoperative results according to the type of nasal bone fractures. Methods We reviewed 313 patients who had a closed reduction of nasal bone fracture. The classification of nasal bone fracture by Stranc and Robertson was used to characterize the fracture type: frontal impact group type I (FI), frontal impact group type II (FII), lateral impact group type I (LI), lateral impact group type II (LII), and comminuted fracture group (C). For each patient, we tried to use the same axial image section of computed tomographic (CT) scans before and immediately after operation. Postoperative outcomes were classified into 4 grades: excellent (E), good (G), fair (F), and poor (P). We also analyzed postoperative complications by fracture type. Results Regarding the postoperative CT images, 189 subjects showed E results, 99 subjects showed G, 18 subjects showed F, and 7 subjects showed P reduction. The rate of operation results graded as E by each fracture type was 66.67% in FI, 52.0% in FII, 64.21% in LI, 62.79% in LII, and 21.74% in C. Complications of FI (7.14%), LII (13.95%), and C (13.04%) groups occurred more than in the FII (4.00%) and LI (4.21%) groups. Conclusion It seems that the operation result by fracture type was better in the FI, LI, and LII type than the FII and C type; after one month, however, LII type showed more complications than other types. The septal fracture can be thought to affect early reduction results in nasal bone fractures. PMID:28913300

  19. Three-dimensional mandibular motion after closed and open reduction of unilateral mandibular condylar process fractures.

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    Sforza, Chiarella; Ugolini, Alessandro; Sozzi, Davide; Galante, Domenico; Mapelli, Andrea; Bozzetti, Alberto

    2011-06-01

    To detect the changes in 3D mandibular motion after two types of condylar fracture therapies. Using a 3D motion analyzer, free mandibular border movements were recorded in 21 patients successfully treated for unilateral fractures of the mandibular condylar process (nine patients: open reduction, rigid internal fixation, and functional treatment; 12 patients: closed reduction and functional treatment; follow-up: 6-66 months), and in 25 control subjects. No differences were found among the groups at maximum mouth opening (MO), protrusion and in lateral excursions. During opening, the patients had a larger maximal deviation to the fractured side than the controls (controls 2.3 mm, open treatment 3.9 mm, closed treatment 4.2 mm; Kruskal-Wallis test, p=0.014; closed treatment vs. controls, p=0.004), with a larger coronal plane angle (controls 2.4°, open treatment 3.6°, closed treatment 4.4°; p=0.016; closed treatment vs. controls, p=0.013). In the closed treatment patients, a longer follow-up was related to increased maximum MO (p=0.04), sagittal plane angle (p=0.03), and reduced lateral mandibular deviation during MO (p=0.03). Mandibular condylar fractures can recover good function; some kinematic variables of mandibular motion were more similar to the norm in the open treatment patients than in closed treatment patients. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  20. Closed fractures of the proximal tibia treated with a functional brace.

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    Martinez, Alberto; Sarmiento, Augusto; Latta, Loren L

    2003-12-01

    It generally is agreed that fractures of the proximal tibia, when treated with intramedullary nails, are more likely to present technical difficulties and to be associated with an increased rate of complications. This study reports on 108 closed fractures located in the proximal third of the tibia that were treated with functional braces. Nonunion occurred in 2.7% of the patients; the final displacement and shortening averaged 20% and 3.5 mm, respectively. Eighty-eight percent of the fractures healed with less than 6 degrees of angular deformity. It seems that functional braces for closed fractures of the tibia, located in its proximal third, are a viable therapeutic approach that offers satisfactory clinical and radiographic results in a high percentage of instances.

  1. Calcaneal spurs among San and Khoi skeletons.

    Science.gov (United States)

    Caroline, Cermak; Kirchengast, Sylvia

    2015-01-01

    Only few studies considered the prevalence of calcaneal enthesophytes commonly called heel spurs among historic skeleton samples. In the present study the frequency of plantar calcaneal spurs among 54 19(th) century Khoisan skeletons was analyzed. Five individuals (9.6 %) had a plantar calcaneal spur at the right side or left side. Calcaneal spurs were more likely to occur in older individuals. More than 20 % of the individuals aged between 40 and 60 years (mature) showed plantar spurs, while 6.2 % of the individuals aged between 20 and 40 years had plantar spurs; however this difference was not significant. No sex differences were present in the prevalence of calcaneal spurs. Male and female individuals did not differ in the metric dimensions of the calcanceal spurs significantly.

  2. A PROSPECTIVE STUDY OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN TREATED BY CLOSED REDUCTION

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    Ch. Imobi

    2015-08-01

    Full Text Available There is no universal agreement regarding the management of displaced supracondylar fracture of the humerous in children. According to some orthopaedic surgeon almost all supracondylar humeral fractures should be treated operatively by reduction and pinning. While according to others closed reduction and pinning should be used for Gartland type II and some type III fractures. We present 50 cases of displaced supracondylar fracture treated by closed manipulative reduction under G.A. and immobilization with a posterior plaster of paris slab and collar and cuff. OBJECTIVE : T o assess the functional results of the injured elbow and to study the incidence of change in the carrying angle of the elbow. MATERIALS AND METHODS: This prospective study was conducted in 50 patients with extension type of displaced supracondylar fractures of humerus in children (Gartland type II and type III treated by closed manipulative reduction and immobilization in flexion of the elbow with a posterior plaster of paris slab and collar and cuff. Patients were followed up for 6 months. Flexion type of supracondylar fracture and those fractures which are absolutely indicated for operative intervention, Viz an open fracture and severe vascular compromise were excluded from the study. The range of movement and carrying angle was measured with the help of a Goniometer and Flynn criteria were used for functional assessment. RESULTS: At the end of follow up period, the end results were graded as excellent in 40%, good in 42%, fair in 12% and poor in 6%. A satisfactory result was therefore obtained in 94% and unsatisfactory result in 6% of the 50 patients who were followed and evaluated. CONCLUSION: This closed method of treatment for all practical proposes produces least complications, shorter hospital stay, can be expected to yield reproducible consistent satisfactory results not surpassed by any other method of treatment.

  3. Displaced Anterior Column Acetabular Fracture: Closed Reduction and Percutaneous CT-Navigated Fixation

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    Huegli, R.W.; Staedele, H.; Messmer, P.; Regazzoni, P.; Steinbrich, W.; Gross, T. [Univ. Hospital of Basel (Switzerland). Dept. of Radiology

    2004-10-01

    The purpose of this study is to demonstrate the feasibility of computer-tomography-navigated closed reduction and percutaneous fixation (CRPF) in a patient with an externally rotated left acetabular fracture. After a follow-up of 18 months the patient was pain-free and had a normal range of motion in both hip joints. Radiologically, the fracture was fully consolidated, remodelled, and there were no signs of osteoarthritis. To our knowledge, CT-navigated CRPF of a rotated acetabular fracture has not been reported before. Further studies regarding the feasibility of the method are warranted(CRPF)

  4. SURGICAL OUTCOME OF DIAPHYSEAL FRACTURES OF HUMERUS BY ANTEGRADE INTERLOCKING NAILING IN CLOSED REDUCTION

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    Koramutla Harsha

    2015-03-01

    Full Text Available BACKGROUND: Fractures involving the shaft of humerus are commonly encountered by orthopedic surgeons in day to day practice. Humeral shaft fracture can be treated using intramedullary fixation technique. Flexibl e intramedullary nails like Rush nail, Enders nail have been used utilizing ante grade and retrograde methods. This technique has largely replaced plating method very often. But, retrograde nailing can be regarded as a minimally invasive procedure and just ifiable to use for fixation of isolated humeral shaft fractures in certain situation. In this study we have evaluated the effectiveness of surgical and functional outcomes of closed ante grade interlocking nailing in the management of diaphyseal fractures of humerus. METHODS: A series of 30 patients with diaphyseal fractures of humerus were treated with ante grade interlocking nailing during October 2008 to October 2010. All the patients were followed up 6 weeks, 12 weeks and 24 weeks and results were analy sed. X rays were taken to assess radiological union of fracture during the follow up. Assessment of fracture union and shoulder and elbow movement was recorded. Final evaluation was done at the end of 6 months. Data was presented as mean ± SD, actual numbe rs and percentages. Wilcoxo n test and chi - square test were used appropriately. RESULTS: All 30 patients in our study were followed up for a minimum period of 6 months. 56.7%cases were male patients 43.3% were female patients. More than 50 % of cases in the series were between the ages of 18 - 35 years. 60% fractures were comminuted 6.6% were of oblique type, 33.3% were of transverse type. The average time interval from the time of admission to the time of surgery was 3 days. The most common mode of injury was road traffic accident. Commented fractures are predominant in our study. Clinical outcome was 60% of cases had excellent results and 30 % had moderate result. 3 patients (10% had poor result, due to limitation of shoulder

  5. Outcomes of open versus closed treatment of mandibular subcondylar fractures: a prospective randomized study.

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    Singh, Virendra; Bhagol, Amrish; Goel, Mahesh; Kumar, Ish; Verma, Ajay

    2010-06-01

    To compare open reduction and internal fixation with closed treatment and maxillomandibular fixation for the management of subcondylar fractures of the mandible. Forty patients with subcondylar fractures of the mandible were evaluated. All fractures were displaced; either angulated between 10 degrees and 35 degrees or the ascending ramus was shortened by more than 2 mm. Clinical and radiographic evaluation was performed 6 months after the trauma. Clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening, and occlusion. Radiographic parameters included level of the fracture, deviation of the fragment, and shortening of the ascending ramus. Subjective parameters included pain according to a visual analog scale. Nonparametric data were compared for statistical significance with a chi(2) analysis and parametric data with an independent samples t test (P protrusion, significant (P = .00) differences were observed between both groups (open 39.6/12.5/5.9 mm vs closed 33.5/9.8/4.1 mm). The visual analog scoring revealed significant (P = .00) difference with less pain in the operative treatment group (1.1 open vs 5.2 closed). No statistically significant difference was found between the 2 groups for occlusion (P = .86). Both treatment options for condylar fractures of the mandible yielded acceptable results. However, operative treatment was superior in all objective and subjective functional parameters except occlusion. 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Comparison between the gold standard DXA with calcaneal quantitative ultrasound based-strategy (QUS) to detect osteoporosis in an HIV infected cohort.

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    Quiros Roldan, Eugenia; Brianese, Nigritella; Raffetti, Elena; Focà, Emanuele; Pezzoli, Maria Chiara; Bonito, Andrea; Ferraresi, Alice; Lanza, Paola; Porcelli, Teresa; Castelli, Francesco

    Osteoporosis represents one of the most frequent comorbidity among HIV patients. The current standard method for osteoporosis diagnosis is dual-energy X-ray absorptiometry. Calcaneal quantitative ultrasound can provide information about bone quality. The aims of this study are to compare these two methods and to evaluate their ability to screen for vertebral fracture. This cross-sectional study was conducted in HIV patients attending the Clinic of Infectious and Tropical Diseases of Brescia during 2014 and who underwent lumbar/femoral dual-energy X-ray absorptiometry, vertebral fracture assessment and calcaneal quantitative ultrasound. The assessment of osteoporosis diagnostic accuracy was performed for calcaneal quantitative ultrasound and for vertebral fracture comparing them with dual-energy X-ray absorptiometry. We enrolled 73 patients and almost 48% of them had osteoporosis with at least one of the method used. Vertebral fracture were present in 27.4%. Among patients with normal bone measurements, we found vertebral fracture in proportion between 10% and 30%. If we used calcaneal quantitative ultrasound method and/or X-ray as screening, the percentages of possible savable dual-energy X-ray absorptiometry ranged from 12% to 89% and misclassification rates ranged from 0 to 24.6%. A combined strategy, calcaneal quantitative ultrasound and X-Ray, identified 67% of patients with low risk of osteoporosis, but 16.4% of patients were misclassified. We observed that patients with osteoporosis determined by calcaneal quantitative ultrasound and/or dual-energy X-ray absorptiometry have higher probability to undergo vertebral fracture, but neither of them can be used for predicting vertebral fracture. Use of calcaneal quantitative ultrasound for screening is a reasonable alternative of dual-energy X-ray absorptiometry since our study confirm that none strategy is clearly superior, but both screen tools must be always completed with X-ray. Copyright © 2017 Sociedade

  7. Comparing hospital outcomes between open and closed tibia fractures treated with intramedullary fixation.

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    Smith, Evan J; Kuang, Xiangyu; Pandarinath, Rajeev

    2017-07-01

    Tibial shaft fractures comprise a large portion of operatively treated long bone fractures, and present with the highest rate of open injuries. Intramedullary fixation has become the standard of care for both open and closed injuries. The rates of short term complications and hospital length of stay for open and closed fractures treated with intramedullary fixation is not fully known. Previous series on tibia fractures were performed at high volume centers, and data were not generalizable, further they did not report on length of stay and the impact of preoperative variables on infections, complications and reoperation. We used a large surgical database to compare these outcomes while adjusting for preoperative risk factors. Data were extracted from the ACS-NSQIP database from 2005 to 2014. Cases were identified based on CPT codes for intramedullary fixation and categorized as closed vs open based on ICD9 code. In addition to demographic and case data, primary analysis examined correlation between open and closed fracture status with infection, complications, reoperation and hospital length of stay. Secondary analysis examined preoperative variables including gender, race, age, BMI, and diabetes effect on outcomes. There were 272 cases identified. There were no significant demographic differences between open and closed tibia fracture cases. Open fracture status did not increase the rate of infection, 30day complications, reoperation, or length of stay. The only preoperative factor that correlated with length of stay was age. There was no correlation between BMI, presence of insulin dependent and nondependent diabetes, and any outcome measure. When considering the complication rates for open and closed tibial shaft fractures treated with intramedullary fixation, there is no difference between 30-day complication rate, length of stay, or return to the operating room. Our reported postoperative infection rates were comparable to previous series, adding validity to

  8. Complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle

    NARCIS (Netherlands)

    Niezen, E. T.; Bos, R. R. M.; de Bont, L. G. M.; Stegenga, B.; Dijkstra, P. U.

    This study analysed the relationship between complaints and mandibular function after closed treatment of fractures of the mandibular condyle in a prospective study. In a I-year follow-up, complaints were assessed during physical examination and function was assessed using the mandibular function

  9. Isolated posterior cruciate ligament injuries associated with closed tibial shaft fractures: a report of two cases.

    Science.gov (United States)

    Huang, Yu-Han; Liu, Ping-Cheng; Chien, Sung-Hsiung; Chou, Pei-His; Lu, Cheng-Chang

    2009-07-01

    Knee ligament injuries associated with tibia shaft fractures are usually neglected and treatment is delayed. To our knowledge, no case presentation discusses the clinical result of closed tibial shaft fracture with concomitant ipsilateral isolated PCL injury. In this literature, we report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant PCL injury and discuss the treatment options. We report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant posterior cruciate ligament (PCL) injury. Case 1 received open reduction with plate fixation for the tibial shaft fracture, and he also received arthroscopic reconstruction of PCL with bone-patellar tendon-bone graft due to neglecting PCL injury 5 months later after fracture fixation. Case 2 sustained left tibial-fibular shaft fracture with isolated PCL injury confirmed by magnetic resonance image on the first day of injury. She received tibia fixation with intramedullary nail and conservative treatment with bracing and rehabilitation for PCL injury. In case 1, the male patient only focused on fracture healing without any knee rehabilitation. His knee flexed deeply for protected weight bearing in the injured leg which may have exacerbated the posterior instability and reduced the possibility of PCL healing. The end result of knee function was poor even though PCL reconstruction was done later. In case 2, the female patient with diagnosed posterior cruciate ligament injury on the day of injury, her knee was immobilized in brace with full extension, which improved PCL healing. In addition, she received rehabilitation of quadriceps strengthening, and hamstring muscle contraction was avoided in her daily activity. After rehabilitation, the female patient did not complain of severe subjective instability even with an obvious posterior translation on posterior drawer test. We need to perform a careful physical examination of ipsilateral knee in

  10. A new technique of closed intramedullary nailing in fractures of the proximal humerus with varus deformity

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    A. N. Chelnokov

    2015-01-01

    Full Text Available Introduction. Varus displacement is common in fractures of the proximal humerus. Development of new low invasive surgical modalities providing anatomy restoration and non-traumatic fracture fixation is actual. Purpose of the study was development of the low invasive technique of closed interlocking nailing providing reduction of the typical varus displacement in fractures and posttraumatic deformities of the proximal humerus. Material and methods. A new technique of correction of the proximal humerus in fractures and posttraumatic deformities was applied in 12 patients - 7 with two-part fractures and 5 with posttraumatic varus deformities. The surgical technique includes application of a small wire circular external frame. Its proximal part is secured to the humeral head to reduce varus displacement along with connection to the distal part of the frame, and the reached alignment is fixed by an intramedullary nail. Results. In all 12 cases we succeeded to reduce the varus deformity. At 1 year follow-up healing was reached in 11 patients, and in one patient exchange compression nailing was performed. Constant score in 1 year was 76±17 after fracture treament, and 70±16 in posttraumatic deformities, which corresponeded to good results. Conclusion. The presented technique allows to reach 40-50° angular correction without open approach and significant soft tissue damage. The obtained results confirm efficacy of the new technique and pertinence of its use in patients with fractures and posttraumatic deformities of this localization. The introduced technique of closed nailing appears to be a promising approach in reconstructive surgery of the proximal humerus.

  11. Closed treatment of overriding distal radial fractures without reduction in children.

    Science.gov (United States)

    Crawford, Scott N; Lee, Lorrin S K; Izuka, Byron H

    2012-02-01

    Traditionally, distal radial fractures with marked displacement and angulation have been treated with closed or open reduction techniques. Reduction maneuvers generally require analgesia and sedation, which increase hospital time, cost, patient risk, and the surgeon's time. In our study, a treatment protocol for pediatric distal radial fractures was used in which the fracture was left shortened in an overriding position and a cast was applied without an attempt at anatomic fracture reduction. Consecutive patients three to ten years of age presenting between 2004 and 2009 with a closed overriding fracture of the distal radial metaphysis were followed prospectively. Our protocol consisted of no analgesia, no sedation, and a short arm fiberglass cast gently molded to correct only angulation. Patients were followed for at least one year. All parents or guardians were given a questionnaire assessing their satisfaction with the treatment. Financial analysis was performed with use of Current Procedural Terminology codes and the average total cost of care. Fifty-one children with an average age of 6.9 years were included in the study. Initial radial shortening averaged 5.0 mm. Initial sagittal and coronal angulation averaged 4.0° and 3.2°, respectively. The average duration of casting was forty-two days. Residual sagittal and coronal angulation at the time of final follow-up averaged 2.2° and 0.8°, respectively. All fifty-one patients achieved clinical and radiographic union with a full range of wrist motion. All parents and guardians answered the questionnaire and were satisfied with the treatment. Cost analysis demonstrated that closed reduction with the patient under conscious sedation or general anesthesia is nearly five to six times more expensive than the treatment used in this study. Adding percutaneous pin fixation increases costs nearly ninefold. This treatment protocol presents an alternative approach to overriding distal radial fractures in children and

  12. Treatment of an open distal tibia fracture with segmental bone loss in combination with a closed proximal tibia fracture: a case report.

    Science.gov (United States)

    Park, Jin; Yang, Kyu Hyun

    2012-08-01

    The treatment of open distal tibia fractures remains challenging, particularly when the fracture is infected and involves segmental bone loss. We report the case of a 38-year-old man who sustained an open distal tibiofibular fracture with segmental bone loss and a closed proximal tibial fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture was infected, and the skin was covered after the wound became culture negative. The tibia was then internally transported with a ring external fixator; the closed fracture of the proximal tibia served as the corticotomy for internal transport without conventional corticotomy. After 5 cm internal transport, the docking site of the distal tibia was fixed with a locking plate and autogenous cancellous bone graft. Bone graft was also used to the distal tibiofibular space to achieve distal tibiofibular synostosis. We describe one treatment option for an infected open fracture of the distal tibia with segmental bone loss that is accompanied by a closed fracture of the proximal tibia. This method can treat two fractures simultaneously.

  13. Closed reduction and percutaneous annulated screw fixation in the treatment of comminuted proximal humeral fractures.

    Science.gov (United States)

    Yu, Zhe; Zheng, Lianhe; Yan, Xiaodong; Li, Xiaoxiang; Zhao, Jian; Ma, Bao'an

    2017-01-01

    Displaced proximal humeral fractures remain a challenge to orthopedic surgeons. The purpose of this study was to evaluate the functional and radiological outcomes of patients with comminuted proximal humeral fractures treated with closed reduction and percutaneous screw fixation (CRPF). The authors retrospectively reviewed 38 cases of displaced proximal humeral fractures (2-, 3- or 4-part fractures according to the Neer classification) that were treated using the CRPF technique from May 2009 to April 2013. From this group 26 patients were followed up for a period ranging from 9 to 24 months (averaging 12.9 months) and evaluated for the functional and radiological outcomes by a series of standard questionnaires and measurements. The fractures in all 26 patients were healed within an average time of 14.6 weeks (ranging from 11 to 27 weeks), and the mean interval between the operation and fully functional activity was 18.6 weeks (ranging from 15 to 32 weeks). At the final follow-up visit, no patient showed shoulder instability; the mean range of abduction motion was 146.5° (ranging from 72° to 180°). For all patients, no statistically significant difference in the functional outcomes was observed between their 6-month and final follow-up visits; or in the radiological findings between their immediate post-operative and final follow-up examinations. The CRPF technique is a safe and effective therapeutic option for comminuted proximal humeral fractures. Good stability is obtained and aggressive impairment of the soft tissue and periosteum around the fracture is avoided, which allows for an early painless range of motion. The technique promotes bone healing, prevents ischemic osteonecrosis of the head of the humerus and leads to few complications.

  14. Calcaneal tendon: imaging findings; Tendao calcaneo: avaliacao por imagem

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    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio [Colegio Brasileiro de Radiologia e Diagnostico por Imagem, Sao Paulo, SP (Brazil)]. E-mail: crismontandon@hotmail.com; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos [Goias Univ., Goiania, GO (Brazil). Hospital de Clinicas. Dept. de Diagnostico por Imagem e Anatomia Patologica

    2003-12-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  15. Displaced articular calcaneus fractures: classification and fracture scores: a preliminary study.

    Science.gov (United States)

    Harnroongroj, Thos; Chuckpaiwong, Bavornrit; Angthong, Chayanin; Nanakorn, Pongtep; Sudjai, Narumol; Harnroongroj, Thossart

    2012-03-01

    To review and group configurations of displaced articular calcaneal fracture advantaged for classification and radiographic fracture scores. Between 2002 and 2011, medical records and radiographs of patients who sustained acute displaced articular calcaneal fractures were reviewed. The calcanealfracture configurations were grouped as avulsion, bending, burst, or combination. Radiographic displaced articular calcaneal fracture score was designed to include Bohler and Gissane angles, degrees of posterior subtalar joint line parallel, degrees of varus, and burst. The calcaneal fracture score was modified as power of the fracture response to treatment (PFRT). Prevalence of the fracture types, pre- and post-reduction fracture scores including PFRT were studied and statistically analyzed. Sixty-four patients had 77 acute displaced articular calcaneal fractures. The classification consisted of type I avulsion, type II compression bending, type III compression burst, type IV avulsion burst, and type V bending burst. Type IV is the most common. The radiographic calcaneal fracture scores were 10 points. Pre-, post-reduction calcaneal fracture scores and PFRTof type I, II, III, IV, and V were 4.17 (0.41), 0 and 1 (0), 4.63 (2.13), 0.50 (0.93) and 0.84 (0.35), 6.94 (2.05), 3.18 (1.38) and 0.50 (0.27), 8.03 (1.12), 3.03 (2.42) and 0.62 (0.30), and 7.22 (2.11), 3.00 (2.50) and 0.59 (0.29) respectively. Statistical analysis showed significant difference (p fracture scores contained 10 points and were used for determining complexity of the fractures. PFRT was used for evaluating efficacy of fracture treatment.

  16. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction.

    Science.gov (United States)

    Rodríguez-Merchán, E C

    1995-06-01

    Prospectively, 40 patients with an average age of 45 (20-65) with closed transverse fractures of the middle one-third of the humerus without associated radial nerve palsy were treated. All had failed nonoperative reduction and were then operated on with either compression plating or intramedullary fixation with Hackethal nails and a postoperative ready-made fracture brace. These surgeries were performed at an average of 7 days (4-10) after closed reduction. The Hackethal nailing group consisted of 20 patients (17 men, 3 women) with a mean age of 47 years (22-64); within 2 days after surgery the patients were allowed to begin active and passive range-of-motion exercises of the elbow and the shoulder with the arm protected by a ready-made fracture brace; the average follow-up period for this group was 18 months (12-50). These patients (with one exception) required a second surgical procedure with a second anesthesia to remove the symptomatic nails; moreover, they had to be protected in a brace for 6 months. The compression plate group consisted of 20 patients (14 men, 6 women) with a mean age of 45 years (20-65); within 2 days after surgery the patient was allowed to begin the same rehabilitation program; in this group no braces were used postoperatively. All fractures treated with Hackethal nailing healed except for one delayed union. Functional results in this group were 12 excellent, 4 good, 1 fair, and 3 poor. All fractures treated by compression plating healed except in one case of delayed union.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures

    Directory of Open Access Journals (Sweden)

    Nadeem A Lil

    2012-07-01

    Full Text Available The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2 weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation post- operatively, there is a need for application of an above-elbow cast after nailing.

  18. Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis.

    Science.gov (United States)

    Zhou, Binghua; Zhou, You; Tao, Xu; Yuan, Chengsong; Tang, Kanglai

    2015-01-01

    Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis. Copyright © 2015 American College of

  19. [Closed reposition of an acute midfoot luxation fracture in Charcot arthropathy with the ring fixator].

    Science.gov (United States)

    Delhey, P; Bürklein, D; Kessler, S; Volkering, C

    2010-07-01

    Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.

  20. Assessment of the Treatment Outcome of Closed Extra-Articular Distal Tibia Fracture: IM Nailing vs Plating

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    Seyed Abas Behgoo

    2009-11-01

    Full Text Available Background:The tibial diaphyseal fractures are the most common type of long bone fractures encountered by most orthopedic surgeons.In accordance with descriptive indices of tibia fractures on the basis of their location in the bone,distal tibia fractures have the second incidence of all tibia fractures after the middle tibia fractures.The purpose of the study was to assess the complications and treatment outcome of closed extra-articular distal tibia fracture. Methods:The results of the management for 76 patients with closed extra-articular distal tibia fracture by intramedullary nailing and plating were reviewed retrospectively.The variables included AO (Arbeitsgemeinschaft fur Osteosynthesefragenclassification of tibia fracture, the mean duration of union, malunion,and nonunion.   Results: Twenty seven and forty nine patients were treated by intramedullary(IM nailing and plating respectively.The most common type of fractures was A1 which was observed in twenty five patients. Initial union and nonunion occurred in   sixty three and thirteen patients respectively. Eight patients had nonunion in plating   group and five of twenty seven patients in IM nailing group. Eleven of twenty seven patients in IM nailing group suffered from malunion while only four patients in the other group had this complication.   Conclusion: The plating Technique in comparison with IM nailing has a satisfactory functional outcome.The technique has a lower incidence of malunion and nonunion, and it should be recommended as a good treatment option for the management of extra-articular closed fracture of distal tibia.  

  1. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Baskin, Kevin M.; Cahill, Ann Marie; Kaye, Robin D. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Born, Christopher T. [Temple University Hospital/Temple Children' s Hospital, Temple Sports Medicine, Marlton, NJ (United States); Grudziak, Jan S. [Children' s Hospital of Pittsburgh, Department of Orthopedic Surgery, Pittsburgh, PA (United States); Towbin, Richard B.

    2004-12-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability. (orig.)

  2. Accuracy Analysis of a Robot System for Closed Diaphyseal Fracture Reduction

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    Changsheng Li

    2014-10-01

    Full Text Available We have developed a robot system for closed diaphyseal fracture reduction. Because accuracy is essential for the treatment effects of the robot system and for the safety of both the patients and surgeons, we analysed accuracy in a systematic way. Both the structure of the robot and the operation procedure are described. Using the transfer model of errors in series and the error differential solving method for parallel mechanisms, an error model was established, and the main influencing factors of errors were considered. The Monte Carlo method was used to perform the simulation based on the error model. Experiments of image registration, of the mechanism and of the whole robot system were tested in different aspects to verify that the results of the simulation are correct. The system accuracy was compared with clinical standards to show that the robot system fulfilled the requirements for closed diaphyseal fracture reduction. The accuracy analysis method also provides an efficient path for other medical robots.

  3. Avaliação biomecânica das fraturas intra-articulares do calcâneo e sua correlação clínica radiográfica Biomechanical evaluation of intra articular calcaneal fracture and clinical radiographic correlation

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2004-06-01

    Full Text Available O presente estudo teve o objetivo de oferecer uma avaliação clínica, radiográfica e biomecânica de pacientes com fratura intraarticular de calcâneo, submetidos à redução aberta e fixação interna. A amostra consistiu em 22 pacientes, 20 do sexo masculino e dois do sexo feminino, com idade média de 40,95 (± 11,63 anos. Os autores realizaram avaliações radiográficas do ângulo de Böhler e Gissane, no pré e no pós-operatório, além de utilizarem a tomografia computadorizada para avaliação da classificação de Sanders. A avaliação da Distribuição da Pressão Plantar foi realizada pelo sistema F-scan. Os resultados clínicos encontrados foram satisfatórios apresentando, pontuação média de 75,5 no critério da AOFAS.. A redução cirúrgica resultou em uma melhora dos ângulos de Böhler e Gissane. O estudo mostrou diferenças estatisticamente significantes entre o antepé o retropé fraturados no que tange sobre a área de contato, pressão e força de reação do solo. Os valores encontrados para estes parâmetros foram maiores no retropé que no antepé fraturados. A trajetória de Pressão (COP foi menor no pé fraturado que no pé normal. Encontrou-se correlação entre o Ângulo de Gissane após a redução e o Segundo Pico de Força, indicando que quanto melhor a redução deste ângulo , melhor a impulsão. Também encontrou-se a correlação entre a pontuação AOFAS e o Primeiro Pico de Força, mostrando que quanto melhor o resultado clínico melhor o apoio do retropé.The present study had an objective to perfom a clinical, radiographic and biomechanical evaluation in patients with calcaneal fractures submitted to open reduction with internal fixation. The sample consisted of 22 patients - 20 male and 2 female with an average age of 40,95 (±11,63 years old. The authors have done radiographic evaluation of the pre and post operatory of Böchler and Gissane angles; furthermore, they used a CT scanning for Sander

  4. Calcaneal BMD Obtained by Dual X-Ray and Laser Predicts Future Hip Fractures—A Prospective Study on 4 398 Swedish Women

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    Torkel B. Brismar

    2010-01-01

    Full Text Available The predictive value of dual X-ray and laser (DXL calcaneal BMD (BMDDXL on hip fractures was prospectively studied in 4,398 females aged 55 to 99 years. The average follow-up period was 3 years and 11 months with a total of 17,270 person years. Fractures were identified from the national patient register. After inclusion, 130 females sustained a hip fracture. The age adjusted hazard ratio for T-score −2.5 was 2.64. Of all patients who sustained a hip fracture 78% had a T-score of −2.5 or below. The annual hip fracture rate was 0.26% at T-scores ≥−2, but 1.5% at T-scores ≤−2.5. The area under curve for the model including calcaneal BMDDXL, follow-up time, and age to prospectively predict hip fractures was 0.84. Conclusions. Calcaneal BMDDXL obtained by DXL Calscan predicts hip fractures and may therefore be suitable for diagnosing osteoporosis and for predicting fracture risk.

  5. Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination

    Energy Technology Data Exchange (ETDEWEB)

    Tresley, Jonathan [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States); University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); Subhawong, Ty K.; Singer, Adam D.; Clifford, Paul D. [Jackson Memorial Hospital, Department of Diagnostic Radiology, Miami, FL (United States)

    2016-07-15

    To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. We categorized calcaneal fractures according to the Sanders classification, and pilon fractures according to the Ruedi and Allgower and the Arbeitsgemeinschaft fuer Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA) classifications. Ankle tendons were assessed for dislocation or entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. A total of 312 fractures (91 pilon only, 193 calcaneal only, and 14 ankles with ipsilateral pilon and calcaneal fractures) were identified in 273 patients. Twenty-two pilon, 42 calcaneal, and nine combination fractures were associated with 99 occurrences of tendon entrapment or superior peroneal retinacular injury. Such findings were associated with multiple fractures (p = 0.002). Multifragmentary pilon fractures were associated with posterior tibial and flexor digitorum longus tendon entrapment (p < 0.0001 and p = 0.0003 for Ruedi/Allgower and AO-OTA, respectively), and multifragmentary Sanders type 3 or 4 calcaneal fractures were associated with superior peroneal retinacular injury (p = 0.0473) compared to simple fracture patterns. Thirty-nine percent of tendon entrapments or retinacular injuries were prospectively identified, 85 % by musculoskeletal radiologists (p < 0.0001). Approximately 25 % of calcaneal and pilon fractures were retrospectively identified to contain posteromedial tendon entrapment or superior peroneal retinacular injury. Radiologists should meticulously search for such injuries, particularly when analyzing multifragmentary and multiple fractures. (orig.)

  6. Compartment syndrome of the upper arm after closed reduction and percutaneous pinning of a supracondylar humerus fracture.

    Science.gov (United States)

    Diesselhorst, Matthew M; Deck, Jason W; Davey, Joseph P

    2014-03-01

    Supracondylar fractures of the humerus are the most frequently seen elbow fractures in children. One of the most feared complications of this fracture, that is, compartment syndrome of the forearm is seen rarely. Compartment syndrome of the upper arm is an even more rare occurrence and to date, has not been reported in association with an isolated supracondylar humerus fracture in a child. A 9-year-old boy was cared for at our facility for a severe (Gartland type III) supracondylar humerus fracture and developed a compartment syndrome in the perioperative period. A clinical, radiographic, and literature review of this case was undertaken to better define this occurrence. This patient sustained a closed supracondylar humerus fracture in association with a motor and sensory deficit of the radial nerve. Because of the severity of the deformity, a provisional reduction was performed in the emergency department. Eleven hours after the injury, a routine closed reduction and percutaneous pinning was performed. Although significant swelling was noted at that time, compartment syndrome was not clinically suspected. He was observed as an inpatient because of this persistent swelling. Over the next day, he developed considerable tenderness over the anterior arm and mobile wad musculature, hence, compartment pressure measurements were made. These confirmed a compartment syndrome in the anterior compartment of the arm and equivocally in the mobile wad. An urgent compartment release of the arm was done, which resulted in full recovery. This is the first report of a compartment syndrome of the arm after an isolated supracondylar humerus fracture in a child. The presence of the associated fracture made the classic signs of compartment syndrome difficult to assess. Ultimately, muscle tenderness and compartment pressure measurement were most helpful in making this diagnosis. A high index of suspicion should be maintained for compartment syndrome of the arm as well as the forearm

  7. Calcaneal loading during walking and running

    Science.gov (United States)

    Giddings, V. L.; Beaupre, G. S.; Whalen, R. T.; Carter, D. R.

    2000-01-01

    PURPOSE: This study of the foot uses experimentally measured kinematic and kinetic data with a numerical model to evaluate in vivo calcaneal stresses during walking and running. METHODS: External ground reaction forces (GRF) and kinematic data were measured during walking and running using cineradiography and force plate measurements. A contact-coupled finite element model of the foot was developed to assess the forces acting on the calcaneus during gait. RESULTS: We found that the calculated force-time profiles of the joint contact, ligament, and Achilles tendon forces varied with the time-history curve of the moment about the ankle joint. The model predicted peak talocalcaneal and calcaneocuboid joint loads of 5.4 and 4.2 body weights (BW) during walking and 11.1 and 7.9 BW during running. The maximum predicted Achilles tendon forces were 3.9 and 7.7 BW for walking and running. CONCLUSIONS: Large magnitude forces and calcaneal stresses are generated late in the stance phase, with maximum loads occurring at approximately 70% of the stance phase during walking and at approximately 60% of the stance phase during running, for the gait velocities analyzed. The trajectories of the principal stresses, during both walking and running, corresponded to each other and qualitatively to the calcaneal trabecular architecture.

  8. Calcaneal Bone Mass Modification in Recreational Runners.

    Science.gov (United States)

    Escamilla-Martínez, Elena; Martínez-Nova, Alfonso; Gómez-Martín, Beatriz; Sánchez-Rodríguez, Raquel; Fernández-Seguín, Lourdes María; Pedrera-Zamorano, Juan Diego

    2016-11-01

    The calcaneus is the bone of the foot that first receives the impact of running, generating vibrations that might have a positive effect in modifying the trabecular bone mass. The objective of this study was to determine the variation in calcaneal bone density in runners during a 6-month training season, comparing it with a control sample. Bone density of the heel was measured in 33 male recreational runners by means of a contact ultrasonic bone analyzer. Measurements were made on three occasions during a training season: at the beginning, at 350 km, and at 700 km. All of the runners wore the same model of running shoes during this period. Measurements of bone density were also made in a control sample of 62 men who did not engage in physical exercise. There was a significant decrease in mean calcaneal bone density over the course of the training season (from 86.1 dB/MHz to 83.2 dB/MHz; P = .006), but no significant differences with the control sample value (from 80.7 dB/MHz to 81.1 dB/MHz; P = .314). The runners' body composition changed during the study period, with lean mass increasing and fat mass decreasing. Distance running seems to have a negative effect on calcaneal bone mass density during the course of a 700-km training season.

  9. The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

    Directory of Open Access Journals (Sweden)

    Gulseren Kayalar

    2009-01-01

    Full Text Available OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA. MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO, dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT, covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05. A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001, body mass index (BMI (r=0.223, p=0.001, number of live births (r=-0.229, p=0.001, breast feeding time (r=-0.064, p=0.001, and age at menarche (r=-0.050, p=0.008. The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001 and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001 at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001 and calcaneal

  10. Locking plate external fixation and negative pressure wound therapy for treatment of a primary infection in a closed clavicle fracture.

    Science.gov (United States)

    Kenyon, Robert M; Morrissey, David I; Molony, Diarmuid C; Quinlan, John Francis

    2016-11-28

    Infection in a clavicle fracture is uncommon, but remains a challenging problem. A paucity of soft tissue coverage often combined with significant displacement and interfragmentary movement add complexity to an already difficult situation for effective infection treatment. External fixation in principle offers a means of achieving fracture stability, while the infection is being eradicated. We present the case of a closed clavicle fracture, initially treated conservatively, that presented 5 weeks later with infection. The fracture was definitively treated with external fixation using a locking plate positioned superficially to the skin, plus negative pressure wound therapy and subsequent secondary closure and antibiotic therapy. This case illustrates a novel method of treatment in this unusual presentation that was well tolerated by the patient and resulted in a good clinical outcome. 2016 BMJ Publishing Group Ltd.

  11. Feasibility of C-arm guided closed intramedullary pinning for the stabilization of canine long bone fractures.

    Science.gov (United States)

    Kaur, Anupreet; Kumar, Ashwani; Kumar, Deepesh; Mohindroo, Jitender; Saini, Narinder Singh

    2015-12-01

    To evaluate the feasibility of C-arm guided closed intramedullary pinning (simple Steinmann and end threaded) techniques for the stabilization of various canine long bone fractures. The present study was conducted on 19 dogs with long bone fractures which were stabilized using simple Steinmann (Group I; n=6) and end threaded (Group II; n=13) pinning under C-arm guidance. Signalment, history of trauma, clinical examination, and hematobiochemical findings were recorded at the time of presentation. Radiography of the affected limb was carried out in two views to determine type and site of the fracture. Treatment of all the fractures was attempted using simple Steinman and end threaded pinning under the C-arm guidance. The success and failure of the closed technique were correlated with age, site, and type of fractures. The mean body weight and age of the dogs were 18.53±2.18 kg and 21.58±5.85 months, respectively. Early presented cases at a mean day of 2.84±0.54 were included. Out of 19 cases, it was possible to place implant successfully in 10 cases (success rate 52.63%) only. The remaining 9 cases had serious intraoperative complications like a misdirection of the pin after engaging the proximal fragment (n=3), missing the proximal fragment completely, and formation of the false tract (n=6). The majority of these complications were associated with younger age and proximal or distal third oblique fractures. High success rate of C-arm guided closed pinning was observed in midshaft fractures (75%) and transverse fractures (77.78%) in dogs of more than 1 year of age (77.78%). Simple Steinmann pinning was better feasible in a closed manner with a high success rate (66.70%) but also had implant related complications. Although, C-arm guided end threaded pinning was less (46.15%) successful, slightly tedious and time-consuming but had better implant stability than that of simple intramedullary pinning. From the present study, it was concluded that C-arm guided closed

  12. Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures.

    Science.gov (United States)

    Glickel, Steven Z; Catalano, Louis W; Raia, Frank J; Barron, O Alton; Grabow, Ryan; Chia, Benjamin

    2008-12-01

    The purpose of this study was to review the long-term outcomes of patients with distal radius fractures treated with closed reduction and percutaneous pinning. We retrospectively reviewed 54 patients with 55 AO type A2, A3, C1, or C2 distal radius fractures treated with closed reduction and percutaneous pinning. The average age of the patients was 57 years. All patients returned for follow-up examination at an average of 59 months, with a minimum of 22 months. Measurements included active range of motion, grip strength, pain assessment, Disabilities of the Arm, Shoulder, and Hand scores, and final radiographic assessment. The paired t-test was used to determine significant differences. All fractures healed within 6 weeks. Active range of motion and grip strength of the injured wrist were statistically equal to those of the uninjured wrist for each of the parameters except wrist flexion and forearm supination. However, the difference in wrist flexion was 5 degrees and the difference in supination was 4 degrees , both of which are of little clinical importance. Eighty-five percent of patients were pain free. Radiographic parameters comparing the immediate postoperative view with the views taken at final follow-up showed no significant differences. One patient required reoperation for loss of reduction after a fall in the preoperative period, and 3 others had minor complications. Patients treated with closed reduction and percutaneous pinning for distal radius fractures had excellent range of motion, normal Disabilities of the Arm, Shoulder, and Hand scores, and no significant differences in the radiographic parameters between fracture fixation and fracture healing. Complications were few. Pinning is an efficacious, low-cost treatment option for 2- and 3-part distal radius fractures with excellent long-term results. Therapeutic IV.

  13. Effectiveness of Serial Measurement of Differential Pressure in Closed Tibial Diaphyseal Fractures in Diagnosing Acute Compartment Syndrome using Whiteside's Technique.

    Science.gov (United States)

    Ramprasath, D R; Thirunarayanan, V; David, J; Anbazhagan, S

    2016-03-01

    Acute Compartment Syndrome is a limb-threatening emergency and it occurs most commonly after fractures. The aim of our study is to find out the effectiveness of serial measurement of differential pressure in closed tibial diaphyseal fractures, in diagnosing acute compartment syndrome, using Whiteside's technique. A total of 52 cases in the age group of 15 to 55 years admitted with closed fractures were studied for serial compartment pressure as well as serial differential pressure. Eight patients had persistent compartment pressure > 40mmHg, out of which only two patients had persistent differential pressure compartment pressure serially and calculating differential pressure serially, acute compartment syndrome can be diagnosed or ruled out with higher precision, so that unnecessary fasciotomies can be avoided.

  14. Avaliação quantitativa ultra-sonográfica do calcâneo permite diferenciar mulheres com e sem fraturas ósseas recentes Quantitative calcaneal ultrasound evaluation allows distinguishing women with and without fractures

    Directory of Open Access Journals (Sweden)

    Lorena Aguirre Zambrano Velho

    2007-06-01

    Full Text Available OBJETIVO: Estudos internacionais apontam o ultra-som de calcâneo (QUS como um excelente método para avaliar a qualidade óssea e o risco de fraturas. O objetivo deste estudo foi comparar o QUS de um grupo de mulheres brasileiras fraturadas com outro de não- fraturadas e verificar se as medidas do pé direito e esquerdo e duas medidas seqüenciais em cada pé eram estatisticamente equivalentes. MÉTODOS: Foram avaliadas 52 mulheres. Vinte e seis eram fraturadas e 26 sem fraturas, pareadas por idade (± 2, anos de pós-menopausa (± 2, e índice de massa corpórea (kg/m² (± 2. RESULTADOS: Os resultados foram comparados pelo teste t de Student para amostras pareadas. Os valores (média ± DP para o índice de elasticidade (SI foram 54,9 (± 16,6 e 80,4 (± 17,3 e o T Score foi -2,9 (± 0,94 e -1,3 (± 0,95 para o grupo com e sem fraturas, respectivamente. A primeira e segunda medidas do SI para cada pé, bem como as medidas dos pés direito e esquerdo foram similares. Houve significância estatística (pOBJECTIVE: International studies have pointed out quantitative ultrasound as an important method to assess bone fragility and risk of fracture. This study was performed to compare quantitative ultrasound (QUS in two groups of Brazilian women, those with a fracture and those with no previous history of fracture. The aim was to assess whether there was any difference between the right and the left foot s and whether two sequential measurements in each foot were statistically equivalent... METHODS: A total of 52 women, 26 with and 26 with no fractures, matched by age (± 2 years, years since menopause (± 2 years, and body mass index (kg/m² (± 2 were evaluated. RESULTS: Results were compared by the Student's t test for matched samples. Values (mean ± SD for the stiffness index (SI were 54.9 (± 16.6 and 80.4 (± 17.3, and for the T Score were -2.9 (± 0.94 and -1.3 (± 0.95 for the groups with and with no fractures, respectively. The first and

  15. Dual Fixation of Calcaneal Tuberosity Avulsion with Concomitant Achilles Tendon Rupture: A Novel Hybrid Technique

    Directory of Open Access Journals (Sweden)

    Gautham Prabhakar

    2017-01-01

    Full Text Available Fracture of the calcaneal tuberosity with a concomitant Achilles tendon rupture presents a difficult challenge for the treating surgeon. The ultimate goal of treatment is to restore function of both the gastrocnemius-soleus complex and the Achilles tendon. This particular subset of fractures occurs often in diabetics and elderly patients with osteoporosis making fixation of the displaced fragment rather complex. If the Achilles tendon disruption is only discovered later once the fracture is healed, subsequent management is difficult with surgical treatment being more morbid. While this is a rare injury, the consequences of a missed chronic Achilles tendon disruption are severe with significant dysfunction. It is therefore important to have a high index of suspicion for concomitant injury and to be prepared for dual fixation. We present a novel hybrid surgical fixation technique, which may be used in this instance.

  16. Does Anticoagulant Medication Alter Fracture-Healing? A Morphological and Biomechanical Evaluation of the Possible Effects of Rivaroxaban and Enoxaparin Using a Rat Closed Fracture Model.

    Directory of Open Access Journals (Sweden)

    Peter Michael Prodinger

    Full Text Available Low molecular weight heparin (LMWH is routinely used to prevent thromboembolism in orthopaedic surgery, especially in the treatment of fractures or after joint-replacement. Impairment of fracture-healing due to increased bone-desorption, delayed remodelling and lower calcification caused by direct osteoclast stimulation is a well-known side effect of unfractioned heparin. However, the effect of LMWH is unclear and controversial. Recent studies strongly suggest impairment of bone-healing in-vitro and in animal models, characterized by a significant decrease in volume and quality of new-formed callus. Since October 2008, Rivaroxaban (Xarelto is available for prophylactic use in elective knee- and hip-arthroplasty. Recently, some evidence has been found indicating an in vitro dose independent reduction of osteoblast function after Rivaroxaban treatment. In this study, the possible influence of Rivaroxaban and Enoxaparin on bone-healing in vivo was studied using a standardized, closed rodent fracture-model. 70 male Wistar-rats were randomized to Rivaroxaban, Enoxaparin or control groups. After pinning the right femur, a closed, transverse fracture was produced. 21 days later, the animals were sacrificed and both femora harvested. Analysis was done by biomechanical testing (three-point bending and micro CT. Both investigated substances showed histomorphometric alterations of the newly formed callus assessed by micro CT analysis. In detail the bone (callus volume was enhanced (sign. for Rivaroxaban and the density reduced. The bone mineral content was enhanced accordingly (sign. for Rivaroxaban. Trabecular thickness was reduced (sign. for Rivaroxaban. Furthermore, both drugs showed significant enlarged bone (callus surface and degree of anisotropy. In contrast, the biomechanical properties of the treated bones were equal to controls. To summarize, the morphological alterations of the fracture-callus did not result in functionally relevant deficits.

  17. Psychological-behavioral characteristics and fractures in children are closely related.

    Science.gov (United States)

    Zheng, Pengfei; Ju, Li; Ma, Xiaoming; Lou, Yue

    2014-11-01

    This work aimed to study the relationship between psychological-behavioral characteristics and fractures in children to provide a basis for development of preventive strategies. The study included 84 children hospitalized for fractures (fracture group) and 78 children without fractures (control group). The following questionnaires were utilized: temperament questionnaire, Eysenck Personality Questionnaire, and the Achenbach Child Behavior Checklist (CBCL). There were more children with problem behaviors in the fracture group than in the control group (Pfractures (Pfracture group than the control group (Pfracture group than the control group in 4-5-year and/or 6-11-year olds. In addition, in 6-11-year olds, boys in the fracture group had higher scores for restlessness, aggression, and violation of discipline and girls in the fracture group had higher scores for aggression and depression than those in the control group (PChildren with fractures had more psychological and behavioral problems. Psychological intervention measures could be adopted to reduce the occurrence of fractures in children.

  18. The value of calcaneal bone mass measurement using a dual X-ray laser Calscan device in risk screening for osteoporosis.

    Science.gov (United States)

    Kayalar, Gulseren; Cevikol, Alev; Yavuzer, Gunes; Sanisoglu, Yavuz; Cakci, Aytul; Arasil, Tansu

    2009-01-01

    To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (penergy X-ray laser T-score and age (r= -0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r= -0.229, p=0.001), breast feeding time (r= -0.064, p=0.001), and age at menarche (r= -0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.33, p=0.001) at the femoral neck were statistically significant. Bone mineral density measurements in the calcaneus using a dual energy X-ray laser are valuable

  19. [Minimal invasive elastic intramedullary nails and external fixation for treatment of comminuted closed fracture of tibia-fibula shaft].

    Science.gov (United States)

    Yu, Yang; Chen, Wei-kai; Cui, Wei; Zhou, Yi-fei; Chen, Hua; Yang, Lei

    2015-05-01

    To investigate the clinical results of external fixation and AO titanium elastic intramedullary nailing for treatment of tibia-fibula comminuted closed fractures. From June 2010 to June 2012,58 patients with tibia-fibula comminuted closed fractures were treated with external fixation and AO titanium elastic intramedullary nailing, including 31 males and 27 females with an average age of 38.5 years old ranging from 21 to 57 years old. According to the system of AO Classification, the fractures were classified as type B1 in 9 cases,type B2 in 7 cases, type B3 in 10 cases, type Cl in 14 cases, type C2 in 12 cases,and type C3 in 6 cases. According to the system of Winquist-Hanson,the fractures' comminuted were classified as grade 1 in 23 cases, grade 2 in 17 cases, grade 3 in 12 cases, and grade 4 in 6 cases. According to the system of Johner-Wruhs, clinical results were compared between different type and grade groups by the time of last followed-up. All 58 patients were followed up with an average time of 6.8 months (ranged from 18 to 36 weeks). All fractures had clinical healing with an average time of 28 weeks (ranged from 24 to 32 weeks). The total rate of good to excellent results was 91.4%. The rate of good to excellent in the group of grade 1 was higher than that of other grades. The complication rates and fracture healing time would increase respectively with higher Winquist-Hanson's grade. The complication rates in the group of type C3 was higher than that of other types, but the rate of good to excellent was lower than that of other types. The complication rates in the group of type B1 was lower than that of other types,but the rate of good to excellent was higher than that of other types. Minimal invasiveusing AO titanium elastic intramedullary nailing combined with external fixation for treatment of tibia-fibula fractures especially for the multiple-segment,long spiral mild-to-moderate comminuted with hidden fracture can get satisfactory reduction and

  20. Closed and open grade I and II tibial shaft fractures treated by reamed intramedullary nailing

    OpenAIRE

    Djahangiri, A.

    2006-01-01

    RESUME Objectif : Le but de cette étude est d'évaluer les résultats du traitement par enclouage centre-médullaire alésé des fractures diaphysaires du tibia aussi bien fermées que pour les fractures ouvertes de stade I et II selon Gustillo. Méthodes: Entre 1997 et 2000, 119 patients présentant une fracture diaphysaire du tibia ont été traités dans notre service par un enclouage centre-médullaire alésé. En postopératoire, 96 patients, soit 70 fractures fermées et 26 fractures ouvert...

  1. Closed retrograde multiple intramedullary Kirschner wires fixation for humeral shaft fractures with the limb flexed over an articulated support.

    Science.gov (United States)

    Sié, Essoh J B; Kacou, Aka D; Traoré, A; Mobiot, C; Bamba, I; Lambin, Y

    2014-03-01

    To evaluate the results of multiple closed intramedullary Kirschner wiring via a supracondylar entry point for humeral shaft fractures. The charts of 37 patients with humeral shaft fractures treated with the Hackethal's technique between January 2007 and December 2011 were reviewed retrospectively. The operation was performed with the patient lying in supine (n = 22) or lateral (n = 15) position. The elbow was flexed over an articulated support with the arm kept in a vertical position. Thirty-three patients were available for final evaluation with a mean follow-up delay of 14 (range, 6-24) months. We were concerned about fracture union, range of motion of the shoulder and the elbow, and complications. Final evaluation used the criteria by Qidwai. Bone union rate was 94%. Restriction of ranges of motion of the shoulder more than 20° was noticed in two patients due to protruding wires. Three patients developed limitation of elbow extension owing to backing out of the wires. The overall results were excellent (n = 26; 79%), good (n = 4; 12%), and poor (n = 3; 9%). Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction.

  2. Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

    Directory of Open Access Journals (Sweden)

    Kang-Young Choi

    2012-07-01

    Full Text Available In the treatment of mandibular condyle fracture, conservative treatment using closedreduction or surgical treatment using open reduction can be used. Management of mandibularcondylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma.For each type of condylar fracture,the treatment method must be chosen taking intoconsideration the presence of teeth, fracture height, patient’sadaptation, patient’s masticatorysystem, disturbance of occlusal function, and deviation of the mandible. In the past, closedreduction with concomitant active physical therapy conducted after intermaxillary fixationduring the recovery period had been mainly used, but in recent years, open treatment ofcondylar fractures with rigid internal fixation has become more common. The objectiveof this review was to evaluate the main variables that determine the choice of an open orclosed method for treatment of condylar fractures, identifying their indications, advantages,and disadvantages, and to appraise the current evidence regarding the effectiveness ofinterventions that are used in the management of fractures of the mandibular condyle.

  3. Closed treatment of condylar fractures by intermaxillary fixation with thermoforming plates.

    Science.gov (United States)

    Terai, Haruhiko; Shimahara, Masashi

    2004-02-01

    We report a new intermaxillary fixation (IMF) method for condylar fractures using a thermoforming plate. Fifteen cases of condylar fracture were selected and thermoforming plates were applied. The patient's recover was uneventful in all 15 cases, and the period of IMF ranged from 7 to 17 days, (mean 12) for the following 7 days IMF was used only at night together with functional jaw training during the day. The outcome was good. IMF using a thermoforming plate may be a useful technique for selected condylar fractures.

  4. OUTCOMES IN CLOSED REAMED INTERLOCKING NAIL IN FRACTURES OF SHAFT OF FEMUR

    National Research Council Canada - National Science Library

    Mohammad, Taj; Khan, Alamzeb; Sawati, Alamzeb; Ahmed, Ashfaq; Awan, Abdus Saboor; Saboor, Abdus; Siddique

    2015-01-01

    .... Violent forces are required to break this and strongest of human bones. There are various treatment modalities for femoral shaft fractures in adults like traction, brace, platting, intramedullary nail (IMN...

  5. Closed reduction and fluoroscopic-assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats.

    Science.gov (United States)

    Boekhout-Ta, Christina L; Kim, Stanley E; Cross, Alan R; Evans, Richard; Pozzi, Antonio

    2017-01-01

    To report complications and clinical outcome of dogs and cats that underwent fluoroscopic-assisted percutaneous pinning (FAPP) of physeal fractures. Retrospective study. Client-owned dogs (n = 37) and cats (n = 4). Records (August 2007-August 2014) of physeal fractures treated with FAPP in 3 hospitals were evaluated. Data collected included signalment, fracture characteristics (etiology, location, duration, Salter-Harris classification, preoperative and postoperative displacement), surgical information (implant size, surgical duration), and outcome assessment information (functional outcome, radiographic outcome, and complications). The majority of animals (92%) were classified as full functional outcome. No significant predictors of functional outcome were identified. The overall complication rate was 15% (n = 6). Elective pin removal rate was 41% (n = 17). Goniometry and limb circumference measurements of the affected and contralateral limbs were not significantly different in dogs for which measurements were obtained. Seventeen of 18 animals (16 dogs, 2 cats) measured had bone length changes on follow-up radiographs. FAPP is associated with an excellent functional outcome in a narrow selection of fracture configurations, specifically those with minimal displacement and for which anatomical alignment can be achieved with closed reduction. © 2016 The American College of Veterinary Surgeons.

  6. [Is calcaneal osteotomy justified in Haglund's disease?].

    Science.gov (United States)

    Maynou, C; Mestdagh, H; Dubois, H H; Petroff, E; Elise, S

    1998-11-01

    The authors report their experience of Zadek's wedge osteotomy in the treatment of posterior talalgia in adults and evaluate the various radiographical measurements for calcaneus deformity measurement.... This procedure was performed in 27 patients with a total of 36 calcanea treated between 1985 and 1996. The sex ratio was 20 women for 7 men with an average age of 27 years. Prior to this osteotomy nine feet were operated by resection of the postero-superior tuberosity with recurrence of pain and disability, and two patients presented an inflammatory arthritis. For the surgical procedure, the patient was placed in lateral position. Skin incision was five to six centimeters long, curvilinear along the lateral side of the tendo achillis. Two dorsal pins were inserted, creating a triangle so that the apex pointed plantarly and the base dorsally. The sagittal saw was then used to create a wedge osteotomy with a dorsal base of seven to ten millimeters. A screw was then driven across the osteotomy site for ultimate fixation. Eighty per cent (29 osteotomies) of patients had been examined clinically and radiologically with a mean follow-up of 29 months. Considering pain, daily activity and discomfort with footwear, results were excellent in 12 cases, good in 10, fair in 5 and poor in two cases. No radiological criteria used for the diagnosis of Haglund's disease were absolutely reliable. The "total angle" of Ruch, the "c.l angle" of Chauveaux and the "parallel pitch lines" of Heneghan reflect the amount of deformation most accurately, but especially, the calcaneal inclination angle was always increased (16 cases between 18 degrees and 30 degrees, 6 cases > 30 degrees). All patients had a weight-bearing calcaneal talus, either alone or in the context of posterior pes cavus. This study confirms the responsibility of rearfoot morphostatic disorders in posterior talalgia and the goods results obtained by Zadek osteotomy.

  7. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Ignacio [Musculoskeletal Research Fellow at NYU Langone Medical Center, New York, NY (United States); Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires (Argentina); Rosenberg, Zehava [NYU Langone Medical Center, New York, NY (United States); Zember, Jonathan [Albert Einstein College of Medicine Jacobi Medical Center, Bronx, NY (United States)

    2016-04-15

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  8. Characteristic calcaneal ossification: an additional early radiographic finding in infants with fibrodysplasia ossificans progressiva

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Sachi [Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi (Japan); Victoria, Teresa [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Kayserili, Huelya [Koc University School of Medicine (KUSOM), Medical Genetics Department, Istanbul (Turkey); Zackai, Elaine [Children' s Hospital of Philadelphia, Department of Medical Genetics, Philadelphia, PA (United States); Nishimura, Gen; Haga, Nobuhiko; Nakashima, Yasuharu; Miyazaki, Osamu [The Research Committee on Fibrodysplasia Ossificans Progressiva, Tokyo (Japan); Kitoh, Hiroshi [Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi (Japan); The Research Committee on Fibrodysplasia Ossificans Progressiva, Tokyo (Japan)

    2016-10-15

    We have clinically encountered children with fibrodysplasia ossificans progressiva who had abnormal calcaneal ossification. To evaluate whether calcaneal ossification variants are significant radiographic findings in children with fibrodysplasia ossificans progressiva. Lateral feet radiographs in nine children who fulfilled the diagnostic criteria of fibrodysplasia ossificans progressiva were reviewed. The studies were obtained during infancy or early childhood. Fourteen lateral foot radiographs of fibrodysplasia ossificans progressiva were available for this study (ages at examination: 1-104 months). Four children ages 2 months to 11 months showed double calcaneal ossification centers; 7 children had plantar calcaneal spurs that decreased in size with age. Overall, eight of nine children with fibrodysplasia ossificans progressiva demonstrated double calcaneal ossifications and/or plantar calcaneal spurs in infancy or childhood. Double calcaneal ossification centers in early infancy and plantar calcaneal spurs in childhood are frequently seen in children with fibrodysplasia ossificans progressiva and may be a useful radiologic indicator for early diagnosis. (orig.)

  9. Comparison Study of the Use of Absorbable and Nonabsorbable Materials as Internal Splints after Closed Reduction for Nasal Bone Fracture

    Directory of Open Access Journals (Sweden)

    Chang Ryul Yi

    2014-07-01

    Full Text Available Background The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. Methods The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A or SPF (group B was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. Results PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. Conclusions The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.

  10. FAILED PRIMARY TREATMENT OF CALCANEAL FRACTURE. WHAT TO DO?

    Directory of Open Access Journals (Sweden)

    Matej Andoljšek

    2008-02-01

    When conservative treatment fails, operative treatment is indicated in most patients withbone and joint problems. The goals of surgical treatment are pain relief and restoration oftalocalcaneal alignment. In lateral impingement, when subtalar joint and general alignmentof the tuber are preserved, removal of the bulged lateral wall could suffice. In suchcases a corrective osteotomy of the tuber is rarely indicated. In painfull subtalar arthrosisfusion is the only option. Limited fusion is preferable. »In situ« subtalar fusion is advisablein cases without malalignment or deformity. When we have arthrosis and varus/valgusdeformity with preserved height, arthrodesis with corrective osteotomy is indicated. In mostcases, where complex deformity is present, corrective subtalar distraction bone-blockarthrodesis should be done

  11. A Novel Closed Method to Retrieve Broken Teflon Tube During Intramedullary Nailing in Proximal Humeral Fracture

    Directory of Open Access Journals (Sweden)

    Yuk Fai Lau

    2017-12-01

    Full Text Available Broken medullary tubes have been used for intramedullary (IM nailing of femoral and tibial fractures. In these reported cases, fragments of the medullary tube were retrieved by opening the fracture sites or left in situ, which might jeopardize periosteal blood supply. We herein present the case of a 58-year-old woman who underwent IM nailing for proximal humeral fracture, which was complicated by breakage of the medullary tube intraoperatively. Different instruments including guide rods, straight forceps, and cement extract hook were used to retrieve the retained fragments from the medullary canal, but these attempts were unsuccessful. Finally, the fragments were successfully removed using an anterior cruciate ligament (ACL ENDOBUTTON depth gauge. This case highlights that medullary tubes can break during humeral IM nailing, which could be minimized by ensuring integrity of the medullary tube prior to surgery and disposing medullary tubes with more than 100 exposures. A novel method of using ACL ENDOBUTTON depth gauge to retrieve retained tube fragments is recommended because of its long and slim design.

  12. Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

    Science.gov (United States)

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

    Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

  13. Dynamic and functional gait analysis of severely displaced intra-articular calcaneus fractures treated with a hinged external fixator or internal stabilization.

    Science.gov (United States)

    Besch, Lutz; Radke, Birgit; Mueller, Michael; Daniels-Wredenhagen, Mark; Varoga, Deike; Hilgert, Ralf-Erik; Mathiak, Guenther; Oehlert, Katharina; Seekamp, Andreas

    2008-01-01

    The purpose of this article was to assess functional gait outcome. Fifty-five patients with severely displaced intra-articular calcaneus fractures and soft tissue damage were evaluated prospectively with computerized dynamic pedography and a clinical scoring scale. The treatment protocol assigned 30 patients to open reduction and internal fixation (ORIF) and 25 to closed reduction and stabilization with a biomechanically tested hinged external fixator. Gait parameter was evaluated by measuring plantar pressure distribution, length of a double-step, double-step duration, standing duration, effective foot length, and width of gait. Pedographic measurements were performed with a custom-made gait analysis system (medilogic Gangas, Berlin, Germany). Results were graded by an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scales. Radiographs were reviewed according to the Sanders classification at the time of follow-up (7.3 years). All measurements were statistically analyzed (t test; Mann-Whitney U test). Aberrations were associated with all calcaneal fractures in both groups. Dynamic gait analysis showed gait asymmetry in all patients. The type of treatment (ORIF or a hinged fixator) of severely displaced calcaneus fractures did not affect gait analysis nor result in significantly different (P > .05) patient outcome scores. The gait analysis system allows a valid dynamic pedographic measurement. The hinged external fixator can be recommended in displaced intra-articular calcaneal fractures with severe soft tissue damage to reduce complications associated with ORIF. ACFAS Level of Clinical Evidence: 2c.

  14. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Storgård Jensen, Simon; Kofod, Thomas

    2008-01-01

    The clinical outcome of closed vs open reduction and rigid fixation was compared based on a systematic review of the literature. Ten non-randomized retrospective studies were found. In six of these ten studies, the complication rate was significantly increased when open reduction and plating...... or wires. Nerve injuries were slightly increased when open reduction was found (although not significant). With regard to occlusal disturbances, no difference was found in the open and closed reduction group. Concerning overall complication problems, six of seven studies showed more problems after open...... in case of more complicated fractures cannot be excluded, which might explain the differences found between the two procedures. Prospective, randomized clinical trials are needed to illuminate this problem....

  15. [Physiotherapeutic proceeding in symptomatic calcaneal spur treatment].

    Science.gov (United States)

    Kociuga, Natalia; Kociuga, Jerzy; Woldańska-Okońska, Marta; Kubsik, Anna

    Calcaneal spur is one of the most common disorders associated with foot pain. According to appearance of pain in each step during the day, it is important to find the most effective method of treatment. This article is a review of medical reports about non-operative treatment method. It shows that ultrasound therapy was the most common physical intervetion used so far, and mostly occurs to be effective. However one of the comparative studies improves higher efficiency of phonopheresis. Another comparative study, shows higher efficiency of combined ultrasound and laser therapy, than exclusive laser therapy. There haven't been found any articles that would evaluate efficacy of electrotherapy and short wave diathermy (electric field) in the treatment of mentioned disorder. Studies that describe the effect of ESWT treatment were also analyzed in this article, and all of them confirm its effectiveness in heel spur therapy, showing no side-effects. Cryotherapy also causes positive effect in treatment of this disorder. However Cryoultrasound therapy that uses the energy of two interconnected terapeutic techniques which is cryotherapy and ultrasounds, proved to be more effective.

  16. A Thermo-Hydro-Mechanical modeling of fracture opening and closing due heat extraction from geothermal reservoir

    Science.gov (United States)

    Nand Pandey, Sachchida; Chaudhuri, Abhijit; Kelkar, Sharad

    2015-04-01

    -water injection. The initial fracture aperture was taken 1mm. The Young's modulus of rock matrix and joint stiffness were taken as 15GPa and 15GPa/m respectively. Our results show that the contraction of rock due to cooling causes the opening of the fracture near injection well. However in some regions where temperature drop is insignificant the compressive stress develops and fracture closes. As the heat extraction continues with time, further contraction of rock causes more aperture growth between the wells. For the above-mentioned computational domain, due to cold-water (20 °C) at mass flow rate 4kg/s, the aperture in the vicinity of the injection well increases by 75%. Our simulation for joint stiffness equal to 50GPa/m, show that the magnitudes of normal tensile and compressive stresses in the fracture/joint are almost same but the aperture alteration is proportionally reduced. Since the joint stiffness is a nonlinear function of opening, it is important to include a suitable nonlinear model for joint opening/closing while simulating the fracture transmissivity alter during heat extraction.

  17. Clinical study of emergency treatment and selective closed reduction for the treatment of supracondylar humerus fracture in children

    Directory of Open Access Journals (Sweden)

    Wei Zhong

    2016-11-01

    Full Text Available Objective: To study the effect of emergency treatment, selective closed reduction combined with percutaneous Kirschner wire fixation on the treatment of Gartland type-II and type-III supracondylar humerus fracture. Methods: Children who sustained the Gartland type-II and type-III supracondylar fractures of humerus treated with selective closed reduction combined with percutaneous Kirschner wire fixation in our hospital from May 2012 to August 2015 were analyzed retrospectively. They were divided into group A (emergency operation group and group B (selective operation group according to different operation timing. Perioperative situation, blood biochemical parameters, swelling degree and elbow joint function of affected limb were compared between two groups. Results: Operation time for patients of group A was significantly shorter than that of group B [(17.19 ± 2.85 vs. (21.43 ± 3.91 min], and frequency of fluoroscopy during operation of group A was obviously less than that of group B [(6.03 ± 0.95 vs. (7.61 ± 0.92 times]. Swelling index of affected limb in group A at 3 days, 5 days and 7 days after injury was all significantly lower than that in group B [(1.20 ± 0.17 vs. (1.38 ± 0.14, (1.13 ± 0.13 vs. (1.30 ± 0.18, (1.02 ± 0.15 vs. (1.22 ± 0.15]. Hospital for special surgery score at 1 week, 2 weeks, 3 and 4 weeks after removing Kirschner wire had no significant difference between group A and B (88.75 ± 10.18 vs. (89.14 ± 10.52, (94.22 ± 10.85 vs. (93.85 ± 11.08, (95.52 ± 11.27 vs. (95.92 ± 12.19, (95.43 ± 10.96 vs. (96.02 ± 11.38. Contents of serum alanine transaminase, aspertate aminotransferase, total protein, albumin and C-reactive protein in perioperative period had no obvious difference between patients in group A and B. Conclusions: Emergency closed reduction combined with percutaneous Kirschner wire fixation for Gartland type-II and type-III supracondylar humerus fracture in children has less trauma, low swelling degree

  18. A case report of Schatzker type VI tibial plateau fracture treated with double reverse traction closed reduction combined with minimally invasive percutaneous plate osteosynthesis technique: A case report.

    Science.gov (United States)

    Li, Dian-Qing; Song, De-Ye; Ni, Jiang-Dong; Ding, Mu-Liang; Huang, Jun

    2017-11-01

    The knee joint is an important weight-bearing joint, tibial plateau fractures affect knee function and stability. High-energy intra-articular fractures involving the tibial plateau can cause management-related problems such as wound dehiscence; severe comminution leading to malalignment; and delayed complications such as varus collapse, implant failure, and arthritis of the knee joint. The treatment of severe or complex tibial plateau fractures can be quite difficult. Traditional methods of open reduction and plating require extensive exposures, which may further compromise soft tissue and devascularize bone fragments, leading to infection. In this case, a novel device, double reverse traction combined with MIPPO technique, was used and provided the possibility of minimally invasive and personalized orthopedic surgery to treat severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture and got satisfactory results. A previously healthy 56-year-old man presented to the emergency room after a fall from a height, who lost the movement of the left knee with pain and swelling. X-rays showed a tibial plateau comminuted fracture, Schatzker type VI, and tibial shaft fracture. Applying less extensile exposure and the indirect reduction technique of double reverse traction and closed reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique, we got satisfactory recovery of the severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture. This severe comminuted fracture and tibial shaft fracture were successfully reduced and got satisfactory recovery of knee joint function. Double reverse traction combined with MIPPO technique can reduce the risk of surgical complications, such as bleeding, oozing, and wound infection. It can be applied in patients with comorbidities such as cardiac disease, hypertension, and heart failure who may otherwise not be candidates for surgery. The cost burden is

  19. [Case-control study on close reduction and plaster slab fixation combined with plaster external traction for the treatment of pediatric Gartland type III supracondylar humerus fractures].

    Science.gov (United States)

    Kang, Yu-Xiang; Wei, Xiao-Chun; Li, Hai-Ming

    2014-07-01

    To compare the therapeutic effects between close reduction and plaster slab fixation combined with plaster external traction and operation for the treatment of pediatric closed Gartland type III supracondylar humerus fractures without neurovascular injury complications. From June 2009 to June 2012, 151 children with closed Gartland III supracondylar humerus fractures were retrospectively studied and divided into two groups, including 87 boys and 64 girls, ranging in age from 1 to 12 years old with an average of 5.3 years old. Among them, 76 children (conservative group) were treated with close reduction and plaster slab fixation combined with plaster external traction; 75 children (operation group) underwent surgical operation. The time of elbow joint function exercise, the healing time of fracture, the function recovery of elbow joint and carrying angle was recorded and analyzed. The therapeutic effects were evaluated by the Flynn criteria system. All patients were followed up from 6 to 36 months (18.3 months on average). The average time of fracture healing and elbow joint functional exercise of the conservative group was shorter than those of operation group (P 0.05). According to Flynn criteria system, in conservative group, the result was excellent in 31 cases, good in 35, fair in 7, and poor in 3; in operation group, 27 in excellent, 30 in good, 17 in fair and 1 in poor; there was no significant difference between two groups in therapeutic effects (P > 0.05). Close reduction and plaster slab fixation combined with plaster external traction in treatment of pediatric closed Gartland type III supracondylar humerus fractures without neurovascular injury complications,which has similar effect to surgical treatment, and the time of fracture healing and elbow joint function exercise are significantly shorter.

  20. Plantar fasciitis and the calcaneal spur: Fact or fiction?

    Science.gov (United States)

    Johal, K S; Milner, S A

    2012-03-01

    Plantar fasciitis is a common diagnosis in patients presenting with heel pain. The presence of co-existing calcaneal spurs has often been reported but confusion exists as to whether it is a casual or significant association. The lateral heel radiographs of nineteen patients with a diagnosis of plantar fasciitis and nineteen comparison subjects with a lateral ankle ligament sprain matched for age and sex, were reviewed independently by two observers. Objective measurements of calcaneal spur length and a subjective grading of spur size were recorded. There was a significantly higher prevalence of calcaneal spurs in the cases than the comparison group (89% versus 32%; McNemar chi-square=9.09, df=2, p=0.00257). There was good inter- and intra-observer agreement. The current study has demonstrated a significant association between plantar fasciitis and calcaneal spur formation. Further research is warranted to assess whether the association is causal. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  1. Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report.

    Science.gov (United States)

    Jiang, Hai; Wu, Yongtao; Dang, Youting; Qiu, Yusheng

    2017-01-01

    Pediatric radial neck fractures are uncommon. Severely displaced and angulated fractures usually require treatment. Our goals for treatment are to avoid incision, reduce the fracture adequately with no reduction loss, and achieve good postoperative function. We aimed to observe the clinical outcomes of closed reduction with the percutaneous leverage technique and internal fixation with Kirschner-wires (K-wires) to treat angulated radial neck fractures in children.From January 2011 to April 2013, we treated 16 cases of angulated radial neck fracture in 12 boys and 4 girls. Five fractures were type II and 11 fractures were type III using the O'Brien classification. One K-wire was percutaneously introduced into the fracture site using the leverage technique to attain good reduction. Two K-wires were introduced from the proximal to the distal areas of the fracture site. The elbow was immobilized by cast in 90° of flexion and the forearm in supination for 3 to 4 weeks. The K-wires were removed at 3 to 4 weeks postoperatively. All cases were followed up for a mean duration of 3 years 6 months.According to the Metaizeau reduction classification, 12 cases were excellent, and 4 cases were good. According to the Metaizeau clinical classification, 14 cases were excellent, and 2 cases were good. There was no necrosis of the radial head. There was no infection, radioulnar synostosis, and damage of the radial nerve deep branch. There was no limitation in the pronation and supination functions of the forearm.Closed reduction using the percutaneous leverage technique and internal fixation using K-wires is easy to perform. It is encouraged to use this approach as the clinical outcome is good. level IV-retrospective case, treatment study.

  2. Fracture

    OpenAIRE

    Bourdin, Blaise; Francfort, Gilles A.

    2011-01-01

    These notes begin with a review of the mainstream theory of brittle fracture, as it has emerged from the works of Griffi th and Irwin. We propose a re-formulation of that theory within the confi nes of the calculus of variations, focussing on crack path prediction. We then illustrate the various possible minimality criteria in a simple 1d-case as well as in a tearing experiment and discuss in some details the only complete mathematical formulation so far, that is that where global minimality ...

  3. The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures.

    Directory of Open Access Journals (Sweden)

    Zhiyong Li

    Full Text Available OBJECTIVE: This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. METHODS: From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females with a mean age of 44.8 years (range, 20-64 years. There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females with a mean age of 46.3 years (range, 23-64 years. There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. RESULTS: In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months. All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100. In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months. The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68 and 16.2% (11/68, respectively, significantly higher than those in study group (both P<0.05. The mean Harris score in control group was 83.8 (41-100, significantly lower than that in study group (P<0.05. CONCLUSION: Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.

  4. Displaced Intra-articular Fractures of the Calcaneus: with an emphasis on minimally invasive surgery

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2009-01-01

    textabstractDisplaced intra-articular calcaneal fractures are complex injuries. Classically these fractures are treated with open reduction and internal fixation (ORIF) or conservatively. When comparing these two treatment modalities, ORIF has a significantly higher rate of wound complications and

  5. Hypertrophic osteoarthropathy manifested with isolated calcaneal periostitis in bone scintigraphy.

    Science.gov (United States)

    Moralidis, Efstratios; Gerasimou, Georgios; Theodoridou, Athina; Hilidis, Ilias; Mylonaki, Efrosyni; Gotzamani-Psarrakou, Anna

    2010-05-01

    Hypertrophic osteoarthropathy (HOA) is an incompletely understood syndrome characterized by digital clubbing and periosteal proliferation of long bones and it is commonly associated with primary lung tumors. Bone scintigraphy is a sensitive method in detecting HOA and characteristic findings have been reported. We present the case of a man with newly diagnosed non-small cell lung cancer, unremarkable clinical examination and blood tests and no digital clubbing. During disease staging, however, bone scintigraphy showed intense calcaneal cortical proliferation bilaterally without involvement of other parts of the skeleton. Cortical reaction of both calcanei resolved significantly after chemotherapy. This case indicates that HOA may manifest with isolated calcaneal periostitis bilaterally, which is a new addition to the literature.

  6. Complications and patient-injury after ankle fracture surgery. -A closed claim analysis with data from the Patient Compensation Association in Denmark

    DEFF Research Database (Denmark)

    Bjørslev, Naja; Ebskov, Lars Bo; Mersø, Camilla

    2018-01-01

    BACKGROUND: The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the Danish health care system. In this study, we have analysed closed claims in which patients suffered injuries due....... This study indicates that extra attention should be paid to the most technically demanding fractures as the pronation-external-rotation-, diabetic- and fragility fractures. Surgeons should follow the recommendations for ORIF. Emphasis should also focus on adequate postoperative plans. This study finds a high...

  7. Characteristics of calcaneal bone infarction: an MR imaging investigation

    Energy Technology Data Exchange (ETDEWEB)

    Abrahim-Zadeh, R.; Klein, R.M.; Leslie, D.; Norman, A. [Department of Radiology, New York Medical College, Macy Pavillion, Valhalla, NY 10595 (United States)

    1998-06-01

    Objective. Bone infarction (BI) of the calcaneus is an uncommon entity which has received little mention in the recent literature. In this paper, we review the MR images of six calcanei with BI, which demonstrate a pattern of presentation that may explain the etiology of BI at this unusual location. Design. A retrospective review was performed of the transcribed reports of the foot or ankle MR examinations at our institution. MR images of examinations with any marrow signal abnormality were reviewed for presence of BI and its distribution. Patients. Based on MRI criteria, four patients had calcaneal BI (none biopsy proven); they ranged in age from 37 to 51 years old. Two patients were diagnosed with systemic lupus erythematosus, one with fibrositis, and another with polymyositis. All were treated with corticosteroids. Results. Six calcanei (in four patients) contained a region of calcaneal BI. In five of the six, the lesions were entirely or predominantly located in the posterior half of the calcaneus. Conclusion. Two theories are proposed which may explain why BI predominantly occurs in the posterior half of the calcaneus. First, the convergence of the recurrent intraosseous calcaneal vessels may occasionally produce the equivalent of a single dominant vessel that is more prone to vascular accidents. Secondly, the region between the recurrent and the epiphyseal vessels may act as a watershed zone, increasing its susceptibility to ischemia. (orig.) With 4 figs., 1 tab., 8 refs.

  8. [Percutaneous surgery for plantar fasciitis due to a calcaneal spur].

    Science.gov (United States)

    Apóstol-González, Saúl; Herrera, Jesús

    2009-01-01

    Determine the efficacy of percutaneous surgical treatment for talalgia due to a calcaneal spur. This is an observational, descriptive, clinical series analyzing the outcomes of 10 patients with a diagnosis of talalgia due to plantar fasciitis with a calcaneal spur treated with percutaneous foot surgery. The end result was assessed with a visual analog scale (VAS) to measure pain, the patients' opinion and their return to activities of daily living. Central tendency and scatter measurements were calculated. The inferential analysis was done with the non-parametric chi square (chi2) test. Most patients were females (90%) and mean age was 40.5 years. Follow-up was 12 months. One patient had bleeding of the approached area. Pain was reduced from 8 to 1.5 in the VAS. Nine patients returned to their activities. Two patients had occasional mild pain upon prolonged bipedestation. Ninety percent of results were satisfactory. Percutaneous foot surgery in talalgias caused by plantar fasciitis due to a calcaneal spur is a simple and effective method. It reduces the operative time and allows for an early return of patients to their activities of daily living.

  9. The conundrum of calcaneal spurs: do they matter?

    Science.gov (United States)

    Moroney, Paul J; O'Neill, Barry J; Khan-Bhambro, Khalid; O'Flanagan, Shay J; Keogh, Peter; Kenny, Paddy J

    2014-04-01

    Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. We have demonstrated the relevance of a radiographic finding once considered irrelevant.

  10. The Comparison Between Affected and Non-Affected Side of the Calcaneal Bone Density in Chronic Hemiparetic Patients

    Directory of Open Access Journals (Sweden)

    Demet Ofluoğlu

    2005-06-01

    Full Text Available Stroke is a non-traumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficit characterized by loss of motor control, altered sensation, cognitive or language impairment, disequilibrium, or coma. Immobilization is an important risk factor for osteoporosis. The aim of this study was to compare between affected and non-affected side’s calcaneal bone mineral density in chronic hemiparetic patients. Thirty-tree unilateral and independently mobile hemiparetic patients due to stroke were included in the study. The exclusion criteria were to have poor general health status, bilateral involvement, congenital dislocation of hip and past calcaneal fracture history. Motor functional level, spasticity and daily living activities of the patients were assessed by using Brunstrom, Ashworth and Barthel scales, respectively. The calcaneal bone mineral density was evaluated with DXL-Calscan in both affected and non-affected side of all patients. Patients’ mean age and duration of disease were 58.9±11.9 years and 20±19.4 months, respectively. 48.5% of patients were male and 60.6% has right side hemiparesis. Their mean spasticity level was 1.6±1.2 according to Ashworth Scale. Mean motor functional level and activity of daily living score were 4.5±1 and 87.4±22.2, respectively. The calcaneal mean T score was –2.1±0.9 and –1.7±0.7 in affected and non-affected side, respectively. In the pearson correlation analysis, there were positive correlation between age and non-affected Z score (r=0.42, p=0.01; Brunstrom score and affected side T score (r=0.48, p=0.005; Brunstrom score and affected side BMD (r=0.51, p=0.002. On the other hand, there were negative correlation between age and disease duration (r=-0.36, p=0.03; Ashworth score and Brunstrom (r=-0.66, p=0.0001, affected side T score (r=-0.41, p=0.01, affected side Z score (r=-0.35, p=0.04, affected BMD (r=-0.46, p=0.01. However, there was no

  11. PERCUTANEOUS BIPLANAR EXTERNAL FIXATOR METHOD FOR TREATMENT OF CALCONEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar

    2015-07-01

    Full Text Available Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patient s. We have used a biplanar percutaneous external fixator for treating calcaneal fractures per operative visualization of the fractures. We have treated 20 calcaneal fractures in 18 patients, 12 intra articular and five extra articular, with our percutaneou s external fixator system with under image intensifier and achieving the fracture reduction. Functional outcome was measured using the American Orthopaedic Foot and ankle society Hind foot score. All fractures united with a mean of 55 days. Partial weight bearing was possible in a mean of 1.8 days and full bearing was possible in a mean of 11.6 days. All the patients were returned to their original work within six weeks. Minor infectious complications occurred in 17.6 percent of cases. The average AOFAS sco re at six months follow up was 83.8. We conclude that our percutaneous external fixator technique for fracture calcaneum is an effective alternative to the currently available – surgical and conservative treatment modalities especially in lower socio econo mic labor population who need to return to their job as early as possible. Level of Evidence – IV Case series

  12. Study of the X-Ray Diagnosis of Unstable Pelvic Fracture Displacements in Three-Dimensional Space and its Application in Closed Reduction.

    Science.gov (United States)

    Shi, Chengdi; Cai, Leyi; Hu, Wei; Sun, Junying

    2017-09-19

    ABSTRACTS Objective: To study the method of X-ray diagnosis of unstable pelvic fractures displaced in three-dimensional (3D) space and its clinical application in closed reduction. Five models of hemipelvic displacement were made in an adult pelvic specimen. Anteroposterior radiographs of the pelvis were analyzed in PACS. The method of X-ray diagnosis was applied in closed reductions. From February 2012 to June 2016, 23 patients (15 men, 8 women; mean age, 43.4 years) with unstable pelvic fractures were included. All patients were treated by closed reduction and percutaneous cannulate screw fixation of the pelvic ring. According to Tile's classification, the patients were classified into type B1 in 7 cases, B2 in 3, B3 in 3, C1 in 5, C2 in 3, and C3 in 2. The operation time and intraoperative blood loss were recorded. Postoperative images were evaluated by Matta radiographic standards. Five models of displacement were made successfully. The X-ray features of the models were analyzed. For clinical patients, the average operation time was 44.8 min (range, 20-90 min) and the average intraoperative blood loss was 35.7 (range, 20-100) mL. According to the Matta standards, 7 cases were excellent, 12 cases were good, and 4 were fair. The displacements in 3D space of unstable pelvic fractures can be diagnosed rapidly by X-ray analysis to guide closed reduction, with a satisfactory clinical outcome.

  13. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction.

    Science.gov (United States)

    Codesido, Pablo; Mejía, Ana; Riego, Jonathan; Ojeda-Thies, Cristina

    2017-08-01

    Subtrochanteric fractures are more difficult to treat than other proximal femoral fractures. The aim of this study was to report the outcomes for patients with subtrochanteric fractures treated using a cephalomedullary nail following open reduction and cerclage wiring versus closed reduction alone, regarding health-related quality of life (HRQoL) and social function. We performed a prospective cohort study including patients aged 60 years or older suffering fragility subtrochanteric fractures of the femur treated with cephalomedullary nails, with a minimum 2-year follow-up. We defined two treatment groups: one treated with closed reduction manoeuvres (60 patients), and another treated with open reduction and cerclage wiring (30 patients). The outcomes were mortality, orthopaedic complications (reoperation and no-union), social function (Jensen Index), and HRQoL (EQ-5D index score). There were no differences regarding sex, age, side affected, type of implant, anaesthetic risk, 1-year mortality, and orthopaedic complications. Surgical time was longer in the cerclage wire group, but length of stay was 2 days shorter for the cerclage group and reduction was better. Patients treated with cerclage wiring had significantly better EQ-ED at 12 months (0.66 ± 0.22 points vs. 0.78 ± 0.15 points); and social status at 12 and 18 months (2.77 ± 1.00 points vs. 2.10 ± 1.22 points). Better reduction is achieved when using cerclage wires for fragility subtrochanteric fractures. These fractures had a negative effect on quality of life and social function, but better outcomes were observed in the cerclage group.

  14. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2008-08-01

    Full Text Available Abstract Background Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Methods Weightbearing lateral foot radiographs of 216 people (140 women and 76 men aged 62 to 94 years (mean age 75.9, SD 6.6 were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. Results Of the 216 participants, 119 (55% had at least one plantar calcaneal spur and 103 (48% had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5. Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0, report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8 and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4. No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. Conclusion Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.

  15. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

    Science.gov (United States)

    Menz, Hylton B; Zammit, Gerard V; Landorf, Karl B; Munteanu, Shannon E

    2008-08-11

    Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Weightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, SD 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. Of the 216 participants, 119 (55%) had at least one plantar calcaneal spur and 103 (48%) had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5). Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0), report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8) and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4). No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.

  16. Evolution and Allometry of Calcaneal Elongation in Living and Extinct Primates

    Science.gov (United States)

    Boyer, Doug M.; Seiffert, Erik R.; Gladman, Justin T.; Bloch, Jonathan I.

    2013-01-01

    Specialized acrobatic leaping has been recognized as a key adaptive trait tied to the origin and subsequent radiation of euprimates based on its observed frequency in extant primates and inferred frequency in extinct early euprimates. Hypothesized skeletal correlates include elongated tarsal elements, which would be expected to aid leaping by allowing for increased rates and durations of propulsive acceleration at takeoff. Alternatively, authors of a recent study argued that pronounced distal calcaneal elongation of euprimates (compared to other mammalian taxa) was related primarily to specialized pedal grasping. Testing for correlations between calcaneal elongation and leaping versus grasping is complicated by body size differences and associated allometric affects. We re-assess allometric constraints on, and the functional significance of, calcaneal elongation using phylogenetic comparative methods, and present an evolutionary hypothesis for the evolution of calcaneal elongation in primates using a Bayesian approach to ancestral state reconstruction (ASR). Results show that among all primates, logged ratios of distal calcaneal length to total calcaneal length are inversely correlated with logged body mass proxies derived from the area of the calcaneal facet for the cuboid. Results from phylogenetic ANOVA on residuals from this allometric line suggest that deviations are explained by degree of leaping specialization in prosimians, but not anthropoids. Results from ASR suggest that non-allometric increases in calcaneal elongation began in the primate stem lineage and continued independently in haplorhines and strepsirrhines. Anthropoid and lorisid lineages show stasis and decreasing elongation, respectively. Initial increases in calcaneal elongation in primate evolution may be related to either development of hallucal-grasping or a combination of grasping and more specialized leaping behaviors. As has been previously suggested, subsequent increases in calcaneal

  17. Evolution and allometry of calcaneal elongation in living and extinct primates.

    Science.gov (United States)

    Boyer, Doug M; Seiffert, Erik R; Gladman, Justin T; Bloch, Jonathan I

    2013-01-01

    Specialized acrobatic leaping has been recognized as a key adaptive trait tied to the origin and subsequent radiation of euprimates based on its observed frequency in extant primates and inferred frequency in extinct early euprimates. Hypothesized skeletal correlates include elongated tarsal elements, which would be expected to aid leaping by allowing for increased rates and durations of propulsive acceleration at takeoff. Alternatively, authors of a recent study argued that pronounced distal calcaneal elongation of euprimates (compared to other mammalian taxa) was related primarily to specialized pedal grasping. Testing for correlations between calcaneal elongation and leaping versus grasping is complicated by body size differences and associated allometric affects. We re-assess allometric constraints on, and the functional significance of, calcaneal elongation using phylogenetic comparative methods, and present an evolutionary hypothesis for the evolution of calcaneal elongation in primates using a Bayesian approach to ancestral state reconstruction (ASR). Results show that among all primates, logged ratios of distal calcaneal length to total calcaneal length are inversely correlated with logged body mass proxies derived from the area of the calcaneal facet for the cuboid. Results from phylogenetic ANOVA on residuals from this allometric line suggest that deviations are explained by degree of leaping specialization in prosimians, but not anthropoids. Results from ASR suggest that non-allometric increases in calcaneal elongation began in the primate stem lineage and continued independently in haplorhines and strepsirrhines. Anthropoid and lorisid lineages show stasis and decreasing elongation, respectively. Initial increases in calcaneal elongation in primate evolution may be related to either development of hallucal-grasping or a combination of grasping and more specialized leaping behaviors. As has been previously suggested, subsequent increases in calcaneal

  18. Femur ultrasound (FemUS)-first clinical results on hip fracture discrimination and estimation of femoral BMD

    DEFF Research Database (Denmark)

    Barkmann, R; Dencks, S; Laugier, P

    2010-01-01

    -based assessment of osteoporosis. INTRODUCTION: Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement...

  19. Usefulness of calcaneal quantitative ultrasound stiffness for the evaluation of bone health in HIV-1-infected subjects: comparison with dual X-ray absorptiometry

    Directory of Open Access Journals (Sweden)

    Fantauzzi A

    2016-05-01

    Full Text Available Alessandra Fantauzzi,1 Marco Floridia,2 Fabrizio Ceci,3 Francesco Cacciatore,4 Vincenzo Vullo,5 Ivano Mezzaroma1 1Department of Clinical Medicine, Sapienza – University of Rome, 2Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità (ISS, 3Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, 4U.O. of Cardiac Rehabilitation, Fondazione Salvatore Maugeri, IRCCS, Istituto di Telese Terme, Benevento, 5Department of Public Health and Infectious Diseases, Sapienza – University of Rome, Rome, Italy Objectives: With the development of effective treatments and the resulting increase in life expectancy, bone mineral density (BMD alteration has emerged as an important comorbidity in human immunodeficiency virus type-1 (HIV-1-infected individuals. The potential contributors to the pathogenesis of osteopenia/osteoporosis include a higher prevalence of risk factors, combined antiretroviral therapy (cART-exposure, HIV-1 itself and chronic immune activation/inflammation. Dual-energy X-ray absorptiometry (DXA is the “gold standard” technique for assessing bone status in HIV-1 population. Methods: We conducted a cross-sectional study to investigate bone mineral status in a group of 158 HIV-1-infected subjects. The primary endpoint was the feasibility of calcaneal quantitative ultrasound (QUS as a screening tool for BMD. All subjects were receiving stable cART and were virologically suppressed (HIV-RNA <37 copies/mL from at least 12 months. Calcaneal QUS parameters were analyzed to obtain information on bone mass and microarchitecture. The results were compared with those obtained by DXA. Results: No correlations were found between DXA/QUS parameters and demographic or HIV-1-specific characteristics, also including cART strategies. In the univariate analyses BMD, QUS indexes, and Fracture Risk Assessment Tool scores conversely showed significant associations with one or more

  20. The conundrum of calcaneal spurs: do they matter?

    LENUS (Irish Health Repository)

    Moroney, Paul J

    2013-12-30

    Background: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. Methods: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). Results: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Conclusion: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant.

  1. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis

    OpenAIRE

    Cosentino, R.; Falsetti, P; Manca, S; Stefano, R.; Frati, E; Frediani, B; Baldi, F; Selvi, E; Marcolongo, R

    2001-01-01

    OBJECTIVE—To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis.
METHODS—60 patients (43 women, 17 men) were examined who had talalgia associated with heel spur. A single blind randomised study was performed in which 30 patients underwent a regular treatment (group 1) and 30 a simulated one (shocks of 0 mJ/mm2 energy were applied) (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of enthes...

  2. Subtalar arthroscopy with calcaneal skeletal traction in a hanging position.

    Science.gov (United States)

    Kim, Hyong Nyun; Ryu, Seung Ryol; Park, Jung Min; Park, Yong Wook

    2012-01-01

    Several arthroscopic approaches to the subtalar joint have been developed in the supine, lateral, or prone position. However, it is difficult to use the posteromedial portal with the patient in the supine or lateral position and the anterolateral portal with the patient prone. Furthermore, obtaining joint distraction in the lateral or prone position is difficult. We present a technique that enables the combination of 2 posterior portals and lateral portals to the subtalar joint with calcaneal skeletal traction in a hanging position for better visualization and instrumentation of the joint. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture

    Energy Technology Data Exchange (ETDEWEB)

    Raman, Subha [University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States); Wallace, E.C. [University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States); UMass Memorial Medical Center, Division of Pediatric Radiology, Worcester, MA (United States)

    2011-12-15

    Irreducible fracture of the distal tibial physis due to interposed soft tissue including periosteum is well documented in the orthopedic literature but is uncommon. This condition has been associated with subsequent growth disturbance and requires open reduction. There are very few prior reports of MRI depiction of soft tissue interposition and none of periosteal interposition in the distal tibial physis. This is a relatively common location of physeal injury and related growth disturbance. We present a case of periosteum trapped in the distal tibial physis, diagnosed on MRI, in a Salter-Harris II fracture and its management implications. (orig.)

  4. Efficacy of immobilization of the tarsal joint to alleviate strain on the common calcaneal tendon in dogs.

    Science.gov (United States)

    Lister, Stephanie A; Renberg, Walter C; Roush, James K

    2009-01-01

    To measure strain in the common calcaneal tendon during trotting in dogs and to compare strain before and after immobilization of the tarsal joint. 6 dogs. A microminiature strain gauge was surgically implanted on the tendinous portion of the gastrocnemius muscle. Surface electromyography (EMG) values, percentage strain, and ground reaction forces were measured before and after immobilization. Peak vertical force; vertical impulse; initial, maximum, and final strain; and peak-to-peak EMG amplitude were recorded. Data were analyzed by use of a repeated-measures ANOVA and paired t tests. Timing of strain data correlated closely with foot strike of the hind limb and EMG activity in all dogs. Maximum tendon strain was simultaneous with peak vertical force. Continued muscle contraction was evident after immobilization. There was no significant difference in maximum strain after immobilization, compared with maximum strain during normal motion. Minimum strain, both at the beginning and end of the strain curve, was significantly decreased for the immobilized state, compared with results for nonimmobilized joints. Immobilization of the tarsal joint did not eliminate calcaneal tendon strain during weight bearing in dogs. Decreased isometric muscle contraction during the swing phase of the gait could account for smaller minimum strain in immobilized joints. Immobilization is frequently applied after Achilles tendon rupture to alleviate strain and force on the sutured repair, with possible complications because of the immobilization method. Consideration of these findings could be important in adjusting current treatment recommendations.

  5. Adult calcaneal osteitis: incidence, etiology, diagnostics and therapy

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    Tiemann, A. H.

    2012-07-01

    Full Text Available Calcaneal osteomyelitis presents a complicated situation. The specific anatomy of the os calcis and its surrounding soft tissues plays an important role in the planning and realization of the procedures needed in order to eradicate the osteomyelitic focus. The calcaneus represents a spongious bone; a fact that supports the developement of an osteomyelitis. It is the strongest bone of the foot and is highly important for the biomechanical features of physiological walking. The surrounding soft tissues are thin and contain various important anatomical structures. These might be damaged during the treatment of the osteomyelitis. In addition the vascularization of the os calcis is delicate and may be compromized during the surgical osteomyelitis treatment. Calcaneus osteomyelitis may be classified based on the routes of infection into exogenous and endogenous forms. Additionally from the clinical point of view acute and chronic forms may be distinguished from an early and a late infection. Exogenous calcaneal osteomyelitis mostly is the result of an infection with S. aureus. The treatment is equal to the therapy in other locations and based on: •Eradication of the bone infection •Sanitation of the soft tissue infection •Reconstruction of bone and soft tissue Especially the preservation and restoration of the soft tissue is important. Thus plastic surgical procedures play an essential role. The main object of treatment is the preservation of a biomechanical functioning foot. This may be impossible due to the local situation. Calcanectomy or even below knee amputation may be needed in those cases.

  6. Comparing low-dose intravenous ketamine-midazolam with intravenous morphine with respect to pain control in patients with closed limb fracture

    Science.gov (United States)

    Ahmadi, Omid; Isfahani, Mehdi Nasr; Feizi, Awat

    2014-01-01

    Background: We assessed the effects of low-dose IV ketamine-midazolam versus morphine on pain control in patients with closed limb fracture(s); and also compared the incidence of adverse events (cardio-pulmonary) between two groups. Materials and Methods: This prospective, single-blind, non-inferiority trial randomized consecutive emergency department (ED) patients aged 18-60 years to two groups: Receiving 300-500 mcg/kg ketamine plus 0.03 mg/kg midazolam, or 0.05-0.1 mg/kg morphine. Visual analogue score (VAS) and adverse events were verified during an interval of 30 minutes. Results: Two hundred and thirty — six patients were selected, among whom 207 were males (87.3%). The average age was 29 ± 2, (range, 18-60 years). The VAS score at T30 (i.e., 30 minutes after initial analgesic dose) was significantly decreased compared with VAS score at T0, in both groups. No statistically significant difference, however, was observed between the two groups (–6.1 ± 1.1 versus –6.2 ± 1.0; P = 0.16). With regard to systolic blood pressure and respiratory rate, however, a meaningful difference was noted between the two groups (1.5 ± 6.4 versus –2.1 ± 6.6; P = 0.000 for SBP, and –0.2 ± 1.1 versus –1.1 ± 6.1; P = 0.048 for RR). Conclusion: Low-dose intravenous ketamine plus midazolam has the same analgesic effects as morphine on pain control in trauma patients with closed limb fracture(s), in addition to less respiratory adverse events. PMID:25197290

  7. Comparing low-dose intravenous ketamine-midazolam with intravenous morphine with respect to pain control in patients with closed limb fracture

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    Omid Ahmadi

    2014-01-01

    Full Text Available Background: We assessed the effects of low-dose IV ketamine-midazolam versus morphine on pain control in patients with closed limb fracture(s; and also compared the incidence of adverse events (cardio-pulmonary between two groups. Materials and Methods: This prospective, single-blind, non-inferiority trial randomized consecutive emergency department (ED patients aged 18-60 years to two groups: Receiving 300-500 mcg/kg ketamine plus 0.03 mg/kg midazolam, or 0.05-0.1 mg/kg morphine. Visual analogue score (VAS and adverse events were verified during an interval of 30 minutes. Results: Two hundred and thirty - six patients were selected, among whom 207 were males (87.3%. The average age was 29 ± 2, (range, 18-60 years. The VAS score at T30 (i.e., 30 minutes after initial analgesic dose was significantly decreased compared with VAS score at T0, in both groups. No statistically significant difference, however, was observed between the two groups (-6.1 ± 1.1 versus -6.2 ± 1.0; P = 0.16. With regard to systolic blood pressure and respiratory rate, however, a meaningful difference was noted between the two groups (1.5 ± 6.4 versus -2.1 ± 6.6; P = 0.000 for SBP, and -0.2 ± 1.1 versus -1.1 ± 6.1; P = 0.048 for RR. Conclusion: "Low-dose" intravenous ketamine plus midazolam has the same analgesic effects as morphine on pain control in trauma patients with closed limb fracture(s, in addition to less respiratory adverse events.

  8. Pediatric and adolescent intra-articular fractures of the calcaneus

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    Marcel Dudda

    2013-06-01

    Full Text Available Calcaneal fractures in childhood are very rare, whereas particularly intra-articular displaced fractures are not typical in skeletally immature children. Various techniques of osteosynthesis have been described. This study aimed to determine clinical and radiological outcome after surgical treatment of intra-articular calcaneal fractures. Fourteen intra-articular fractures of the calcaneus were included in this retrospective study. Eleven children (2 girls and 9 boys aged 6-16 years (average age 11.5 years underwent surgical treatment. One child sustained a Type II open fracture of both calcanei. All injuries occurred after a high-energy trauma; 3 patients had multiple additional fractures. The clinical and radiological postoperative follow up was an average 44 months. In 4 cases, a reduction through a minimally invasive approach and fixation with K-wires or screws could be achieved. Eleven fractures were treated with open reduction and internal fixation with plate osteosynthesis, K-wires or screws. In one case with open fractures of both heel bones, an additional external fixator was applied. The surgical treatment approach adopted enabled the pre-operative Boehler’s angle (average 16° to be improved to an average 30°. In all cases, except for the patient with open fractures, a good functional result and outcome could be achieved. In calcaneal fractures in childhood, anatomical reduction is the determining factor, as in fractures in adults, whereas the surgical technique seems to have no influence on clinical outcome in children. The wound healing problems that have often been described were not observed in this age group.

  9. Relationship between the mandibular cortical index and calcaneal bone mineral density in postmenopausal women

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    Eglė Jagelavičienė

    2016-01-01

    Conclusions: The relation between MCI and calcaneal BMD was determined. The diagnostic discrimination of the MCI was found to be not sufficient in screening the women with postmenopausal osteoporosis and its application in clinical practice might be limited.

  10. Delayed Reconstruction by Total Calcaneal Allograft following Calcanectomy: Is It an Option?

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    Benjamin Degeorge

    2016-01-01

    Full Text Available Many options are available in literature for the management of delayed reconstruction following calcanectomy. In cases of low-grade tumor lesions, conservative surgery can be considered. We describe a case of delayed reconstruction by calcaneal allograft after calcanectomy for low-grade chondrosarcoma. At 12-month follow-up, the patient had no pain; MSTS score and AOFAS score were satisfactory. Subtalar nonunion was observed with no secondary displacement or graft necrosis. The aim of conservative treatment for this patient was to restore normal gait with plantigrade locomotion and function of the Achilles tendon. Calcaneal reconstruction by total allograft is an alternative approach following calcanectomy for calcaneal tumors. We also discussed other options of calcaneal reconstruction.

  11. Medial calcaneal neuropathy: a missed etiology of chronic plantar heel pain

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    Emmanuel Kamal Aziz Saba

    2017-01-01

    Conclusion Medial calcaneal neuropathy is present in a considerable number of patients with chronic plantar heel pain. It should be taken into consideration during the assessment of any patient with chronic plantar heel pain.

  12. Emergency Closed Reduction of a C4/5 Fracture Dislocation with Complete Paraplegia Resulting in Profound Neurologic Recovery

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    Christian W. Müller

    2013-01-01

    Full Text Available Introduction. Cervical spinal cord injuries due to traumatic fractures are associated with persistent neurological deficits. Although clinical evidence is weak, early decompression, defined as <24–72 h, has been frequently proposed. Animal studies show better outcomes after early decompression within one hour or less, which can hardly ever be achieved in clinical practice. Case Presentation. A 37-year-old patient was hospitalized after being hit by a shying horse. After diagnosis of C4/5 fracture dislocation and complete paraplegia, she was intubated and sedated with deep relaxation. Emergency reduction was performed at approximately 120 minutes after trauma. Subsequently, a standard anterior decompression, discectomy, and fusion were carried out. She was then transferred to a specialized rehabilitation hospital. Her neurologic function improved from AIS grade A on admission to grade B postoperatively and grade D after four months of rehabilitation. One year after the accident, she was ambulatory without walking aids and restarted horse riding. Discussion and Conclusion. Rarely in clinical practice, decompression of the spine canal can be performed as early as in this case. This case highlights the potential benefit of utmost early reduction in cervical fracture dislocations with compression of the spinal cord.

  13. [Case-control study on close manipulative reduction combined with minimally invasive percutaneous plate fixation for the treatment of proximal humeral fractures].

    Science.gov (United States)

    Liu, Yin-Wen; Wei, Xiao-En; Gao, Ning-Yang; Li, Zhi-Qiang; Kuang, Yong; Zhan, Hong-Sheng; Shi, Yin-Yu; Zheng, Yu-Xin

    2014-04-01

    To compare the clinical effects of close manipulative reduction combined with minimally invasive percutaneous plate fixation(MIPPO) and conventional open reduction and internal fixation (ORIF) for the treatment of proximal humerus fractures. From April 2008 to March 2013, among the 75 patients with fractures of proximal humerus, 26 patients were male and 49 patients were female, ranging in age from 22 to 80 years; 18 patients had injuries caused by traffic accident and 57 patients had injuries caused by falling down. According to Neer classification, there were 49 cases of two-part fractures and 26 cases of three-part fractures. All the patients were divided into two groups: MIPPO group and ORIF group. There were 12 males and 21 females in the MIPPO group,including 22 cases of Neer two parts and 11 cases of Neer three parts, who were treated with close manipulative reduction combined with MIPPO. While the other 42 patients were in the ORIF group,including 16 males and 26 females. Among those patients,27 cases belonged to Neer two parts and 15 cases of Neer three parts, who were treated with ORIF. Length of the incision, blood loss, operating time, early postoperative pain(recorded by VAS), neck-shaft angle of proximal humerus and postoperative function of shoulder(recorded by Constant-Murley score, including pain, function, ROM and muscle length) were compared. The mean lengths of incision were (6.74 +/- 0.38) cm in MIPPO group and (16.82 +/- 1.74) cm in ORIF group;blood losses were (110.15 +/- 29.49) ml in MIPPO group and (326.19 +/- 59.71) ml in ORIF group; operation times were (48.60 +/- 10.18) min in MIPPO group and (68.84-16.22) min in ORIF group. VAS of patients in MIPPO group on the 1st and 3rd days postoperatively were lower than those of patients in the ORIF group. The postoperative radiographs verified good position of all screws and satisfactory reduction of bone fracture reduction in both groups. All the patients were followed up,and the durig ranged

  14. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma.

    Science.gov (United States)

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-06-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma.

  15. The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: A systematic review

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2012-01-01

    textabstractBackground: Although open reduction and internal fixation via the extended lateral approach is currently considered gold-standard, severely comminuted calcaneal fractures might not be amendable for reconstruction. The primary aim of the current review study was to assess the functional

  16. Associations between short one-leg standing time and speed of sound of calcaneal bone in a general population: the Shimanami Health Promoting Program (J-SHIPP) study.

    Science.gov (United States)

    Kido, Tomoko; Tabara, Yasuharu; Igase, Michiya; Uetani, Eri; Ochi, Namiko; Miki, Tetsuro; Kohara, Katsuhiko

    2010-04-01

    Loss of bone mass is a major cause of fracture in the elderly. One-leg standing (OLS) time has been postulated to be predictive of reduced bone mass. Here, we conducted a cross-sectional study to clarify whether OLS time measurements are associated with the speed of sound (SOS) of calcaneal bone independent of muscle mass in the lower extremity, a major confounding factor for the association, in a community-dwelling population of middle-aged to elderly subjects. The study subjects consisted of 770 apparently healthy middle-aged to elderly community-residents. Quantitative assessment of calcaneal bone was done using a quantitative ultrasound technique. OLS time with eyes open was measured with a maximum time of 60 s. Femoral muscle cross-sectional area (CSA) was measured from a computed tomography image. Subjects who could not stand 60 s on one leg (n = 192) showed significantly lower SOS (1487 +/- 20, 1501 +/- 24 m/s, P 0.1). OLS time less than 60 s was significantly associated with reduced SOS independent of age, sex and muscle mass in the lower extremity.

  17. Correlação entre a ultrassonometria óssea do calcâneo e a densitometria em mulheres pós-menopausadas com fraturas por fragilidade óssea Correlation between calcaneal bone ultrasound measurements and densitometry among postmenopausal women with fractures caused by bone fragility

    Directory of Open Access Journals (Sweden)

    Frederico Barra Moraes

    2011-04-01

    Full Text Available OBJETIVO: Avaliar a correlação entre a ultrassonometria (US do calcâneo e a densitometria (DEXA em mulheres pós-menopausadas que já apresentavam uma fratura por fragilidade. MÉTODOS: Realizada coorte retrospectiva em 35 mulheres com fraturas osteoporóticas (punho ou coluna, deambulando, acima dos 40 anos, pós-menopausadas, sem tratamento prévio para osteoporose. Dessas, 16 com menos de 60 anos e 19 acima. Foram comparadas a Broadband Ultrasound Attenuation (BUA e a Speed of Sound (SOS com os sítios de DEXA (L1-L4, fêmur total, colo de fêmur e punhos, sendo utilizados dois valores de BUA diferentes como ponto de corte para osteoporose: BUA OBJECTIVE: To assess the correlation between ultrasound (US measurement on the calcaneus and bone densitometry (DEXA, among postmenopausal women who already presented fragility fractures. METHODS: 35 postmenopausal women over 40 years of age, with the ability to walk and presenting osteoporotic fractures of the wrist or spine, without previous treatment for osteoporosis, were analyzed in a retrospective cohort. Of these, 16 were under 60 and 19 were over 60. The broadband ultrasound attenuation (BUA and speed of sound (SOS were compared using DEXA (L1-L4, total femur, femoral neck and wrist. Two different values of BUA were used as cutoff points for osteoporosis: BUA < 60 dB/MHz and BUA < 64 dB/MHz (P < 0.05; and SOS < 1600 m/s. The confidence interval was 95%. The DEXA and US data were plotted on dispersion graphs and, through linear regression, it was possible to establish correlations. Following this, the sample was stratified according to age (up to 60 years and 60 years and over. Thus, the values were again compared and correlated. RESULTS: The best correlation obtained between DEXA and US was between the T-score of the wrist and BUA < 64 dB/ MHz, with 92% sensitivity and 95% specificity. Better sensitivity at all DEXA sites was obtained when US was performed on patients over 60 years of age

  18. Estimation of calcaneal loading during standing from human footprint depths using 3D scanner

    Science.gov (United States)

    Wibowo, Dwi Basuki; Haryadi, Gunawan Dwi; Widodo, Achmad; Rahayu, Sri Puji

    2017-01-01

    This research studies the relationship between footprint depths and load in the calcaneal area when human standing in an upright posture. Footprint depths are deformation in the calcaneal area obtained from the z-value extraction of the Boolean operation acquired from unloaded foot scanning using 3D scanner and loaded foot using foot plantar scanner. To compare peak loads estimated from footprint depth maximum, force sensing resistor (FSR) sensor is attached over the shoe insole with zero heel height in the calcaneal area. Twenty participants were selected from students of Mechanical Engineering Department Diponegoro University with the average the age and the body weight 19.5 years and 55.27 kg respectively. Results that were relatively accurate was found on the calcaneal loading estimation by footprint depth is presented by curve and data distribution which are in good agreement with the result of the measurement. A significant difference in estimating calcaneal loading is mainly caused by plantar foot position of research subjects which is not perpendicular to foot ankle and hallux. In addition, plantar foot position which bends to front/back/side affects the result of footprint depths.

  19. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot.

    Science.gov (United States)

    Chundru, Usha; Liebeskind, Amy; Seidelmann, Frank; Fogel, Joshua; Franklin, Peter; Beltran, Javier

    2008-06-01

    To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter's neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10-92 years. Pearson chi-square analyses and Fisher's exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, pcalcaneal edema (15.0% vs 3.0%, P=0.005), calcaneal spur (48.0% vs 7.0%, Pcalcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter's neuropathy.

  20. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis.

    Science.gov (United States)

    Cosentino, R; Falsetti, P; Manca, S; De Stefano, R; Frati, E; Frediani, B; Baldi, F; Selvi, E; Marcolongo, R

    2001-11-01

    To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis. 60 patients (43 women, 17 men) were examined who had talalgia associated with heel spur. A single blind randomised study was performed in which 30 patients underwent a regular treatment (group 1) and 30 a simulated one (shocks of 0 mJ/mm(2) energy were applied) (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of enthesophytosis were evaluated by x ray examination. Variations in the grade of enthesitis were evaluated by sonography. A significant decrease of VAS was seen in group 1. Examination by x ray showed morphological modifications (reduction of the larger diameter >1 mm) of the enthesophytosis in nine (30%) patients. Sonography did not show significant changes in the grade of enthesitis just after the end of the treatment, but a significant reduction was seen after one month. In the control group no significant decrease of VAS was seen. No modification was observed by x ray examination or sonography. ESWT is safe and improves the symptoms of most patients with a painful heel, it can also structurally modify enthesophytosis, and reduce inflammatory oedema.

  1. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

    Energy Technology Data Exchange (ETDEWEB)

    Chundru, Usha [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Liebeskind, Amy; Beltran, Javier [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Seidelmann, Frank; Franklin, Peter [Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Fogel, Joshua [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Brooklyn College, Department of Economics, Brooklyn, NY (United States)

    2008-06-15

    To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter's neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10-92 years. Pearson chi-square analyses and Fisher's exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p < 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P<0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P < 0.001), plantar fasciitis (52.5% vs 11.0%, P<0.001), and PTTD (32.0% vs 11.0%, P<0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter's neuropathy. (orig.)

  2. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

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    Thulesius Hans

    2010-03-01

    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  3. The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis.

    Science.gov (United States)

    Kuyucu, Ersin; Koçyiğit, Figen; Erdil, Mehmet

    2015-09-01

    Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  4. Normative size of the osseous part of calcaneal bursa and its comparison with other calcaneal articular areas.

    Science.gov (United States)

    Mahato, Niladri Kumar

    2017-08-01

    The retro-calcaneal bursa presents a synovial and a non-synovial osseous part of variable dimensions. Studies objectively measuring the variability of the size of this osseous bursal surface cannot be found in literature. The objective of this study was to investigate (i) the dimension variability of the bony part of the bursa and (ii) the relationship of this surface to other articulating areas of the calcaneus. A digital planimeter was used to measure the bursae (n=86) and other articular surface areas of the calcaneus and statistically compared with ANOVA and correlation estimations. The osseous area measured 1.12 (±0.55) cm2, with only the superior articulating area demonstrating a weak correlation to this osseous surface. The osseous area presents a weak correlation with the axial articulating area of the calcaneus. Information on the size of the bony bursa may help safe excision of retrocalcaneal exostoses and in Achille's tendon repair around the posterior tuberosity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Relationship of calcaneal and iliac apophyseal ossification to peak height velocity timing in children.

    Science.gov (United States)

    Nicholson, Allen D; Liu, Raymond W; Sanders, James O; Cooperman, Daniel R

    2015-01-21

    Ossification of the calcaneal apophysis has never been fully characterized. We examined the ossification sequence of the calcaneus in relation to ossification of the iliac apophysis and the timing of the peak height velocity (PHV). Ninety-four healthy children (forty-nine girls and forty-five boys), from three to eighteen years old, were followed longitudinally through growth with annual serial radiographs and physical examinations. These were done at least annually from ten to fifteen years of age. The PHV was calculated using the height measurements of each child. We measured and compared calcaneal and iliac crest apophyseal ossification using foot and pelvic radiographs made on the same day. We correlated the PHV with the degree of calcaneal and iliac ossification. Ossification of the calcaneal apophysis occurred in an orderly fashion, with the ossification center first appearing a mean of 4.7 years (95% confidence interval [CI], 5.2 to 4.2 years) before the PHV. The apophysis spread across the plantar surface more quickly than the dorsal surface. The apophysis extended completely over the plantar surface a mean of 0.86 year (95% CI, 1.0 to 0.7 year) before the PHV. Fusion of the apophysis followed complete plantar extension over the next two years and was typically complete a mean of 2.1 years (95% CI, 2.0 to 2.2 years) after the PHV. Fusion began in the middle of the apophysis and proceeded outward. Iliac apophyseal ossification did not appear prior to the PHV in any subject. The calcaneal apophysis ossifies in a consistent fashion characterized by six different stages. The calcaneal stages occur during narrow intervals in relation to the PHV, allowing the calcaneal system to be used for assessment of skeletal maturity. The PHV occurs prior to iliac ossification, whereas the calcaneal apophysis has four stages of ossification before and two stages after the PHV. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  6. Structure of the Achilles tendon at the insertion on the calcaneal tuberosity.

    Science.gov (United States)

    Edama, Mutsuaki; Kubo, Masayoshi; Onishi, Hideaki; Takabayashi, Tomoya; Yokoyama, Erika; Inai, Takuma; Watanabe, Hiroshi; Nashimoto, Satoshi; Kageyama, Ikuo

    2016-11-01

    Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius (LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in

  7. Pipkin Fractures: Fracture of the Head of Femur A Case Report ...

    African Journals Online (AJOL)

    Pipkin fracture is the fracture of the head of the femur. It can be associated with neck of femur fracture or / and posterior dislocation of the hip. This fracture is very rare fracture and has not been reported at our sub- region. We present this fracture in a 26 year old with a type I Pipkin fracture treated with closed reduction and ...

  8. Pediatric Phalanx Fractures.

    Science.gov (United States)

    Abzug, Joshua M; Dua, Karan; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O

    2017-02-15

    Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits in the United States for fractures. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which make fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.

  9. Nose fracture

    Science.gov (United States)

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It most ... occurs with other fractures of the face. Nose injuries and neck ...

  10. Effectiveness of using ultrasound therapy and manual therapy in the conservative treatment of calcaneal spur – pilot study

    Directory of Open Access Journals (Sweden)

    Twarowska Natalia

    2016-06-01

    Full Text Available Introduction: Calcaneal spur is a pathology of the fibrocartilage enthesis of the Achilles tendon and plantar fascia or a pathology of the mixed enthesis of the flexor digitorum brevis muscle. Ultrasound therapy is commonly applied in the conservative treatment of a calcaneal spur. Foot muscle strengthening exercises, stretching exercises and soft tissue therapy are indicated as effective methods of conservative treatment. The aim of the study was to compare and assess the effects of ultrasound therapy and selected techniques of manual therapy on pain level and functional state in patients with calcaneal spur.

  11. Fracture fixation.

    Science.gov (United States)

    Taljanovic, Mihra S; Jones, Marci D; Ruth, John T; Benjamin, James B; Sheppard, Joseph E; Hunter, Tim B

    2003-01-01

    The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation. Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint. External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator. The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods. Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used. Copyright RSNA, 2003

  12. Gentamycin-impregnated calcium phosphate cement for calcaneal osteomyelitis: a case report.

    Science.gov (United States)

    Iwakura, Takashi; Lee, Sang Yang; Niikura, Takahiro; Miwa, Masahiko; Sakai, Yoshitada; Nishida, Kotaro; Kuroda, Ryosuke; Kurosaka, Masahiro

    2014-12-01

    We report a case of chronic calcaneal osteomyelitis in a diabetic patient who was successfully treated with radical debridement and gentamycin-impregnated calcium phosphate cement. At 1.5-year follow-up, the patient could walk without any assistance. Calcium phosphate cement is an effective local antibiotic delivery system and a biocompatible material for filling the debrided space to facilitate bone formation.

  13. Effectiveness of using ultrasound therapy and manual therapy in the conservative treatment of calcaneal spur – pilot study

    OpenAIRE

    Twarowska Natalia; Niemierzycka Agnieszka

    2016-01-01

    Introduction: Calcaneal spur is a pathology of the fibrocartilage enthesis of the Achilles tendon and plantar fascia or a pathology of the mixed enthesis of the flexor digitorum brevis muscle. Ultrasound therapy is commonly applied in the conservative treatment of a calcaneal spur. Foot muscle strengthening exercises, stretching exercises and soft tissue therapy are indicated as effective methods of conservative treatment. The aim of the study was to compare and assess the effects of ultrasou...

  14. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

    Energy Technology Data Exchange (ETDEWEB)

    Kose, Ozkan [Diyarbakir Education and Research Hospital, Orthopaedics and Traumatology Clinic, Diyarbakir (Turkey); Diclekent Bulvari, Ataslar Serhat Evleri, Diyarbakir (Turkey)

    2010-04-15

    Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot. A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study. Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen. Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified. (orig.)

  15. Skull fracture

    Science.gov (United States)

    Basilar skull fracture; Depressed skull fracture; Linear skull fracture ... Skull fractures may occur with head injuries . The skull provides good protection for the brain. However, a severe impact ...

  16. Advantages of using CT for the diagnosis and classification of intra-articular fractures of the os calcis

    Energy Technology Data Exchange (ETDEWEB)

    Heuchemer, T.; Bargon, G.; Bauer, G.; Mutschler, W.

    1988-07-01

    The superiority of CT over conventional radiography in demonstrating intra-articular fractures of the os calcis was demonstrated in 34 patients. The advantages consist in being able to demonstrate the joint without superposition and the exact demonstration of the position, size, shape and number of fragments. Shortening or widening of the os calcis can be easily recognized, as well as fractures of the medial or lateral cortex. At the same time it is possible to evaluate soft tissues, particularly the peroneal ligament. The conventional classification of calcaneal fractures has been newly evaluated in the light of the ability to recognize involvement of the joint and the course of the main fracture lines.

  17. Analysis of 213 currently used rehabilitation protocols in foot and ankle fractures.

    Science.gov (United States)

    Pfeifer, Christian G; Grechenig, Stephan; Frankewycz, Borys; Ernstberger, Antonio; Nerlich, Michael; Krutsch, Werner

    2015-10-01

    Fractures of the ankle, hind- and midfoot are amongst the five most common fractures. Besides initial operative or non-operative treatment, rehabilitation of the patients plays a crucial role for fracture union and long term functional outcome. Limited evidence is available with regard to what a rehabilitation regimen should include and what guidelines should be in place for the initial clinical course of these patients. This study therefore investigated the current rehabilitation concepts after fractures of the ankle, hind- and midfoot. Written rehabilitation protocols provided by orthopedic and trauma surgery institutions in terms of recommendations for weight bearing, range of motion (ROM), physiotherapy and choice of orthosis were screened and analysed. All protocols for lateral ankle fractures type AO 44A1, AO 44B1 and AO 44C1, for calcaneal fractures and fractures of the metatarsal as well as other not specific were included. Descriptive analysis was carried out and statistical analysis applied where appropriate. 209 rehabilitation protocols for ankle fractures type AO 44B1 and AO 44C1, 98 for AO 44A1, 193 for metatarsal fractures, 142 for calcaneal fractures, 107 for 5(th) metatarsal base fractures and 70 for 5(th) metatarsal Jones fractures were evaluated. The mean time recommended for orthosis treatment was 6.04 (SD 0.04) weeks. While the majority of protocols showed a trend towards increased weight bearing and increased ROM over time, the best consensus was noted for weight bearing recommendations. Our study shows that there exists a huge variability in rehabilitation of fractures of the ankle-, hind- and midfoot. This may be contributed to a lack of consensus (e.g. missing publication of guidelines), individualized patient care (e.g. in fragility fractures) or lack of specialization. This study might serve as basis for prospective randomized controlled trials in order to optimize rehabilitation for these common fractures. Copyright © 2015 Elsevier Ltd

  18. Supracondylar Fracture

    Directory of Open Access Journals (Sweden)

    Jessica Andrusaitis

    2017-07-01

    Full Text Available History of present illness: A 15-year-old male presented to the emergency department with right elbow pain after falling off a skateboard. The patient denied a decrease in strength or sensation but did endorse paresthesias to his hand. On exam, the patient had an obvious deformity of his right elbow with tenderness to palpation and decreased range of motion at the elbow. Sensation, motor function, and pulses were intact. Radiographic imaging was obtained. Significant findings: The pre-reduction films show a type III supracondylar fracture. There is complete displacement of the distal humerus anteriorly. Specific findings for supracondylar fracture include: a posterior fat pad (red arrow and a displaced anterior humeral line (yellow line.1 When no fracture is present, the anterior humeral line should intersect the middle third of the capitellum; in this X-ray, it does not intersect the capitellum at all. This X-ray demonstrates a normal radiocapitellar line (blue line that intersects the capitellum. The presence of a narrow anterior fat pad aka “sail sign” can be normal. Discussion: Supracondylar fractures of the humerus occur at the distal portion of the humerus without involving the growth plate.2 This is the second most common fracture in children overall. In children, it is the most common fracture of the elbow.3 This injury has a high risk of neurovascular compromise, such as compartment syndrome or ischemic contracture, and thus the clinician must perform immediate and frequent neurovascular assessments focusing on the distributions of the brachial artery in addition to the median, ulnar, and radial nerves.4 Hyperextension injuries that typically occur following a fall onto an outstretched arm are responsible for 95% of supracondylar fractures.1 A type I supracondylar fracture is non-displaced and can be treated with immobilization through a posterior splint and sling5 with close follow-up, type II is angulated but with an intact

  19. [Comparative study on effect and safty of treating on calcaneus fractures with manipulative reduction with percutaneous K-wire fixation].

    Science.gov (United States)

    Qi, Yue-Feng; Zheng, Yi-Bing; Wang, Peng; Li, Ye; Chen, Wen-xue; Dong, Yan-Xu; Jin, Li-Kun; Wang, Chen-Xi; Li, Xu

    2013-04-01

    To explore the clinical effects and safty of manipulative reduction with percutaneous poking K-wire fixation for the treatment of the calcaneus fractures and analyze the indication of the minimal invasion. From December 2008 to December 2011,135 closed calcaneal fractures cases were divided randomly into poking group and plate group, treated respectively by percutaneous poking reduction and operative reduction. In poking group, there were 69 cases (82 feet) including 60 males and 9 females, with an average age of (43.29+/-10.46) years ranging from 18 to 64 years; 30 cases of left, 26 cases of right and 13 cases of double; 54 feet of Essex-Lopresti classification tongue form, 28 feet of joint compression; 33 feet of Sanders type II ,49 of type III. In plate group, there were 66 cases (75 feet) including 58 males and 8 females,with an average age of (46.00+/-2.42) years ranging from 21 to 63 years; 31 cases of left, 26 cases of right and 9 cases of double; 48 feet of Essex-Lopresti classification tongue form, 27 feet of joint compression; 28 feet of Sanders type II, 47 of type III. According to Kerr scoring standard,clinical effects and complications were evaluated combining with Sanders and Essex-Lopresti classification. All 135 cases were followed up after 24 weeks. Fractures were recoveried in 8 to 12 weeks (means 10.2 weeks). In poking group, there were 2 cases of infection, 5 cases of wire movement; in plate group,18 cases of wound local skin necrosis, 5 cases of calf intestines nerve injured; there were statistical significant (P0.05). In the caes of Sanders type III, there were no significant differences on effects of tongue form fractures with percutaneous poking and operative reduction (P>0.05). There were significant differences on effects and complications of compressing form fractures (P<0.01), operative reduction better than percutaneous poking. Pain, walking,Kerr scoring of tongue form fractures of Sanders II , III with poking reduction were better than

  20. Lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis.

    Science.gov (United States)

    Sadek, Ahmed Fathy; Fouly, Ezzat Hassan; Elian, Mostafa Mohammed

    2015-08-01

    To compare the outcome following lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis. 30 women and 3 men aged 30 to 60 (mean, 45) years with resistant plantar fasciitis were randomised to undergo release of the first branch of the lateral plantar nerve with (group 1, n=18) or without (group 2, n=15) calcaneal drilling. Patients were followed up for a mean of 27 months. According to the modified Mayo scoring system for plantar fasciotomy, group 1 was superior to group 2 in terms of score (93.9±6.97 vs. 83±8.2, pplantar nerve achieves better outcome than release alone in patients with resistant plantar fasciitis.

  1. [The Postero-Lateral Approach--An Alternative to Closed Anterior-Posterior Screw Fixation of a Dislocated Postero-Lateral Fragment of the Distal Tibia in Complex Ankle Fractures].

    Science.gov (United States)

    von Rüden, C; Hackl, S; Woltmann, A; Friederichs, J; Bühren, V; Hierholzer, C

    2015-06-01

    The dislocated posterolateral fragment of the distal tibia is considered as a key fragment for the successful reduction of comminuted ankle fractures. The reduction of this fragment can either be achieved indirectly by joint reduction using the technique of closed anterior-posterior screw fixation, or directly using the open posterolateral approach followed by plate fixation. The aim of this study was to compare the outcome after stabilization of the dislocated posterolateral tibia fragment using either closed reduction and screw fixation, or open reduction and plate fixation via the posterolateral approach in complex ankle fractures. In a prospective study between 01/2010 and 12/2012, all mono-injured patients with closed ankle fractures and dislocated posterolateral tibia fragments were assessed 12 months after osteosynthesis. Parameters included: size of the posterolateral tibia fragment relative to the tibial joint surface (CT scan, in %) as an indicator of injury severity, unreduced area of tibial joint surface postoperatively, treatment outcome assessed by using the "Ankle Fracture Scoring System" (AFSS), as well as epidemiological data and duration of the initial hospital treatment. In 11 patients (10 female, 1 male; age 51.6 ± 2.6 years [mean ± SEM], size of tibia fragment 42.1 ± 2.5 %) the fragment fixation was performed using a posterolateral approach. Impaired postoperative wound healing occurred in 2 patients of this group. In the comparison group, 12 patients were treated using the technique of closed anterior-posterior screw fixation (10 female, 2 male; age 59.5 ± 6.7 years, size of tibia fragment 45.9 ± 1.5 %). One patient of this group suffered an incomplete lesion of the superficial peroneal nerve. Radiological evaluation of the joint surface using CT scan imaging demonstrated significantly less dislocation of the tibial joint surface following the open posterolateral approach (0.60 ± 0.20 mm) compared to the closed

  2. Health related quality of life of children with calcaneal apophysitis: child & parent perceptions.

    Science.gov (United States)

    James, Alicia M; Williams, Cylie M; Haines, Terry P

    2016-06-24

    Children with a clinical diagnosis of calcaneal apophysitis reportedly experience impaired physical ability. Patient reported outcome assessments measure the level of conditional specific interference in everyday life. The aim of this study was to assess and compare the child and parent perceptions of health related quality of life (QOL) associated with calcaneal apophysitis. This is a longitudinal repeated measure study nested within a randomized comparative effectiveness trial. Children who had symptoms of calcaneal apophysitis were recruited from local advertising and from the caseload of podiatrists within the health setting (Australia). The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) was completed at baseline, 1, 2, 6 and 12 month time points by both child and parent. A total of 133 children were recruited and 124 participated in the study with 101 completing the OxAFQ-C at all five time points. The inter-rater reliability between the child and parent for the physical domain ranged between poor (0.06) to good (0.77) agreement, and the footwear domain ranged between poor (0.09) to good (0.66) across the time points. Both the school and emotional domains had moderate (0.46) to good (0.77) agreement. Children with calcaneal apophysitis have differing perceptions of health related QOL impact compared to their parents. Parents initially reported greater impact than their child however there was convergence of agreement over the follow-up period. These findings suggest understanding the impact from both child and parent perspective is imperative during treatment. ACTRN12609000696291.

  3. Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers.

    Science.gov (United States)

    Ehrmann, Christine; Maier, Matthias; Mengiardi, Bernard; Pfirrmann, Christian W A; Sutter, Reto

    2014-09-01

    To determine the spectrum of magnetic resonance (MR) imaging findings at the calcaneal attachment of the plantar fascia in asymptomatic volunteers. The study was approved by the institutional review board, and informed consent was obtained from all subjects. MR imaging was performed in 77 asymptomatic volunteers (mean age, 48.0 years; age range, 23-83 years) with use of a 1.5-T system. There were 40 women (mean age, 49.0 years; age range, 24-83 years) and 37 men (mean age, 48.0 years; age range, 23-83 years). Signal intensity characteristics and thickness of the medial, central, and lateral fascicles of the plantar fascia were assessed independently by two radiologists. The presence of soft-tissue edema, bone marrow edema, and bone spur formation at the attachment of the plantar fascia was noted. Datasets were analyzed with inferential statistic procedures. The mean thickness of the plantar fascia was 0.6 mm (medial fascicle), 4.0 mm (central fascicle), and 2.3 mm (lateral fascicle). Increased signal intensity in the plantar fascia was seen with the T1-weighted sequence in 16 of the 77 volunteers (21%), the T2-weighted sequence in six (7.8%), and the short inversion time inversion-recovery sequence in six (7.8%). Soft-tissue edema was seen deep to the plantar fascia in five of the 77 volunteers (6.5%) and superficial to the plantar fascia in 16 (21%). A calcaneal spur was detected in 15 of the 77 volunteers (19%). Calcaneal bone marrow edema was present in four volunteers (5.2%). T1-weighted signal intensity changes in the plantar fascia, soft-tissue edema superficial to the plantar fascia, and calcaneal spurs are common findings in asymptomatic volunteers and should be used with caution in the diagnosis of plantar fasciitis. Increased signal intensity within the plantar fascia with fluid-sensitive sequences is uncommon in asymptomatic volunteers.

  4. Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial.

    Science.gov (United States)

    James, Alicia M; Williams, Cylie M; Haines, Terry P

    2016-10-01

    Calcaneal apophysitis, is a relatively common cause of heel pain in children. Very few randomised studies have evaluated treatment options. This trial compared the effectiveness of currently employed treatment options for the relief of pain and disability associated with calcaneal apophysitis. Factorial 2×2 randomised comparative effectiveness trial with 1, 2, 6 and 12-month follow-up. Participants were recruited from the caseload of podiatrists at Monash health and Peninsula Health. Children aged 8-14 years with clinically diagnosed calcaneal apophysitis. Treatment factor 1: two different types of in-shoe orthoses: a heel raise or prefabricated orthoses. Treatment factor 2: footwear replacement or no footwear replacement. Our primary outcome was functional disability, the secondary outcomes were pain and ankle dorsiflexion range. A total of 133 children and their parents responded to the recruitment advertisement, 124 participated in the trial.At the 1 and 2-month follow-up points, there was a main effect of the shoe insert (heel raise) in only the physical domain for the Oxford ankle foot questionnaire (p=0.04). At the 6 and 12-month follow-up points, there was no main effect or interaction effect for any outcome measure. This trial indicates at the 2-month time point there is a relative advantage in the use of heel raises over prefabricated orthoses for the treatment for calcaneal apophysitis. At 12 months there was no relative advantage to any one of the investigated treatment choices over another. Therefore, if a physical impact is experienced for greater than 2 months, the selection of treatment choice may defer to clinical judgement, cost-minimisation and or patient preference. ACTRN12609000696291. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Correlates of Calcaneal Quantitative Ultrasound Parameters in Patients with Diabetes: The Study on the Assessment of Determinants of Muscle and Bone Strength Abnormalities in Diabetes

    Directory of Open Access Journals (Sweden)

    Francesco Conti

    2017-01-01

    Full Text Available Objective. Quantitative ultrasound (QUS provides an estimate of bone mineral density (BMD and also evaluates bone quality, which has been related to increased fracture risk in people with diabetes. This study aimed at assessing the correlates of calcaneal QUS parameters in diabetic subjects encompassing various degrees of micro and macrovascular complications and a wide-range of peripheral nerve function. Methods. Four hundred consecutive diabetic patients were examined by QUS to obtain values of broadband ultrasound attenuation (BUA, the speed of sound (SOS, quantitative ultrasound index (QUI, and BMD. Results. Among surrogate measures of complications, sensory and motor nerve amplitude and heart rate response to cough test and standing correlated with QUS parameters at univariate analysis, together with age, body mass index (BMI, waist circumference, lipid profile, and renal function. Multivariate analysis revealed that BUA, SOS, QUI, and BMD were independently associated with age, male gender, hemoglobin A1c, BMI (or fat, but not fat-free mass, and somatic and autonomic nerve function parameters. Conclusions. These data indicate that peripheral nerve dysfunction is associated with worse QUS parameters, possibly contributing to increased fracture risk in diabetes. The positive relation of QUS measures with adiposity needs further investigation. This trial is registered with ClinicalTrials.gov (NCT01600924.

  6. Factors Associated with Pain Severity in Children with Calcaneal Apophysitis (Sever Disease).

    Science.gov (United States)

    James, Alicia M; Williams, Cylie M; Luscombe, Michelle; Hunter, Reshele; Haines, Terry P

    2015-08-01

    To identify any association between the pain experienced as a result of calcaneal apophysitis, anthropometric data, and lower limb measurements. This study was a cross-sectional study, nested within a wider randomized, comparative efficacy trial. One hundred twenty-four children between the ages of 8 and 14 years with a clinical diagnosis of calcaneal apophysitis were recruited for this study. Of the participating children, 72 were male. The measures recorded were height, weight, waist circumference, body mass index, foot posture, and ankle joint range of motion; comparison with normative values was also completed. Univariate and multivariable regression analyses were undertaken to identify factors associated with the severity of pain experienced (visual analog scale). The children within this study had a higher mean body mass index (P < .001), increased weight (P < .001), and were taller (P < .001) compared with normative values. The children also demonstrated differences in foot posture and ankle joint range of motion. Multivariable regression analyses identified that older participants (P = .046) and those who had experienced pain for longer (P = .043) reported higher pain severity. Children presenting with calcaneal apophysitis were anthropometrically different from their peers and had experienced a lengthy period of pain. Therefore, early management focussing on the anthropometric differences may minimize the intensity and duration of pain experienced. Registered with Australian New Zealand Clinical Trials Registry: ACTRN12609000696291. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Effects of medial and lateral displacement calcaneal osteotomies on tibiotalar joint contact stresses.

    Science.gov (United States)

    Steffensmeier, S J; Saltzman, C L; Berbaum, K S; Brown, T D

    1996-11-01

    Translational calcaneal osteotomies are used clinically to realign the mechanical axis of the lower limb. In this study, the effects of medial and lateral displacements of the posteroinferior fragment on tibiotalar joint contact mechanics were assessed using pressure-sensitive film. Eight osteotomized fresh-frozen cadaver specimens were loaded in each of three testing positions: neutral position (no shift), 1 cm of lateral displacement of the inferior fragment with respect to the superior fragment, and 1 cm of medial displacement of the inferior fragment. For an applied load of 1,330 N, two times body weight, a 1 cm lateral displacement shifted the center of pressure an average of 1.06 mm laterally, whereas a 1 cm medial displacement shifted the center of pressure an average of 1.58 mm medially. While global contact parameters (contact area, spatial mean contact stress, and peak local contact stress) were not appreciably altered by osteotomy, regional contact parameters changed in a reproducible and statistically significant manner. Among four nominally equal-sized, parasagittally bounded cartilage zones, lateral displacements consistently unloaded the most medial zone and increased loading of the most lateral zone; medial calcaneal displacements had the converse effect. These cadaver results suggest that translational calcaneal osteotomies may be used clinically to partially offload focal areas of cartilage along the medial and lateral borders of the tibiotalar joint.

  8. A tuber calcanei avulsion fracture developed on the basis of idiopathic osteoporosis in a young male: a case report.

    Science.gov (United States)

    Terzi, R; Özer, T

    2015-09-01

    Calcaneus fractures constitute 1.2 % of all fractures. Tuber calcanei avulsion fractures constitute 1.3-2.7 % of calcaneus fractures. Osteoporosis, osteomalacia, and diabetes mellitus have been reported to increase the risk of development of these fractures. It has been reported that tuber calcanei avulsion fractures in elderly females might develop due to osteoporosis. As far as we know, no tuber calcanei avulsion fracture developing on the basis of osteoporosis without presence of a trauma has been reported in young males in the literature. In the current case report, a 41-year-old male patient who was admitted with complaints of pain in the left heel and diagnosed with calcaneal avulsion fracture that developed on the basis of idiopathic osteoporosis and who was treated with conservative methods was presented.

  9. Surgical management of a diabetic calcaneal ulceration and osteomyelitis with a partial calcanectomy and a sural neurofasciocutaneous flap

    Directory of Open Access Journals (Sweden)

    Georgios D. Georgakopoulos

    2010-10-01

    Full Text Available The treatment of calcaneal osteomyelitis in diabetic patients poses a great challenge to the treating physician and surgeon. The use of a distally based sural neurofasciocutaneous flap after an aggressive debridement of non-viable and poorly vascularized tissue and bone that is combined with a thorough antibiotic regimen provides a great technique for adequate soft tissue coverage of the heel. In this case report, the authors describe the aforementioned flap as a versatile alternative to the use of local or distant muscle flaps for diabetic patients with calcaneal osteomyelitis and concomitant large wounds.

  10. Operative treatment of the displaced intraarticular fractures of the calcaneus

    Directory of Open Access Journals (Sweden)

    Popović Zoran

    2003-01-01

    Full Text Available Most calcaneal fractures occur in male industrial workers, having significant economic repercussions. Although current operative treatment has improved the outcome of the treatment in many patients, there is still no consensus on the classification, treatment, operative technique, or postoperative management. Computed tomographic scanning has improved our understanding of these fractures substantially, and has allowed the consistent analysis of the results of the treatment. The focus of current treatment is on the operative methods, internal fixation by leg-screw and plate through the lateral Kocher approach. Between April 1998 and July 2002, we treated operatively 6 displaced intraarticular fractures of the calcaneus. A lateral Kocher incision, leg-screw, and plate fixation were used. Neither infection, nor nonunion, or malunion occurred. All the patients presently have painless foot, use normal footwear, and are capable of normal activities.

  11. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  12. Effect of whole-body vibration exercise in preventing falls and fractures

    DEFF Research Database (Denmark)

    Jepsen, Ditte Beck; Thomsen, Katja; Hansen, Stinus

    2017-01-01

    of retrieved publications. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials examining the effect of WBV on fracture risk in adults ≥50 years of age. The primary outcomes were fractures, fall rates and the proportion of participants who fell. Secondary outcomes were bone mineral density......OBJECTIVE: To investigate the effect of whole-body vibration exercise (WBV) on fracture risk in adults ≥50 years of age. DESIGN: A systematic review and meta-analysis calculating relative risk ratios, fall rate ratio and absolute weighted mean difference using random effects models. Heterogeneity...... (BMD), bone microarchitecture, bone turnover markers and calcaneal broadband attenuation (BUA). RESULTS: 15 papers (14 trials) met the inclusion criteria. Only one study had fracture data reporting a non-significant fracture reduction (risk ratio (RR)=0.47, 95% CI 0.14 to 1.57, P=0.22) (moderate...

  13. CT classification of intra-articular calcaneus fractures. CT-Klassifikation intraartikulaerer Kalkaneusfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Haeberle, H.J. (Abt. fuer Roentgendiagnostik, Zentrum fuer Radiologie, Univ. Ulm (Germany)); Minholz, R.; Bader, C. (Abt. fuer Roentgendiagnostik, Zentrum fuer Radiologie, Univ. Ulm (Germany)); Tomczak, R. (Abt. fuer Roentgendiagnostik, Zentrum fuer Radiologie, Univ. Ulm (Germany)); Rilinger, N. (Abt. fuer Roentgendiagnostik, Zentrum fuer Radiologie, Univ. Ulm (Germany)); Friedrich, J.M. (Abt. fuer Roentgendiagnostik, Zentrum fuer Radiologie, Univ. Ulm (Germany)); Bauer, G. (Abt. fuer Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Univ. Ulm (Germany)); Mutschler, W. (Abt. fuer Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Univ. Ulm (Germany))

    1993-12-01

    93 patients with 102 intraarticular calcaneus fractures (ICF) were examined by CT from 1986 to 1992. The images were evaluated with the use of a modified classification based on the number of fractured heel bone facets (2 facets in 4.8%, 3 facets in 53.9%, 4 facets in 32.3%, comminution in 8.8% of the fractures), the involvement of the calcaneoucuboid joint (60.8%) and the fracture mechanism (tongue-type in 28.4%, joint depression in 62.7%) with the weight-bearing calcaneal compartments taken into special consideration. In that way, each intraarticular calcaneus fracture could be scored, enabling a fast diagnosis comprising factors relevant for the therapy and prognosis. (orig.)

  14. Clinicopathological studies of fractures of the calcaneus with special reference to findings of CT and prescale

    Energy Technology Data Exchange (ETDEWEB)

    Tajima, Wataru

    1987-11-01

    A comparative study was undertaken in 116 cases of fracture of the calcaneus using prescale footprints, clinical and radiological findings. According to the CT findings, fractures can be classified into four types: two part, three part, four part and crush fracture. Based on the CT images taken at the time of injury, prognosis for two part fractures was good, whereas the prognosis for crush fractures was poor. There was a significant correlation between the lateral protrusion rate (PR) as seen on the CT images and the clinical results. In fact, in those cases where the lateral protrusion rate was over 30%, clinical results were poor. With regards to footprints, in cases with poor clinical results, weight applied on the forefoot was decreased. Significant correlation was also noted between clinical results and sole pressure distribution. Finally, tendovaginitis of the peroneal tendons caused by a widening of the calcaneal body no less than incongruity of the subtalar joint was a factor of pain induction.

  15. Pediatric Distal Radius Fractures.

    Science.gov (United States)

    Dua, Karan; Abzug, Joshua M; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O

    2017-02-15

    Distal radius fractures are the most common orthopaedic injury that occur in the pediatric population. The annual incidence of distal radius fractures has increased as a result of earlier participation in sporting activities, increased body mass index, and decreased bone mineral density. Most distal radius fractures are sustained after a fall onto an outstretched arm that results in axial compression on the extremity or from direct trauma to the extremity. Physeal fractures of the distal radius are described based on the Salter-Harris classification system. Extraphyseal fractures of the distal radius are described as incomplete or complete based on the amount of cortical involvement. A thorough physical examination of the upper extremity is necessary to rule out any associated injuries. PA and lateral radiographs of the wrist usually are sufficient to diagnose a distal radius fracture. The management of distal radius fractures is based on several factors, including patient age, fracture pattern, and the amount of growth remaining. Nonsurgical management is the most common treatment option for patients who have distal radius fractures because marked potential for remodeling exists. If substantial angulation or displacement is present, closed reduction maneuvers with or without percutaneous pinning should be performed. Patients with physeal fractures of the distal radius that may result in malunion who present more than 10 days postinjury should not undergo manipulation of any kind because of the increased risk for physeal arrest.

  16. Comparing fixation used for calcaneal displacement osteotomies: a look at removal rates and cost.

    Science.gov (United States)

    Lucas, Douglas E; Simpson, G Alex; Philbin, Terrence M

    2015-02-01

    The calcaneal displacement osteotomy is a procedure frequently used by foot and ankle surgeons for hindfoot angular deformity. Traditional techniques use compression screw fixation that can result in prominent hardware. While the results of the procedure are generally good, a common concern is the development of plantar heel pain related to prominent hardware. The primary purpose of this study is to retrospectively compare clinical outcomes of 2 fixation methods for the osteotomy. Secondarily a cost analysis will compare implant costs to hardware removal costs. Records were reviewed for patients who had undergone a calcaneal displacement osteotomy fixated with either lag screw or a locked lateral compression plate (LLCP). Neuropathy, previous ipsilateral calcaneus surgery, heel pad trauma, or incomplete radiographic follow-up were exclusionary. Thirty-two patients (19.4%) required hardware removal from the screw fixation group compared to 1 (1.6%) of the LLCP group, which is significant (P cost was remarkably different with screw fixation costing on average $247.12, compared to the LLCP costing $1175.59. Although the LLCP cost was significantly higher, cost savings were identified when the cost of removal and removal rates were included. This study demonstrates that this device provides adequate stabilization for healing in equivalent time to screw fixation. The LLCP required decreased rates of hardware removal with fewer postoperative visits over a shorter period of time. Significant savings were demonstrated in the LLCP group despite the higher implant cost. Therapeutic, Level III, Retrospective Comparative Study. © 2014 The Author(s).

  17. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.

    Science.gov (United States)

    Kirkpatrick, Joshua; Yassaie, Omid; Mirjalili, Seyed Ali

    2017-06-01

    The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain. © 2017 Anatomical Society.

  18. Is calcaneal inclination higher in patients with insertional Achilles tendinosis? A case-controlled, cross-sectional study.

    Science.gov (United States)

    Shibuya, Naohiro; Thorud, Jakob C; Agarwal, Monica R; Jupiter, Daniel C

    2012-01-01

    Insertional Achilles tendinosis is a condition where a patient complains of isolated pain at the Achilles tendon insertion site due to intratendinous degeneration. It has been suggested that this condition is associated with cavus foot deformity. However, to our knowledge, there is no study that has confirmed this observation. We carried out a cross-sectional, case-controlled study to explore the association of increased calcaneal inclination-a surgically important characteristic of cavus foot deformity-with insertional Achilles tendinosis. Patients with Achilles tendinosis and matched controls without the pathology were compared. Although a statistically significant difference was detected in calcaneal inclination angle between these 2 groups (p = .038), we felt that the difference was not clinically significant (calcaneal inclination angle = 20.9 vs. 18.9, respectively). Within the limitations of the study, we conclude that there is no clinically significant difference in calcaneal inclination between those with or without insertional Achilles tendinosis. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

    Directory of Open Access Journals (Sweden)

    Pendse Aniruddha

    2006-01-01

    Full Text Available Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months. Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

  20. Management of cold and pulseless hand after closed reduction and percutaneous pinning of pediatric humerus supracondylar fracture: Is it really necessary to explore brachial artery?

    Directory of Open Access Journals (Sweden)

    Tolga Ege

    2015-04-01

    Results: We verified anatomical reduction using plain radiographs. However, all patients had cold and pulseless hands. Therefore, papaverine was injected subcutaneously and the operated extremities were warmed and elevated for at least 1 hour. During this period, serial doppler examinations were performed. After a mean period of 30 minutes (range of 15 to 90 minutes, we detected brachial and radial arterial flow upon doppler examination, along with warm hands. Patients were followed for at least two days in the clinic and all of the patients healed without any complications. Conclusions: We advise initial conservative management of cold and pale hands after reduction of a supracondylar fracture, including warming, elevation and papaverine-HCL injection within at least 30 minutes following surgery. If this treatment fails, emergency arterial exploration is needed. Additionally, if the patient has a cold and pale hand before the operation, arterial exploration is needed along with reduction. [Hand Microsurg 2015; 4(1.000: 12-15

  1. [Retrograde nailing in a tibial fracture].

    Science.gov (United States)

    Valls-Mellado, M; Martí-Garín, D; Fillat-Gomà, F; Marcano-Fernández, F A; González-Vargas, J A

    2014-01-01

    We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  2. The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years.

    Science.gov (United States)

    Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Gray, Bridget; Briggs, Andrew; Lall, Ranjit; Chesser, Tim Js; Pallister, Ian; Lamb, Sarah E; Willett, Keith

    2016-10-01

    Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. Trauma and orthopaedic departments of 24 NHS hospitals. Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle

  3. A retrospective analysis of zygomatic fracture etiologies

    Directory of Open Access Journals (Sweden)

    Yoshiaki Sakamoto

    2017-12-01

    Conclusion: The severities of the zygomatic fractures, their causes, and the associated patient ages were closely related. Based on this study, possible prevention strategies for zygomatic fractures need to be considered.

  4. Surgical Management of Patellar Fractures.

    Science.gov (United States)

    Kakazu, Rafael; Archdeacon, Michael T

    2016-01-01

    The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement, comminution, and fracture pattern, which often guide treatment. Modern treatment options include internal fixation using tension bands with Kirschner wires or cannulated screws, lag screw fixation, partial patellectomy, and rarely total patellectomy. Nondisplaced, closed patellar fractures or fractures with less than 2-mm articular steps can be successfully treated conservatively. Open fractures, articular step of 2 mm or greater, and loss of knee extension are indications for surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Open reduction and internal fixation of displaced intraarticular fractures of the calcaneus - influence of type of fracture and congruency of the subtalar joint upon functional result

    Directory of Open Access Journals (Sweden)

    Matej Andoljšek

    2005-11-01

    Full Text Available Background: More and more, open reduction and internal fixation (ORIF followed by early motion are advocated for displaced intraarticular fractures of the calcaneus. In prospective study the author asked, what are the results of ORIF with the calcaneal plate in intraarticular fractures of the calcaneus, and whether type of fracture and/or congruity in the subtalar joint influence these results.Methods: Forty-three intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV according to Sanders classification were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed for a few days until soft tissues recuperate. Motion of the ankle and the subtalar joint was encouraged immediately, partial weight bearing after 6–8 weeks and full weight bearing after 3–4 month. After surgery, subtalar joint was found congruent in 33 (77% and non-congruent (within 2 mm in ten fractures.Results: Functional results of 36 fractures with a representative type distribution were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86% and not satisfactory in five (14%. All fractures with unsatisfactory results were comminutive (Type III or IV. Four fractures with congruent joint had unsatisfactory, and eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse. However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint and analysis of variance showed that interaction of these two factors was not important.Conclusions: This prospective study confirms that ORIF enables satisfactory results in majority of displaced intraarticular fractures of the calcaneus. It also confirms that comminution in the

  6. The effects of medial and lateral displacement calcaneal osteotomies on ankle and subtalar joint pressure distribution.

    Science.gov (United States)

    Davitt, J S; Beals, T C; Bachus, K N

    2001-11-01

    We compared the pressure distribution in the ankle and posterior facet of the subtalar joint following 1 cm medial and lateral displacement calcaneal osteotomies to the pressure distribution in the intact foot. Six cadaver specimens were loaded in neutral alignment while pressure measurements were recorded. A 1-cm medial displacement osteotomy shifted the average center of force in the ankle 1.0 mm medially (p = 0.36) while a lateral displacement osteotomy shifted the center of force 1.1 mm laterally (p = 0.42). There was also a slight shift in the percentage of pressure toward the side of the talus to which the calcaneus was shifted. For the lateral displacement osteotomy, the pressure increased 4.0% in the lateral-most quadrant (p = 0.05), while the medial osteotomy increased the pressure 1.3% in the medial quadrant (p = 0.30). In the subtalar joint, a medial displacement osteotomy shifted the pressure distribution slightly medially (5.9%, p = 0.06) and more anteriorly (9.6%, p = 0.02) while the distribution was shifted laterally (5.9%, p = 0.17) and anteriorly (5.6%, p = 0.03) with a lateral displacement osteotomy. These shifts of percentage of pressure between quadrants of the joints were slight-less than 5% in the ankle and less than 10% in the subtalar joint. Significant translation of the calcaneal tuberosity appears to have only a small effect on pressure distribution in the ankle and posterior facet of the subtalar joint in a weighted cadaver model.

  7. Fracture opening/propagation behavior and their significance on pressure-time records during hydraulic fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Takashi Kojima; Yasuhiko Nakagawa; Koji Matsuki; Toshiyuki Hashida

    1992-01-01

    Hydraulic fracturing with constant fluid injection rate was numerically modeled for a pair of rectangular longitudinal fractures intersecting a wellbore in an impermeable rock mass, and numerical calculations have been performed to investigate the relations among the form of pressure-time curves, fracture opening/propagation behavior and permeability of the mechanically closed fractures. The results have shown that both permeability of the fractures and fluid injection rate significantly influence the form of the pressure-time relations on the early stage of fracture opening. Furthermore it has been shown that wellbore pressure during fracture propagation is affected by the pre-existing fracture length.

  8. Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation.

    Science.gov (United States)

    Dzaja, Ivan; MacDermid, Joy C; Roth, James; Grewal, Ruby

    2013-12-01

    We sought to compare direct costs and clinical and radiographic outcomes for distal radius fractures (DRF) treated with open reduction internal fixation with volar locking plates (VLP) versus closed reduction and percutaneous pinning (CRPP). We identified patients with AO-type A and C1 DRFs from a prospective database. Outcomes were assessed at 6 weeks and at 3, 6 and 12 months, and surgical care costs were estimated. Twenty patients were treated with CRPP and 24 with VLP. There were no significant differences in patient-rated wrist evaluation (PRWE) scores between the 2 groups at any time point (mean 16.2 ± 23.1 in the CRPP group v. 21.5 ± 23.6 in the VLP group, p = 0.91). Overall alignment was maintained in both groups; however, there was a greater loss of radial height over time with CRPP than VLP (0.97 mm v. 0.25 mm, p = 0.018). The mean duration of surgery was longer for VLP than CRPP (113.9 ± 39.5 min v. 86.5 ± 7.8 min, p = 0.029), but there were fewer clinic visits (5.2 ± 1.4 v. 7.8 ± 1.3, p cost per case was greater for VLP than CRPP ($1637.27 v. $733.91). Based on PRWE scores, VLPs did not offer any significant advantage over CRPP in patients with simple fracture types between 3 and 12 months, but they were much more costly. Whether VLP offers any functional advantage earlier in recovery, thereby justifying their expense, requires further investigation in the form of a prospective randomized trial with a detailed cost analysis.

  9. Urinary Mineral Concentrations in European Pre-Adolescent Children and Their Association with Calcaneal Bone Quantitative Ultrasound Measurements

    Directory of Open Access Journals (Sweden)

    Karen Van den Bussche

    2016-05-01

    Full Text Available This study investigates differences and associations between urinary mineral concentrations and calcaneal bone measures assessed by quantitative ultrasonography (QUS in 4322 children (3.1–11.9 years, 50.6% boys from seven European countries. Urinary mineral concentrations and calcaneal QUS parameters differed significantly across countries. Clustering revealed a lower stiffness index (SI in children with low and medium urinary mineral concentrations, and a higher SI in children with high urinary mineral concentrations. Urinary sodium (uNa was positively correlated with urinary calcium (uCa, and was positively associated with broadband ultrasound attenuation and SI after adjustment for age, sex and fat-free mass. Urinary potassium (uK was negatively correlated with uCa but positively associated with speed of sound after adjustment. No association was found between uCa and QUS parameters after adjustment, but when additionally adjusting for uNa, uCa was negatively associated with SI. Our findings suggest that urinary mineral concentrations are associated with calcaneal QUS parameters and may therefore implicate bone properties. These findings should be confirmed in longitudinal studies that include the food intake and repeated measurement of urinary mineral concentrations to better estimate usual intake and minimize bias.

  10. Double calcaneal osteotomy with percutaneous Steinmann pin fixation as part of treatment for flexible flatfoot deformity: a review of consecutive cases highlighting our experience with pin fixation.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2015-01-01

    Surgical correction of flexible flatfoot deformity and posterior tibial tendon dysfunction has been extensively reported in published studies. When appropriate, calcaneal osteotomies for flatfoot correction have been a favorite of foot and ankle surgeons because of the corrective power achieved without the need to fuse any rearfoot joints. The medial displacement calcaneal osteotomy and Evans calcaneal osteotomy, together termed the double calcaneal osteotomy, have been reported several times by various investigators with a wide variety of fixation options. We undertook an institutional review board-approved retrospective review of 9 consecutive patients (11 feet), who had undergone double calcaneal osteotomy with 2 percutaneous Steinmann pin fixation for the correction of flexible flatfoot deformity, with or without posterior tibial tendon dysfunction. All patients had radiographic evidence of bone healing of the posterior calcaneal osteotomy and incorporation of the Evans osteotomy bone graft at 6 weeks and demonstrated clinical healing at 6 weeks. All patients had 2 percutaneous Steinmann pins placed through both osteotomies, and these were removed an average of 6 weeks postoperatively. No patient developed pin site complications. The only complication noted was sural neuritis, which was likely incision related. No patients had delayed union or nonunion, and we did not identify any graft shifting postoperatively. The present retrospective series highlights our experience with 2 percutaneous Steinmann pin fixation, demonstrating equal or better results than many previous published fixation methods for double calcaneal osteotomy. It is cost-effective and minimizes the potential risk of iatrogenic Achilles pathologic features associated with screw fixation. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Crushing and Fracture of Lightweight Structures

    DEFF Research Database (Denmark)

    Urban, Jesper

    2003-01-01

    . Crushing experiments conducted on full-scale aluminum plate intersections reveal that the crushing behaviour is highly affected by material fracture during the deformation. Several fracture criteria from the literature have been reviewed and three fracture models have been compared with material...... on these two fracture models a new fracture criterion, denoted RTCL fracture criterion, is proposed and the fracture criterion is implemented in the FE-program LS-DYNA as a user subroutine. The crushing behaviours of the full-scale aluminum plate intersections have been simulated with LS......-DYNA and the implemented fracture criterion and the simulations agree well with the experiments. New closed form solutions for the dissipated energy during axial compression of aluminum plate intersections have been developed and the effect of fracture is included analytically based of the fracture criterion by Cockcroft...

  12. Arthroscopic Subtalar Arthrodesis after a Calcaneus Fracture Covered with a Forearm Flap

    Directory of Open Access Journals (Sweden)

    Frederick Michels

    2011-01-01

    Full Text Available Surgical treatment of intraarticular calcaneal fractures is often associated with postoperative wound problems. Soft tissue necrosis, bone loss and uncontrollable infection are a challenge for the surgeon and amputation may in some cases be the ultimate solution. A free flap can be very helpful to cover a significant soft tissue defect and help in fighting the infection. However, the free flap complicates the surgical approach if subtalar arthrodesis and bone reconstruction are needed. This study demonstrates the value of an arthroscopic technique to resect the remaining articular cartilage in preparation for subtalar arthrodesis and bone grafting. This approach avoids compromising the soft tissues and minimizes damage to the free flap.

  13. Operative versus Non operative treatment of displaced intraarticular fracture of calcaneum: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Meena, S; Hooda, A; Sharma, P; Mittal, S; Sharma, J; Chowdhury, B

    2017-12-01

    Various studies comparing operative and non-operative intervention for displaced intrarticular calcaneal fractures have reported conflicting findings in the past. The objective of this meta-analysis was to compare the efficacy and safety of open reduction and internal fixation (ORIF) vis-a-vis conservative management. Relevant randomized controlled trials (RCTs) comparing operative and non-operative intervention for displaced intraarticular calcaneal fractures were assessed and included in this meta-analysis. Data was extracted independently and methodological quality was further assessed. The inclusion criteria of this meta-analysis were: randomized controlled trials comparing operative with non-operative intervention for displaced intra-articular fractures of calcaneum and reporting atleast one of the main outcomes as failure to resume pre-injury work, residual pain and other complications. Eight randomized controlled trials fulfilled the criteria for this meta-analysis. Pooled results showed that patients managed conservatively failed to resume pre-injury work (RR 0.60, 95% CI = 0.37-0.98, P = 0.04). However operative intervention was associated with more complications (RR 1.74, 95% CI = 1.28 to 2.37, P = 0.0005). There was no statistically significant difference in residual pain (RR 0.73 95% CI = 0.40-1.36, P = 0.33) and reoperation (RR = 0.75, 95% CI = 0.48-1.16, P = 0.20) between the two groups. Surgery can benefit patients with calcaneal fracture and increases their likelihood to resume pre-injury work. However, the complication rates are significantly higher in the operative group. Since the included trials have used different scores to measure patient outcomes, hence little effective data could.

  14. fracture criterion

    Indian Academy of Sciences (India)

    Fracture in metallic glasses. What are the connections between nano- and micro- mechanisms and toughness? Metallic glasses are schizophrenic in the fracture sense. PDF Create! 5 Trial www.nuance.com ...

  15. Shoulder Fractures

    Science.gov (United States)

    ... arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus ... age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is ...

  16. Hand Fractures

    Science.gov (United States)

    ... lead to arthritis down the road. In addition, fractures in children occasionally affect future growth of that bone. Figure 1: Examples of fractures in fingers Figure 2: Examples of plates, pins ...

  17. Cosmetic rhinoseptoplasty in acute nasal bone fracture.

    Science.gov (United States)

    Kim, Ji Heui; Lee, Jung Woo; Park, Chan Hum

    2013-08-01

    Traditionally, rhinoseptoplasty for nasal bone fracture is only considered after an unsatisfactory outcome from initial closed reduction. However, better surgical outcomes may be achieved if rhinoseptoplasty is performed at the same time as the nasal bone fracture reduction. This study investigated the surgical outcomes of patients who underwent rhinoseptoplasty concomitantly with nasal bone fracture reduction according to their computed tomography image-based nasal bone fracture classifications. Case series with chart review. Academic tertiary care medical center. Fifty-six patients who underwent rhinoseptoplasty concomitantly with nasal bone fracture reduction were enrolled in this study. Nasal bone fractures were classified into 6 types by computed tomography scans. Two independent facial plastic surgeons evaluated the outcomes 6 months postoperatively using a visual analog scale. The nasal tip projection and rotation were measured using the pre- and postoperative profile views. The satisfaction scores of type I, IIo, and IIIo fractures without septal fracture were significantly higher than those of type II, III, and IV fractures with septal fractures. Among the patients, 82.1% underwent lower vault surgery. The nasal tip projection and rotation were increased after surgery in patients without septal fractures, whereas the tip rotation was elevated but the projection was unchanged postoperatively in patients with septal fractures. Rhinoseptoplasty for acute nasal bone fractures can be performed at the same time as nasal bone fracture reduction. However, nasal bone fracture with septal fracture should be managed carefully.

  18. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  19. Inclusion Requires Fracturing

    Science.gov (United States)

    Anila, Swarupa

    2017-01-01

    Inclusion strategies and approaches in interpretive planning processes for exhibitions are often resisted because they challenge precedents in museum practice. Maintaining traditional models may seem more comfortable for many museum professionals than to do the work of closely examining, fracturing, and transforming the practices that prioritize…

  20. The fate of Böhler's angle in conservatively-treated displaced intra-articular calcaneal fractures

    NARCIS (Netherlands)

    B. Bakker (Berdine); J.A. Halm (Jens); E.M.M. van Lieshout (Esther); T. Schepers (Tim)

    2012-01-01

    textabstractPurpose: Although the predictive value of Böhler's angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Böhler's angle during follow-up are frequently reported following surgical treatment of displaced intra-articular

  1. Stress Fractures

    Science.gov (United States)

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  2. Fracture Patterns Differ Between Osteogenesis Imperfecta and Routine Pediatric Fractures.

    Science.gov (United States)

    Peddada, Kranti V; Sullivan, Brian T; Margalit, Adam; Sponseller, Paul D

    2018-01-19

    It is important to estimate the likelihood that a pediatric fracture is caused by osteogenesis imperfecta (OI), especially the least severe type of OI (type 1). We reviewed records of 29,101 pediatric patients with fractures from 2003 through 2015. We included patients with closed fractures not resulting from motor vehicle accidents, gunshot wounds, nonaccidental trauma, or bone lesions. Patients with OI of any type were identified through International Classification of Diseases-9 code. We randomly sampled 500 pediatric patients in whom OI was not diagnosed to obtain a control (non-OI) group. We reviewed age at time of fracture, sex, fracture type, laterality, and bone and bone region fractured. Bisphosphonate use and OI type were documented for OI patients. Subanalysis of patients with type-1 OI was performed. The Fisher exact and χ tests were used to compare fracture rates between groups. P<0.05 was considered significant. Positive likelihood ratios for OI were calculated by fracture pattern. The non-OI group consisted of 500 patients with 652 fractures. The OI group consisted of 52 patients with 209 fractures. Non-OI patients were older at the time of fracture (mean, 9.0±5.0 y) than OI patients (mean, 5.5±4.4 y) (P<0.001). OI patients had more oblique, transverse, diaphyseal, and bilateral long-bone fractures than non-OI patients (all P<0.001). Non-OI patients had more buckle (P=0.013), metaphyseal (P<0.001), and physeal (P<0.001) fractures than OI patients. For patients with type-1 OI and long-bone fractures (n=18), rates of transverse and buckle fractures were similar compared with controls. Transverse humerus (15.2), olecranon (13.8), and diaphyseal humerus (13.0) fractures had the highest positive likelihood ratios for OI, and physeal (0.09) and supracondylar humerus (0.1) fractures had the lowest. Transverse and diaphyseal humerus and olecranon fractures were most likely to indicate OI. Physeal and supracondylar humerus fractures were least likely

  3. TALONAVICULAR JOINT ARTHRODESIS AND MEDIAL DISPLACEMENT CALCANEAL OSTEOTOMY FOR TREATMENT OF PATIENTS WITH PLANOVALGUS DEFORMITY

    Directory of Open Access Journals (Sweden)

    G. O. Dubovik

    2012-01-01

    Full Text Available The aim of this study was to assess the results of talonavicular joint arthrodesis and medial displacement calcaneal osteotomy for surgical correction of pes planovalgus. Fourteenth patients with a pes planovalgus deformity were underwent surgery from February 2008 to December 2011. The mean age was 45,5. In 90% of cases, operations were performed on one foot, and 10% of cases at two feet. All patients were assessed before the operation with the scale of the American Orthopaedic Foot and Ankle Society (AOFAS. According to the AOFAS scale, the average improvement was 41 before the operation had reached values of 84.2 after the operation. Radiography showed an average decrease in the angle of the longitudinal arch from 12 and an average decrease in the angle of deviation between the vehicle collision and the calcaneus to 38°, increasing the height of a set of 5 mm. This combination of procedures allows greater correction and stability than either procedure performed alone, and provides a viable alternative to triple arthrodesis.

  4. Multiphysics of Fractures across Scales

    Science.gov (United States)

    Pyrak-Nolte, L. J.

    2016-12-01

    Remote monitoring of fluid flow in fractured rock faces challenges because fractures are topologically complex, span a range of length scales, and are routinely altered due to physical and chemical processes. A long-standing goal has been to find a link between fluid flow supported by a fracture and the seismic response of that fracture. This link requires a relationship between intrinsic fracture properties and macroscopic scattered wave fields. Furthermore, such a link among multiphysical properties of fracture should be retained as the scale of observation changes. Recently, Pyrak-Nolte and Nolte (Nature Comm., 2016) demonstrated, numerically, that a scaling relationship exists between fluid flow and fracture specific stiffness, linked through the topology of the fracture void geometry (i.e. fracture void space and contact area spatial distributions). This scaling relationship holds for fractures with either random or spatially correlated aperture distributions. To extend these results, a heuristic numerical study was performed to determine if fracture specific stiffness determined from seismic wave attenuation (defined through a displacement-discontinuity boundary condition) corresponds to static stiffness based on deformation measurements. In the long wavelength limit, static and dynamic stiffness are closely connected. As the scattering conditions of the fracture move out of the long-wavelength limit, a frequency-dependent stiffness is defined that captures low-order corrections, extending the regime of applicability of the displacement discontinuity model. The displacement discontinuity theory has a built-in scaling parameter that ensures some set of discontinuities will be optimal for detection as different wavelengths sample different subsets of fractures. Future studies will extend these concepts to fracture networks. Acknowledgments: The U.S. Department of Energy, Office of Science, Basic Energy Sciences, Chemical Sciences, Geosciences, and Biosciences

  5. Olfactory Dysfunction in Nasal Bone Fracture.

    Science.gov (United States)

    Kim, Sug Won; Park, Beom; Lee, Tae Geun; Kim, Ji Ye

    2017-06-01

    All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I-IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.

  6. Closed reduction of a fractured bone

    Science.gov (United States)

    ... pushing or pulling the bone. This is called traction. After the bone is set: You will have ... BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction . 5th ed. ...

  7. Fractures of the hallux in children.

    Science.gov (United States)

    Petnehazy, Thomas; Schalamon, Johannes; Hartwig, Charlotte; Eberl, Robert; Kraus, Tanja; Till, Holger; Singer, Georg

    2015-01-01

    Foot fractures account for 5% to 13% of pediatric fractures. Fractures of the hallux require special attention due to its role in weight bearing, balance, and pedal motion. In this study, a large series of children with hallux fractures is presented. All children treated with fractures of the hallux between June 2004 and December 2011 were included. The medical records were analyzed and X-rays were reviewed. The fractures were classified according to their anatomic location and the type of fracture. Three hundred seventeen patients (mean age = 11.7 years; range, 1-18 years; 65% male) sustained a fracture of the hallux. Most accidents (28%) occurred at sports facilities, and soccer was the most common cause of a fracture of the hallux (28%). Closed injuries were diagnosed in 92% of the patients; 8% of the children presented with open fractures. In 144 children, the growth plate was affected. Fifty-nine patients presented with diaphyseal fractures, 42 patients with osseous avulsions, and 40 patients with fractures of the distal part of the phalanx. Nineteen children had incomplete and 13 patients comminuted fractures. The vast majority of the children (86%) were treated conservatively. Operative interventions were required in 14% of the patients. Good outcome was achieved in both conservatively and operatively treated patients. In children, fractures of the hallux were most often caused by ball sports and had a good prognosis. The vast majority of these fractures could be treated conservatively yielding good outcome. Level IV, case series. © The Author(s) 2014.

  8. A Fracture Decoupling Experiment

    Science.gov (United States)

    Stroujkova, A. F.; Bonner, J. L.; Leidig, M.; Ferris, A. N.; Kim, W.; Carnevale, M.; Rath, T.; Lewkowicz, J.

    2012-12-01

    Multiple observations made at the Semipalatinsk Test Site suggest that conducting nuclear tests in the fracture zones left by previous explosions results in decreased seismic amplitudes for the second nuclear tests (or "repeat shots"). Decreased seismic amplitudes reduce both the probability of detection and the seismically estimated yield of a "repeat shot". In order to define the physical mechanism responsible for the amplitude reduction and to quantify the degree of the amplitude reduction in fractured rocks, Weston Geophysical Corp., in collaboration with Columbia University's Lamont Doherty Earth Observatory, conducted a multi-phase Fracture Decoupling Experiment (FDE) in central New Hampshire. The FDE involved conducting explosions of various yields in the damage/fracture zones of previously detonated explosions. In order to quantify rock damage after the blasts we performed well logging and seismic cross-hole tomography studies of the source region. Significant seismic velocity reduction was observed around the source regions after the initial explosions. Seismic waves produced by the explosions were recorded at near-source and local seismic networks, as well as several regional stations throughout northern New England. Our analysis confirms frequency dependent seismic amplitude reduction for the repeat shots compared to the explosions in un-fractured rocks. The amplitude reduction is caused by pore closing and/or by frictional losses within the fractured media.

  9. Hip fracture - discharge

    Science.gov (United States)

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - ...

  10. Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Chad Correa

    2017-09-01

    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  11. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Ouellette, H.; Salamipour, H.; Thomas, B.J.; Kassarjian, A.; Torriani, M. [Division of Musculoskeletal Radiology, Massachusetts General Hospital, Boston, MA (United States)

    2006-11-15

    To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief.

  12. Management of long bone fractures using SIGN nail: experience ...

    African Journals Online (AJOL)

    Background: Intramedullary nailing with interlocking nails has become the treatment of choice for closed diaphyseal fractures of femur and tibia. When possible locked nailing should be performed as a closed procedure. Fractures fixed by interlocking nailing have comparatively less complications in fracture healing.

  13. The effect of acupuncture therapy on the repair of the calcaneal tendon (tendo calcaneus communis) in dogs

    OpenAIRE

    SHARIFI, Davood; SASANI, Fahang; BAKHTIARI, Jalal; REZAEI, Taher

    2009-01-01

    The effect of acupuncture therapy on the healing process of the calcaneal tendon (tendo calcaneus communis) of the dog was evaluated after tendon splitting in 10 adult mixed breed dogs. Complete, full thickness splitting of the right Achilles tendon, 2 cm in length, was performed using a scalpel blade. The dogs were randomly divided into 2 groups (group 1 and 2) of 5 dogs each. The dogs in group 2 were subjected to acupuncture therapy 10 min/day for 2 weeks, starting on postoperative day 3. T...

  14. Unstable Pelvic Fractures Associated with Femoral Shaft Fractures: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Chun-Liang Wu

    2013-04-01

    Full Text Available Background: Both pelvic fractures and femoral shaft fractures are caused by high-energy injuries. When unstable pelvic fractures and femoral shaft fractures occur concomitantly, the optimal treatment method is controversial. The aim of this study was to establish a reasonable principle for treating such complicated injuries. Methods: Forty patients sustaining unstable pelvic fractures and concomitant femoral shaft fractures were treated in a 7-year period. The initial management of the fractures was started at the emergency service according to the Advanced Trauma Life Support protocol. Unstable pelvic fractures were wrapped by cloth sheets and femoral shaft fractures were immobilized with a splint. Angiography was performed on patients with unstable hemodynamic status. The definitive treatment for combined fractures was performed after stabilizing the hemodynamics. Closed nailing was used for femoral shaft fractures, and pelvic fractures were treated with various techniques. Results: The mortality rate was 12.5% (5/40 during admission. Thirty-three patients were followed up for an average of 32 months (range, 12-76 months. There were 33 cases of unstable pelvic fractures and 36 instances of femoral shaft fractures. The union rate for pelvic fractures was 100% (33/33, while femoral shaft fractures had a 94.4% (34/36 union rate. The average healing time was 3.3 months (range, 1.6-8.1 months and 4.1 months (range, 2.5-18.2 months for pelvic and femoral shaft fractures, respectively. After fracture, 34 hips (94% achieved a satisfactory result in the Harris hip score and 30 knees (83% achieved a satisfactory result in the Mize knee score. Conclusions: Stabilization of the hemodynamics in patients with combined fractures should be the first aim. Angiography to stop arterial bleeding in the pelvis is often life-saving. The definitive treatment for combined fractures, such as pelvic fractures and femoral shaft fractures, should wait until hemodynamics

  15. CALCANEAL MINERAL DENSITY IN CHILDREN ATHLETES AND TAKE-OFF LEG

    Directory of Open Access Journals (Sweden)

    Borislav Obradović

    2010-06-01

    Full Text Available It is well-known that physical activity has an anabolic effect on the bone tissue. To examine the influence of the take-off lower limb to the bone density we studied a group of prepubertal boys and girls at the initial phase of their peak bone mass acquisition. A sample consisted of 60 subjects ie., 32 soccer players (boys, 10.7±0.5 years old and 28 swimmers (15 girls and 13 boys, 10.8±0.8 years old, who had performed at least one year of high-level sport training (10-15 hours per week for soccer players, 8-12 hours per week for swimmers. The sample was divided into two groups: the first consisted of 40 subjects, with the left take-off leg, while the second consisted of 20 subjects, with the right take-off leg. The bone mineral density (BMD measurements of the left and the right calcaneus were performed using ultrasound densitometer “Sahara” (Hologic, Inc., MA, USA. There were no significant differences between the groups in regard to BUA and SOS of both the left and the right take-off lower legs. Mean BUA of the take-off left leg and the take-off right leg were different, but not significantly (p>0.05. Likewise, mean SOS of the take-off left leg and the take-off right leg were different, but it was not significant (p>0.05. The results do not indicate that the take-off lower limb has an influence on calcaneal bone mineral density.

  16. Femur ultrasound (FemUS)--first clinical results on hip fracture discrimination and estimation of femoral BMD.

    Science.gov (United States)

    Barkmann, R; Dencks, S; Laugier, P; Padilla, F; Brixen, K; Ryg, J; Seekamp, A; Mahlke, L; Bremer, A; Heller, M; Glüer, C C

    2010-06-01

    A quantitative ultrasound (QUS) device for measurements at the proximal femur was developed and tested in vivo (Femur Ultrasound Scanner, FemUS). Hip fracture discrimination was as good as for DXA, and a high correlation with hip BMD was achieved. Our results show promise for enhanced QUS-based assessment of osteoporosis. Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement has been introduced yet. We developed a QUS scanner for measurements at the femur (Femur Ultrasound Scanner, FemUS) and tested its in vivo performance. Using the FemUS device, we obtained femoral QUS and DXA on 32 women with recent hip fractures and 30 controls. Fracture discrimination and the correlation with femur bone mineral density (BMD) were assessed. Hip fracture discrimination using the FemUS device was at least as good as with hip DXA and calcaneal QUS. Significant correlations with total hip bone mineral density were found with a correlation coefficient R (2) up to 0.72 and a residual error of about one half of a T-score in BMD. QUS measurements at the proximal femur are feasible and show a good performance for hip fracture discrimination. Given the promising results, this laboratory prototype should be reengineered to a clinical applicable instrument. Our results show promise for further enhancement of QUS-based assessment of osteoporosis.

  17. Hip Fractures.

    Science.gov (United States)

    Ramponi, Denise R; Kaufmann, Judith; Drahnak, Gwendolen

    Hip fractures are associated with significant morbidity and mortality and a major health problem in the United States (). Eighty percent of hip fractures are experienced by 80-year-old women. Plain radiographs usually confirm the diagnosis, but if there is a high level of suspicion of an occult hip fracture, magnetic resonance imaging or bone scan is the next step to confirm the diagnosis. Areas of the hip bone have varied bone strength and blood supply, making the femoral neck one of the most vulnerable areas for fracture. A consultation to an orthopedic surgeon will determine surgical interventions.

  18. Hamate fractures.

    Science.gov (United States)

    Sarabia Condés, J M; Ibañez Martínez, L; Sánchez Carrasco, M A; Carrillo Julia, F J; Salmerón Martínez, E L

    2015-01-01

    The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  19. Colles Fracture

    OpenAIRE

    Sánchez León, Belisario; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...

  20. Minimally invasive repair of a calcaneus fracture in a Standardbred foal.

    Science.gov (United States)

    Bonilla, Alvaro G; Smith, Katie J

    2012-11-01

    A 4-month-old Standardbred colt was examined because of a fractured right calcaneus of 8 days' duration with increased distraction of the fracture fragment evident on sequential radiographs. The foal was severely lame with diffuse periarticular tarsal swelling. Radiographically, a complete, displaced long oblique fracture of the right calcaneal body was evident. Because the fracture gap was increasing with time and lameness remained severe, despite medical management, surgical repair was recommended. The foal was anesthetized, and minimally invasive fracture reduction and internal fixation were achieved by use of two 4.5-mm cortical screws placed in lag fashion via stab incisions over the lateral aspect of the calcaneus. External coaptation with a Robert-Jones bandage only was used after surgery. The foal recovered well and the fracture healed appropriately, but at 8 weeks following surgery, tenosynovitis of the tarsal sheath had developed. This was attributed to the tip of the distal screw encroaching on the sheath. The screw was removed under anesthesia and the tarsal sheath drained. The tenosynovitis resolved with rest and bandaging. Fourteen months after surgery, the colt was free of lameness. Findings suggested that a minimally invasive internal fixation technique for treatment of a calcaneus fracture in horses may be successful and may be associated with decreased morbidity, compared with the use of open reduction and plate fixation.

  1. Effects of calcaneal eversion on three-dimensional kinematics of the hip, pelvis and thorax in unilateral weight bearing.

    Science.gov (United States)

    Tateuchi, Hiroshige; Wada, Osamu; Ichihashi, Noriaki

    2011-06-01

    Understanding the kinematic chain from foot to thorax will provide a better basis for assessment of malalignment of the body. The purpose of this study was to investigate the effects of induced calcaneal eversion on the kinematics of the hip, pelvis and thorax in three dimensions under unilateral weight-bearing. Twenty-eight healthy males were requested to stand on one leg under three conditions: normal (standing directly on the floor), and on wedges producing 5° and 10° calcaneal eversion. Recorded kinematic parameters included the angles of the hip joint, pelvis, and thorax in three dimensions. Eversion induced by wedges produced significant increases in hip flexion, hip medial rotation, pelvic anterior tilt, and thoracic lateral tilt and axial rotation to the standing side. In the frontal plane, pelvic lateral tilt to the standing side was decreased in 5° eversion condition compared with normal condition; conversely, it was increased in 10° eversion condition compared with 5° eversion condition. Arch height was negatively correlated with change in thoracic axial rotation to standing side from the normal to 10° eversion (r=-.528, pthorax through the hip joint and the pelvis. Copyright © 2011 Elsevier B.V. All rights reserved.

  2. Broadband ultrasound attenuation in the calcaneal region: a comparative study of single-position versus scanning systems.

    Science.gov (United States)

    Maia, Joaquim A; Costa, Eduardo T; Neto, João F Marques; Button, Vera L S N

    2008-01-01

    This work describes a system developed to measure the broadband ultrasound attenuation (BUA) in the calcaneal region. The patient's calcanei were inspected using a microcomputer-controlled X-Y axis displacement unit with two 500-kHz, central-frequency, ultrasound transducers. The transducers facing each other are submerged in a small water tank with a support for the patient's foot between them. The system allows data to be collected from a single position or by scanning the calcaneal region to obtain a BUA map. Tests were carried out on 201 patients (110 using the single-position method, and 91 using the scanning method). The results were compared with those of densitometry tests performed using the dual energy X-ray absorptiometry (DEXA) technique (single position: r=0.50; Pposition method is more susceptible to errors due to the difficulty in positioning the transducers relative to the calcaneus. The scanning method provides better results and can be used to screen patients before referring them for DEXA.

  3. Comparison of rates of union and hardware removal between large and small cannulated screws for calcaneal osteotomy.

    Science.gov (United States)

    Sayres, Stephanie C; Gu, Yang; Kiernan, Samuel; DeSandis, Bridget Ann; Elliott, Andrew J; O'Malley, Martin J

    2015-01-01

    The calcaneal osteotomy is a common procedure to correct hindfoot malalignment. Reported union rates are high, utilizing fixation methods including staples, plates, and most commonly cannulated screws. We began our practice using 6.5 mm and 7.3 mm cannulated screws, but complaints of postoperative posterior heel pain led to hardware removal in many patients. A switch to smaller 4.5 mm cannulated screws resulted in fewer symptoms, thus we hypothesized that using a smaller screw would decrease screw removal while maintaining an equally high union rate. The records of patients who underwent a calcaneal osteotomy by 2 surgeons between January 1996 and April 2012 were retrospectively reviewed. The rates of hardware removal and union were compared between osteotomies held with two 7.3 mm, 6.5 mm, and 4.5 mm cannulated screws. There were 272 feet that met the inclusion criteria. The hardware removal rate for 130 osteotomies held with two 7.3 mm screws was 29.2% and the removal rate for 115 osteotomies held with 4.5 mm screws was 13.0%, which was significantly different (P hardware removal. There was no loss of position from the smaller screws and we feel that the 4.5mm cannulated screw provides sufficient compression and achieves a high rate of union equal to that of the larger screws. Level IV, retrospective case series. © The Author(s) 2014.

  4. Greenstick Fractures

    Science.gov (United States)

    ... small, "green" branch on a tree. Most greenstick fractures occur in children younger than 10 years of age. This type ... mistaken for sprains or bruises. More-severe greenstick fractures may cause an obvious ... your doctor if your child has persistent pain in an injured limb. Seek ...

  5. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig

    2013-01-01

    . The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis......Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate...

  6. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  7. Ankle fracture - aftercare

    Science.gov (United States)

    Malleolar fracture; Tri-malleolar; Bi-malleolar; Distal tibia fracture; Distal fibula fracture; Malleolus fracture ... Some ankle fractures may require surgery when: The ends of the bone are out of line with each other (displaced). The ...

  8. Three-Dimensional CT Findings of Os Calcaneus Secundarius Mimicking a Fracture

    Directory of Open Access Journals (Sweden)

    Mehmet Deniz Bulut

    2014-01-01

    Full Text Available Os calcaneus secundarius is one of several accessory ossicles of the foot that have been identified as normal variants of skeletal development. It may cause ankle pain and may mimic an avulsion fracture of the anterior calcaneal process. A twenty-year-old male was admitted to our institution with right ankle pain following an inversion injury. An axial CT image of the patient’s right ankle revealed a shape with smooth and sharp margins, identified as a well-corticated bone fragment in the subtalar region. A diagnosis of an accessory ossicle, os calcaneus secundarius, was made based on radiographic findings. As a result of this case, it is recommended that potential locations of the accessory bones should be well understood in order to prevent misdiagnosis and inappropriate surgical procedures. Os calcaneus secundarius must be considered when an apparent bone fragment or a suspicious fracture line at the anterior region of os calcaneus is demonstrated.

  9. Emergency department external fixation for provisional treatment of pilon and unstable ankle fractures

    Directory of Open Access Journals (Sweden)

    Craig R Lareau

    2015-01-01

    Full Text Available Unstable ankle fractures and impacted tibial pilon fractures often benefit from provisional external fixation as a temporizing measure prior to definitive fixation. Benefits of external fixation include improved articular alignment, decreased articular impaction, and soft tissue rest. Uniplanar external fixator placement in the Emergency Department (ED ex-fix is a reliable and safe technique for achieving ankle reduction and stability while awaiting definitive fixation. This procedure involves placing transverse proximal tibial and calcaneal traction pins and connecting the pins with two external fixator rods. This technique is particularly useful in austere environments or when the operating room is not immediately available. Additionally, this bedside intervention prevents the patient from requiring general anesthesia and may be a cost-effective strategy for decreasing valuable operating time. The ED ex-fix is an especially valuable procedure in busy trauma centers and during mass casualty events, in which resources may be limited.

  10. Epidemiology of tibial shaft fractures

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    Grecco Marco Aurélio Sertório

    2002-01-01

    Full Text Available In this work an epidemiological analysis on tibial shaft fractures was performed. During four years, our service treated 179 fractures, 132 in male, 47 in female, aged 14 to 83 years. The 21 to 30-year-old patiens were the more injured. Of these, 120 were open and 59 close fractures of which prevailing cause was road traffic accident. The study based on patients promptuaries analyses and radiographs. The fractures occurred 97 times in the middle third (54.18%; 102 times (56.98% presented simple fragments, and 57 (31.38% oblique lines. We treated close and open fractures, respectively, 48 and 38 cases with plaster cast immobilization; 3 and 67 with external fixation after plaster cast immobilization; 5 and 12 with osteosynthesis by means of plate and screws, and 2 and 3 with external fixation only. In both close and open fractures, respectively, 7 and 20 cases of pseudarthrosis and 1 and 11 of infections have occurred. With the data obtained we verified an actual validity of the epidemiological studies as a contribution for better identifying lesions features and their treatment and complications. This allows proceedings and apprenticeship refinement.

  11. [BIOMECHANICS STUDY ON ACETABULAR POSTERIOR WALL FRACTURE].

    Science.gov (United States)

    Tang, Yang; Hu Xiaopeng; Lu, Xiongwei; Zhang, Yuntong; Zhang, Chuncai; Wang, Panfeng; Zhao, Xue

    2015-08-01

    To study the experimental biomechanics of acetabular posterior wall fractures so as to provide theoretical basis for its clinical treatment. Six formalin-preserved cadaveric pelvises were divided into groups A and B (n=3). The fracture models of superior-posterior wall and inferior-posterior wall of the acetabulum were created on both hips in group A; fractures were fixed with two interfragmentary screws and a locking reconstruction plate. The fracture models of superior-posterior wall of acetabulum were created on both hips in group B; fractures were fixed with two interfragmentary screws and a locking reconstruction plate at one side, and with acetabular tridimensional memory fixation system (ATMFS) at the other side. The biomechanical testing machine was used to load to 1 500 N at 10 mm/min speed for 30 seconds. The displacement of superior and inferior fracture sites was analyzed with the digital image correlation technology. No fracture or internal fixation breakage occurred during loading and measuring; the displacement valuess of the upper and lower fracture lines were below 2 mm (the clinically tolerable maximum value) in 2 groups. In group A, the displacement values of the upper and lower fracture lines at superior-posterior wall fracture site were significantly higher than those at inferior-posterior wall fracture site (P fracture line were significantly higher than those of lower fracture line (P fracture types. In group B, the displacement values of the upper and lower fracture lines at the side fixed with screws and a locking reconstruction plate were similar to the values at the side fixed with ATMFS, all being close to 2 mm; the displacement values of the upper fracture line were significantly higher than those of lower fracture line (P acetabulum is much greater than that of the inferior-posterior wall of acetabulum and they should be discriminated, which might be the reasons of reduction loss, femoral head subluxation, and traumatic arthritis

  12. Sclerostin in institutionalized elderly women: associations with quantitative bone ultrasound, bone turnover, fractures, and mortality.

    Science.gov (United States)

    Amrein, Karin; Dobnig, Harald; Wagner, Doris; Piswanger-Sölkner, Claudia; Pieber, Thomas R; Pilz, Stefan; Tomaschitz, Andreas; Dimai, Hans Peter; Fahrleitner-Pammer, Astrid

    2014-06-01

    To evaluate the association between levels of circulating sclerostin (an emerging biomarker and important regulator of bone formation) and laboratory parameters of bone and mineral metabolism, bone mineral density and quality measured using quantitative ultrasound (QUS), fracture risk, and mortality. Prospective cohort study. Austrian nursing homes (N = 95). Female nursing home residents aged 70 and older (mean 84 ± 6; N = 539). Serum sclerostin, bone turnover markers, and bone mineral density and quality were measured at baseline. Participants were followed for clinical fractures and all-cause mortality. Partial correlation analysis adjusted for age, weight, and renal function revealed a significant positive correlation between sclerostin levels and calcaneal stiffness and radial and phalangeal speed of sound (all P fracture (12%). Sclerostin was not predictive of mortality. In women with a negative fracture history, it was significantly but not linearly associated with fracture risk. In institutionalized elderly women, there is a significant relationship between serum sclerostin levels and QUS indices, bone turnover, and PTH, but sclerostin was not strongly associated with important clinical outcomes. Thus, it remains unclear whether sclerostin is a clinically useful predictor of fractures or mortality, at least in this setting. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  13. Ulnar nerve paralysis after forearm bone fracture

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    Carlos Roberto Schwartsmann

    2016-08-01

    Full Text Available ABSTRACT Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  14. Ulnar nerve paralysis after forearm bone fracture.

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Ruschel, Paulo Henrique; Huyer, Rodrigo Guimarães

    2016-01-01

    Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  15. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  16. Evidence-based medicine: Metacarpal fractures.

    Science.gov (United States)

    Bloom, Jacob M P; Hammert, Warren C

    2014-05-01

    After studying this article, the participant should be able to: (1) Determine the need for operative treatment of metacarpal fractures. (2) Describe the position of immobilization for nonoperative treatment of fifth metacarpal fractures. (3) Assess the differences between intramedullary pinning and transverse pinning of displaced metacarpal fractures. (4) Compare the advantages of plating and pinning for treatment of displaced metacarpal fractures. (5) Recognize appropriate timing and treatment of open metacarpal fractures. The body of evidence regarding the treatment of metacarpal fractures continues to grow. Conservative management, closed reduction with percutaneous Kirschner wire fixation, intramedullary fixation, and open reduction and internal fixation with plates and/or screws are all accepted treatment modalities. The goal of this review is to highlight the most recent literature and the best evidence available for the management of metacarpal fractures.

  17. Evaluation the treatment outcomes of intracapsular femoral neck fractures with closed or open reduction and internal fixation by screw in 18-50-year-old patients in Isfahan from Nov 2010 to Nov 2011

    Directory of Open Access Journals (Sweden)

    Mohammad Javdan

    2013-01-01

    Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

  18. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality.

    Science.gov (United States)

    Thapa, Deepak; Ahuja, Vanita

    2014-03-01

    Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  19. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2014-01-01

    Full Text Available Plantar fasciitis (PF is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF. Following a diagnostic medial calcaneal nerve (MCN block at its origin, we observed reduction in verbal numerical rating scale (VNRS in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF. All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  20. CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

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    Walter W. Virkus

    2008-12-01

    displaced bimalleolar fracture in insulin dependant middle aged woman; Man-agement of calcaneal fractures; Fixation technic for a displaced talar neck fracture in a patient in ER; Indica-tions for surgical treatment of metatarsal fractures; Bone grafting in acute fractures; Management of a nonunion of plated midshaft tibia fracture; Management of a child with a twisted ankle and normal x-rays; Assessment of com-partment syndrome in foot.The Section III is about “GENERAL FRACTURE CARE” including: Management of multiple orthopedic injuries and damage control orthopedics; Bone stimula-tion in nonunion; Indications for locking plates; Fractures requiring anatomic reduction.AUDIENCE: Mainly trauma fellows and practicing or-thopedists are the targeted audience of the book, but not only the basic knowledge for the orthopedic residents but also the expert advices for complicated and controversial cases pointing experienced surgeons widen the spectrum of audience. Also non-physician personnel may benefit the basic knowledge from brief answers given in a casual format.ASSESMENT: “Curbside Consultation in Fracture Man-agement:49 Clinical Questions” offering practical, brief, evidence based answers to frequently asked questions especially those have been often left controversial related with the treatment of fractures of upper and lower extrem-ity, pelvic fractures is a useful resource mainly for resi-dents, fellows and junior orthopedists. Casual format that mimics a “curbside” dialog of colleagues and also the rich illustrations by images and diagrams makes the advanced knowledge in the text easier to understand and learn. Questions are carefully chosen from a wide spectrum of subjects related to fracture management to form a unique reference including high and low energy trauma fractures, pediatric fractures, fractures in elderly, multiple orthope-dic injury, and general fracture care. Assessment of frac-tures and diagnostic approach, postoperative care and

  1. Mandibular fracture and complications associated with different ...

    African Journals Online (AJOL)

    Mandibular fracture sometimes is associated with complications which influence its prognosis. Aspects of the complications of mandibular fracture investigated are those emanating from the methods of treatment employed in its management. Such methods of treatment include conservative, closed reduction with ...

  2. Fractures of the femoral neck.

    Science.gov (United States)

    Kyle, Richard F

    2009-01-01

    Fractures of the femoral neck are increasing at an exponential rate as a result of the longevity of the general population. The Garden and Pauwels classifications both are routinely used to describe displacement and stability of femoral neck fractures. Osteonecrosis and nonunion remain problematic because of the compromised blood supply to the femoral head in displaced fractures. Nondisplaced fractures and displaced fractures in patients physiologically younger than 65 years are treated with closed or open reduction and internal fixation. Anatomic reduction is the single most important step in the treatment and fixation of these difficult fractures. Because of the higher complication rate in patients physiologically older than 65 years, a prosthetic replacement may be considered for the treatment of displaced fractures. In patients who are low-level community ambulators or nursing home ambulators with comorbidities and who are not expected to live more than 5 years after injury, a hemiprosthesis is indicated. In active, elderly patients physiologically older than 65 years who are expected to live longer than 5 years after injury, a total hip replacement is the treatment of choice. Total hip replacement relieves pain and allows faster rehabilitation than other forms of treatment in this age group. Patients with preexisting hip disease also are treated with total hip replacement. An algorithm that considers physiologic age and activity level of the patient is helpful when deciding whether to fix or replace the hip in a patient with a displaced femoral neck fracture. It is also useful in deciding what type of prosthesis to use. The treatment of femoral neck fractures remains complex and difficult. Because of the enormous burden of this injury, orthopaedists must improve results in the care of femoral neck fractures.

  3. Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sendeht Ayuba J

    2008-05-01

    Full Text Available Abstract Background Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading. Methods We recruited 102 male athletes: these included football (n = 68, running (n = 15, handball (n = 7, taekwando (n = 6, cycling (n = 2, judo (1, badminton (1 and high jump (1. Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer. Results The mean age of athletes was 25 ± 6 years. The means of BMI and energy expenditure were 21.9 ± 2.0 kg/m2 and 35.0 ± 13.7 kcal/kg/day, respectively. Footballers were younger (p Conclusion Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.

  4. The Value of Calcaneal Quantitative Ultrasound And Phalangeal Radiographic Absorbsiometry in Diagnosis of Osteoporosis: A Comparative Study - Original Investigation

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    İlknur Aktaş

    2006-09-01

    Full Text Available Aims: The current method for screening osteoporosis involves dual-energy x-ray absorptiometry (DEXA. The aim of this study to determine specifity and sensitivity of the calcaneal quantative ultrasound (QUS and radiographic absorbsiometri (RA. Materials and Methods: We enrolled a total of 69 community-dwelling people aged between 30-81 years. Of all the patient's phalangeal bone mineral density (BMD was measured using RA; calcaneal BMD was measured by using QUS; lumbar spine and hip regions BMD was measured using by DEXA. The screening results conducted by QUS and RA were compared with the DEXA results. Results: While QUS measurements revealed osteopenia in 21 cases (30.4% and osteoporosis in 31 cases (44.9%; RA measurements revealed osteopenia in 21 cases (30.4% and osteoporosis in 33 cases (47.8%. Whereas according to lumbar vertebra DEXA results: 21 cases revealed osteopenia, and 30 cases revealed osteoporosis; according to hip DEXA results: 26 cases revealed osteopenia, and 19 cases revealed osteoporosis. The sensitivity, specificity, positive predictive value, and negative predictive value for identifying cases with osteoporosis by QUS were 66.7%, 78.8%, 77.4%, 68.4%, respectively, and by RA were 75%, 81.8%, 81.8%, 75%, respectively. Conclusion: QUS and RA seem to be valid and practical method. Due to highly concordant RA and lumbar vertebral DEXA results, RA appears to be a useful technique for assessing osteoporosis. (Osteoporoz Dünyasından 2006; 12: 43-6

  5. A Segmental Fracture of Humerus with Ipsilateral Forearm Fracture

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    Ruban Raj Joshi

    2016-12-01

    Full Text Available Introduction: Simultaneous segmental humerus fracture with ipsilateral forearm is an uncommon injury and scarcely mentioned in the literature. Case report: We present a case report on such a complex injury in a 9-year old child after falling down from the first floor of his house while playing. The injury pattern consist of ipsilateral supracondylar fracture humerus with distal humerus  and ipsilateral distal forearm fracture. Open reduction and pinning of the both injuries was obtained. Conclusion: Ipsilateral multiple fractures in children often result from high energy trauma and are associated with complications. Immediate reduction and fixation is required. If satisfactory reduction cannot be achieved by closed technique, open reduction should be considered to avert additional soft tissue injury and forthcoming complications.

  6. Early history of scapular fractures.

    Science.gov (United States)

    Bartoníček, Jan; Kozánek, Michal; Jupiter, Jesse B

    2016-01-01

    The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

  7. Hydraulic fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Clampitt, R.L.

    1973-04-17

    A method of fracturing a subterranean porous formation penetrated by a well bore consists of injecting down the well and into the formation, at a pressure sufficient to fracture the formation, a fracturing fluid comprising an aqueous gel. This gel is composed of water to which there has been added: a water-thickening amount of a water-dispersible polymer selected from the group consisting of polyacrylamides and polymethacrylamides; crosslinked polyacrylamides and crosslinked polyacrylamides; polyacrylic acid and polymethacrylic acid; polyacrylates; polymers of N-substituted acrylamides; copolymers of acrylamide with another ethylenically unsaturated monomer copolymerizable therewith; mixtures of the polymers; a water-soluble compound of a polyvalent metal which is capable of gelling the water when the valence of the metal is reduced to a lower valence state; and a water-soluble reducing agent. (31 claims)

  8. [Stress fractures].

    Science.gov (United States)

    Uhl, M

    2016-07-01

    Bone stress injuries are due to repetitive mechanical overuse of the skeleton and occur as a result of microscopic lesions sustained when bone is subjected to repeated submaximal stress. Over time accumulation of such injuries can lead to bone failure and fractures. Stress-related bone injuries are relatively common among otherwise healthy persons who have recently started new or intensified forms of physical training activities. Stress injuries lead to typical findings on radiography, bone scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) and need to be discriminated from other conditions, in particular infections and neoplasms. Stress fractures must be differentiated from insufficiency fractures that occur in bones with reduced mechanical resistance or disturbed structure.

  9. Noncontact plating technique in an open fracture

    Science.gov (United States)

    Tuhanioğlu, Ümit; Oğur, Hasan Ulaş; Çiçek, Hakan; Seyfettinoğlu, Fırat; Çiloğlu, Osman; Kapukaya, Ahmet

    2017-01-01

    Aim In comparison with closed fractures, open fractures have an increased risk of infection, there are soft tissue-related problems, and difficulties are experienced in union. The aim of this study was to evaluate and discuss the results of osteosynthesis applied with a noncontact plate in Gustilo–Anderson Type 2, 3a, and 3b fractures. Method The study included 23 patients applied with debridement + noncontact plate osteosynthesis + soft tissue procedures in a single session for the treatment of an open fracture. A follow-up card was created to evaluate the patients in respect of age, gender, fracture level, fracture etiology, open fracture type, preoperative and postoperative sedimentation and C-reactive protein values, antibiotics used and duration of use, time to union, and complications. Results In all 23 patients, full bone union was obtained at mean 22.5 weeks (range: 16–36 weeks). Complications developed in 9 patients. Implant failure occurred in 3 patients. In 5 patients, infection developed which required repeated debridements. Conclusion In open fractures, noncontact plating following debridement seems to be a good alternative treatment method to intramedullar nailing, especially in metaphyseal and metaphyseo-diaphyseal fractures and in spiral oblique diafiz fractures. Noncontact plating may also be a good alternative to intramedullar nailing for open fracture treatment if the patients have additional pathologies such as contusion and thoracic injury. PMID:28652756

  10. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M

    2011-02-01

    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  11. Fluid Production Induced Stress Analysis Surrounding an Elliptic Fracture

    Science.gov (United States)

    Pandit, Harshad Rajendra

    Hydraulic fracturing is an effective technique used in well stimulation to increase petroleum well production. A combination of multi-stage hydraulic fracturing and horizontal drilling has led to the recent boom in shale gas production which has changed the energy landscape of North America. During the fracking process, highly pressurized mixture of water and proppants (sand and chemicals) is injected into to a crack, which fractures the surrounding rock structure and proppants help in keeping the fracture open. Over a longer period, however, these fractures tend to close due to the difference between the compressive stress exerted by the reservoir on the fracture and the fluid pressure inside the fracture. During production, fluid pressure inside the fracture is reduced further which can accelerate the closure of a fracture. In this thesis, we study the stress distribution around a hydraulic fracture caused by fluid production. It is shown that fluid flow can induce a very high hoop stress near the fracture tip. As the pressure gradient increases stress concentration increases. If a fracture is very thin, the flow induced stress along the fracture decreases, but the stress concentration at the fracture tip increases and become unbounded for an infinitely thin fracture. The result from the present study can be used for studying the fracture closure problem, and ultimately this in turn can lead to the development of better proppants so that prolific well production can be sustained for a long period of time.

  12. Is Surgical Navigation Useful for Treating Zygomatic Arch Fractures?

    Science.gov (United States)

    Baek, Min Kwan; Jung, Joo Hyun; Kim, Seon Tae; Oh, Na Rae; Bang, Yu Jin; Kang, Il Gyu

    2017-07-01

    To report the case of a 58-year-old man with a zygomatic arch fracture, which was well localized and reduced using a surgical navigation system. In this clinical report, the authors suggest intraoperative surgical navigation systems are useful diagnostically and for localizing sites of zygomatic arch fractures. The patient underwent successful closed reduction of zygomatic arch fractures using a surgical navigation system. Surgical navigation is a useful tool for identifying the locations of zygomatic arch fractures and for guiding closed reduction. Surgical navigation is recommended for localizing the sites of zygomatic fractures.

  13. Distribution and natural history of stress fractures in U. S. Marine recruits

    Energy Technology Data Exchange (ETDEWEB)

    Greaney, R.B.; Gerber, F.H.; Laughlin, R.L.; Kmet, J.P.; Metz, C.D.; Kilcheski, T.S.; Rao, B.R.; Silverman, E.D.

    1983-02-01

    In a prospective study of stress injuries of the lower extremities of U.S. Marine recruits, researchers derived a frequency distribution of stress fractures. The most frequently fractured bone was the tibia (73%), while the single most common site was the posterior calcaneal tuberosity (21%). The natural history of stress fractures by scintigraphy and radiography has been outlined, showing the evolutionary changes on either study as a universal progression independent of injury site or type of stress. An identical spectrum of changes should be present within any group undergoing intense new exercise. The frequency distribution of stress fractures should be a function of differing forms and intensities of exercise, therefore, our figures should not be applied to other groups. Researchers used the presence of a scintigraphic abnormality at a symptomatic site as the criterion for diagnosis of stress fracture. Since the distribution of skeletal radiotracer uptake is directly dependent on local metabolic activity, it is expected that a focal alteration in bone metabolism will result in a scintigram approaching 100% sensitivity for the abnormality (9). In the proper clinical setting, the specificity should approximate this figure; however, a focal, nonstress-related bone abnormality which has not manifested any radiographic change, such as early osteomyelitis, could result in a false-positive examination. Specificity cannot, therefore, be accurately determined without an actual determination of the pathologic changes within the bone, necessarily involving biopsy.

  14. Calcaneal ultrasound bone densitometry in inflammatory bowel disease--a comparison with double x-ray densitometry of the lumbar spine.

    Science.gov (United States)

    Fries, W; Dinca, M; Luisetto, G; Peccolo, F; Bottega, F; Martin, A

    1998-12-01

    The aim of this study was to measure ultrasound (US) densitometric parameters [Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS), and stiffness of the os calcis] in patients with inflammatory bowel disease (IBD) and to compare the results with those obtained with conventional x-ray absorptiometry (DXA) of the lumbar spine. Twenty-two patients with Crohn's disease (13 with ileal and nine with ileocolonic disease), 11 patients with ulcerative colitis (eight with left-sided and three with pancolitis), and 18 healthy controls. US densitometry of the right heel and DXA of the lumbar spine were performed within the same day. Compared to controls, IBD patients had significantly lower values with both methods, US and DXA. Forty-nine percent of patients had a lumbar T score below -1. Calcaneal SOS and stiffness of these patients were significantly reduced (p < 0.03 and p < 0.05, respectively). Positive significant correlations were found between lumbar DXA and calcaneal US parameters. Lumbar bone density and calcaneal US stiffness correlated inversely with the lifetime prednisone intake (p < 0.03 andp < 0.05, respectively), but not with age or duration of disease. A cut-off level of 80 dB/MHz for calcaneal BUA predicted axial osteopenia correctly in 74%, but some underestimation of spinal BMD was observed, especially in female patients with Crohn's disease. US evaluation of the os calcis gives results similar to those of conventional DXA and therefore may be used for screening IBD patients for axial osteoporosis. Because US does not expose patients to radiation, repeated measurements are possible and may be used to assess short term variations and the effect of treatment of IBD-associated bone disease.

  15. Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon.

    Science.gov (United States)

    Oliveira, Flávia Schlittler; Pinfildi, Carlos Eduardo; Parizoto, Nivaldo Antônio; Liebano, Richard Eloin; Bossini, Paulo Sergio; Garcia, Elvio Bueno; Ferreira, Lydia Masako

    2009-04-01

    Calcaneous tendon is one of the most damaged tendons, and its healing may last from weeks to months to be completed. In the search after speeding tendon repair, low intensity laser therapy has shown favorable effect. To assess the effect of low intensity laser therapy on the process of tissue repair in calcaneous tendon after undergoing a partial lesion. Experimentally controlled randomized single blind study. Sixty male rats were used randomly and were assigned to five groups containing 12 animals each one; 42 out of 60 underwent lesion caused by dropping a 186 g weight over their Achilles tendon from a 20 cm height. In Group 1 (standard control), animals did not suffer the lesion nor underwent laser therapy; in Group 2 (control), animals suffered the lesion but did not undergo laser therapy; in Groups 3, 4, and 5, animals suffered lesion and underwent laser therapy for 3, 5, and 7 days, respectively. Animals which suffered lesion were sacrificed on the 8th day after the lesion and assessed by polarization microscopy to analyze the degree of collagen fibers organization. Both experimental and standard control Groups presented significant values when compared with the control Groups, and there was no significant difference when Groups 1 and 4 were compared; the same occurred between Groups 3 and 5. Low intensity laser therapy was effective in the improvement of collagen fibers organization of the calcaneous tendon after undergoing a partial lesion.

  16. Effect of fracture compliance on wave propagation within a fluid-filled fracture.

    Science.gov (United States)

    Nakagawa, Seiji; Korneev, Valeri A

    2014-06-01

    Open and partially closed fractures can trap seismic waves. Waves propagating primarily within fluid in a fracture are sometimes called Krauklis waves, which are strongly dispersive at low frequencies. The behavior of Krauklis waves has previously been examined for an open, fluid-filled channel (fracture), but the impact of finite fracture compliance resulting from contacting asperities and porous fillings in the fracture (e.g., debris, proppants) has not been fully investigated. In this paper, a dispersion equation is derived for Krauklis wave propagation in a fracture with finite fracture compliance, using a modified linear-slip-interface model (seismic displacement-discontinuity model). The resulting equation is formally identical to the dispersion equation for the symmetric fracture interface wave, another type of guided wave along a fracture. The low-frequency solutions of the newly derived dispersion equations are in good agreement with the exact solutions available for an open fracture. The primary effect of finite fracture compliance on Krauklis wave propagation is to increase wave velocity and attenuation at low frequencies. These effects can be used to monitor changes in the mechanical properties of a fracture.

  17. Como são tratadas as fraturas diafisárias fechadas do fêmur no Brasil? Estudo transversal How are closed femoral diaphyseal fractures treated in Brazil? A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Robinson Esteves Santos Pires

    2006-01-01

    Full Text Available Realizou-se um estudo transversal no 36º Congresso Brasileiro de Ortopedia e Traumatologia, onde foi pesquisada a opinião de ortopedistas brasileiros sobre aspectos do tratamento de fraturas diafisárias do fêmur no adulto. Quinhentos e sete questionários foram respondidos integralmente e encontrou-se concordância entre os ortopedistas em relação aos seguintes aspectos: configuração do traço de fratura e lesão de partes moles ou de estruturas neurovasculares como parâmetros principais para decisão sobre o tratamento; classificação das fraturas, em que a AO foi a mais adotada; haste intramedular anterógrada bloqueada fresada para tratamento das fraturas transversas e oblíquas curtas no istmo; placa ponte para o tratamento das fraturas com traço complexo; tração esquelética pré-operatória; infecção como complicação mais freqüente e uso de heparina de baixo peso molecular no pós-operatório. Houve conflito de opiniões nas seguintes questões: uso de mesa de tração para realização de osteossíntese intramedular; intervalo de tempo entre o trauma e a cirurgia; tempo de utilização de antibióticos e tempo médio de hospitalização. Em relação à literatura, houve concordância em relação aos parâmetros principais para decisão sobre o tratamento; método de fixação das fraturas com traço simples no istmo; classificação adotada; profilaxia antitrombótica. Diferiram da literatura questões como o método de fixação das fraturas com traço complexo; tempo de utilização dos antibióticos, intervalo médio entre o trauma e a osteossíntese e tempo de internação.A cross-sectional study was performed during the 36th Brazilian Congress of Orthopaedics and Traumatology, where the opinions of Brazilian orthopaedic surgeons addressing the treatment of femoral diaphyseal fractures in adults were surveyed. Five hundred and seven questionnaires were fully completed and the results show agreement in the following

  18. Open intramedullary nailing for segmental long bone fractures: an ...

    African Journals Online (AJOL)

    Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98–100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures ...

  19. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  20. Bilateral Monteggia fracture in adults

    Directory of Open Access Journals (Sweden)

    Ristić Dejan

    2011-01-01

    Full Text Available Introduction. In 1814 Giovanni Monteggia first described two cases of fractures of the proximal third of ulna with dislocation of the radial head. These fractures are more common in children than in adults, and mutual Monteggia fracture is a rare complication. This study presents a treatment course of a patient with bilateral Monteggia fracture. Case report. A 55- year-old patient was injured by falling in the yard. Radiography showed bilateral Monteggia fracture type II (by the Badon classification. Operative treatment of fracture was done by a compression plate on the right side and by the zuggurtung technique on the left one. Closed repositioning of the radial head was done on both sides. The patient was wearing a plaster splint for the upper arm for 21 days. After removing the fixation, the function of the elbow was determined by the Broberg Morrey score (BM which was on the right side 45.5 and on the left side 47.5. After the proper physical therapy, four months after the surgery, BM score was 100 on the right side, and 93 on the left one. Conclusion. Surgical treatment and early rehabilitation is the key for the return of good function of both elbows.

  1. Flow upscaling in propped fracture

    Science.gov (United States)

    Jasinski, Lukasz; Dabrowski, Marcin

    2016-04-01

    Proppants in combination with hydraulic fracturing are widely used to maintain the production of oil or gas from low permeability formations (i.e. shale rocks). There are also examples of proppants use in geothermal reservoirs. Flow patterns in propped fracture control transport processes and give information about fracture/matrix exchange surface. Our main motivation is to understand flow behavior in such structures using direct numerical simulations and to find a good upscaling technique to be able to investigate models on reservoir scale. We study fracture made of two parallel plane walls, where void space between them is filled with partial monolayer of proppant. As the fracture is affected by closing pressure, the proppant grains are squeezed between two opposite fracture walls which can change the grain shapes or embed the grains into impermeable rock matrix. To take this effect into account and simplify the geometry, the grains are approximated as cylinders. Imposed macroscopic pressure gradient invokes flow in such medium. As the flow is considered in the low Reynolds number regime, a stationary velocity flow field is obtained by solving the Stokes equations in 3D by means of finite element method. Void space between the grains is accurately discretized by using tetrahedral mesh. To reduce computational effort, the Stokes equation is reduced over the fracture aperture to 2D Stokes-Brinkman equation, which is further numerically solved and compared against numerical solution in 3D. Systematic flow calculations using 2D Stokes-Brinkman equation are performed for periodic domain and no slip boundary condition on the grain surface. Results are discussed in terms of effective properties as a function of geometrical parameters of the medium, such as proppant packing fraction and proppant grain diameter to fracture aperture ratio.

  2. Closed Internal Degloving of the Flank

    Science.gov (United States)

    Remy, Lindsay F.; Azurdia, Jacob; Fansa, Ashraf; Ebraheim, Nabil A.

    2017-01-01

    Originally described in 1853 by Dr. Morel-Lavellee, closed internal degloving injuries represent an important, although uncommon, source of morbidity in trauma patients. These injuries are typically the result of a shearing or crushing force that traumatically separates the skin and subcutaneous tissue from the underlying fat. This results in disruption of perforating blood vessels and lymphatics, leading to hematoma/seroma formation. We describe two cases in which industrial crush injuries resulted in lumbar transverse process fracture. Both patients developed closed degloving injuries of the flank. To the author’s knowledge, this is the first case series describing the occurrence of closed internal degloving injuries of the flank with transverse process fractures. We advise that a high level of suspicion for these lesions to occur with transverse spinal fractures should be maintained, as they may arise several years after initial injury. PMID:28913385

  3. Comparative outcomes of surgical treatment of patients with Impression fractures of the calcaneus

    Directory of Open Access Journals (Sweden)

    G. S. Golubev

    2013-01-01

    Full Text Available Current prospective investigation with historical control was performed to compare functional results of less invasive surgical treatment of calcaneal comminuted fractures with ordinary surgical methods. Data of 40 patients is being analyzed. One patient was lost for follow up. Patients have been divided to four subgroups according to used surgical technologies. Groups differ by trauma on reposition and method of fracture’s fixation: open reduction and plating (ORIF, cannulated screws with triple thread (FusiFix, external fixation, other (diafixation, ordinary cortical or metaphyseal screws. Foot function was estimated by FAOS scale between 1 and six and more years after surgery. Combination of modified principles of reposition after Essex - Lopresti, using of original instrument set and C-arc with FusiFix stable fixation enables minimal complications add ratio. This method also creates good possibilities for foot functional recovery (average normalized FAOS index is 92 after 1 year comparatively to 60 (ORIF and 57(ExFix.

  4. Distal radius triplane fracture.

    Science.gov (United States)

    Parkar, A A H; Marya, S; Auplish, S

    2014-11-01

    A triplane fracture is so named because of the three planes traversed by the fracture line. These are physeal fractures that result from injury during the final phase of maturation and cessation of growth. This fracture pattern typically involves the distal tibia. We present a rare case of a triplane fracture involving the distal radius.

  5. Identical fracture patterns in combat vehicle blast injuries due to improvised explosive devices; a case series

    Directory of Open Access Journals (Sweden)

    Commandeur Joris

    2012-10-01

    Full Text Available Abstract Background In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar. During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. Case presentation The described cases comprise paired thoracic vertebral fractures, radial neck fractures, calcaneal fractures and talar fractures. Moreover, the different types of blast injury are mentioned and related to the injuries described in our series. Acknowledging the different blast mechanisms is important for understanding possible injury patterns. Conclusion From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS.

  6. Identifying Fracture Types and Relative Ages Using Fluid Inclusion Stratigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Dilley, Lorie M.; Norman, David; Owens, Lara

    2008-06-30

    Enhanced Geothermal Systems (EGS) are designed to recover heat from the subsurface by mechanically creating fractures in subsurface rocks. Understanding the life cycle of a fracture in a geothermal system is fundamental to the development of techniques for creating fractures. Recognizing the stage of a fracture, whether it is currently open and transmitting fluids; if it recently has closed; or if it is an ancient fracture would assist in targeting areas for further fracture stimulation. Identifying dense fracture areas as well as large open fractures from small fracture systems will also assist in fracture stimulation selection. Geothermal systems are constantly generating fractures, and fluids and gases passing through rocks in these systems leave small fluid and gas samples trapped in healed microfractures. Fluid inclusions trapped in minerals as the fractures heal are characteristic of the fluids that formed them, and this signature can be seen in fluid inclusion gas analysis. Our hypothesis is that fractures over their life cycle have different chemical signatures that we can see in fluid inclusion gas analysis and by using the new method of fluid inclusion stratigraphy (FIS) the different stages of fractures, along with an estimate of fracture size can be identified during the well drilling process. We have shown with this study that it is possible to identify fracture locations using FIS and that different fractures have different chemical signatures however that signature is somewhat dependent upon rock type. Open, active fractures correlate with increase concentrations of CO2, N2, Ar, and to a lesser extent H2O. These fractures would be targets for further enhancement. The usefulness of this method is that it is low cost alternative to current well logging techniques and can be done as a well is being drilled.

  7. Ultrasound attenuation as a quantitative measure of fracture healing

    Science.gov (United States)

    Gheduzzi, Sabina; Humphrey, Victor F.; Dodd, Simon P.; Cunningham, James L.; Miles, Anthony W.

    2004-10-01

    The monitoring of fracture healing still relies upon the judgment of callus formation and on the manual assessment of the stiffness of the fracture. A diagnostic tool capable of quantitatively measuring healing progression of a fracture would allow the fine-tuning of the treatment regime. Ultrasound attenuation measurements were adopted as a possible method of assessing the healing process in human long bones. The method involves exciting ultrasonic waves at 200 kHz in the bone and measuring the reradiation along the bone and across the fracture zone. Seven cadaveric femora were tested in vitro in intact form and after creating a transverse fracture by sawing through the cortex. The effects of five different fracture types were investigated. A partial fracture, corresponding to a 50% cut through the cortex, a closed fracture, and fractures of widths varying between 1, 2, and 4 mm were investigated. The introduction of a fracture was found to produce a dramatic effect on the amplitude of the signal. Ultrasound attenuation was found to be sensitive to the presence of a fracture, even when the fracture was well reduced. It would therefore appear feasible to adopt attenuation across a fracture as a quantitative measurement of fracture healing.

  8. Determination of calcaneal ultrasound properties ex situ: reproducibility, effects of storage, formalin fixation, maceration, and changes in anatomic measurement site.

    Science.gov (United States)

    Pöpperl, G; Lochmüller, E; Becker, H; Mall, G; Steinlechner, M; Eckstein, F

    1999-09-01

    The objective of this study was to determine the reproducibility of ultrasonic bone properties with a system for measuring calcanei ex situ; the influence of changes of the measurement site; and the effects of fixation, storage, and maceration. We examined 14 fixed calcanei and 12 fresh bones. Ultrasonic measurements were performed ex situ after degassing, using an Achilles+ system and a special positioning device. The instrument precision was 0.16% for speed of sound (SOS), 1.4% for broadband ultrasonic attenuation (BUA), and 1. 8% for the stiffness index (SI). The short-term precision was 0.54%, 1.9%, and 2.8%, respectively. A defined shift of the measurement site (5 mm distal of the middle) led to unpredictable changes in ultrasound (US) properties (r = 0.65 for SOS, 0.82 for BUA, and 0.75 for SI). Embalment with 4% formalin/96% alcohol caused a systematic decrease in SOS, an increase in BUA, and a decrease in SI (mean = -12.7 units; P Maceration did not lead to a systematic increase or decrease of ultrasound variables, but introduced unpredictable changes (r = 0.64-0.94). We conclude that in comparative biomechanical studies it is feasible to measure calcaneal specimens embalmed in formalin/alcohol ex situ, if the primary interest is not in the absolute values but in the correlation with mechanical failure loads at other skeletal sites.

  9. Estimation of sensitivity of island fasciocutaneous neurovascular medial plantar flap in the reconstruction of soft tissue defects in calcaneal region

    Directory of Open Access Journals (Sweden)

    Jevtović Dobrica

    2002-01-01

    Full Text Available The soft tissue cover in the calcaneal region represents one of the great problems in the reconstructive surgery. The distant skin, muscle and musculocutaneous flaps are subjected to ulcers even with the orthopedic shoes. The island fasciocutaneus mid sole neurocutaneous flap can be a good substitute for the soft tissue cover due to its anatomic structure. The flap has the required dimensions, sticks well to the bone and the movements and mobility of the patient is unrestricted. This paper analyses the sensitivity of the transposed flap and the sole distal to the secondary defect observed in 30 patients. The evaluation was made after tactile tests, two-point discrimination test, the warm-cold test, the electrostatus of medial plantar nerve (MPN, and the ninhydrin test. All the tests, including the electrostatus MPN, done after 3 weeks and 3 months after the surgery, showed successful recovery of sensitivity in the transposed medial plantar flap. The results monitored after three months showed that the speed of the neural conduction recovery was 70% of normal neural reaction speed of the MPN. The modified operative techniques provide safe dissection of the plantar nerve with minimal neuropraxia. The postoperative recovery of sensitivity was more rapid, and without loss of sensitivity on the sole.

  10. Ecomorphological analysis of the astragalo-calcaneal complex in rodents and inferences of locomotor behaviours in extinct rodent species

    Science.gov (United States)

    Hautier, Lionel; Marivaux, Laurent; Vianey-Liaud, Monique

    2016-01-01

    Studies linking postcranial morphology with locomotion in mammals are common. However, such studies are mostly restricted to caviomorphs in rodents. We present here data from various families, belonging to the three main groups of rodents (Sciuroidea, Myodonta, and Ctenohystrica). The aim of this study is to define morphological indicators for the astragalus and calcaneus, which allow for inferences to be made about the locomotor behaviours in rodents. Several specimens were dissected and described to bridge the myology of the leg with the morphology of the bones of interest. Osteological characters were described, compared, mechanically interpreted, and correlated with a “functional sequence” comprising six categories linked to the lifestyle and locomotion (jumping, cursorial, generalist, fossorial, climber and semi-aquatic). Some character states are typical of some of these categories, especially arboreal climbers, fossorial and “cursorial-jumping” taxa. Such reliable characters might be used to infer locomotor behaviours in extinct species. Linear discriminant analyses (LDAs) were used on a wider sample of species and show that astragalar and calcaneal characters can be used to discriminate the categories among extant species whereas a posteriori inferences on extinct species should be examined with caution. PMID:27761303

  11. Ecomorphological analysis of the astragalo-calcaneal complex in rodents and inferences of locomotor behaviours in extinct rodent species

    Directory of Open Access Journals (Sweden)

    Samuel Ginot

    2016-10-01

    Full Text Available Studies linking postcranial morphology with locomotion in mammals are common. However, such studies are mostly restricted to caviomorphs in rodents. We present here data from various families, belonging to the three main groups of rodents (Sciuroidea, Myodonta, and Ctenohystrica. The aim of this study is to define morphological indicators for the astragalus and calcaneus, which allow for inferences to be made about the locomotor behaviours in rodents. Several specimens were dissected and described to bridge the myology of the leg with the morphology of the bones of interest. Osteological characters were described, compared, mechanically interpreted, and correlated with a “functional sequence” comprising six categories linked to the lifestyle and locomotion (jumping, cursorial, generalist, fossorial, climber and semi-aquatic. Some character states are typical of some of these categories, especially arboreal climbers, fossorial and “cursorial-jumping” taxa. Such reliable characters might be used to infer locomotor behaviours in extinct species. Linear discriminant analyses (LDAs were used on a wider sample of species and show that astragalar and calcaneal characters can be used to discriminate the categories among extant species whereas a posteriori inferences on extinct species should be examined with caution.

  12. THEORETICAL AND EXPERIMENTAL STUDY ON DURABILITY OF THE CALCANEAL TENDON AND THE PATHOMECHANISM OF ITS ATRAUMATIC, SUBCUTANEOUS BREAK

    Directory of Open Access Journals (Sweden)

    K. Skiba

    2011-11-01

    Full Text Available The pathology of the calcaneal tendon (Achilles presents a serious medical and social problem. This tendon is the strongest plantar flexor of the foot that plays a fundamental role in the accomplishment of human gait. Although this role has long been recognized, neither in medical nor in biomechanical literature can one find a clear description of subcutaneous break of the Achilles tendon. Its pathomechanism and the causes have not been fully accounted for. Many authors concentrate mainly on medical and biological aspects of the damage of the Achilles tendon.They often claim that the vasculature of the tendon itself plays a significant role in the pathogenesis, because the blood supply to the tendon changes with human age, decreasing substantially after the age of 30, leading both to regressive changes in the tendon as well as to a reduction of the tendon’s mechanical strength. The refore a comprehensive description and explanation of this phenomenon needs an interdisciplinary approach, taking into account not only the medical and biological aspects, but also the mechanics sensu largo. The aim of the paper is to put forward a complete description of the pathomechanism of the Achilles tendon spontaneous break, within the framework of its mechanics. The conclusions are based upon a kinematical analysis of the knee joint, a trajectory determination of the point of origin of the gastrocnemius from the initial position of 90 degrees bent up to the full knee extension, and an experimental examination of uniaxial stretching of the Achilles tendon.

  13. PRODUCTIVITY OF FRACTURED HORIZONTAL WELLS

    Directory of Open Access Journals (Sweden)

    Stjepan Antolović

    2009-12-01

    Full Text Available The interest and performance of horizontal drilling and completions has increased during the last two decades. Horizontal wells are advantageous compared to vertical wells in thin reservoirs, reservoirs with favorable vertical permeability and reservoirs with water and gas coning problems. In many reservoirs, the ratio of horizontal permeability to the vertical permeability is substantially larger than one and often is close to 10. Thus, these reservoirs are very good candidates for hydraulic fracturing. By hydraulic fracturing one or more fractures are created, which can be longitudinal or orthogonal. By that, flow is altered and it mostly conducts horizontally through reservoir toward horizontal wellbore. With this altered flow, fluid is produced faster, with less pressure loss by fluid unit of produced fluid. Some of the existing mathematical models to determine the productivity of multifractured horizontal wells are presented in this work (the paper is published in Croatian.

  14. Fracture as a material sink

    Science.gov (United States)

    Volokh, K. Y.

    2017-12-01

    Cracks are created by massive breakage of molecular or atomic bonds. The latter, in its turn, leads to the highly localized loss of material, which is the reason why even closed cracks are visible by a naked eye. Thus, fracture can be interpreted as the local material sink. Mass conservation is violated locally in the area of material failure. We consider a theoretical formulation of the coupled mass and momenta balance equations for a description of fracture. Our focus is on brittle fracture and we propose a finite strain hyperelastic thermodynamic framework for the coupled mass-flow-elastic boundary value problem. The attractiveness of the proposed framework as compared to the traditional continuum damage theories is that no internal parameters (like damage variables, phase fields, etc.) are used while the regularization of the failure localization is provided by the physically sound law of mass balance.

  15. Hand fracture - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000552.htm Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...

  16. Fractured porous media

    CERN Document Server

    Adler, Pierre M; Mourzenko, Valeri V

    2013-01-01

    This monograph on fractures, fracture networks, and fractured porous media provides a systematic treatment of their geometrical and transport properties for students and professionals in geophysics, materials science, and Earth sciences.

  17. Multiphase flow models for hydraulic fracturing technology

    Science.gov (United States)

    Osiptsov, Andrei A.

    2017-10-01

    The technology of hydraulic fracturing of a hydrocarbon-bearing formation is based on pumping a fluid with particles into a well to create fractures in porous medium. After the end of pumping, the fractures filled with closely packed proppant particles create highly conductive channels for hydrocarbon flow from far-field reservoir to the well to surface. The design of the hydraulic fracturing treatment is carried out with a simulator. Those simulators are based on mathematical models, which need to be accurate and close to physical reality. The entire process of fracture placement and flowback/cleanup can be conventionally split into the following four stages: (i) quasi-steady state effectively single-phase suspension flow down the wellbore, (ii) particle transport in an open vertical fracture, (iii) displacement of fracturing fluid by hydrocarbons from the closed fracture filled with a random close pack of proppant particles, and, finally, (iv) highly transient gas-liquid flow in a well during cleanup. The stage (i) is relatively well described by the existing hydralics models, while the models for the other three stages of the process need revisiting and considerable improvement, which was the focus of the author’s research presented in this review paper. For stage (ii), we consider the derivation of a multi-fluid model for suspension flow in a narrow vertical hydraulic fracture at moderate Re on the scale of fracture height and length and also the migration of particles across the flow on the scale of fracture width. At the stage of fracture cleanaup (iii), a novel multi-continua model for suspension filtration is developed. To provide closure relationships for permeability of proppant packings to be used in this model, a 3D direct numerical simulation of single phase flow is carried out using the lattice-Boltzmann method. For wellbore cleanup (iv), we present a combined 1D model for highly-transient gas-liquid flow based on the combination of multi-fluid and

  18. Acetabular Fracture

    OpenAIRE

    Correa, Chad; Lahham, Sari

    2017-01-01

    History of present illness: A 77-year-old female presented to her primary care physician (PCP) with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows), so the patient was referred to the emergency department where a computed tomography (CT) scan was ordered. Significant findings:...

  19. Galeazzi Fracture

    OpenAIRE

    Reid Honda

    2017-01-01

    History of present illness: A 19-year-old male presented to the ED with right forearm pain after being struck in the forearm by a baseball. The patient then threw the ball and felt a sharp “pop” in his arm. The patient complained of sharp pain, worse with movement. Upon examination, the patient was neurovascularly intact. Significant findings: The X-ray showed an acute comminuted fracture of the distal diaphysis of the radius with disruption of the distal radioulnar joint, consisten...

  20. Noncontact plating technique in an open fracture

    Directory of Open Access Journals (Sweden)

    Tuhanioğlu Ü

    2017-06-01

    Full Text Available Ümit Tuhanioğlu, Hasan Ulaş Oğur, Hakan Çiçek, Fırat Seyfettinoğlu, Osman Çiloğlu, Ahmet Kapukaya Department of Orthopaedics and Traumatology, Adana Numune Training and Research Hospital, Adana, Turkey Aim: In comparison with closed fractures, open fractures have an increased risk of infection, there are soft tissue-related problems, and difficulties are experienced in union. The aim of this study was to evaluate and discuss the results of osteosynthesis applied with a noncontact plate in Gustilo–Anderson Type 2, 3a, and 3b fractures.Method: The study included 23 patients applied with debridement + noncontact plate osteosynthesis + soft tissue procedures in a single session for the treatment of an open fracture. A follow-up card was created to evaluate the patients in respect of age, gender, fracture level, fracture etiology, open fracture type, preoperative and postoperative sedimentation and C-reactive protein values, antibiotics used and duration of use, time to union, and complications.Results: In all 23 patients, full bone union was obtained at mean 22.5 weeks (range: 16–36 weeks. Complications developed in 9 patients. Implant failure occurred in 3 patients. In 5 patients, infection developed which required repeated debridements.Conclusion: In open fractures, noncontact plating following debridement seems to be a good alternative treatment method to intramedullar nailing, especially in metaphyseal and metaphyseo-diaphyseal fractures and in spiral oblique diafiz fractures. Noncontact plating may also be a good alternative to intramedullar nailing for open fracture treatment if the patients have additional pathologies such as contusion and thoracic injury. Keywords: plating, open fracture, infection

  1. Quantitative ultrasound parameters as well as bone mineral density are better predictors of trochanteric than cervical hip fractures in elderly women. Results from the EPIDOS study.

    Science.gov (United States)

    Schott, A M; Hans, D; Duboeuf, F; Dargent-Molina, P; Hajri, T; Bréart, G; Meunier, P J

    2005-12-01

    Hip fractures can be separated into cervical and trochanteric fractures. Trochanteric fractures have been associated with up to twice the short-term mortality of cervical fractures in the elderly. There is also evidence suggesting that the mechanisms are different. Evidence from the literature remains limited on the predictive power of bone mineral density (BMD) and quantitative ultrasounds (QUS) for both types of hip fractures. 5703 elderly women aged 75 years or more, who were recruited from the voting lists in the EPIDOS study, and had baseline calcaneal ultrasounds (QUS) and DXA measurements at the hip and the whole body, were analyzed in this paper. Among those, 192 hip fractures occurred during an average follow-up of 4 years, 108 cervical and 84 trochanteric fractures. Femoral neck, trochanteric and whole body BMD were able to predict trochanteric hip fracture (RR's and 95% CI were, respectively, 3.2 (2.4-4.2); 4.8 (3.5-6.6); and 2.8 (2.2-3.6)) more accurately than cervical fractures (respectively, 2.1 (1.7-2.7); 2.3 (1.8-3.0); 1.2 (1.0-1.6)). All ultrasound parameters, SOS, BUA, and stiffness index (SI) were significant predictors of trochanteric (RR's respectively 3.0 (2.2-4.1), 2.5(2.0-3.1), and 3.5(2.6-4.7)) but not cervical fractures. After adjustment for femoral neck or trochanteric BMD ultrasound parameters were still significant predictors of trochanteric fracture, and stiffness tended to be a better predictor of trochanteric fractures than either BUA or SOS with a relative risk of 2.25 (1.6-3.1). A significant decrease of all bone measurements, BMD and QUS, was highly predictive of trochanteric fractures, whereas a decrease of femoral neck and trochanteric BMD were only associated with a slight increase in cervical fracture risk and a low total body BMD or QUS parameters were not significant predictors of cervical fractures. In women who sustained a hip fracture, the decrease of BMD and QUS values increases the risk of trochanteric fracture as

  2. Brittle fracture of polymer transient networks

    Science.gov (United States)

    Arora, S.; Shabbir, A.; Hassager, O.; Ligoure, C.; Ramos, L.

    2017-11-01

    We study the fracture of reversible double transient networks, constituted of water suspensions of entangled surfactant wormlike micelles reversibly linked by various amounts of telechelic polymers. We provide a state diagram that delineates the regime of fracture without necking of the filament from the regime where no fracture or break-up has been observed. We show that filaments fracture when stretched at a rate larger than the inverse of the slowest relaxation time of the networks. We quantitatively demonstrate that dissipation processes are not relevant in our experimental conditions and that, depending on the density of nodes in the networks, fracture occurs in the linear viscoelastic regime or in a non-linear regime. In addition, analysis of the crack opening profiles indicates deviations from a parabolic shape close to the crack tip for weakly connected networks. We demonstrate a direct correlation between the amplitude of the deviation from the parabolic shape and the amount of non linear viscoelasticity.

  3. Spontaneous stress fractures of the femoral neck

    Energy Technology Data Exchange (ETDEWEB)

    Dorne, H.L.; Lander, P.H.

    1985-02-01

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head.

  4. Subtalar Joint Instability and Calcaneal Spurs Associated with the Configuration of the Articular Facets of Adult Human Calcaneum in Indian Population.

    Science.gov (United States)

    Agarwal, Shilpi; Garg, Shilpi; Vasudeva, Neelam

    2016-09-01

    Morphological variations of articular facets of calcaneum may predispose people to joint instability, ligamentous laxity and development of arthritic changes in the subtalar joint. Knowledge of such variations is essential for treatment and diagnostic procedures in orthopaedic surgeries. The aim of this study was to determine patterns of articular facets of calcanei and to establish its correlation with calcaneal spurs. The study was conducted on 580 adult calcanei of Indian origin at Maulana Azad Medical College and pattern of articular facets were observed and classified according to five patterns described in literature. A digital vernier calliper was used to measure separation between anterior and middle facet. Degree of intersecting angle between anterior and medial facets was calculated using UTHSCSA Image Tool software. The calcaneal spurs were observed by visual inspection. Out of 580 calcanei, 66.55% had fused anterior and middle facets (Pattern I), 27.59% had all three facets separate (Pattern II), 5.52% had absence of anterior facet (Pattern III), 0.17% had all three facets fused (Pattern IV) and 0.17% had fused middle and posterior facets (Pattern V). A significant side variation was present in Pattern III with predominance on left side. Mean angle of intersection was 147.70 0 in Pattern I and 133.34 0 in Pattern II calcaneum. Calcaneal spurs were found in 61.38% out of which it was associated with Pattern I in 43.62%, Pattern II in 14.66% and Pattern III in 2.76%. Individuals with Pattern I and III calcaneum were found to be at a greater risk of subtalar joint instability than individuals with Pattern II. Angle of intersection was obtuse in Pattern I which resulted in ligament laxity and unstable joint. Pattern I was more common in Indian population and this fact necessitates modifications of the western surgical techniques to suit the Indian scenario. An association between the presence of spur and facet configuration was found to be significant.

  5. Pulsed Compared to Thermal Radiofrequency to the Medial Calcaneal Nerve for Management of Chronic Refractory Plantar Fasciitis: A Prospective Comparative Study.

    Science.gov (United States)

    Osman, Ayman M; El-Hammady, Dina H; Kotb, Mohamed M

    2016-01-01

    Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations. To evaluate the effect of applying PRF for 6 minutes vs. thermal radiofrequency (TRF) for 90 seconds to the medial calcaneal nerve for treatment of chronic refractory plantar fasciitis pain. Prospective comparative study. Pain, Orthopedic, and Rheumatology and Rehabilitation Clinics of Assiut University Hospital. Twenty patients with refractory chronic bilateral plantar fasciitis received PRF to the medial calcaneal nerve for 6 minutes for one heel and TRF to the same nerve on the other heel (as their own control) for 90 seconds. Numerical verbal rating scale (NVRS) at waking up from bed and after prolonged walking, and satisfaction score were used for assessment of studied patients at one, 3, 6, 12, and 24 weeks from the intervention. All studied patients showed significant improvement in their pain scale after the intervention that lasted for 24 weeks; however, the PRF heels had significantly better pain scale and satisfaction scores at the first and third weeks assessments when compared to the TRF heels. Effective analgesia was achieved after one week or less after PRF compared to 3 weeks for the TRF (P plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial calcaneal nerve, plantar fasciitis, plantar aponeurosis, visual analogue scale.

  6. Thermal convection in three-dimensional fractured porous media

    Science.gov (United States)

    Mezon, C.; Mourzenko, V. V.; Thovert, J.-F.; Antoine, R.; Fontaine, F.; Finizola, A.; Adler, P. M.

    2018-01-01

    Thermal convection is numerically computed in three-dimensional (3D) fluid saturated isotropically fractured porous media. Fractures are randomly inserted as two-dimensional (2D) convex polygons. Flow is governed by Darcy's 2D and 3D laws in the fractures and in the porous medium, respectively; exchanges take place between these two structures. Results for unfractured porous media are in agreement with known theoretical predictions. The influence of parameters such as the fracture aperture (or fracture transmissivity) and the fracture density on the heat released by the whole system is studied for Rayleigh numbers up to 150 in cubic boxes with closed-top conditions. Then, fractured media are compared to homogeneous porous media with the same macroscopic properties. Three major results could be derived from this study. The behavior of the system, in terms of heat release, is determined as a function of fracture density and fracture transmissivity. First, the increase in the output flux with fracture density is linear over the range of fracture density tested. Second, the increase in output flux as a function of fracture transmissivity shows the importance of percolation. Third, results show that the effective approach is not always valid, and that the mismatch between the full calculations and the effective medium approach depends on the fracture density in a crucial way.

  7. Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon

    Science.gov (United States)

    Kobsar, Bradley; Alcantara, Joel

    2009-01-01

    The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon. The care provided involves an array of modalities from exercise and rehabilitation to spinal manipulative therapy. PMID:19421349

  8. Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report

    Directory of Open Access Journals (Sweden)

    Nelson Pelozo Gomes Júnior

    2016-02-01

    Full Text Available ABSTRACT The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome.

  9. Macroscopic properties of fractured porous media

    Science.gov (United States)

    Sangare, D.; Thovert, J.-F.; Adler, P. M.

    2010-03-01

    The macroscopic properties of fractured porous media locally governed by a Laplace equation are determined by several methods. The first one consists in discretizing the porous medium and the fractures and in solving the Laplace equation in the discretized structure. The other methods consist in successive upscalings. The first upscaling replaces the porous medium by a continuum with a given transport property. The second upscaling replaces the fractures by surfaces with equivalent properties. The results of the various methods give very close results. They suggest a simple approximation which is successful when the properties of the fluid and of the continuous porous medium are not too different.

  10. Comparative measurements of mineral salt concentrations in the calcaneus by /sup 125/I. gamma. -absorption measurement in the course of fractures of the lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Mehrlich, P.

    1979-01-01

    In a group of 52 patients aged between 16 and 78 years, all with fractures of the lower extremities, BMC concentrations were determined in a period from 10 weeks to 50 month after the accident in both calcaneal bones and the right ulna. The gamma absorption measurements were carried out in a single-isotope technique in a water bath, using a /sup 125/I source as radionuclides. The results were evaluated by planimetrisation of the absorption curve. The patients were divided in groups according to clinically complicated, clinically uncomplicated, radiologically demineralized, and radiologically and clinically uncomplicated healing. In 11 patients, up to 4 measurements were also carried out as course control measures. The results differed in dependence of the patients' age. The localisation of the fracture had no effect on the degree of demineralisation.

  11. Effect of Aloe vera application on the content and molecular arrangement of glycosaminoglycans during calcaneal tendon healing.

    Science.gov (United States)

    Aro, Andrea Aparecida de; Esquisatto, Marcelo Augusto Marretto; Nishan, Umar; Perez, Mylena Oliveira; Rodrigues, Rodney Alexandre Ferreira; Foglio, Mary Ann; Carvalho, João Ernesto de; Gomes, Laurecir; Vidal, Benedicto De Campos; Pimentel, Edson Rosa

    2014-12-01

    Although several treatments for tendon lesions have been proposed, successful tendon repair remains a great challenge for orthopedics, especially considering the high incidence of re-rupture of injured tendons. Our aim was to evaluate the pharmacological potential of Aloe vera on the content and arrangement of glycosaminoglycans (GAGs) during tendon healing, which was based on the effectiveness of A. vera on collagen organization previously observed by our group. In rats, a partial calcaneal tendon transection was performed with subsequent topical A. vera application at the injury site. The tendons were treated with A. vera ointment for 7 days and excised on the 7(th) , 14(th) , or 21(st) day post-surgery. Control rats received ointment without A. vera. A higher content of GAGs and a lower amount of dermatan sulfate were detected in the A. vera-treated group on the 14(th) day compared with the control. Also at 14 days post-surgery, a lower dichroic ratio in toluidine blue stained sections was observed in A. vera-treated tendons compared with the control. No differences were observed in the chondroitin-6-sulfate and TGF-β1 levels between the groups, and higher amount of non-collagenous proteins was detected in the A. vera-treated group on the 21(st) day, compared with the control group. No differences were observed in the number of fibroblasts, inflammatory cells and blood vessels between the groups. The application of A. vera during tendon healing modified the arrangement of GAGs and increased the content of GAGs and non-collagenous proteins. © 2014 Wiley Periodicals, Inc.

  12. Proximity of the Lateral Calcaneal Artery With a Modified Extensile Lateral Approach Compared to Standard Extensile Approach.

    Science.gov (United States)

    Kwon, John Y; Gonzalez, Tyler; Riedel, Matthew D; Nazarian, Ara; Ghorbanhoseini, Mohammad

    2017-03-01

    The extensile lateral approach (EL) has been associated with increased wound complications such as apical necrosis which may be due partially from violation of the lateral calcaneal artery (LCA). Traditionally, the vertical limb has been placed half-way between the fibula and Achilles tendon, which may be suboptimal given the proximity to the LCA. We hypothesized that placing the vertical limb further posterior (ie, modified EL [MEL]) would increase the distance from the LCA. The purposes of this study were to quantify the location of the LCA in relation to the vertical limb of the traditional EL approach and to determine if utilizing the MEL approach endangered the LCA to a lesser extent. 20 cadavers were used. For the EL approach, the fibula and Achilles tendon were palpated and a line parallel to the plantar foot was drawn between the two. A vertical line (VL), representing the vertical limb of the approach, was drawn at the midway point as a perpendicular extending proximally from the junction of the glabrous/non-glabrous skin (JGNG). For the MEL approach, the anterior border of the Achilles tendon was palpated and a similar vertical line (MVL) was drawn 0.75 cm anterior. Dissection was performed and if the LCA was identified crossing the line VL/MVL, the distance from the JGNG was documented. For the EL approach, the LCA was identified in 17/20 (85%) cadavers at an average distance of 5.0 cm (range 3-7 cm, SD = 1.3 cm) from JGNG. For the ML approach, the LCA was identified in 4/20 (20%) cadavers at an average distance of 5.9 cm (range 3-6.5 cm, SD = 1.7 cm) from the JGNG ( P LCA was encountered 4 times more often during the EL approach as compared to the MEL approach. A modification of the EL approach may decrease iatrogenic injury to the LCA and may decrease wound complications.

  13. Transient pressure analysis of a volume fracturing well in fractured tight oil reservoirs

    Science.gov (United States)

    Lu, Cheng; Wang, Jiahang; Zhang, Cong; Cheng, Minhua; Wang, Xiaodong; Dong, Wenxiu; Zhou, Yingfang

    2017-12-01

    This paper presents a semi-analytical model to simulate transient pressure curves for a vertical well with a reconstructed fracture network in fractured tight oil reservoirs. In the proposed model, the reservoir is a composite system and contains two regions. The inner region is described as a formation with a finite conductivity hydraulic fracture network and the flow in the fracture is assumed to be linear, while the outer region is modeled using the classical Warren–Root model where radial flow is applied. The transient pressure curves of a vertical well in the proposed reservoir model are calculated semi-analytically using the Laplace transform and Stehfest numerical inversion. As shown in the type curves, the flow is divided into several regimes: (a) linear flow in artificial main fractures; (b) coupled boundary flow; (c) early linear flow in a fractured formation; (d) mid radial flow in the semi-fractures of the formation; (e) mid radial flow or pseudo steady flow; (f) mid cross-flow; (g) closed boundary flow. Based on our newly proposed model, the effects of some sensitive parameters, such as elastic storativity ratio, cross-flow coefficient, fracture conductivity and skin factor, on the type curves were also analyzed extensively. The simulated type curves show that for a vertical fractured well in a tight reservoir, the elastic storativity ratios and crossflow coefficients affect the time and the degree of crossflow respectively. The pressure loss increases with an increase in the fracture conductivity. To a certain extent, the effect of the fracture conductivity is more obvious than that of the half length of the fracture on improving the production effect. With an increase in the wellbore storage coefficient, the fluid compressibility is so large that it might cover the early stage fracturing characteristics. Linear or bilinear flow may not be recognized, and the pressure and pressure derivative gradually shift to the right. With an increase in the skin

  14. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  15. Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts.

    Science.gov (United States)

    Hardy, Maureen A

    2004-12-01

    Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed- and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closed- and open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.

  16. Fracture formation post impact on Enceladus?

    Science.gov (United States)

    Craft, Kathleen; Roberts, James

    2017-10-01

    Saturn’s small icy moon Enceladus was observed by the Cassini mission to have jets of ice and vapor emanating from its southern polar terrain (SPT), creating a plume. The fact that the activity is only observed in one region has not been well explained. Hypotheses include a regional sea beneath the SPT or a global ocean that is thicker beneath the SPT, which feeds a group of fractures observed there called the tiger stripes. As Enceladus orbits Saturn, stresses acting on the moon may open and close the fractures enabling interior volatiles to escape and form the plume. Here we investigate how these fractures could have formed and the activity begun. We propose that an impact could have either punctured through or caused substantial melt and fracturing in an ice shell connecting to a liquid layer below. Our goal is to determine whether a formation of fractures resembling the tiger stripes could emerge post-impact.Previous work by Roberts and Stickle (LPSC 2017, #1955) modeled an impact into an ice shell over an ocean and calculated penetration depth and melt temperatures and volumes through the shell thickness. Fracturing would occur during and after the impact, the crater would collapse, water would begin to refreeze and subsequent fluid exchange would occur. Working forward from a point after impact and as the ice shell begins refreezing, we performed finite element modeling to simulate the probable formation of fractures based on the resulting stress regime. Here we explore fracture formation for shells ranging from 1 km to 5 km thick (consistent with gravity and libration studies), to explore formation as the shell cools and thickens through time. We emplaced several fractures, penetrating either entirely or partially across the base to surface. Fracture interactions, tidal stress forcing with orbital true anomalies and ocean water pressurization are considered free parameters in the model. We present results for a number of parameter value combinations and

  17. TREATMENT OF UNSTABLE FRACTURES OF THE TIBIA

    Directory of Open Access Journals (Sweden)

    Dragan Petković

    2004-07-01

    Full Text Available Unstable fractures of cruris are all those fractures which cannot hold satisfactory position even after orthopedic reposition and imobilization.Bone fragments or fractures which redislocate and whithin 7 days after primary well done reposition and adeqate imobilization are also unstable fractures. These fractures can be treated by orthopedic repozition, by transosal traction through calcaneus or through supramalleolar area.These fractures can also be treated surgically by internal or by external fixation. The safest operative method today is external fixation. Using of Mitkovic external flxator this method minimally traumatizes bone and soft tisue of cruris,the operation is not time consuming and complications as infection and nonunion aresignificantly more rare in comparison to internal fixation. External fixation is minimaly invasive method, preserving both periostal and intramedular blood circulation. Mitkovic system also provides biological conditions, which are very similar to biomechanical features of natural tibia and probably it is one of important factor for qicker fracture healing with big periostal callus fortnation.This external flxation system has additional advantages in comparison to other existing devices, especialy in regard of simplicity of application and possibility of accurate closed intraoperative and postoperative fracture reduction.

  18. Pseudoarthrosis in atypical femoral fracture: case report.

    Science.gov (United States)

    Giannotti, S; Bottai, V; Dell'Osso, G; De Paola, G; Ghilardi, M; Guido, G

    2013-11-01

    Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.

  19. Rare combination of ipsilateral acetabular fracture-dislocation and pertrochanteric fracture.

    Science.gov (United States)

    Kuhn, Kevin M; Boudreau, John A; Watson, J T

    2013-08-01

    Acetabular fracture-dislocations are severe injuries that require urgent closed reduction of the hip and often require surgery to restore hip stability. Other authors have described acetabular fracture-dislocations associated with femoral neck fractures, but to our knowledge, this case report is the first to describe an acetabular fracture-dislocation in association with an ipsilateral pertrochanteric fracture and subtrochanteric extension. The polytraumatized patient initially was not stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mm Schanz screw was introduced percutaneously into the femoral head through the primary fracture site under fluoroscopic guidance. With inline traction on the leg, the Schanz screw was used to manipulate the femoral head back into the acetabular fossa. The Schanz screw was removed, the head remained reduced, and a skeletal traction pin was placed to maintain length and alignment of the pertrochanteric fracture until definitive stabilization was possible. We propose a staged treatment strategy consisting of early closed reduction of the hip, and after the patient has been stabilized, reduction and fixation of the fractures. This strategy may be useful in managing an unstable polytraumatized patient or a patient who requires prolonged transfer to receive definitive care.

  20. Fracture and Medium Modeling, by Analizing Hidraulic Fracturing Induced Microseismicity

    Science.gov (United States)

    Gomez Alba, S.; Vargas Jiménez, C. A.

    2014-12-01

    Hydraulic fracturing is an essential technology for most unconventional hydrocarbon resources and many conventional ones as well. The primary limitation on the improvement and optimization of the fracturing process is the minimal access to observe the behavior of the fracture in the subsurface. Without direct observational evidence, hypothetical mechanisms must be assumed and then tested for their validity with indirect information such as wellbore measurements, indirect production and pressure behavior. One of the most important sources of information today is the relation made between micro seismic source mechanisms and fracture behavior. Hydraulic fractures induce some level of micro seismicity when the stress conditions in the Earth are altered by changes in stress during the operations. The result is the sudden movement between rock elements and the radiation of both compressional and shear energy in a seismic range that can be detected and recorded with sensitive receivers. The objective of this work is to provide reasonable information when applying inversion methods in order to estimate the vertical and horizontal spatial heterogeneities in medium and energy radiation distribution of microseisms while fracking operations. The method consist in record microseisms at a previous lineal array of stations (triaxial accelerometers) which are located close to the source coordinates and cover the area of study. The analysis clarify some ideas about what information can be gained from the micro seismic source data and according to the obtained results, what kind of comparisons and associations might be done to evaluate the fracking performance operation. Non uniformities in medium such as faults would be revealed by interpreted scattering coefficients. Fracture properties like distance, velocity and orientation would be also determined by analyzing energy radiation.

  1. An analytical model for hydraulic fracturing in shallow bedrock formations.

    Science.gov (United States)

    dos Santos, José Sérgio; Ballestero, Thomas Paul; Pitombeira, Ernesto da Silva

    2011-01-01

    A theoretical method is proposed to estimate post-fracturing fracture size and transmissivity, and as a test of the methodology, data collected from two wells were used for verification. This method can be employed before hydrofracturing in order to obtain estimates of the potential hydraulic benefits of hydraulic fracturing. Five different pumping test analysis methods were used to evaluate the well hydraulic data. The most effective methods were the Papadopulos-Cooper model (1967), which includes wellbore storage effects, and the Gringarten-Ramey model (1974), known as the single horizontal fracture model. The hydraulic parameters resulting from fitting these models to the field data revealed that as a result of hydraulic fracturing, the transmissivity increased more than 46 times in one well and increased 285 times in the other well. The model developed by dos Santos (2008), which considers horizontal radial fracture propagation from the hydraulically fractured well, was used to estimate potential fracture geometry after hydrofracturing. For the two studied wells, their fractures could have propagated to distances of almost 175 m or more and developed maximum apertures of about 2.20 mm and hydraulic apertures close to 0.30 mm. Fracturing at this site appears to have expanded and propagated existing fractures and not created new fractures. Hydraulic apertures calculated from pumping test analyses closely matched the results obtained from the hydraulic fracturing model. As a result of this model, post-fracturing geometry and resulting post-fracturing well yield can be estimated before the actual hydrofracturing. Copyright © 2010 The Author(s). Journal compilation © 2010 National Ground Water Association.

  2. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture.

    Directory of Open Access Journals (Sweden)

    Duo Wai-Chi Wong

    Full Text Available Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis.A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval.At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites.The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.

  3. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen

    2016-01-01

    Anderson type III fractures with a characteristic fracture pattern that we refer to as "oblique type axis body fracture." Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic "oblique...... was uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion...

  4. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  5. Nonunion of forearm fracture: a rare instance in a toddler

    Directory of Open Access Journals (Sweden)

    Saini Pramod

    2012-12-01

    Full Text Available 【Abstract】 When compared to adults, pediatric frac-tures unite readily and nonunion is quite rare. Nonunion is often associated with open fractures, operative interventions, infection, pediatric osteogenesis imperfecta and neurofibromatosis. There are only a few studies and reports mentioning nonunion following conservative ma-nagement of closed pediatric fractures. We report here a case of an eighteen-month-old child who developed non-union following treatment of fracture of both forearm bones with cast and was successfully treated with plating. To the best of our knowledge, this is the youngest reported case of nonunion following conservative management of closed diaphyseal pediatric fracture. Key words: Forearm; Fractures, bone; Child

  6. FGFR3 deficient mice have accelerated fracture repair

    Science.gov (United States)

    Xie, Yangli; Luo, Fengtao; Xu, Wei; Wang, Zuqiang; Sun, Xianding; Xu, Meng; Huang, Junlan; Zhang, Dali; Tan, Qiaoyan; Chen, Bo; Jiang, Wanling; Du, Xiaolan; Chen, Lin

    2017-01-01

    Bone fracture healing is processed through multiple biological stages that partly recapitulates the skeletal development process. FGFR3 is a negative regulator of chondrogenesis during embryonic stage and plays an important role in both chondrogenesis and osteogenesis. We have investigated the role of FGFR3 in fracture healing using unstabilized fracture model and found that gain-of-function mutation of FGFR3 inhibits the initiation of chondrogenesis during cartilage callus formation. Here, we created closed, stabilized proximal tibia fractures with an intramedullary pin in Fgfr3-/-mice and their littermate wild-type mice. Fracture healing was evaluated by radiography, micro-CT, histology, and real-time polymerase chain reaction (RT-PCR) analysis. The fractured Fgfr3-/- mice had increased formation of cartilaginous callus, more fracture callus, and more rapid endochondral ossification in fracture sites with up-regulated expressions of chondrogenesis related gene. The fractures of Fgfr3-/- mice healed faster with accelerated fracture callus mineralization and up-regulated expression of osteoblastogenic genes. The healing of fractures in Fgfr3-/- mice was accelerated in the stage of formation of cartilage and endochondral ossification. Downregulation of FGFR3 activity can be considered as a potential bio-therapeutic strategy for fracture treatment. PMID:28924384

  7. Genetic factors responsible for long bone fractures non-union

    OpenAIRE

    Szczęsny, Grzegorz; Olszewski, Waldemar L.; Zagozda, Małgorzata; Rutkowska, Joanna; Czapnik, Żanetta; Swoboda-Kopeć, Ewa; Górecki, Andrzej

    2010-01-01

    Introduction Approximately 10–15% of all fractures of long bones heal with delay, prolonged immobilization and repetitive operative interventions. Despite intense investigations, the pathomechanism of impaired healing of skeletal tissue remains unclear. An important role in the pathomechanism of mal-union of close fractures plays subclinically proceeding infections. Aim The question arises whether colonization and proliferation of bacteria in the fracture gap could be related to the mutation ...

  8. Evaluation of osteoporotic fractures in the group of woman over 50 years of age – Comparison of tools FRAX® BMD versus FRAX® BMI

    Directory of Open Access Journals (Sweden)

    Cezary Strugała

    2013-06-01

    Full Text Available Background: The aim of the project is to identify the risk of osteoporotic fractures in women aged over 50, the evaluation of FRAX® BMD and FRAX® BMI in women with and without osteoporotic fractures and the proposal of therapeutic starting points for treatment of osteoporosis. Material and Methods: A group of 1014 women aged 50-89, living in the Kujawsko-Pomorskie province, was investigated. The analysis was based on the WHO definition of osteoporosis. Calculations of 10-year absolute risk of major osteoporotic fractures (AR-10 MOF Fx and femoral neck fractures (AR-10 FN Fx were done using Polish 3.3 version of FRAX® tool. The analysis of fracture risk employed the logistic regression method. Results: A statistically significant relationship was found between the risk of osteoporotic fractures and age, femoral neck BMD, a history of previous osteoporotic fractures, estimated calcaneal BMD and vertebral column BMD. The differences between 10-year absolute risk of major osteoporotic fractures BMD and BMI was small, which means that FRAX® BMI might be a useful tool for GPs and occupational medicine specialists. Conclusions: A high usefulness of the FRAX® BMI tool for evaluating the risk of major osteoporotic fractures provide a new possibility of identifying women at risk of such events. The mean value of 10-year absolute risk of major osteoporotic fractures for FRAX® BMD and BMI was identified as 10% and 12%, respectively and these values were proposed as therapeutic starting points for treatment of osteoporosis in women living in the Kujawsko-Pomorskie province. Med Pr 2013;64(3:327–333

  9. RECONSTRUCTIVE MICROSURGERY IN THE TREATMENT OF SURFACE FORMS OF CALCANEal OSTEOMYELITIS

    Directory of Open Access Journals (Sweden)

    E. S. Tsybul’

    2016-01-01

    Full Text Available One of the most common complications associated with the treatment of calcaneus fracturesis, a necrosis of the edges of the surgical wound and as a result – chronic nonhealing ulcers of the heel region and osteomyelitis of the calcaneus. In the structure of skeletal lesions osteomyelitic chronic osteomyelitis of the calcaneus occurs in 3.1–14.8% of cases, and in relation to the bones of the foot – up to 51%. At the same time after open fractures of the total incidence of deep infection from soft tissue even higher than that for the surface (12.2% vs. 9.6%. The traditional approach to the treatment of osteomyelitis of the calcaneus is often accompanied by poor performance with recurrent osteomyelitis process and highsubsequent disability of working age.Objective: to identify opportunities and assess the effectiveness of the use of reconstructive microsurgery techniques in the treatment of patients with superficial forms of osteomyelitis of the calcaneus, accompanied by the presence of soft tissue defect.Materials and мethods.The results of treatment of 28 patients with superficial forms of osteomyelitis of the calcaneus, which in the period from 2006 to 2013 in RNIITO them. R.R.Vredena were performed reconstructive plastic surgery using microsurgical techniques. Defects covering tissues were located on the sole (20 and back-side surfaces (8 of the calcaneus. Scope of interventions included the radical surgical treatment of osteomyelitis focus, marginal resection of the affected heel bone and tissue replacement of defect cover flap with axial blood supply.Results. With the localization of the defect cover tissues to non-reference surface of the heel region was carried out free plastic ray skin-fascial flap (9 cases. When the location of the defect on the plantar surface of the heel region favored medial plantar flap (10 cases. However, the presence of scarring and damage to the medial plantar artery was performed

  10. The Clamshell Fracture and Adjunctive Acetabuloplasty in the Arthroscopic Osteosynthesis of Femoral Head Fractures With Femoroacetabular Impingement

    OpenAIRE

    Matsuda, Dean K.

    2012-01-01

    The clamshell fracture of the femoral head and its arthroscopic osteosynthesis are described. This suprafoveal osteochondral fracture may have folded onto itself during closed reduction of the associated anterior hip dislocation. The resultant fracture fragment had almost circumferential chondral coverage that required arthroscopic manipulation to “pry apart the clamshell,” permitting arthroscopic reduction. This patient also had pre-existing silent femoroacetabular impingement, and the novel...

  11. Complications of Nasal Bone Fractures.

    Science.gov (United States)

    Hwang, Kun; Yeom, Seung Han; Hwang, Suk Hyun

    2017-05-01

    The aim of this study was to perform a systematic review of the treatment of nasal bone fractures. The search terms ("nasal bone fracture" AND complication) and ("nasal bone fracture" AND [anosmia OR olfaction OR olfactory nerve OR smell]) and (anosmia AND ["nasal preparation" OR "nasal antiseptics"]) were used to search PubMed and SCOPUS. Of the 500 titles, 40 full papers were reviewed. One paper was excluded, and 3 mined papers were added. Ultimately, 12 papers were analyzed. The overall deformity rate was 10.4% ± 4.8%. No significant differences were found between patients who underwent closed reduction (14.7% ± 7.3%) and those who underwent open reduction (9.4% ± 4.4%), between those who underwent local anesthesia (5.8% ± 4.5%), and those who underwent general anesthesia (8.8% ± 3.8%), or between those who received timely treatment (5.7%) and those whose treatment was delayed (9.0%). Septal deviation occurred in 10.0% of patients as a sequela of nasal bone fracture. The nasal obstruction rate was 10.5% ± 5.3%. Fewer patients of nasal obstruction occurred in the open reduction patients (6.9% ± 4.4%) than in the closed reduction patients (15.2%). One patient of epiphora and 1 patient of diplopia were reportedAmong the 77 patients with nasal bone fractures, 29 (37.7% ± 11.3%) complained of olfactory disturbances. No significant associations were found between the type of fracture and the presence of olfactory disturbances. It is recommended for providers to explain to patients that approximately one-tenth of nasal bone fractures exhibit deformity, septal deviation, or nasal obstruction after surgery. Surgeons should take considerable care to avoid the olfactory mucosa during reduction surgery.

  12. [Arthroscopic fracture management in proximal humeral fractures].

    Science.gov (United States)

    Lill, H; Katthagen, C; Jensen, G; Voigt, C

    2013-04-01

    Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results.

  13. Arterial injury and pseudoaneurysm formation after lesser trochanter fracture

    Directory of Open Access Journals (Sweden)

    Susanne Regus

    2015-01-01

    Conclusion: Surgeons should pay attention to any displaced bone fragments close to calcified vessels, especially in the evaluation of routine x-rays following surgical treatment of fractures. This could minimize the potential life-threatening risk of delayed diagnosis, especially because it represents a routine image following surgical fracture treatments.

  14. External skeletal fixation of the tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2005-01-01

    Full Text Available Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitković’s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3% and 33 females (28.7%, average age 43.92 years (16−84. Open tibial shaft fractures were present in 37 (31.36%. All the fractures were treated with Mitković’s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93% patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08% patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85% patient with closed fracture. Malunion was found in 2 (1.69% patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

  15. History of the treatment of scapula fractures.

    Science.gov (United States)

    Bartonícek, Jan; Cronier, Patrick

    2010-01-01

    The history of treatment of scapula fractures is closely connected with the history of the French surgery. Paré (Les œuvres d´Ambroise Paré, conseiller, et premier chirurgien du Roy, Gabriel Buon, Paris, p VCV, 1579), Petit (Traité des maladies des os. Tome second, Charles-Etienne Hochereau, Paris, pp 122–138, 1723), Du Verney (Traité des maladies des os. Tome I, de Burre, Paris, pp 220–231, 1751) and Desault (Œuvres chirurgicales, ou tableau de la doctrine et de la pratique dans le traitement des maladies externes par Xav. Bichat, Desault, Méquignon, Devilliers, Deroi, Paris, pp 98–106, 1798) were the first to point out the existence of these fractures. The first drawing of a scapula fracture was presented by Vogt (Dissertatio de ambarum scapularum dextroeque simul claviculae fractura rara, Dissertatione Universitae Vitembergensi, Wittenberg, 1799). This author was also the first to describe the scapula fracture associated with ipsilateral fracture of the clavicle. The first radiograph of scapula fracture (glenoid fossa fracture) was published by Struthers (Edinburgh Med J 4(3):147–149, 1910). The first internal fixation of scapula fracture using plate was done by Lambotte (1910) who was followed by Lane (The operative treatment of fractures, Medical Publishing Co, London, pp 99–101, 1914) and later by Lenormant (Sur l´ostéosynthèse dans certains fractures de l´omoplate Bulletins et mémoires de la Société de chirgie de Paris, pp 1501–1502, 1923), Dujarier (Fracture du col chirgical de l´omoplate. Ostéosynthèse par plaque en T. Bonne réduction. Bulletin et mémoires de la Société de chirurgie de Paris, pp 1492–1493, 1923) and Basset (Ostéosynthèse d´une fracture de l´omoplate. Bulletin et mémoires de la Société nationale de chirurgie. p 193, 1924). Dupont and Evrard (J Chir (Paris) 39:528–534, 1932) presented the first detailed description of the surgical approach along the lateral border of the scapula including two

  16. proximal femoral periprosthetic fracture fixation with a hooked ...

    African Journals Online (AJOL)

    viii) The wound was closed over a drain. Adjuvant medical and supportive therapy included: (i) Prophylactic antibiotics- intraoperative followed by postop. for three days .... The hybrid fixation of this particular fracture with a locked hooking plate ...

  17. Open versus endoscopic bone resection of the dorsolateral calcaneal edge: a cadaveric analysis comparing three dimensional CT scans.

    Science.gov (United States)

    Roth, Klaus Edgar; Mueller, Ramona; Schwand, Eike; Maier, Gerrit Stefen; Schmidtmann, Irene; Sariyar, Murat; Maus, Uwe

    2014-01-01

    It has been claimed that endoscopic calcaneoplasty offers some advantages over open techniques in the surgical treatment of Haglund's deformity due to reduced postoperative complications like stiffness and pain. Bony over-resection places patients at risk of these complications. The resulting question with regard to the quantitative differences of the extent of the bone removed using these two techniques has not yet been answered. The purpose of the study was to determine the resection volume of calcaneal bone for open and endoscopic surgical techniques. 16 feet obtained from body donors were operated on in equal parts using either open surgical or endoscopic techniques, with the technique selected on a random basis. High-resolution CT scans were obtained before and after the interventional procedure and analysed to obtain 3-D polygon models. Post-operative models were subtracted from pre-operative models to provide the volume change resulting from the intervention. This was then correlated with the bone mineral density (BMD) of the preparation. The extent of bony resection was greater in open surgical techniques than in endoscopic approaches. The average volume of bone resection was 0.80 (±0.34) cm(3) in the endoscopic group and 3.04 (±2.91) cm(3) in the group that underwent open surgery. After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery. The two groups did not differ significantly with regard to BMD (p > 0.1). The extent of the resection fell by 0.011 cm(3) per 1 mg/cm(3) areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density. Assuming that the resection volume was adequate to treat the patient's complaints a smaller resection volume seen in our study using an endoscopic technique might lead to fewer postoperative complaints and faster recovery.

  18. Impaired Fracture Healing after Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    Philipp Lichte

    2015-01-01

    Full Text Available Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP of 35 mmHg for 90 minutes. Serum cytokines (IL-6, KC, MCP-1, and TNF-α were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. μCT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing.

  19. Permeability of displaced fractures

    Science.gov (United States)

    Kluge, Christian; Milsch, Harald; Blöcher, Guido

    2017-04-01

    Flow along fractures or in fissured systems becomes increasingly important in the context of Enhanced Geothermal Systems (EGS), shale gas recovery or nuclear waste deposit. Commonly, the permeability of fractures is approximated using the Hagen-Poiseuille solution of Navier Stokes equation. Furthermore, the flow in fractures is assumed to be laminar flow between two parallel plates and the cubic law for calculating the velocity field is applied. It is a well-known fact, that fracture flow is strongly influenced by the fracture surface roughness and the shear displacement along the fracture plane. Therefore, a numerical approach was developed which calculates the flow pattern within a fracture-matrix system. The flow in the fracture is described by a free fluid flow and the flow in the matrix is assumed to be laminar and therefore validates Darcy's law. The presented approach can be applied for artificially generated fractures or real fractures measured by surface scanning. Artificial fracture surfaces are generated using the power spectral density of the surface height random process with a spectral exponent to define roughness. For calculating the permeability of such fracture-matrix systems the mean fracture aperture, the shear displacement and the surface roughness are considered by use of a 3D numerical simulator. By use of this approach correlation between shear displacement and mean aperture, shear displacement and permeability, as well as surface roughness and permeability can be obtained. Furthermore, the intrinsic measured permeability presents a combination of matrix and fracture permeability. The presented approach allows the separation and quantification of the absolute magnitudes of the matrix and the fracture permeability and the permeability of displaced fractures can be calculated. The numerical approach which is a 3D numerical simulation of the fracture-matrix system can be applied for artificial as well as real systems.

  20. Outcome of SIGN Nail Initiative in Treatment of Long Bone Fractures ...

    African Journals Online (AJOL)

    Background: Currently the standard of treatment for femoral shaft fracture and unstable tibia fracture are closed locking intramedullary nail which require fluoroscopy and fracture table. The objective of this review was to evaluate the outcome of Surgical Implant Generation Network (SIGN ) initiative, locking intramedullary ...

  1. Arthroscopic removal of intraarticular fragments following fracture dislocation of the hip

    Directory of Open Access Journals (Sweden)

    Bagaria Vaibhav

    2008-01-01

    Full Text Available We report here a case of posterior dislocation of hip with fracture of posterior lip of acetabulum, with retained fracture fragments after a successful closed reduction. The fractured fragments were removed by arthroscopy of the hip. The technique of hip arthroscopy used in removing the fragments is discussed.

  2. Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures.

    Science.gov (United States)

    Lentle, Brian C; Brown, Jacques P; Khan, Aliya; Leslie, William D; Levesque, Jacques; Lyons, David J; Siminoski, Kerry; Tarulli, Giuseppe; Josse, Robert G; Hodsman, Anthony

    2007-02-01

    Given the increasing evidence that vertebral fractures are underdiagnosed and not acted on, Osteoporosis Canada and the Canadian Association of Radiologists initiated a project to develop and publish a set of recommendations to promote and facilitate the diagnosis and reporting of vertebral fractures. The identification of spinal fractures is not uniform. More than 65% of vertebral fractures cause no symptoms. It is also apparent that vertebral fractures are inadequately recognized when the opportunity for diagnosis arises fortuitously. It is to patients' benefit that radiologists report vertebral fractures evident on a chest or other radiograph, no matter how incidental to the immediate clinical indication for the examination. The present recommendations can help to close the gap in care in recognizing and treating vertebral fractures, to prevent future fractures and thus reduce the burden of osteoporosis-related morbidity and mortality, as well as fracture-related costs to the health care system. Several studies indicate that a gap exists in regard to the diagnosis of vertebral fractures and the clinical response following such diagnosis. All recommendations presented here are based on consensus. These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of Osteoporosis Canada and the Canadian Association of Radiologists. BENEFITS, HARM, AND COSTS: Prevalent vertebral fractures have important clinical implications in terms of future fracture risk. Recognizing and reporting fractures incidental to radiologic examinations done for other reasons has the potential to reduce health care costs by initiating further steps in osteoporosis diagnosis and appropriate therapy. Physicians should be aware of the importance of vertebral fracture diagnosis in assessing future osteoporotic fracture risk. Vertebral fractures incidental to radiologic examinations done for other reasons should be identified and

  3. Infant skull fracture (image)

    Science.gov (United States)

    Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent protection ... a severe impact or blow can result in fracture of the skull and may be accompanied by ...

  4. Nasal fracture (image)

    Science.gov (United States)

    A nasal fracture is a break in the bone over the ridge of the nose. It usually results from a blunt ... and is one of the most common facial fracture. Symptoms of a broken nose include pain, blood ...

  5. Growth Plate Fractures

    Science.gov (United States)

    .org Growth Plate Fractures Page ( 1 ) The bones of children and adults share many of the same risks for ... also subject to a unique injury called a growth plate fracture. Growth plates are areas of cartilage ...

  6. Bone fracture repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100077.htm Bone fracture repair - series—Indications To use the sharing features ... Go to slide 4 out of 4 Overview Fractures of the bones are classified in a number ...

  7. Femur fracture repair - discharge

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000166.htm Femur fracture repair - discharge To use the sharing features on this page, please enable JavaScript. You had a fracture (break) in the femur in your leg. It ...

  8. Rib fracture - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000539.htm Rib fracture - aftercare To use the sharing features on this page, please enable JavaScript. A rib fracture is a crack or break in one or ...

  9. Nasal fracture - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000554.htm Nasal fracture - aftercare To use the sharing features on this ... that gives your nose its shape. A nasal fracture occurs when the bony part of your nose ...

  10. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...

  11. Metatarsal stress fractures - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  12. Everted skull fracture.

    Science.gov (United States)

    Balasubramaniam, Srikant; Tyagi, Devendra K; Savant, Hemant V

    2011-11-01

    Skull bone fractures are common in trauma. They are usually linear undisplaced or depressed; however, a distinct possibility of elevated fracture remains. We describe an entity of everted fracture skull in which the fracture segment is totally everted. The nature of trauma, management, and complications of this unique case are discussed. A 21-year-old woman involved in a railway accident presented to us with a primary dressing on her wound. Investigations revealed an everted fracture skull. She underwent surgery with good results. We would like to add everted fracture skull to the nomenclature describing skull fractures in addition to elevated compound fracture skull as a new entity. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Management of common fractures.

    Science.gov (United States)

    Walker, Jennie

    2013-02-01

    The incidence of fractures increases with advancing age partly due to the presence of multiple comorbidities and increased risk of falls. Common fracture sites in older people include femoral neck, distal radius and vertebral bodies. Nurses have an important role in caring for older patients who have sustained fractures, not only to maximise function and recovery, but as part of a team to minimise the morbidity and mortality associated with fractures in this group.

  14. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  15. Sprains, Strains and Fractures

    Science.gov (United States)

    ... the bone. Causes Injuries are the most common causes of foot and ankle sprains and fractures. Many fractures and sprains occur during ... or stumbling on uneven ground is another common cause of foot and ankle sprains and fractures. Symptoms Pain, swelling, bruising, and difficulty ...

  16. Obesity and fracture risk

    OpenAIRE

    Gonnelli, S; Caffarelli, C.; Nuti, R.

    2014-01-01

    Obesity and osteoporosis are two common diseases with an increasing prevalence and a high impact on morbidity and mortality. Obese women have always been considered protected against osteoporosis and osteoporotic fractures. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures.

  17. The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Ankle Fracture Pearls and Pitfalls.

    Science.gov (United States)

    Parikh, Shital N; Mehlman, Charles T

    2017-11-01

    Pediatric ankle fractures are common and have unique fracture characteristics because of the presence of distal tibial and fibular physes. When displaced (>3 mm widening of the physis or >2 mm intra-articular gap/step-off), these fractures are typically treated with anatomical reduction and internal fixation. Computed tomography is recommended for preoperative evaluation and surgical planning for intra-articular fractures. These fractures in younger children with substantial growth remaining should be followed closely to monitor for any growth disturbance. Pearls and pitfalls related to the treatment of these fractures would emphasize the physeal-respecting approach to their management.

  18. Multifocal humeral fractures.

    Science.gov (United States)

    Maresca, A; Pascarella, R; Bettuzzi, C; Amendola, L; Politano, R; Fantasia, R; Del Torto, M

    2014-02-01

    Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Stress fractures in runners.

    Science.gov (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T

    2012-04-01

    Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.

  20. [Anatomy of fractures of the inferior scapular angle].

    Science.gov (United States)

    Bartoníček, J; Tuček, M; Malík, J

    2018-01-01

    The aim of this study is to describe the anatomy of fractures of the inferior angle and the adjacent part of the scapular body, based on 3D CT reconstructions. In a series of 375 scapular fractures, we identified a total of 20 fractures of the inferior angle of the scapular body (13 men, 7 women), with a mean patient age of 50 years (range 3373). In all fractures, 3D CT reconstructions were obtained, allowing an objective evaluation of the fracture pattern with a focus on the size and shape of the inferior angle fragment, propagation of the fracture line to the lateral and medial borders of the infraspinous part of the scapular body, fragment displacement and any additional fracture of the ipsilateral scapula and the shoulder girdle. We identified a total of 5 types of fracture involving the distal half of the infraspinous part of the scapular body. The first type, recorded in 5 cases, affected only the apex of the inferior angle, with a small part of the adjacent medial border. The second type, occurring in 4 cases, involved fractures separating the entire inferior angle. The third type, represented by 4 cases, was characterized by a fracture line starting medially close above the inferior angle and passing proximolaterally. The separated fragment had a shape of a big drop, carrying also the distal half of the lateral pillar in addition to the inferior angle. In the fourth type identified in 5 fractures, the separated fragment was formed both by the inferior angle and a variable part of the medial border. The fifth type, being by its nature a transition to the fracture of the infraspinous part of the body, was recorded in 2 cases, with the same V-shaped fragment. Fractures of the inferior angle and the adjacent part of the scapular body are groups of fractures differing from other infraspinous fractures of the scapular body. Although these fractures are highly variable in terms of shape, they have the same course of fracture line and the manner of displacement

  1. Knee-ligament injuries associated with leg fractures. Prospective study.

    Science.gov (United States)

    Matić, A; Kasić, M; Hudolin, I

    1992-09-01

    It has been proved in 25-35% of the cases that knee-ligament injuries are associated with fracture of the femoral diaphysis. No such association has been confirmed between leg fractures and knee ligaments. In order to find out if this is a coincidence, a prospective study was conducted on 229 patients who had undergone operations for leg fractures at various locations and of variable intensity. It was established in 41 cases (17.34%) that the leg fracture was associated with knee-ligament injuries, resulting in joint instability. A significantly higher percentage of associated ligament lesions was found in open fractures as opposed to closed leg fractures. The examination was carried out with the patient under general or block anesthesia. On the basis of what was established it is recommended that the knee be examined clinically in all leg osteosynthesis cases.

  2. [Fractures of the patella].

    Science.gov (United States)

    Wild, M; Windolf, J; Flohé, S

    2010-05-01

    Fractures of the patella account for approximately 0.5% to 1.5% of all skeletal injuries. The diagnosis is made by means of the mechanism of injury, physical and radiological findings. The kind of treatment of patella fractures depends on the type of fracture, the size of the fragments, the integrity of the extensor mechanism and the congruity of the articular surface. Independent of the kind of treatment an early rehabilitation is recommended. Modified tension band wiring is the most commonly used surgical treatment for patella fractures and can be used for almost every type of fracture. Due the superior stability in biomechanical studies two parallel cannulated lag screws combined with a tension band wiring are the treatment of choice for horizontally displaced two-part fractures. In comminuted fractures a partial or total patellectomy may be necessary. However, since the loss of quadriceps muscle power and the poor outcome total patellectomy should be considered as a salvage procedure.

  3. Fracture in Soft Materials

    DEFF Research Database (Denmark)

    Hassager, Ole

    Fracture is a phenomenon that is generally associated with solids. A key element in fracture theory is the so-called weakest link idea that fracture initiates from the largest pre-existing material imperfection. However, recent work has demonstrated that fracture can also happen in liquids, where...... surface tension will act to suppress such imperfections. Therefore, the weakest link idea does not seem immediately applicable to fracture in liquids. This presentation will review fracture in liquids and argue that fracture in soft liquids is a material property independent of pre-existing imperfections....... The following questions then emerge: What is the material description needed to predict crack initiation, crack speed and crack shape in soft materials and liquids....

  4. Orbital fractures: a review

    Directory of Open Access Journals (Sweden)

    Jeffrey M Joseph

    2011-01-01

    Full Text Available Jeffrey M Joseph, Ioannis P GlavasDivision of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, School of Medicine, New York University, New York, NY, USA; Manhattan Eye, Ear, and Throat Hospital, New York, NY, USAAbstract: This review of orbital fractures has three goals: 1 to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2 to explain how to assess and examine a patient after periorbital trauma, and 3 to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.Keywords: orbit, trauma, fracture, orbital floor, medial wall, zygomatic, zygomatic complex, zmc fracture, zygomaticomaxillary complex fractures 

  5. Endoscopic repair of isolated anterior table frontal sinus fractures without fixation.

    Science.gov (United States)

    Egemen, Onur; Özkaya, Özay; Aksan, Tolga; Bingöl, Derya; Akan, Mithat

    2013-07-01

    Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

  6. Tibiofibula Transposition in High-Energy Fractures

    Directory of Open Access Journals (Sweden)

    Peter R. Loughenbury

    2016-01-01

    Full Text Available We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia. Open reduction and exposure of the fracture sites revealed that the distal fibula fragment was “transposed” and entrapped in the medulla of the proximal tibial fragment. Reduction required simulation of the mechanism of injury in order to disengage the fragments and allow reduction. Tibiofibula transposition is a rare complication of high-energy lower limb fractures which has not previously been reported and may prevent adequate closed reduction. Impaction of the distal fibula within the tibial medulla occurs as the limb is realigned by paramedic staff before transfer to hospital. We recommend that when this complication is identified the patient is transferred to the operating room for open reduction and stabilization of the fracture.

  7. Avulsion Fracture of the Calcaneus Treated With a Soft Anchor Bridge and Lag Screw Technique: A Report of Two Cases.

    Science.gov (United States)

    Yoshida, Kazushige; Kasama, Kentaro; Akahane, Tsutomu

    2016-01-01

    The displaced extra-articular avulsion fracture of the calcaneus has been classified as a Böhler type 1c calcaneal fracture, and most cases will require surgical repair. In the present report, we describe 2 patients in whom we performed the soft anchor bridge technique using single loaded suture anchors with lag screws for the repair of Böhler type 1c avulsion fractures of the calcaneus. In one of these patients, clinically relevant osteoporosis complicated the injury. In both cases, bone union was achieved, and by 1.5 months after surgery satisfactory recovery was observed. To our knowledge, the soft anchor bridge technique was first used for the treatment of rotator cuff tears, and the greatest merit of this technique is the ability to generate vertical compression force to the pulled out rotator cuff through the use of knotting sutures. In recent years, the soft anchor bridge technique using 4 suture anchors has also been used for fractures of the greater tuberosity of the humerus, an injury that poses operative difficulties similar to those encountered with an avulsion fracture of the calcaneus owing to the traction force of the rotator cuff and relative weakness of adjacent bone. The outcomes of our patients suggest that the soft anchor bridge technique combined with adjunct lag screws is useful in the fixation of avulsion fractures of the calcaneus. In addition, the result in the elderly patient indicates the possibility of using this technique for patients with osteoporosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  8. The clamshell fracture and adjunctive acetabuloplasty in the arthroscopic osteosynthesis of femoral head fractures with femoroacetabular impingement.

    Science.gov (United States)

    Matsuda, Dean K

    2012-09-01

    The clamshell fracture of the femoral head and its arthroscopic osteosynthesis are described. This suprafoveal osteochondral fracture may have folded onto itself during closed reduction of the associated anterior hip dislocation. The resultant fracture fragment had almost circumferential chondral coverage that required arthroscopic manipulation to "pry apart the clamshell," permitting arthroscopic reduction. This patient also had pre-existing silent femoroacetabular impingement, and the novel use of arthroscopic acetabuloplasty permitted internal fixation by improving the path for headless screw fixation. The arthroscopic techniques and clinical outcome at greater than 2 years are presented. Albeit rare, the clamshell fracture configuration should be recognized and may be amenable to successful arthroscopic osteosynthesis. Of broader clinical impact and application, adjunctive acetabuloplasty may permit the successful osteosynthesis of select femoral head fractures in patients with concurrent acetabular overcoverage by completely arthroscopic techniques that engage both the fracture fragment and the attractive benefits of less invasive surgery.

  9. Analytic crack solutions for tilt fields around hydraulic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Warpinski, N.R.

    2000-01-05

    The recent development of downhole tiltmeter arrays for monitoring hydraulic fractures has provided new information on fracture growth and geometry. These downhole arrays offer the significant advantages of being close to the fracture (large signal) and being unaffected by the free surface. As with surface tiltmeter data, analysis of these measurements requires the inversion of a crack or dislocation model. To supplement the dislocation models of Davis [1983], Okada [1992] and others, this work has extended several elastic crack solutions to provide tilt calculations. The solutions include constant-pressure 2D, penny-shaped, and 3D-elliptic cracks and a 2D-variable-pressure crack. Equations are developed for an arbitrary inclined fracture in an infinite elastic space. Effects of fracture height, fracture length, fracture dip, fracture azimuth, fracture width and monitoring distance on the tilt distribution are given, as well as comparisons with the dislocation model. The results show that the tilt measurements are very sensitive to the fracture dimensions, but also that it is difficult to separate the competing effects of the various parameters.

  10. Rock fracture image acquisition with both visible and ultraviolet illuminations

    Science.gov (United States)

    Wang, Weixing; Hakami, Eva

    2006-02-01

    Swedish Nuclear Fuel and Waste Management Company (SKB) have identified the need for a better understanding of radionuclide transport and retention processes in fractured rock since 1994. In the study, the first hard problem is to obtain rock fracture images of a good quality, since rock surface is very rough, and composed of complicated and multiple fractures, as a result, image acquisition is the first important. As a cooperation project between Sweden and China, we sampled a number of rock specimens for analyzing rock fracture network by visible and ultraviolet image technique, in the field. The samples are resin injected, in which way; opened fractures can be seen clearly by means of UV light illumination, and the rock surface information can be obtained by using visible optical illumination. We used different digital cameras and microscope to take images by two illuminations. From the same samples; we found that UV illumination image gives the clear information of fracture opening or closing, and the visible optical illumination gives the information of the rock surface (e.g. filling materials inside of fractures). By applying this technique, the minimum width of rock fracture 0.01 mm can be analyzed. This paper presents: (1) Rock fracture image acquiring techniques; (2) Rock fracture image acquisition by using UV light illumination and visible optical illumination; and (3) Conclusions. The studied method can be used both in the field and a laboratory.

  11. ARTHROSCOPIC TREATEMENT OF PATELLA FRACTURES IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Igor V. Timofeev

    2017-03-01

    Full Text Available Introduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2–3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment. Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14–17. These were 3 males and 1 female. All patients had sport-related injuries. Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing. Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective method of surgical treatment for patellar fractures.

  12. Comparison of closed femur fracture: Skeletal traction and ...

    African Journals Online (AJOL)

    In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...

  13. Ipsilateral Femoral Neck fracture During Closed Intraedullary Nailing ...

    African Journals Online (AJOL)

    23. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/njotra.v7i1.29317 · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  14. Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study.

    Science.gov (United States)

    Dingemans, Siem A; Birnie, Merel F N; Backes, Manouk; de Jong, Vincent M; Luitse, Jan S; Carel Goslings, J; Schepers, Tim

    2018-01-29

    Infectious complications following lower extremity fracture surgery are a major concern and account for a substantial socio-economic burden to society. The aim of this pilot study was to investigate the feasibility of a new portable single-use negative pressure wound therapy device in patients undergoing major foot ankle surgery. Patients undergoing major foot ankle fracture surgery at a single level 1 trauma centre were eligible for this prospective case series. Patient characteristics were collected, as were fracture and surgical characteristics. Primary outcome was surgical site infection within 30 days as classified by the criteria from the Centers for Disease Control and Prevention. Patients in the prospective cohort were case-matched with a historical cohort from the same institution. Sixty patients were included. In seven patients, the NPWT failed and treatment was ceased. Mean age was 44 years and 85% was ASA 1; 43% of the patients were actively smoking. Indications for surgery were midfoot, calcaneal, talar, and ankle fractures. In 53 patients, four (7.5%) surgical site infections occurred, two superficial (3.3%) and two (3.3%) deep infections. For 47 patients, a match was available. The incidence of surgical site infection did not statistically significantly differ between the prospective cohort and retrospective matched cohort (4.3 versus 14.9%, p = 0.29, respectively). This was also the case when looking at superficial and deep surgical site infections separately (0 versus 8.5%, p = 0.08, and 4.3 versus 6.4%, respectively). We have observed surgical site infections in 7.5% of the patients with the use of prophylactic negative pressure wound therapy. The incidence of surgical site infections was not statistically significantly lower compared to a matched historical cohort.

  15. Odontoid Fracture: Computed Tomography

    Directory of Open Access Journals (Sweden)

    Jonathan Peña

    2016-09-01

    Full Text Available History of present illness: An 84-year-old male presented with left-sided posterior head, neck, and back pain after a ground level fall. Exam was notable for left parietal scalp laceration and midline cervical spine tenderness with no obvious deformities. He was neurovascularly intact, and placed in an Aspen Collar with strict spine precautions. Significant findings: Computed Tomography (CT of the cervical spine showed a stable, acute, non-displaced fracture of the odontoid process extending into the body of C2, consistent with a Type III Odontoid Fracture. He was evaluated by orthopedic spine service who recommended conservative, non-operative management. Discussion: The cervical spine is composed of seven vertebrae, with C1 and C2 commonly referred to as the Atlas and Axis, respectively. Unique to C2 is a bony prominence, the Odontoid Process (Dens. Hyperextension or hyperflexion injuries can induce significant stress causing fractures. Odontoid fractures comprise approximately 10% of vertebral fractures, and there are three types with varying stability.1 Type 1 is the rarest and is a fracture involving the superior segment of the Dens. It is considered a stable fracture. Type 2 is the most common and is a fracture involving the base of the odontoid process, below the transverse component of the cruciform ligament. This fracture is unstable and requires operative stabilization. 2 Type 3 odontoid fractures are classified by a fracture of the Odontoid process, as well as the lateral masses of the C2. Determining the stability of a Type III Odontoid fracture requires radiographic evaluation. Strict cervical spine precautions must be adhered to until adequate imaging and surgical consultation is obtained. CT of the of cervical spine fractures poses several advantages to plain film radiography due to the ability to view the anatomy in three planes. 3 However, if there is concern for ligamentous injury, MRI is the preferred modality.3

  16. Experimental Fracture Measurements of Functionally Graded Materials

    Science.gov (United States)

    Carpenter, Ray Douglas

    The primary objective of this research was to extend established fracture toughness testing methods to a new class of engineering materials known as functionally graded materials (FGMs). Secondary goals were to compare experimental results to those predicted by finite element models and to provide fracture test results as feedback toward optimizing processing parameters for the in-house synthesis of a MoSi2/SiC FGM. Preliminary experiments were performed on commercially pure (CP) Ti and uniform axial tensile tests resulted in mechanical property data including yield strength, 268 MPa, ultimate tensile strength, 470 MPa and Young's modulus, 110 GPa. Results from 3-point bending fracture experiments on CP Ti demonstrated rising R-curve behavior and experimentally determined JQ fracture toughness values ranged between 153 N/mm and 254 N/mm. Similar experimental protocols were used for fracture experiments on a 7- layered Ti/TiB FGM material obtained from Cercom in Vista, California. A novel technique for pre-cracking in reverse 4-point bending was developed for this ductile/brittle FGM material. Fracture test results exhibited rising R-curve behavior and estimated JQ fracture toughness values ranged from 0.49 N/mm to 2.63 N/mm. A 5- layered MoSi2/SiC FGM was synthesized using spark plasma sintering (SPS). Samples of this material were fracture tested and the results again exhibited a rising R-curve with KIC fracture toughness values ranging from 2.7 MPa-m1/2 to 6.0 MPa-m1/2. Finite Element Models predicted rising R-curve behavior for both of the FGM materials tested. Model results were in close agreement for the brittle MoSi2/SiC FGM. For the relatively more ductile Ti/TiB material, results were in close agreement at short crack lengths but diverged at longer crack lengths because the models accounted for fracture toughening mechanisms at the crack tip but not those acting in the crack wake.

  17. Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint.

    Science.gov (United States)

    Liodaki, E; Xing, S G; Mailaender, P; Stang, F

    2015-01-01

    Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author's experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes. © The Author(s) 2014.

  18. Factors associated with recurrent fifth metatarsal stress fracture.

    Science.gov (United States)

    Lee, Kyung-tai; Park, Young-uk; Jegal, Hyuk; Kim, Ki-chun; Young, Ki-won; Kim, Jin-su

    2013-12-01

    Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution. The records of 168 consecutive cases of fifth metatarsal stress fracture (163 patients) treated by modified tension band wiring from March 2002 to June 2011 were evaluated retrospectively. Mean length of follow-up was 23.6 months (range, 10-112 months). Forty-nine cases classified as Torg III were bone grafted initially also. All enrolled patients were elite athletes. Eleven patients experienced nonunion and 18 refracture. The 11 nonunion cases were bone grafted. The 157 patients (excluding nonunion cases) were allocated to either a refracture group or a union group. Clinical features, such as age, weight, fracture classification, time to union, and reinjury history, were compared. Radiological parameters representing cavus deformity and fifth metatarsal head protrusion were compared to evaluate the influence of structural abnormalities. Mean group weights were significantly different (P = .041), but mean ages (P = .879), fracture grades (P = .216, P = .962), and time from surgery to rehabilitation (P = .539) were similar. No significant intergroup differences were found for talocalcaneal (TC) angle (P = .470), calcaneal pitch (CP) angle (P = .847), or talo-first metatarsal (T-MT1) angle (P = .407) on lateral radiographs; for fifth metatarsal lateral deviation (MT5-LD) angle (P = .623) on anteroposterior (AP) radiographs; or for MT5-LD angle (P = .065) on the 30-degree medial oblique radiographs. However, the mean fourth-fifth intermetatarsal (IMA4-5) angle on AP radiographs was significantly greater in the refracture group, and for Torg II cases, mean weight (P = .042), IMA4-5 angle on AP radiographs (P = .014), and MT5-LD angle (P = .043) on 30-degree medial

  19. Immediate results of treatment periprosthetic femoral fractures after hip replacement

    Directory of Open Access Journals (Sweden)

    V. V. Khominets

    2015-01-01

    Full Text Available Periprosthetic fractures are one of the most serious complications after hip replacement. Nineteen periprosthetic femoral fractures operated on during the period 2011-2015 were followed-up retrospectively. Periprosthetic fractures were classified according to the Vancouver classification. The functional results were evaluated using Harrison scale. Bone healing and implant stability were evaluated clinically, on plain radiographs and computed tomography. The periprosthetic fractures in all patients occurred in the postoperative period. Time from operation until fracture varied from 2 weeks to 11 years. A wedge-shaped cemented or cementless stems were implanted during the first surgery: Versys ET, Spotorno, CPT (Zimmer, США: cementless fixation was performed in 16 (84,2% patients, hybrid -in 2 (10,5% and cemented fixation - in 1 (5,3% patient. The fractures of greater trochanter were diagnosed in all patients with type A periprosthetic fractures. In type B1 periprosthetic fracture (8 patients open reduction, cerclage wiring and internal plate osteosynthesis were applied. Loosening stems in 3 patients with type B2 fractures were replaced with Wagner cementless revision component (Wagner SL Revision Stem. Angle-stable plate osteosynthesis and cerclage wiring were also performed. Closed reduction and internal minimal invasive plate osteosynthesis were performed in patients with type C periprosthetic fractures. Bone consolidation was achieved in 18 (94,7% patients, the average term was 14,3±5,2 weeks. The average Harris hip score in all patients 3 months after treatment was 64,9±16,7 points, and in 12 patients (63,2% after a year - 86,5±15,9. Femoral periprosthetic fractures require a specialized approach to choosing the treatment tactic depending on the fracture type and quality of bone tissue. It is necessary to evaluate the femoral component stability, especially in differential diagnosis of type B1 and B2 periprosthetic fractures. Computed

  20. Fractures of the proximal humerus in children and adolescents

    Directory of Open Access Journals (Sweden)

    Ruban Raj Joshi, Dr

    2013-12-01

    Full Text Available Background: In most children proximal humeral fractures are treated non-operatively with generally good results. The aim of the study was to evaluate the clinical outcome of closed/open reduction in children with severely displaced proximal humeral fractures. Materials and Methods: The charts of 15 patients (8 girls and 7 boys; mean age: 9.4 years with proximal humeral fractures who were managed at our institution were reviewed from October 2011 to December 2013. Results: There were 7 metaphyseal fractures and 8 physeal injuries which were angulated according to Neer-Horowitz score as grade II (n=2, grade III(n=4 and grade IV(n=9. Associated lesions comprised open fracture with head trauma in a 2 year old female child which was operated on primarily and the 14 others by secondary intention. All patients were treated surgically with either closed (n = 5 or open (n=10 reduction and internal fixation with Kirschner wire or titanium elastic nails (TENs. They were assessed for clinical and radiological healing at a mean follow up of 1.25 years ranging from 0.5 to 2.0 years. Conclusion: Surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. In addition to the periosteum , long head of the biceps, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Key words: Proximal humerus fracture, Children, Open reduction, Operative.

  1. Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

    Directory of Open Access Journals (Sweden)

    Anendd Jadhav

    2015-01-01

    Full Text Available Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF, and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%. In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA n = 07 (58.33% followed by fall n = 04 (33.33% and assault n = 1 (8.33%. The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.

  2. -Lesser known stress fractures-.

    Science.gov (United States)

    Wybier, M; Hamze, B; Champsaur, P; Parlier, C

    1997-01-01

    Stress fractures of the tibia may disclose a longitudinal orientation which is obvious at bone scanning; a mild periostosis may appear on plain films; CT demonstrates a radially-oriented fracture in one aspect of the diaphyseal cortex. A cortical dissection-like vertically oriented insufficiency fracture may involve the medial aspect of the femoral shaft underlying the lesser trochanter; the fracture is concentric to the femoral cortex at CT. Insufficiency fractures of the sacrum may be misdiagnosed on plain films; bone scanning displays a typical H-shaped increased uptake which is a specific pattern. Insufficiency fractures of the pubis may appear as tumoral bone destruction; however no soft tissue mass is present at CT which in addition demonstrates normal fat tissue abutting the osseous lesion.

  3. Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures

    Energy Technology Data Exchange (ETDEWEB)

    Link, Thomas M. [Department of Clinical Radiology, University of Muenster (Germany); Department of Diagnostic Radiology, Technical University Munich (Germany); Department of Radiology, University of California, San Francisco, CA (United States); Vieth, Volker; Matheis, Julia [Department of Clinical Radiology, University of Muenster (Germany); Newitt, David; Lu, Ying; Majumdar, Sharmila [Department of Radiology, University of California, San Francisco, CA (United States); Rummeny, Ernst J. [Department of Diagnostic Radiology, Technical University Munich (Germany)

    2002-02-01

    The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 {mu}m{sup 2}). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters (p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status. (orig.)

  4. Discrete Fracture Network Characterization of Fractured Shale Reservoirs with Implications to Hydraulic Fracturing Optimization

    Science.gov (United States)

    Jin, G.

    2016-12-01

    Shales are important petroleum source rocks and reservoir seals. Recent developments in hydraulic fracturing technology have facilitated high gas production rates from shale and have had a strong impact on the U.S. gas supply and markets. Modeling of effective permeability for fractured shale reservoirs has been challenging because the presence of a fracture network significantly alters the reservoir hydrologic properties. Due to the frequent occurrence of fracture networks, it is of vital importance to characterize fracture networks and to investigate how these networks can be used to optimize the hydraulic fracturing. We have conducted basic research on 3-D fracture permeability characterization and compartmentization analyses for fractured shale formations, which takes the advantages of the discrete fracture networks (DFN). The DFN modeling is a stochastic modeling approach using the probabilistic density functions of fractures. Three common scenarios of DFN models have been studied for fracture permeability mapping using our previously proposed techniques. In DFN models with moderately to highly concentrated fractures, there exists a representative element volume (REV) for fracture permeability characterization, which indicates that the fractured reservoirs can be treated as anisotropic homogeneous media. Hydraulic fracturing will be most effective if the orientation of the hydraulic fracture is perpendicular to the mean direction of the fractures. A DFN model with randomized fracture orientations, on the other hand, lacks an REV for fracture characterization. Therefore, a fracture permeability tensor has to be computed from each element. Modeling of fracture interconnectivity indicates that there exists no preferred direction for hydraulic fracturing to be most effective oweing to the interconnected pathways of the fracture network. 3-D fracture permeability mapping has been applied to the Devonian Chattanooga Shale in Alabama and the results suggest that an

  5. Proximal humeral fractures

    OpenAIRE

    Mauro, Craig S.

    2011-01-01

    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  6. Sphenotemporal buttress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Jend-Rossmann, I.

    1984-09-01

    A new fracture type visible of CT images of the base of the skull is described. In this fracture the sphenoidal connection to the zygomatic and temporal bone breaks off all its three extensions. It was recognized in five patients with severe head injuries. In three surviving patients it was associated with ipsilateral persistent amaurosis. This fracture should alert the investigator to the possible sequelae of the head injury.

  7. Hip fracture after hemiplegia.

    Science.gov (United States)

    Mulley, G.; Espley, A. J.

    1979-01-01

    In a series of 57 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right- and left-sided hemiplegia, and often occurred within one year of the stroke. Two factors seem to be important in the genesis of hip fractures in hemiplegic patients: the tendency of stroke patients to fall to the affected side as a result of impaired locomotor function, and the development of disuse osteoporosis in the hemiplegic limb. PMID:471862

  8. [Fractures of the midfoot].

    Science.gov (United States)

    Boack, D H

    2004-07-01

    The immediate reduction of luxations and severe dislocations is necessary to protect the soft tissue. The soft tissue lesions determine the timing and partially the options of the operative treatment too. The conventional standard X-rays are sufficient to classify most of the fractures. Conservative treatment or minimal-invasive intramedullary techniques of fixation are sufficient in the treatment in most of the fractures. Screw- and plate-osteosynthesis are a good choice only in intra-articular fractures or sometimes in fractures of the first or fifth metatarsals. The clinical outcome is almost good and the rate of complications is low.

  9. Pathological fractures in children

    Science.gov (United States)

    De Mattos, C. B. R.; Binitie, O.; Dormans, J. P.

    2012-01-01

    Pathological fractures in children can occur as a result of a variety of conditions, ranging from metabolic diseases and infection to tumours. Fractures through benign and malignant bone tumours should be recognised and managed appropriately by the treating orthopaedic surgeon. The most common benign bone tumours that cause pathological fractures in children are unicameral bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological fractures through a primary bone malignancy are rare, these should be recognised quickly in order to achieve better outcomes. A thorough history, physical examination and review of plain radiographs are crucial to determine the cause and guide treatment. In most benign cases the fracture will heal and the lesion can be addressed at the time of the fracture, or after the fracture is healed. A step-wise and multidisciplinary approach is necessary in caring for paediatric patients with malignancies. Pathological fractures do not have to be treated by amputation; these fractures can heal and limb salvage can be performed when indicated. PMID:23610658

  10. Treatment of forearm fractures

    National Research Council Canada - National Science Library

    Macintyre, N R; Ilyas, A M; Jupiter, J B

    2009-01-01

    Fractures of the forearm represent common injuries. Understanding the anatomy and function of the radius, ulna, interosseous membrane, proximal and distal radioulnar joints is critical to appropriate management...

  11. Bracing for thoracolumbar fractures.

    Science.gov (United States)

    Chang, Victor; Holly, Langston T

    2014-01-01

    Traumatic fractures of the thoracolumbar spine are relatively common occurrences that can be a source of pain and disability. Similarly, osteoporotic vertebral fractures are also frequent events and represent a significant health issue specific to the elderly. Neurologically intact patients with traumatic thoracolumbar fractures can commonly be treated nonoperatively with bracing. Nonoperative treatment is not suitable for patients with neurological deficits or highly unstable fractures. The role of operative versus nonoperative treatment of burst fractures is controversial, with high-quality evidence supporting both options. Osteoporotic vertebral fractures can be managed with bracing or vertebral augmentation in most cases. There is, however, a lack of high-quality evidence comparing operative versus nonoperative fractures in this population. Bracing is a low-risk, cost-effective method to treat certain thoracolumbar fractures and offers efficacy equivalent to that of surgical management in many cases. The evidence for bracing of osteoporotic-type fractures is less clear, and further investigation will be necessary to delineate its optimal role.

  12. Pediatric Scaphoid Fractures.

    Science.gov (United States)

    Ting, Beverlie; Sesko Bauer, Andrea; Abzug, Joshua M; Cornwall, Roger; Wyrick, Theresa O; Bae, Donald S

    2017-02-15

    Scaphoid fractures are the most common type of carpal injuries that occur in children and adolescents. The injury pattern seen in children and adolescents who have scaphoid fractures has recently shifted to resemble that of adults who have scaphoid fractures, with scaphoid waist fractures being the most common injury pattern. This shift has been attributed to increased body mass index in children and adolescents as well as more intense participation in extreme sports by both children and adolescents. The diagnosis of scaphoid fractures is based on both a clinical examination and radiographic fi ndings. If a scaphoid fracture is clinically suspected but initial radiographs are negative, cast immobilization followed by repeat imaging can lead to accurate diagnosis of the injury. MRI can aid in the diagnosis of a scaphoid injury in pediatric patients with incomplete ossifi cation of the scaphoid. Acute nondisplaced scaphoid fractures have a high rate of healing with cast immobilization; however, surgery should be considered in patients who have displaced scaphoid fractures with delayed presentation. In general, patients with scaphoid fractures who undergo appropriate treatment and achieve successful union have excellent long-term functional outcomes.

  13. Fracture of the styloid process associated with the mandible fracture

    Directory of Open Access Journals (Sweden)

    K N Dubey

    2013-01-01

    Full Text Available Fracture of the styloid process (SP of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

  14. Mandibular Condyle Fractures and Treatment Modalities

    Directory of Open Access Journals (Sweden)

    Halil ibrahim Kisa

    2014-08-01

    Full Text Available Maxillofacial injuries are most commonly associated with falls, motor and vehicle accidents, sports-related trauma, and interpersonel violence. The complexity of mandibular condyle region and its anatomic proximity to other craniofacial structures complicate diagnosis and treatment. Thus, treatment approaches of mandibular condyle fracture are still controversial. In the literature, different success rates are reported about observation versus treatment, closed reduction versus open reduction and fixation methods. In the present article, controversial issues related to mandibular condyle fractures were reviewed under the light of current literature. In conclusion, the simplest way that can be done with the least risk of complication should be chosen during treatment planning. In addition, current adjunctive treatment methods accelerating healing of fracture should be considered. [Archives Medical Review Journal 2014; 23(4.000: 658-671

  15. IPIRG programs - advances in pipe fracture technology

    Energy Technology Data Exchange (ETDEWEB)

    Wilkowski, G.; Olson, R.; Scott, P. [Batelle, Columbus, OH (United States)

    1997-04-01

    This paper presents an overview of the advances made in fracture control technology as a result of the research performed in the International Piping Integrity Research Group (IPIRG) program. The findings from numerous experiments and supporting analyses conducted to investigate the behavior of circumferentially flawed piping and pipe systems subjected to high-rate loading typical of seismic events are summarized. Topics to be discussed include; (1) Seismic loading effects on material properties, (2) Piping system behavior under seismic loads, (3) Advances in elbow fracture evaluations, and (4) {open_quotes}Real{close_quotes} piping system response. The presentation for each topic will be illustrated with data and analytical results. In each case, the state-of-the-art in fracture mechanics prior to the first IPIRG program will be contrasted with the state-of-the-art at the completion of the IPIRG-2 program.

  16. Wave dynamics of deformation and fracture

    Science.gov (United States)

    Yoshida, S.; Sadeqi, S.

    2017-10-01

    Transition from advanced deformation to fracture of solids is discussed based on wave dynamics derived from a recent field theory. A wave equation has been derived to describe elastic and plastic dynamics comprehensively with a single switching parameter. With this wave equation, a numerical model has been constructed, and elasto-plastic behaviors of deformation waves have been studied. Results of the numerical study indicate that development of stress concentration plays a key role in the transition from advanced deformation to fracture, which is accompanied by the change of deformation wave dynamics from decaying wave-like to solitary wave-like. These results are consistent with previous experimental observations that the generation of a Portevin-Le Chatelier band is closely related to transition from deformation to fracture. From the numerical and experimental observations, the physics behind the transition is discussed.

  17. [Analysis on complications of elastic nail treating children's long bone fractures].

    Science.gov (United States)

    Yao, Lu-feng; Chen, Qiu; Zhong, Zhao-ping; Xu, Rong-ming; Wang, Hao-ran; Peng, Lin-rui; Ren, Rong

    2009-02-01

    To analyze the reasons on complications of treatment with elastic nail in children's long bone fracture. Sixty-six cases (75 parts of long bone fratures) were treated by elastic nail including 49 male and 17 female. The age ranged from 3 to 17 years, mean 7.8 years. There were 35 femur fractures (2 cases were hibateral), 20 tibia and fibula fractures (12 cases were tibia fractures), 8 radial fractures (1 case was ulna fracture) and 3 humerus fractures. The cases included 4 open fractures and 62 closed fractures. All cases were fresh fractures, no multi-segmental fractures. Three cases associated with brain and chest injuries. These cases were treated by open or closed reduction and internal fixaion with elastic nail. A cast or brace had been used after operation for a month. Following-up included the function of the joint,the bottom of the nail and the callus. Complications were timely recorded. All the patients were followed-up for 12 to 29 months, averaged 17 months. The cases occurrenced compilications including 2 cases of nonunion, 2 of new fracture, 1 of displacment, 4 of joint dysfunction, 3 of irritation of the bottom of the nail and 1 malunion. Strict indication, well design,canonical operation is a good way to avoid compliacations. At the same time,early treatment can reduce the sequela.

  18. Non-linear hydrotectonic phenomena: Part I - fluid flow in open fractures under dynamical stress loading

    Energy Technology Data Exchange (ETDEWEB)

    Archambeau, C.B. [Univ. of Colorado, Boulder, CO (United States)

    1994-01-01

    A fractured solid under stress loading (or unloading) can be viewed as behaving macroscopically as a medium with internal, hidden, degrees of freedom, wherein changes in fracture geometry (i.e. opening, closing and extension) and flow of fluid and gas within fractures will produce major changes in stresses and strains within the solid. Likewise, the flow process within fractures will be strongly coupled to deformation within the solid through boundary conditions on the fracture surfaces. The effects in the solid can, in part, be phenomenologically represented as inelastic or plastic processes in the macroscopic view. However, there are clearly phenomena associated with fracture growth and open fracture fluid flows that produce effects that can not be described using ordinary inelastic phenomenology. This is evident from the fact that a variety of energy release phenomena can occur, including seismic emissions of previously stored strain energy due to fracture growth, release of disolved gas from fluids in the fractures resulting in enhanced buoyancy and subsequent energetic flows of gas and fluids through the fracture system which can produce raid extension of old fractures and the creation of new ones. Additionally, the flows will be modulated by the opening and closing of fractures due to deformation in the solid, so that the flow process is strongly coupled to dynamical processes in the surrounding solid matrix, some of which are induced by the flow itself.

  19. Hip Fractures among Older Adults

    Science.gov (United States)

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...

  20. Compression fractures of the back

    Science.gov (United States)

    ... most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss. Alternative Names Vertebral compression fractures Images Compression fracture References Cosman F, de Beur ...

  1. The Process of Hydraulic Fracturing

    Science.gov (United States)

    Hydraulic fracturing, know as fracking or hydrofracking, produces fractures in a rock formation by pumping fluids (water, proppant, and chemical additives) at high pressure down a wellbore. These fractures stimulate the flow of natural gas or oil.

  2. Displaced patella fractures.

    Science.gov (United States)

    Della Rocca, Gregory J

    2013-10-01

    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)

    2008-01-01

    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...

  4. Atypical femoral fractures

    African Journals Online (AJOL)

    2013-01-24

    Jan 24, 2013 ... A 73 year-old female patient was admitted to the orthogeriatrics unit at Helen Joseph Hospital in 2012 with a fracture of her right femur, following a fall from standing height. She was known to have severe osteoporosis, having sustained multiple previous fragility fractures involving her right distal radius, left ...

  5. Tension band fixation of medial malleolus fractures.

    Science.gov (United States)

    Ostrum, R F; Litsky, A S

    1992-01-01

    A prospective study on tension band fixation of medial malleolus fractures was performed on 30 consecutive patients with 31 fractures from October 1987 until December 1990. All patients had at least a displaced medial malleolus fracture unreduced by closed methods. The fractures were classified into small, medium and large using a modified Lauge-Hansen classification. There were no nonunions or movements of wires postoperatively and only two patients had subjective complaints with reference to the wires that required hardware removal. There was one 2-mm malreduction and one patient with a wound slough and subsequent osteomyelitis. One fragment had 2 mm of displacement after fixation but went on to union. A biomechanical study was undertaken to compare fixation of the medial malleolus with K wires alone, K wires plus a tension band, and two cancellous screws. The tension band fixation provided the greatest resistance to pronation forces: for times stiffer than the two screws and 62% of the intact specimen. Tension band fixation of the medial malleolus is a biomechanically strong and clinically acceptable method of treatment for displaced medial malleolus fractures. This method of fixation may be especially useful for small fragments and in osteoporotic bone.

  6. Temporal Bone Fracture Causing Superior Semicircular Canal Dehiscence

    Directory of Open Access Journals (Sweden)

    Kevin A. Peng

    2014-01-01

    Full Text Available Importance. Superior semicircular canal dehiscence (SCD is a third window lesion of the inner ear causing symptoms of vertigo, autophony, tinnitus, and hearing loss. A “two-hit” hypothesis has traditionally been proposed, whereby thinly developed bone overlying the superior canal is disrupted by a sudden change in intracranial pressure. Although the symptoms of SCD may be precipitated by head injury, no previous reports have described a temporal bone fracture directly causing SCD. Observations. Two patients sustained temporal bone fractures after closed head trauma, and developed unilateral otologic symptoms consistent with SCD. In each instance, computed tomography imaging revealed fractures extending through the bony roof of the superior semicircular canal. Conclusions and Relevance. Temporal bone fractures, which are largely treated nonoperatively, have not previously been reported to cause SCD. As it is a potentially treatable entity, SCD resulting from temporal bone fracture must be recognized as a possibility and diagnosed promptly if present.

  7. [Evaluation of condylar fractures treatment].

    Science.gov (United States)

    Andrade Filho, Eduardo Fausto de; Martins, Dulce Maria Fonseca Soares; Sabino Neto, Miguel; Toledo J nior Cd, Carlos de Souza; Pereira, Max Domingues; Ferreira, Lydia Massako

    2003-01-01

    We analysed 40 patients with mandibular condylar process fractures, treated through the closed (intermaxilary fixation or conservatively) or open methods (wire internal fixation,titanium miniplates, bone reduction or articular exploration), from January 1993 to January 1999. We evaluated these patients clinically with pre-determined criteria through the temporomandibular articulation touching (ATM), by observing the mandibular symmetry, dental oclusion, deviation to the mouth opening and maximum interincisal opening, besides the questionnaire about the complaints at ATM, disfunction of the mastication system and satisfaction of the treatment. We found an index of good clinical results of, at least, 70% (in the maximum interincisal opening) in the patients submitted to IMF. In the conservative method, we found an index of, at least, 42.9% and in the patients submitted to wire open reduction, at least, 28.6% (in the ATM touching exam) without significant difference in the clinical exams; the pain index at ATM in the closed method was 3.7% and in the open one was 15.4%; mastication disfunction was 22.2% in the closed method and 15.4% in the open one; we only found 7.1% dissatisfied patients in the closed method. There was no significant difference in the method results. The closed method - with IMF and conservative - and the open reduction - with ORIF - brought good clinical results in an evaluation up to 6 months. We could also conclude that there is no difference in the complaint results after the open or closed treatment according to the patients' opinion.

  8. Dry fracture method for simultaneous measurement of in-situ stress state and material properties

    Energy Technology Data Exchange (ETDEWEB)

    Serata, S. [Serata Geomechanics, Inc., Richmond, CA (United States); Oka, S.; Kikuchi, S. [JDC Corp., Tokyo (Japan)

    1996-04-01

    Based on the dry fracture principle, a computerized borehole probe has been developed to measure stress state and material properties, simultaneously. The probe is designed to obtain a series of measurements in a continuing sequence along a borehole length, without any interruptive measures, such as resetting packers, taking indentation of borehole wall, overcoming, etc. The new dry fracture probe for the single fracture method is designed to overcome the difficulties posed by its ancestor which was based on the double fracture method. The accuracy of the single fracture method is confirmed by a close agreement with the theory, FE modeling and laboratory testing.

  9. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

    Halliday, K.E., E-mail: kath.halliday@nuh.nhs.uk [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Broderick, N.J.; Somers, J.M. [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Hawkes, R. [Department of Radiology, Paul O' Gorman Building, Bristol (United Kingdom)

    2011-11-15

    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  10. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  11. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  12. The ESR1 (6q25 locus is associated with calcaneal ultrasound parameters and radial volumetric bone mineral density in European men.

    Directory of Open Access Journals (Sweden)

    Kate L Holliday

    Full Text Available Genome-wide association studies (GWAS have identified 6q25, which incorporates the oestrogen receptor α gene (ESR1, as a quantitative trait locus for areal bone mineral density (BMD(a of the hip and lumbar spine. The aim of this study was to determine the influence of this locus on other bone health outcomes; calcaneal ultrasound (QUS parameters, radial peripheral quantitative computed tomography (pQCT parameters and markers of bone turnover in a population sample of European men.Eight single nucleotide polymorphisms (SNP in the 6q25 locus were genotyped in men aged 40-79 years from 7 European c