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Sample records for calcaneus

  1. Fractures on the calcaneus

    NARCIS (Netherlands)

    Tanke, Gerhardus Marinus Henricus

    1982-01-01

    ln 823 patients with a displaced calcaneus fracturea study was carried out to assess the difference in the duration until recovery between those patients who were treated by operation and those who were treated conservatively. This was preceded by a study of the literature in which the accent was

  2. Aneurysmal bone cyst of the calcaneus

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    Hertzanu, Y.; Mendelsohn, D.B.; Gottschalk, F.

    1984-04-01

    Aneurysmal bone cyst of the calcaneus is an uncommon entity. Radiographs showed a large lytic expanding lesion arising in the calcaneus with cortical disruption inferiorly. CT of the patient with this condition showed fluid-fluid levels that were the result of blood layering. These findings may suggest the specific diagnosis.

  3. Primary xanthoma of calcaneus bone: Case report

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    Ghalib Ahmed

    2014-01-01

    CONCLUSION: We present this case to raise the suspicion of this lesion that is rarely described in the literatures. This is the first case of primary xanthoma of calcaneus bone that has been reported in Qatar.

  4. Aneurysmal Bone Cyst of the Calcaneus

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    Veysel Kaplanoglu

    2014-01-01

    Full Text Available Aneurysmal bone cysts (ABCs are benign, non-neoplastic, expansile, vascular, locally destructive lesions. The lesion may arise de novo (65% or secondarily (35% in pre-existing benign or malignant lesions (giant cell tumor, osteoblastoma, chondroblastoma, angioma, and others. The calcaneus is a rare localization for ABC, comprising only 1.6% of the cases. In this paper, we present a case of a female patient with a 3-month history of heel pain that got worse and was accompanied by swelling and difficulty in walking. The magnetic resonance images of the postero-lateral calcaneus showed a contrast-enhanced cystic lesion located in the medullary cavity; exophytic portion of the tumor extended into the soft tissue causing distinctive cortical thinning. Heterogeneous hyperintense septae formations and blood level components were also detected. After correlation with pathology results, the lesion was diagnosed as an ABC. Since an ABC of the calcaneus is a rarely seen phenomenon, we present the radiologic findings in this case and a review of the literature.

  5. An unrecognized foreign body retained in the calcaneus

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    Lee, Ro Woon; Choi, Soo Jung; Hwang, Jae Kwang; Ahn, Jae Hong; Kang, Chae Hoon; Shin, Dong Rock [Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

    2017-06-15

    We describe a case of an unrecognized foreign body retained in the calcaneus. The patient denied any history of trauma. The skin overlying the calcaneus was intact with no local signs of inflammation. The retained foreign body was not observed on the radiograph of the calcaneus. Magnetic Resonance Imaging showed a tubular low signal intensity lesion in the calcaneal body, surrounded by strongly enhanced soft tissue and bone marrow edema caused by a foreign body reaction. A foreign body retained in the calcaneus was suspected on the basis of these findings. Surgical exploration and curettage was performed, and a rod shaped wooden fragment was found.

  6. Fractures of the calcaneus in racing greyhounds.

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    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.

  7. [Monostotic fibrous dysplasia of the calcaneus: two case reports].

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    Hauger, O; Rivel, J; Moinard, M; Dallet, E; Diard, F

    2003-05-01

    The authors report two unusual cases of aggressive monostotic fibrous dysplasia involving the calcaneus. This lesion occurs on the 2th decade of life. The main symptom is talalgia. On plain films, differential diagnosis includes aggressive cystic or pseudocystic lesions of the calcaneus. On MR imaging, the tumor matrix is more suggestive of the diagnosis. Treatment of this aggressive form of fibrous dysplasia consists of a surgical curettage completed by cryotherapy and graft because of a high level of recurrence.

  8. [Menopause and ultrasonographic measurements of calcaneus].

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    López-Caudana, Alma Ethelia; Castillo-Calderón, María Griselda; Ávila-Jiménez, Laura

    2014-01-01

    In Mexico, calcaneal ultrasound measurements -bone mineral density (BMD), broadband ultrasound attenuation (BUA), speed of sound (SOS), ultrasonic quantitative index (QUI)- and their differences in regards to menopause have not been documented. It was carried out a cross-sectional study in 862 women from 20 to 90 years old, incorporated through consecutive sample, who were users of the Sistema para el Desarrollo Integral de la Familia (DIF) in Morelos. Sociodemographic, reproductive and life style factors were identified. BMD, BUA, SOS and QUI were measured with quantitative ultrasound (QUS), using a Sunlight Omnisense 7000 S device. Adjusted differences in the mean of these measurements were estimated between pre and postmenopausal women through multiple linear regression. The medians were: BMD, 0.455 g/cm² (IQR, interquartile range = 0.378, 0.538); BUA, 66.0 dB/mHz (IQR = 54.3, 78.1); SOS, 1530.7 m/s (IQR = 1509.8, 1551.7); QUI = 83.7 units (IQR = 71.1, 96.6). In postmenopausal women, adjusted mean for BUA was -4.34 dB/mHz (CI 95 % = -8.23,-0.43); for SOS, -4.26 m/s (CI 95 % = -13.82, 5.30) ; for QUI, -4.42 units (CI 95 % = -8.64,-0.19). This report increases information about the clinical applicability of QUS. SOS in calcaneus does not reflect changes related with menopause.

  9. Primary Lymphoma of the Calcaneus: A Case Report

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    Khodamorad Jamshidi

    2016-07-01

    Full Text Available Introduction Primary Non-Hodgkin’s lymphoma (NHL of the bone is a rare condition. Calcaneus is also an uncommon site for this kind of lymphoma. Case Presentation We hereby present a case of primary non-Hodgkin’s lymphoma of the calcaneus, which was diagnosed and treated at our hospital. The patient had a minor twisting trauma of his ankle but symptoms were present for one year after trauma. The patient complained from instability and swelling of his ankle. After paraclinic assessments, a pathologic lesion was detected in his calcaneus, so incisional biopsy was done and the pathology diagnosis was a large B-cell non-Hodgkin’s lymphoma. Bone marrow assessment was negative for the disease. The patient was treated by chemotherapy and radiotherapy and currently the disease is in remission and patient is doing his previous full activity without any important complication. Conclusions Lymphoma is a rare condition in the foot region but we suggest to be more wise for chronic, uncommon symptoms after minor injuries, as lymphoma of the bone can present mysterious and nonspecific symptoms as was seen in this patient. It may be better to do more assessments to prevent delayed diagnosis of such rare conditions. These rare cases may have atypical imaging and clinical appearance, which can lead to misdiagnosis.

  10. [A rare entity: intraosseous synovial cyst of the calcaneus].

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    Mestdagh, H; Maynou, C; Forgeois, P; Lecomte-Houcke, M

    1997-01-01

    The authors report a rare case of a histologically proven intraosseous ganglion found in the calcaneus. A 59 year old carpenter was referred to our institution because of progressive talalgia with swelling of the hindfoot, increasing with prolonged standing and walking at job. X rays showed a multilobular radiolucent cyst developed in the anterior part of the left calcaneus, outlined by a rim of sclerotic bone. A lateral cortical split revealed by CT was deemed to be a traumatic communication with the soft tissue. At biopsy, a gelatinous and hematic content was noted but pathologic examination of the cyst walls failed to reveal the diagnosis; there were no malignant cells. 5 weeks later, the cyst and its contents were excised through lateral approach and the defect filled with cancellous bone graft. At pathological examination, a final diagnosis of ganglion cyst was determined. One year after surgery, the patient was asymptomatic; no sign of recurrence was observed. Intraosseous ganglia are benign subchondral cysts which rarely involve foot bones. When pain becomes consistent and swelling occurs because of overlooked fracture, malignant bone tumors should be ruled out. Histological examination is mandatory to confirm the diagnosis. Excision of the cyst and bone grafting are effective; recurrence is infrequent.

  11. [Experiment studies on fractures of the human calcaneus under vertical pressure (author's transl)].

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    Plaue, R; Oellers, B; Salditt, G

    1977-04-22

    In 60 cases typical compression fractures of the calcaneus were achieved by means of static compression of the test preparation. Afterwards the load bearing capacity of the fractured calcaneus was studied. In case of pure vertical compression the calcaneus does not loose much stability. The load bearing capacity of the studied bones after fracture achieved on an average still 63% of the initial value. In adequate cases of compression fractures, not only the early mobilization but the early weight bearing has to be discussed.

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

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    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.

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

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    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.

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

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    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°.

  15. 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.

  16. Occult fracture of the calcaneus - another toddler's fracture

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    Starshak, R.J.; Simons, G.W.; Sty, J.R.

    1984-01-01

    Fractures of the calcaneus have been considered rare among children. We feel this may be erroneous since in the last 12 months we have seen 10 such fractures among children, 19 and 41 months of age, who presented with acute limping. The fractures were detected with bone imaging which was performed when initial radiographs were noncontributory. Subsequent radiographs of the calcaneus were positive for fracture in 4 to 10 while follow up radiographs confirmed healing fractures in the two children so evaluated. The sensitivity of bone imaging for the detection of occult fractures in toddlers is emphasized.

  17. Myxoid chondrosarcoma in the calcaneus: a case report with MR imaging findings

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    Kwon, Jong Won; Kwack, Kyu-Sung [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-Do (Korea); Choi, Jung-Ah; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-Do (Korea); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Oh, Joo Han [Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seong Nam, Gyeongi-Do (Korea); Chung, Jin Haeng [Seoul National University Bundang Hospital, Department of Pathology, Seong Nam, Gyeongi-Do (Korea)

    2007-06-15

    Skeletal myxoid chondrosarcoma is an extraordinarily rare neoplasm with a distinct histological morphology. Herein, we report a case of a myxoid chondrosarcoma in the calcaneus of a 20-year-old man with a description of its MR imaging (MRI) and histological findings. (orig.)

  18. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture.

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    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.

  19. ''Duplicate calcaneus'': a rare developmental defect observed in several skeletal dysplasias

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    Cormier-Daire, V. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Hopital Necker-Enfants-Malades, 75 - Paris (France); University of Southern California, Los Angeles, CA (United States). School of Medicine; Savarirayan, R. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Victorian Clinical Genetics Services, Royal Children' s Hospital, Victoria (Australia); Unger, S.; Rimoin, D.L. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Lachman, R.S. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Dept. of Radiology, UCLA School of Medicine, Los Angeles, CA (United States); Medical Genetics, Cedars-Sinai Medical Center, Los Angeles, CA (United States)

    2001-01-01

    Duplication of the calcaneus is a rarely observed radiographic finding that probably results from delayed coalescence of two primary calcaneal centers of ossification. We performed a review of 2,500 computerized cases of skeletal dysplasias and syndromes with bone involvement in the International Skeletal Dysplasia Registry, searching for those cases in which a duplicate calcaneus had been recorded. We found that it was a non-random feature of three skeletal dysplasias and groups comprising thanatophoric dysplasia and the chondrodysplasia punctata and short rib (polydactyly) groups. We conclude that duplication of the calcaneus should be considered a consistent feature of these entities and may reflect a more generalized developmental defect. (orig.)

  20. Quantitative Evaluation of Trabecular Bone Structure by Calcaneus MR Images Texture Analysis of Healthy Volunteers and Osteoporotic Subjects

    National Research Council Canada - National Science Library

    Herlidou, S

    2001-01-01

    The aim of this study is to evaluate, in vivo, trabecular bone structure of the calcaneus of healthy volunteers and osteoporotic patients by texture analysis of MR images Automated methods of texture...

  1. 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.

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

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    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.)

  3. Low-intensity pulsed ultrasound accelerates healing in rat calcaneus tendon injuries.

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    Jeremias Júnior, Sérgio Luiz; Camanho, Gilberto Luis; Bassit, Ana Cristina Ferreira; Forgas, Andrea; Ingham, Sheila J M; Abdalla, Rene Jorge

    2011-07-01

    Controlled laboratory study. To evaluate the effect of low-intensity therapeutic ultrasound on the murine calcaneus tendon healing process. Therapeutic ultrasound promotes formation and maturation of scar tissue. Calcaneus tendon tenotomy and tenorrhaphy was performed on 28 Wistar rats. After the procedure, the animals were randomly divided into 2 groups. The animals in the experimental group received a 5-minute ultrasound application, once a day, at a frequency of 1 MHz, a spatial average temporal average intensity of 0.1 W/cm2, and a spatial average intensity of 0.52 W/cm2 at a 16-Hz frequency pulse mode (duty cycle, 20%). Data for the injured side were normalized in relation to the data from the contralateral healthy calcaneus tendon (relative values). The animals in the control group received sham treatment. After a 28-day treatment period, the animals were sacrificed and their tendons surgically removed and subjected to mechanical stress testing. The parameters analyzed were cross-sectional area (mm2), ultimate load (N), tensile strength (MPa), and energy absorption (mJ). A significant difference between groups was found for the relative values of ultimate load and tensile strength. The mean ± SD ultimate load of the control group was -3.5% ± 32.2% compared to 33.3% ± 26.8% for the experimental group (P = .005). The mean tensile strength of the control group was -47.7% ± 19.5% compared to -28.1% ± 24.1% for the experimental group (P = .019). No significant difference was found in cross-sectional area and energy absorption. Low-intensity pulsed ultrasound produced by a conventional therapeutic ultrasound unit can positively influence the calcaneus tendon healing process in rats.

  4. Superior performance of cone beam tomography in detecting a calcaneus fracture

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    Lohse, Christian

    2015-11-01

    Full Text Available Cone beam computed tomography is a state-of-the-art imaging tool, initially developed for dental and maxillofacial application. With its high resolution and low radiation dose, cone beam tomography has been expanding its application fields, for example, to diagnosis of traumata and fractures in the head and neck area. In this study, we demonstrate superior and satisfactory performance of cone beam tomography for the imaging of a calcaneus fracture in comparison to conventional and computed tomography.

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

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    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.

  6. Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy

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    Tamer Ahmed EL-Sobky

    2015-01-01

    Full Text Available Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy.

  7. Sex determination from the calcaneus in a 20th century Greek population using discriminant function analysis.

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    Peckmann, Tanya R; Orr, Kayla; Meek, Susan; Manolis, Sotiris K

    2015-12-01

    The skull and post-cranium have been used for the determination of sex for unknown human remains. However, in forensic cases where skeletal remains often exhibit postmortem damage and taphonomic changes the calcaneus may be used for the determination of sex as it is a preservationally favored bone. The goal of the present research was to derive discriminant function equations from the calcaneus for estimation of sex from a contemporary Greek population. Nine parameters were measured on 198 individuals (103 males and 95 females), ranging in age from 20 to 99 years old, from the University of Athens Human Skeletal Reference Collection. The statistical analyses showed that all variables were sexually dimorphic. Discriminant function score equations were generated for use in sex determination. The average accuracy of sex classification ranged from 70% to 90% for the univariate analysis, 82.9% to 87.5% for the direct method, and 86.2% for the stepwise method. Comparisons to other populations were made. Overall, the cross-validated accuracies ranged from 48.6% to 56.1% with males most often identified correctly and females most often misidentified. The calcaneus was shown to be useful for sex determination in the twentieth century Greek population. Copyright © 2015 The Chartered Society of Forensic Sciences. Published by Elsevier Ireland Ltd. All rights reserved.

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

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    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.

  9. Sex estimation from measurements of the calcaneus: Applications for personal identification in Thailand.

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    Scott, Shelby; Ruengdit, Sittiporn; Peckmann, Tanya R; Mahakkanukrauh, Pasuk

    2017-09-01

    As a coastal region, Thailand has been significantly affected by climate change. The impacts of climate change in Thailand - temperature increase, rising sea levels, and violent flooding - are predicted to multiply in both frequency and intensity in the next few decades, which may cause an increase in mass disasters and fatalities in the region. The 2004 tsunami catastrophe in Thailand demonstrated the lack of forensic anthropology expertise and the lack of population specific methods in the region. The goal of this research is to derive population specific discriminant functions from the calcaneus for sexing unidentified skeletal remains from a contemporary Thai population. Nine variables of the calcaneus were measured from 232 individuals (116 males and 116 females) of the Chiang Mai skeletal collection with age ranges from 22 to 96 years. All nine calcanei variables were sexually dimorphic. Multivariate and univariate discriminant function analyses were completed. The multivariate analyses showed accuracy rates from 81.5% to 87.7% in males and 84.0% to 87.7% in females. The accuracy rates from the univariate analyses ranged from 71.6% to 84.0% in males and 67.9% to 85.2% in females. Comparisons to other populations were made and the results demonstrated the need for population specific discriminant functions. Overall, the cross-validation accuracies ranged from 73.4% to 94.3% with males identified correctly more often than females. This study demonstrates that the calcaneus is useful for sex estimation in the contemporary Thai population. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Quantitative ultrasound imaging of the calcaneus: precision and variations during a 120-Day bed rest.

    Science.gov (United States)

    Laugier, P; Novikov, V; Elmann-Larsen, B; Berger, G

    2000-01-01

    This study reports on the precision and variation of quantitative ultrasound (US) parameters [broadband ultrasonic attenuation (BUA) or slope of the frequency-dependent attenuation in dB/MHz and speed of sound (SOS m/second)] after 120 days of continuous bed rest in six normal male volunteers. Quantitative US was measured at the calcaneus using a new US bone imaging scanner. The measurements were carried out on both heels at approximately 2-week intervals. The short-term precision was 0.31% for SOS and 2.8% for BUA. The long-term precision was 0.58% for SOS, 4.7% for BUA. A significant decrease of SOS values of -26 m/second (P < 0.0001) for the right heel and -17 m/second (P < 0.05) for the left heel was found at the group level. In terms of percentage change this represents -1.7% for the right heel and -1.1% for the left heel. These percentage decrements were 3.5-5.5 times that of the short-term precision and 2-3 times that of the long-term precision of the technique. At the individual level, the decrease of SOS was statistically significant (P < 0.05) or marginally significant (P < 0.1) for four out of 6 subjects. For 2 other subjects, similar trends were observed, but without reaching statistical significance. BUA did not change significantly during follow-up. These results are consistent with previous findings on changes of ultrasonic properties from the calcaneus during aging, pregnancy, or therapy, showing that calcaneus SOS is a valuable index of bone loss. These preliminary data suggest that prolonged exposure to simulated weightlessness may lead to a lower SOS, which then could be used for the follow-up of bone demineralization occurring during long-term space flights.

  11. Assessment of the relationship between broadband ultrasound attenuation and bone mineral density at the calcaneus using BUA imaging and DXA.

    Science.gov (United States)

    Chappard, C; Laugier, P; Fournier, B; Roux, C; Berger, G

    1997-01-01

    The purposes of this study was to determine the relationship between broadband ultrasound attenuation (BUA) and bone mineral density (BMD) measured at different regions of the calcaneus with identical site-matched regions of interest (ROIs). Dual-energy X-ray absorptiometry (DXA) measurements of the calcaneus and BUA imaging were performed in 30 women (15 premenopausal and 15 postmenopausal). Four square ROIs were located in the great tuberosity and one square ROI in the foramen calcaneus. A ROI adapted to the shape and size of the whole calcaneus was also considered. All ROIs were analyzed three times with both techniques to minimize intra-observer variability. The correlation coefficient between attenuation and frequency was used as an index of BUA measurement error. Before accepting a measurement of BUA in inhomogeneous material, it could be useful to map the spatial variations of the measurement error. In all ROIs we found the BUA and BMD were strongly related (r = 0.78-0.91, p < 0.001). The correlation between BUA and BMD was slightly higher in the inferior part of the posterior tuberosity than in the superior part and in the foramen calcaneus. The very high correlation between attenuation and frequency found in all ROIs (r = 0.99) suggests that measurement errors of propagation were probably not significant. Ultrasound imaging yields the opportunity for studying the spatial acoustic properties in the calcaneus and their relation to bone mass or structural parameters provided by independent imaging techniques. BUA measured with current transmission techniques reflects mainly bone mass, and microarchitecture to a smaller extent.

  12. The Effect of Suture Anchor Insertion Angle on Calcaneus Pullout Strength: Challenging the Deadman's Angle.

    Science.gov (United States)

    Weiss, William M; Saucedo, Ramon P; Robinson, John D; Lo, Chung-Chieh Jason; Morris, Randal P; Panchbhavi, Vinod K

    2017-10-01

    Refractory cases of Achilles tendinopathy amenable to surgery may include reattachment of the tendon using suture anchors. However, there is paucity of information describing the optimal insertion angle to maximize the tendon footprint and anchor stability in the calcaneus. The purpose of this investigation is to compare the fixation strength of suture anchors inserted at 90° and 45° (the Deadman's angle) relative to the primary compressive trabeculae of the calcaneus. A total of 12 matched pairs of adult cadaveric calcanei were excised and potted to approximate their alignment in vivo. Each pair was implanted with 5.5-mm bioabsorbable suture anchors placed either perpendicular (90°) or oblique (45°) to the primary compressive trabeculae. A tensile load was applied until failure of anchor fixation. Differences in failure load and stiffness between anchor fixation angles were determined by paired t-tests. No significant differences were detected between perpendicular and oblique suture anchor insertion relative to primary compressive trabeculae in terms of load to failure or stiffness. This investigation suggests that the fixation strength of suture anchors inserted perpendicular to the primary compression trabeculae and at the Deadman's angle are possibly comparable. Biomechanical comparison study.

  13. Possible application of CT morphometry of the calcaneus and talus in forensic anthropological identification.

    Science.gov (United States)

    Inamori-Kawamoto, Osamu; Ishikawa, Takaki; Michiue, Tomomi; Mustafa, Asmaa Mohammed Hishmat; Sogawa, Nozomi; Kanou, Tetsuya; Oritani, Shigeki; Maeda, Hitoshi

    2016-03-01

    Computed tomography (CT) data provide information for volumetric and radiographic density analysis. The present study investigated the application of virtual CT volumetry of the tarsal bones to estimation of the sex, stature, and body weight using postmortem CT (PMCT) data of forensic autopsy cases. Three-dimensional (3D) images of the bilateral foot bones of intact Japanese subjects after adolescence (age ≥ 15 years, n = 179, 100 males and 79 females) were reconstructed on an automated CT image analyzer system. Measured parameters were mass volume, mean CT value (HU), and total CT value of the talus and calcaneus. Mean CT values of these bones showed age-dependent decreases in elderly subjects over 60 years of age for both sexes, with significant sex-related differences especially in the elderly. The mass volumes and total CT values of the talus and calcaneus showed significant sex-related differences, and also moderate correlations with body height and weight for bilateral bones in all cases (r = 0.58-0.78, p forensic identification; however, greater variations should be considered in body weight estimations of females.

  14. Intra-articular osteoid osteoma of the calcaneus: a case report and review

    Directory of Open Access Journals (Sweden)

    Tomo Hamada, MD

    2016-09-01

    Full Text Available Osteoid osteoma of the calcaneus is rare and frequently misdiagnosed as arthritis because of similar symptoms. In addition, radiographic findings may be nonspecific, and magnetic resonance imaging (MRI may show a bone marrow edema and changes in adjacent soft tissue. A 19-year-old man presented with a 6-month history of persistent pain and swelling in the left hind foot; diagnostic computed tomography and MRI analyses revealed lesions suggesting an intra-articular osteoid osteoma of the calcaneus. Initial MRI did not show specific findings. On operation, the tumor was removed by curettage; pathologic findings demonstrated woven bone trabeculae surrounded by connective tissue, confirming the diagnosis. To the best of our knowledge, MRI scans in all cases of calcaneal osteoid osteoma reported till 3 months after the injury exhibited a nidus. We believe that calcaneal osteoid osteoma should be considered as a differential diagnosis in patients undergoing MRI 3 months after symptom presentation; early computed tomography is critical in diagnosis.

  15. A comparison between the patella and the calcaneus using ultrasound velocity and attenuation as predictors of bone mineral density

    Science.gov (United States)

    Han, S. M.; Davis, J.

    1997-10-01

    The bone mineral density (BMD), ultrasound velocity (UV) and attenuation were examined in sixteen matched sets of human patellae and calcanei. For the sixteen calcanei, BMD was strongly correlated with all ultrasound parameters. Calcaneal UV appeared to be inferior to attenuation in the ability to predict BMD. For the sixteen patellae, the average UV was found to be greater in the superior/inferior direction than in the anterior/posterior and medial/lateral directions. It was found that patella BMD was significantly correlated with each of three directional ultrasound velocities. The relationship between BMD and ultrasound attenuation parameters was not significant in the patella. A comparative study of the two different bone sets demonstrated that the BMDs of the patella and calcaneus were significantly correlated with each other. Ultrasound velocity of calcaneus, measured in the medial/lateral direction, was not significantly associated with any of three directional ultrasound velocities in the patella. Similarly, ultrasound attenuation parameters of calcaneus were not significantly correlated with those of patella. The present study also demonstrated evidence that when predicting BMDs at their respective sites using ultrasound, the calcaneus appeared to be superior to the patella.

  16. Quantitative ultrasound imaging at the calcaneus using an automatic region of interest.

    Science.gov (United States)

    Fournier, B; Chappard, C; Roux, C; Berger, G; Laugier, P

    1997-01-01

    A new approach to measuring bone properties at the calcaneus using ultrasound parametric imaging has recently emerged. However, an additional source of observer-related error is the substantial regional variations in the pattern of ultrasound parameters. The contribution of intra-observer and inter-observer variability to the coefficient of variation can be eliminated using an algorithm which selects the region of interest (ROI) completely automatically. The objective of the present study was the clinical assessment of an automatic ROI for both broadband ultrasonic attenuation (BUA) and speed of sound (SOS) measurement using ultrasound parametric imaging. The automatic ROI was defined as the circular region of lowest attenuation in the posterior tuberosity of the calcaneus. We have tested this algorithm using clinical images of the calcaneus from 265 women. Mean coefficients of variation were 1.6% (95% confidence interval 1.4%-1.9%) and 0.26% (95% confidence interval 0.23%-0.32%) for BUA and SOS respectively (standardized CV was 2.1% for BUA and 2.6% for SOS). Z-scores in an osteoporotic group were -0.61 and -0.52 for BUA and SOS respectively. In healthy women, the age-related decline was -0.50 dB/ MHz per year (0.7%/year) for BUA and -1.2 m/s per year (0.08%/year) for SOS. In the subgroup of healthy postmenopausal women, using stepwise multiple regression, we found that BUA was predicted best by years since menopause (YSM) and weight, with overall model r2 = 0.28; SOS was predicted best by YSM only (r2 = 0.21). Neither the range of biological variation of ultrasound parameters nor the clinical value were affected by the choice of the region of lowest attenuation for measurement. The automatic procedure was totally independent of operator interaction, therefore excluding loss of precision due to intra- or inter-observer variability. The results showed the high precision and robustness of the procedure. These factors make this approach viable for routine clinical

  17. Bilateral complex regional pain syndrome following spinal cord injury and bilateral calcaneus fracture

    Directory of Open Access Journals (Sweden)

    Ahmet Boyacı

    2013-09-01

    Full Text Available Complex regional pain syndrome (CRPS is a disease affectingone or more extremities, characterized by spontaneouspain, allodynia, hyperpathia and hyperalgesia.CRPS is separated into Type 1 and Type 2. CRPS whichdevelops after a nociceptive event is labeled as Type 1and when it develops following peripheral nerve damage,Type 2. Although the pathogenesis is not fully understood,peripheral and central sensitivity are held responsible.Bilateral lower extremity involvement is extremely rare.However, it should be borne in mind that it can develop intraumatic injuries which occur in more than one area anddiagnosis and commencement of a rehabilitation programshould be made in the early period. The case is presentedhere of bilateral Type 1 CRPS developing after incompletespinal cord injury and bilateral calcaneus fracture. JClin Exp Invest 2013; 4 (3: 360-363Key words: complex regional pain syndrome, calcaneusfracture, spinal cord injury

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

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    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.

  19. Contribution of magnetic resonance imaging in the diagnosis of talus skip metastases of Ewing's sarcoma of the calcaneus in a child: a case report

    Directory of Open Access Journals (Sweden)

    Fikry Tarik

    2011-09-01

    Full Text Available Abstract Introduction Ewing's sarcoma of the calcaneus is rare. About thirty cases with calcaneus involvement have been reported in the literature. Talus skip metastases have rarely been described in the available literature Case presentation We report a case of a 14-year-old Moroccan boy, who presented with Ewing's sarcoma of his right calcaneus, diagnosed by swelling of the calcaneus evolving over a year. Radiography, computed tomography and magnetic resonance imaging showed an important tumoral process of the calcaneus and talus skip metastases. The diagnosis was confirmed with histology after a biopsy. In spite of amputation and postoperative chemotherapy, our patient died six months later due to secondary respiratory distress after lung metastasis. Conclusion Imaging, especially magnetic resonance, is important in the diagnosis of Ewing sarcoma and skeletal skip metastases. Treatment of Ewing's sarcoma consists of chemotherapy, radiation therapy and surgical resection depending on the stage and extent of the disease. With the exception of lesions in the calcaneus, the prognosis for disease-free survival of Ewing's sarcoma of the foot is excellent.

  20. Trabecular microarchitecture in established osteoporosis: relationship between vertebrae, distal radius and calcaneus by X-ray imaging texture analysis.

    Science.gov (United States)

    Mallard, F; Bouvard, B; Mercier, P; Bizot, P; Cronier, P; Chappard, D

    2013-02-01

    Osteoporosis is an alteration of bone mass and microarchitecture leading to an increased risk of fractures. A radiograph is a 2D projection of the 3D bone network exposing a texture, that can be assessed by texture analysis. We compared the trabecular microarchitecture of the spine, radius and calcaneus in a series of osteoporotic cadavers. Thirty-four cadavers (11 men, 23 women), mean age 85.2±2.1years, were radiographed from T4 to L5 to identify those with vertebral fractures (FV). Non-fractured vertebrae (NFV), radius and calcaneus were taken and analyzed by densitometry, radiography and texture analysis under run-length, skeletonization of the trabeculae, and fractal geometry. Six subjects (five women, one man) were selected, mean age 82.5±5.5years. Twelve calcanei and 10 radii were taken. Two radii were excluded. The texture of NFV was significantly correlated (Pradius for horizontal run-lengths. No relationship between the texture of NFV and calcaneus was found. In the horizontal direction (perpendicular to the stress lines), the microarchitecture of NFV and radius showed a disappearance of the transverse rods anchoring the plates. Due to its particular microarchitecture, the calcaneus is not representative of the vertebral status. Bone densitometry provides no information about microarchitecture. Texture analysis of X-ray images of the radius would be a minimally invasive tool, providing an early detection of microarchitectural alterations. IV retrospective study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  1. 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.

  2. Insufficiency fracture of the body of the calcaneus in elderly patients with osteoporosis: a report of two cases.

    Science.gov (United States)

    Ito, Kazuo; Hori, Kiyonari; Terashima, Yoshinori; Sekine, Masatoshi; Kura, Hideji

    2004-05-01

    Two cases of insufficiency fracture of the body of the calcaneus are presented to show its clinical presentation and diagnosis. It often is overlooked as a cause of pain in the ankle region. Both patients were elderly women with pain developing at the lateral aspect of the hindfoot in the absence of significant trauma. Physical examination was significant for marked tenderness at the superolateral aspect of the calcaneus. These clinical features suggested the diagnosis, which was confirmed by radionuclide bone scan and magnetic resonance imaging. Magnetic resonance imaging was the diagnostic tool in both cases, after abnormal bone scans and normal plain radiographs. Radiologic alterations were not seen for up to 2 months after the onset of pain. Treatment consisted of rest and protected weightbearing for 8 weeks, with complete resolution of symptoms in both patients. An insufficiency fracture of the body of the calcaneus should be considered in a differential diagnosis of elderly patients with osteoporosis with spontaneous pain in the ankle region.

  3. Trabecular architecture in the StW 352 fossil hominin calcaneus.

    Science.gov (United States)

    Zeininger, Angel; Patel, Biren A; Zipfel, Bernhard; Carlson, Kristian J

    2016-08-01

    Australopithecus africanus has been interpreted as having a rigid lateral foot. One mechanism contributing to a rigid foot during push-off in humans is a calcaneocuboid joint (CCJ) with limited dorsiflexion and a "close-packed" talocalcaneal joint (TCJ). In contrast, apes likely have a greater CCJ range of motion and lack a close-packed TCJ. Differences in tarsal arthrokinematics may result in different joint loading environments. In Homo sapiens, we tested the hypothesis that dorsal and plantar CCJ and the TCJ show evidence of predictable habitual loading. In Pan troglodytes, Gorilla gorilla, Gorilla beringei, and Papio ursinus, we tested the hypothesis that only the dorsal CCJ shows evidence of predictable loading. Specifically, we predicted similarity in trabecular properties across the dorsal and plantar CCJ in H. sapiens, but dissimilarity in non-humans. Additionally, we investigated trabecular properties of an A. africanus calcaneus (StW 352) to evaluate joint loading patterns in this hominin and ultimately address the evolution of these properties in H. sapiens. Contrary to predictions, the H. sapiens dorsal CCJ has a significantly higher elongation index, bone volume fraction, trabecular thickness, and trabecular number than the plantar CCJ, while trabecular properties in non-humans do not always differ as predicted between regions. H. sapiens exhibits trabecular morphology indicative of less variable TCJ loading than other groups, having the most anisotropic and rod-like struts oriented in line with predicted principal loads. Multivariate analysis shows that the StW 352 dorsal CCJ matches P. ursinus best, while the plantar CCJ matches G. beringei best and the TCJ matches that of G. gorilla best. Overall patterns suggest that the StW 352 calcaneus experienced more variable loading than H. sapiens, but less variable loading than P. troglodytes, G. gorilla, G. beringei, and P. ursinus, consistent with a large range of foot movements, probably

  4. Sex estimation in a contemporary Turkish population based on CT scans of the calcaneus.

    Science.gov (United States)

    Ekizoglu, Oguzhan; Inci, Ercan; Palabiyik, Figen Bakirtas; Can, Ismail Ozgur; Er, Ali; Bozdag, Mustafa; Kacmaz, Ismail Eralp; Kranioti, Elena F

    2017-10-01

    Building a reliable biological profile from decomposed remains depends heavily on the accurate estimation of sex. A variety of methods based on every single skeletal element have been developed over the years for different populations employing both osteological and virtual methods. The latter seem to be a reasonable alternative in countries lacking osteological reference collections. The current study used 3D virtual models of calcanei from CT scans of living adults to develop a sex estimation method for contemporary Turkish. Four hundred and twenty eight calcanei CT scans were analysed. The sample was divided in two subsamples: an original (N=348) and a validation sample (N=80) with similar distribution of males and females. Nine classical measurements were taken using the 3D models of the calcanei and two different statistical methods (Discriminant function analysis and Binary logistic regression) were used. Classification accuracy ranged from 82% to 98% for the validation sample and it was consistently high using any of the two methods. Sex bias seems to be lower for most of the logistic regression equations compared to the discriminant functions. These results, however, need further testing to be verified. Based on the results of this study we recommend the use of both methods for sex estimation from the measurements of the calcaneus bone in a Turkish population. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.

    Science.gov (United States)

    Kachlik, D; Musil, V; Vasko, S; Klaue, K; Stingl, J; Baca, V

    2010-01-01

    Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine: The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region--the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18" and 19" centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of "not very appropriate" terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations.

  6. Relationships among ultrasonic and mechanical properties of cancellous bone in human calcaneus in vitro.

    Science.gov (United States)

    Wear, Keith A; Nagaraja, Srinidhi; Dreher, Maureen L; Sadoughi, Saghi; Zhu, Shan; Keaveny, Tony M

    2017-10-01

    Clinical bone sonometers applied at the calcaneus measure broadband ultrasound attenuation and speed of sound. However, the relation of ultrasound measurements to bone strength is not well-characterized. Addressing this issue, we assessed the extent to which ultrasonic measurements convey in vitro mechanical properties in 25 human calcaneal cancellous bone specimens (approximately 2×4×2cm). Normalized broadband ultrasound attenuation, speed of sound, and broadband ultrasound backscatter were measured with 500kHz transducers. To assess mechanical properties, non-linear finite element analysis, based on micro-computed tomography images (34-micron cubic voxel), was used to estimate apparent elastic modulus, overall specimen stiffness, and apparent yield stress, with models typically having approximately 25-30 million elements. We found that ultrasound parameters were correlated with mechanical properties with R=0.70-0.82 (pmechanical properties beyond that provided by bone quantity alone (p≤0.05). Adding ultrasound variables to linear regression models based on bone quantity improved adjusted squared correlation coefficients from 0.65 to 0.77 (stiffness), 0.76 to 0.81 (apparent modulus), and 0.67 to 0.73 (yield stress). These results indicate that ultrasound can provide complementary (to bone quantity) information regarding mechanical behavior of cancellous bone. Published by Elsevier Inc.

  7. Ultrasonic attenuation in human calcaneus from 0.2 to 1.7 MHz.

    Science.gov (United States)

    Wear, K A

    2001-03-01

    Ultrasonic attenuation has been demonstrated to be a useful measurement in the diagnosis of osteoporosis. Most studies have employed ultrasound in a range of frequencies from about 200 kHz-300 kHz to 600 kHz-1 MHz, and many have assumed a linear dependence of attenuation on frequency. In order to investigate the attenuation properties of human calcaneus at higher frequencies, 16 defatted human calcanea were interrogated in vitro using two matched pairs of transducers with center frequencies of 500 kHz and 2.25 MHz. The linear dependence of attenuation on frequency seems to extend up to at least 1.7 MHz. The correlation between attenuation coefficient and frequency from 400 kHz to 1.7 MHz was r = 0.999 (95% confidence interval, CI, = 0.998-1.00). The measurements suggest that some deviations from linear frequency dependence of attenuation may occur at lower frequencies (below 400 kHz), however.

  8. Ultrasound Propagation Through the Calcaneus: Dependence on "bone Quality" and Prediction by Biot's Theory.

    Science.gov (United States)

    Grimm, Michele J.

    1995-01-01

    34 lower limbs were obtained from 17 individuals aged 33 to 92 years. Measurements of ultrasound attenuation and velocity were made on the intact heels and at four sequential stages of dissection resulting in a core of trabecular bone. Measurements of Young's modulus, porosity, mean trabecular plate separation, mean trabecular plate thickness, and density were subsequently obtained on the bone cores. Soft tissue was found to have a significant but correctable effect on attenuation and velocity values. The effect of cortical bone was also significant, but could not be corrected for in a clinical situation. Measurement of ultrasound attenuation and velocity appeared to be a promising technique for the assessment of "bone quality" in the calcaneus when measurements were made on either the intact heel or specimens of trabecular bone. Ultrasound attenuation and BUA were significantly related to mean trabecular plate separation. A combination of attenuation and velocity parameters was found to provide a good estimate of trabecular Young's modulus, with 70 percent of the variation in modulus described by this linear model of in situ measurements and R^2 increasing to 0.81 for measurements made in the trabecular core alone. Experimental measurements of modulus, porosity, tortuosity, permeability, and pore size were used with Biot's theory to predict ultrasound velocity and attenuation due to internal losses resulting from the interaction of the bone and marrow components. While the Biot-type internal losses contributed only a fraction of the attenuation seen experimentally, the qualitative relationships found between attenuation and measures of porosity or pore size agree with those seen experimentally. When surface reflections from a Biot material, scattering, and internal losses due to bone and fat absorption were included in the model, the predicted attenuation was of the same order of magnitude as that obtained in the experiments. Surface reflection was the dominant

  9. Ultrasound parametric imaging of the calcaneus: in vivo results with a new device.

    Science.gov (United States)

    Laugier, P; Fournier, B; Berger, G

    1996-05-01

    An ultrasound transmission scanning system was constructed to make in vivo parametric images of the acoustic properties of the heel. Broadband ultrasonic attenuation (BUA) images were obtained in transmit mode by using a pair of broadband focused transducers (center frequency 0.5 MHz, diameter 29 mm, focus 50 mm) immersed in a water bath at room temperature. With these characteristics, the theoretical beam width at the focus was approximately 5 mm. The total duration of the acquisition period was 3 minutes. Comparison of the BUA image and the radiograph of the calcaneus was possible in one case and showed that all the anatomical details could be identified. The images reported here demonstrate the wide range of BUA found in both the whole bone and within a ROI centered in the posterior part of the bone thus reinforcing the idea of tremendous heterogeneity of the acoustic properties of bone. This suggests that the accurate control of the position of the measurement site is of the utmost importance for between-subject comparison and for repetitive measurements. We proposed a new method, the likelihood image, as an efficient way of highlighting the regions of the image suspected to be subject to waveform distortion. It could be used to guide the selection of the optimal measurement site. Our results suggest that ultrasound parametric imaging has the potential for enhancing the current ultrasound technique by (1) allowing reproducible, repetitive measurements, (2) permitting the selection of similar optimal measurement sites in all subjects, and (3) avoiding accuracy errors due to waveform distortion.

  10. 2D arrays device for calcaneus bone transmission: an alternative technological solution using crossed beam forming.

    Science.gov (United States)

    Defontaine, M; Bonneau, S; Padilla, F; Gomez, M A; Nasser Eddin, M; Laugier, P; Patat, F

    2004-04-01

    In the context of manned space flight with the European Space Agency, a quantitative ultrasound device for transmission imaging through the calcaneus bone has been developed. It includes two matrix transducers of 576 elements each in order to electronically perform the scanning and the focusing of the 500 kHz ultrasonic beam. This device called the BEAM scanner, provides two parametric images of attenuation (BUA, broadband ultrasonic attenuation) and velocity (SOS, speed of sound) of the investigated skeletal site. The cost and complexity of such a device has motivated the study of an alternative solution, less demanding in terms of technology, based on a crossed beam former [H. Ermert et al., A new concept for a real-time ultrasound transmission camera, in: IEEE Ultrasonics Symposium Proceedings, 2000, pp. 1611-1614]. It consists in forming two perpendicular cylindrically focused planes, one in emission, one in reception, instead of two spherically focused apertures. The crossing line of the two planes replaces the focused beam. The 2D beam forming technological challenge is moved to a 1D simpler and cheaper architecture. In this work the two solutions have been compared for in vivo measurements. Data sets have been acquired using all spatial combinations of emission and reception single elements of the matrix. Then signals have been processed using either the cylindrical or the spherical focussing mode. For cylindrical focussing, the increased level of the side lobes caused severe artefacts. Several apodization techniques have been implemented to reduce these artefacts, resulting in encouraging results. After a brief description of this new ultrasonic method for bone quantitative assessment, several reconstructed images using both processing schemes are presented. Corresponding statistical results obtained in 29 subjects are also provided.

  11. 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...

  12. Ultrasound measurement on the calcaneus: influence of immersion time and rotation of the foot.

    Science.gov (United States)

    Chappard, C; Berger, G; Roux, C; Laugier, P

    1999-01-01

    The aim of this study was to evaluate the influence of immersion time and rotation of the heel around the leg axis on the reproducibility of measurements using an ultrasound bone imaging scanner (UBIS) with a temperature-controlled water bath. Measurements were obtained in 10 men, 11 premenopausal women and 10 postmenopausal women. The right foot of all subjects was scanned 12 times with an interval of 3 min between each scan. The first 10 measurements, performed to study the effect of immersion time, were taken without intermediate repositioning. Measurements 11 and 12 were also taken without removing the foot, but the calcaneus position was varied by an angle of +/-2.5 degrees with respect to the reference position used during the first 10 measurements. Prolonged immersion of the heel led to a decrease in the variations of quantitative ultrasound (QUS) parameters between successive measurements. Following rapid variations with immersion time, the QUS parameters reached a plateau. The effect of immersion time on measurement error remained significant until the first two or three scans for broadband ultrasound attenuation (BUA) and until the sixth or seventh scans for speed of sound (SOS). The variation in BUA was more pronounced (p<0.05) for the group of postmenopausal women (20. 7% change in BUA between the first and tenth scans; p<0.005) than for the group of premenopausal women (6.8% change in BUA between the first and tenth scans; p<0.005). The variations in SOS were similar in the two groups (0.8% variation; p<0.005). The impact of immersion time was smaller for men than for women [2.5%, (p<0.01) and 0.4% (p<0.005) of the change between the first and tenth scans for BUA and SOS respectively]. On the whole, the measurement errors due to rotation of the heel were lower than those caused by immersion time. The variations were significant only in men and premenopausal women. Both immersion time and rotation of the heel may play a role in the precision of QUS and

  13. 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.

  14. Diabetes and change in bone mineral density at the hip, calcaneus, spine, and radius in older women

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    Ann V. Schwartz

    2013-05-01

    Full Text Available Older women with type 2 diabetes mellitus (DM have higher bone mineral density (BMD but also have higher rates of fracture compared to those without DM. Limited evidence suggests that DM may also be associated with more rapid bone loss. To determine if bone loss rates differ by DM status in older women, we analyzed BMD data in the Study of Osteoporotic Fractures (SOF between 1986 and 1998. SOF participants were women >65 years at baseline who were recruited from four regions in the U.S. DM was ascertained by self-report. BMD was measured with dual x-ray absorptiometry (DXA at baseline and at least one follow-up visit at the hip (N=6624 and calcaneus (N=6700 and, on a subset of women, at the spine (N=396 and distal radius (N=306. Annualized percent change in BMD was compared by DM status, using random effects models. Of 6,867 women with at least one follow-up DXA scan, 409 had DM at baseline. Mean age was 70.8 (SD 4.7 years. Baseline BMD was higher in women with DM at all measured sites. In models adjusted for age and clinic, women with prevalent DM lost bone more rapidly than those without DM at the femoral neck (-0.96% vs. -0.59% per year, p < 0.001, total hip (-0.98% vs. -0.70% per year, p<0.001, calcaneus (-1.64% vs. -1.40% per year, p=0.005, and spine (-0.33% vs. +0.33% per year, p=0.033, but not at the distal radius (-0.97% vs. -0.90% per year, p=0.91. These findings suggest that despite higher baseline BMD, older women with DM experience more rapid bone loss than those without DM at the hip, spine and calcaneus, but not the radius. Higher rates of bone loss may partially explain higher fracture rates in older women with DM.

  15. Discrimination of hip fractures by quantitative ultrasound of the phalanges and the calcaneus and dual X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Damilakis, John E-mail: damilaki@med.uoc.gr; Papadokostakis, George; Perisinakis, Kostas; Maris, Thomas; Dimitriou, P.; Hadjipavlou, Alexander; Gourtsoyiannis, Nicholas

    2004-06-01

    The aim of the current study was to evaluate the ability of different techniques used for the assessment of bone status to discriminate between postmenopausal women with and without hip fracture. Fifty-one postmenopausal women (mean age 64.5{+-}6.5) who had sustained a low energy hip fracture and 51 age-matched controls (mean age 64.6{+-}6.0) were studied. Quantitative ultrasound (QUS) assessment was carried out using the Ubis 3000 device capable of measuring broadband ultrasound attenuation (BUA) and speed of sound at the calcaneus (SOS{sub C}) and the Sunlight Omnisense device capable of estimating speed of sound at the phalanges (SOS{sub P}). Femoral neck bone mineral density (BMD) was assessed using dual X-ray absorptiometry. Correlations between QUS variables ranged from r=0.35 to 0.72 and between QUS variables and BMD from r=0.30 to 0.36. BMD was the best discriminator of hip fractures (odds ratio = 3.61, area under curve = 0.824). All QUS variables were significant discriminators of hip fractures with odds ratios ranging from 1.88 to 2.63 and areas under the ROC curves ranging from 0.663 to 0.740. Among the QUS variables, the SOS{sub P} showed the best odds ratio and area under curve. Comparison between the areas under the ROC curve did not show any significant difference between SOS{sub P}, BUA and BMD. On the contrary, the difference between SOS{sub C} and BMD was significant (P<0.05). In conclusion, BMD and QUS variables investigated in the current study were significant discriminators of hip fractures. The differentiation of the hip fractures by BMD was significantly better than that of BUA measured at the calcaneus. Moreover, BMD discriminated fractured patients better than BUA and SOS{sub P}, although the difference did not reach statistical significance.

  16. Kazuistika fyzioterapeutické péče o pacienta po tříštivé zlomenině os calcaneus

    OpenAIRE

    Kania, Richard

    2015-01-01

    Autor: Richard Kania Title: Case report of a patient after comminuted fracture of os calcaneus Summary: The bachelor thesis consists of two parts, general and special. General part contains theoretical description of the diagnosis. It describes anatomy, kinesiology, theoretical knowledge of fractures and their treatment. It also includes surgery procedure description and usage of therapeutic methods in given diagnosis. In special part there is casuistry of patient after comminuted fracture of...

  17. A validation of the first genome-wide association study of calcaneus ultrasound parameters in the European Male Ageing Study

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    Han Thang S

    2011-01-01

    Full Text Available Abstract Background A number of single nucleotide polymorphisms (SNPs have been associated with broadband ultrasound attenuation (BUA and speed of sound (SOS as measured by quantitative ultrasound (QUS at the calcaneus in the Framingham 100K genome-wide association study (GWAS but have not been validated in independent studies. The aim of this analysis was to determine if these SNPs are associated with QUS measurements assessed in a large independent population of European middle-aged and elderly men. The association between these SNPs and bone mineral density (BMD measured using dual-energy X-ray absorptiometry (DXA was also tested. Methods Men aged 40-79 years (N = 2960 were recruited from population registers in seven European centres for participation in an observational study of male ageing, the European Male Ageing Study (EMAS. QUS at the calcaneus was measured in all subjects and blood was taken for genetic analysis. Lumbar spine (LS, femoral neck (FN and total hip (TH BMD were measured by DXA in a subsample of 620 men in two centres. SNPs associated with BUA or SOS in the Framingham study with p -4 were selected and genotyped using SEQUENOM technology. Linear regression was used to test for the association between SNPs and standardised (SD bone outcomes under an additive genetic model adjusting for centre. The same direction of effect and p Results Thirty-four of 38 selected SNPs were successfully genotyped in 2377 men. Suggestive evidence of replication was observed for a single SNP, rs3754032, which was associated with a higher SOS (β(SD = 0.07, p = 0.032 but not BUA (β(SD = 0.02, p = 0.505 and is located in the 3'UTR of WDR77 (WD repeat domain 77 also known as androgen receptor cofactor p44. A single SNP, rs238358, was associated with BMD at the LS (β(SD = -0.22, p = 0.014, FN (β(SD = -0.31,p = 0.001 and TH (β(SD = -0.36, p = 0.002 in a locus previously associated with LS BMD in large-scale GWAS, incorporating AKAP11 and RANKL

  18. 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

  19. In vitro assessment of the relationship between acoustic properties and bone mass density of the calcaneus by comparison of ultrasound parametric imaging and quantitative computed tomography.

    Science.gov (United States)

    Laugier, P; Droin, P; Laval-Jeantet, A M; Berger, G

    1997-02-01

    This in vitro study aimed to add new experimental evidence to clarify the relation between acoustic properties of bone and bone mineral density (BMD) of the human calcaneus. Parametric images of normalized broadband ultrasonic attenuation (nBUA) and ultrasound bone velocity (UBV) were compared with quantitative computed tomography (QCT) images of the calcaneus. The experimental protocol was designed to control the different potential sources of error in acoustic measurements, including the shape and thickness of the samples, intervening soft tissues and cortical bone, boundary effects, and variation in location of the regions of interest (ROIs) analyzed by ultrasound and X-ray. The present study was based on bone specimens from calcaneus removed from 15 cadavers (six male and nine female donors ranging from 69 to 89 years of age). Immersion ultrasonic measurements were performed in the through-thickness direction at normal incidence using a pair of focused broad-band 0.5-MHz transducers. QCT of the specimens was performed using standard 10-mm-thick slices with the Cann-Genant calibration standard. Identical, site-matched ROIs were selected for quantitative analysis on the three images. The pattern of acoustic parameters was similar to that of BMD with QCT. The relationships between nBUA and BMD (r2 = 0.75), between UBV and BMD (r2 = 0.88) and between nBUA and UBV (r2 = 0.84) were highly significant (p < 10(-4). From this study, it appears that ultrasound parameters as measured with current transmission techniques reflect mainly bone quantity and only reflect microarchitecture to a small extent and that BUA and UBV reflect the same bone property.

  20. [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

  1. Risk factors for bone mineral density at the calcaneus in 40–59 year-old male workers: A cross-sectional study in Korea

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    Kim Chong-Soon

    2008-07-01

    Full Text Available Abstract Background Few epidemiologic studies have attempted to investigate the prevalence and risk factors for osteopenia and osteoporosis in middle-aged Asian men. We performed this study to determine the prevalence and risk factors of osteopenia and osteoporosis in this population. Methods This cross-sectional study was conducted from March to July, 2004. The subjects were 2,073 males aged from 40 to 59 years in the KHNP (Korea Hydro & Nuclear Power workplace-based cohort. Bone mineral density (BMD was measured by peripheral, dual-energy, X-ray absorptiometry (DXA at the calcaneus. Anthropometric and lifestyle factors were investigated using a standard, self-reported questionnaire. Results BMD was 0.60 ± 0.09 g/cm2 (mean ± standard deviation and was negatively correlated with age (r = -0.18, P P P P P P In multiple linear regression analysis, the independent determinants associated with BMD were increasing age (coefficient = -0.002, P P P P P Conclusion We suggest that BMD of the calcaneus is correlated negatively with exposure to smoke and increased WHR, but positively with regular exercise and increased BMI.

  2. 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.)

  3. 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.

  4. ERRORS AND COMPLICATIONS IN SURGICAL TREATMENT OF NON-STABLE EQUINO-PLANO-VALGUS FOOT DEFORMITY IN PATIENTS WITH CEREBRAL PALSY, WITH USE OF THE CALCANEUS CORRECTING OSTEOTOMY TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Valery V. Umnov

    2017-03-01

    Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

  5. Assess the discrimination of Achilles InSight calcaneus quantitative ultrasound device for osteoporosis in Chinese women: Compared with dual energy X-ray absorptiometry measurements

    Energy Technology Data Exchange (ETDEWEB)

    Jin Ningning, E-mail: ningning_jin@163.com [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China); Lin Shouqing, E-mail: Shouqing_Lin2003@yahoo.com.cn [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China); Zhang Ying, E-mail: steel_lee@sina.com.cn [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China); Chen Fengling, E-mail: bjzqk@126.com [Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100032 (China)

    2010-11-15

    Since the implementation of quantitative ultrasound (QUS) technology may become a part of future clinical decision making to identify osteoporosis and prevent fractures, this study was initiated to evaluate the correlations of QUS parameters and axial bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) and to assess the discrimination of QUS measurements for osteoporosis and osteopenia defined by WHO criteria. 106 native Chinese women (aged 50.2 {+-} 10.9 SD, 21-74 years) were involved. Each subject received both QUS measurements at left calcaneus with Achilles InSight and DXA measurements with DPX-L at lumbar spine (L{sub 2-4}), total hip and femoral neck. Achilles InSight provided the stiffness index (SI) which derived from Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS), and the T-scores of SI were calculated. We found that the QUS parameter SI was statistically significant but medium correlated (r = 0.458-0.587) with DXA at the lumbar spine, total hip and femoral neck (P < 0.0001 for all correlations). With ROC analysis, the area under the ROC curve of diagnosis of osteoporosis and osteopenia were 0.933 and 0.796, respectively. To identify osteoporosis, when the T-score threshold of SI was defined as -1.4, the sensitivity was 100%, and the specificity was 73.7%. Our study confirmed that QUS measurements performed with Achilles InSight were capable to identify osteoporosis defined by axial BMD using DXA in Chinese women.

  6. Influence of treatment with alendronate on the speed of sound, an ultrasound parameter, of the calcaneus in postmenopausal Japanese women with osteoporosis: a clinical practice-based observational study

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    Iwamoto J

    2012-06-01

    Full Text Available Jun Iwamoto,1 Tetsuya Takada,2 Yoshihiro Sato,3 Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, 2Department of Internal Medicine, Hiyoshi Medical Clinic, Kanagawa, 3Department of Neurology, Mitate Hospital, Fukuoka, JapanPurpose: The influence of alendronate (ALN treatment on the quantitative ultrasound parameters of the calcaneus remains to be established in Japanese patients. The aim of the present clinical practice-based observational study was to examine the influence of ALN treatment for 1 year on the speed of sound (SOS of the calcaneus and bone turnover markers in postmenopausal Japanese women with osteoporosis.Patients and methods: Forty-five postmenopausal Japanese women with osteoporosis who had received treatment with ALN for more than 1 year were enrolled in the study. The SOS and bone turnover markers were monitored over 1 year of ALN treatment.Results: The urinary levels of cross-linked N-terminal telopeptides of type I collagen and serum levels of alkaline phosphatase decreased significantly from the baseline values (–44.9% at 3 months and –22.2% at 12 months, respectively. The SOS increased modestly, but significantly, from the baseline value (0.6% at both 6 and 12 months. The percentage decrease in the urinary levels of cross-linked N-terminal telopeptides of type I collagen at 3 months was significantly correlated with the percentage increase in the SOS only at 6 months (correlation coefficient, 0.299.Conclusion: The present study confirmed that ALN treatment suppressed bone turnover, producing a clinically significant increase in the SOS of the calcaneus in postmenopausal Japanese women with osteoporosis.Keywords: postmenopausal osteoporosis, quantitative ultrasound (QUS, SOS, bone turnover, biochemical markers

  7. The effect of sports activities in children and adolescents on the calcaneus - an investigation with quantitative ultrasound; Einfluss sportlicher Aktivitaet von Kindern und Jugendlichen auf den Kalkaneus - Eine Untersuchung mit quantitativem Ultraschall

    Energy Technology Data Exchange (ETDEWEB)

    Mentzel, H.J.; Malich, A.; Boettcher, J.; Vogt, S.; Kaiser, W.A. [Inst. fuer Diagnostische und Interventionelle Radiologie, Klinikum der Friedrich-Schiller-Univ., Jena (Germany); Wuensche, K. [Rontgenavdelingen, HNT Sykehuset Namsos (Norway)

    2005-04-01

    Purpose: To determine whether quantitative ultrasound (QUS) parameters speed of sound (SOS) and broadband ultrasound attenuation (BUA) on the calcaneus are different between athletic children and a reference population. Patients and Methods: From a college of physical education, 177 children and adolescents (121 boys and 56 girls, age range from 11 to 18 years) were included in this study. QUS was performed on the calcaneus using the Sahara trademark device (Hologic, USA). SOS and BUA were estimated. Regional reference values of 3299 children were used to determine significant differences between athletes and reference population. The influence of activity level, age, height, and weight was estimated using correlation analysis. Results: Sportsmen showed significant (p<0.05) higher values of the QUS parameters (SOS 1581.1 m/s; BUA 69.7 dB/MHz) compared to the reference data (SOS 1563.9 m/s; BUA 64.2 dB/MHz). Significant correlation was observed between BUA and the level of activity, age, weight, and height (p<0.01) and between SOS and weight and height (p<0.05). In the group of soccer players and athletes, significant correlation was found between BUA vs. age and BUA vs. weight (p<0.05). Furthermore, significant correlation was observed between BUA vs. age and weight in Judokas and Wrestlers. For the level of activity, a significant correlation to BUA was only found in the group of Judokas and Wrestlers (p<0.01). Conclusion: An increase in quantitative ultrasound parameters on the calcaneus occurs in children and adolescents with increased physical activity. (orig.)

  8. Association between polymorphisms of apolipoprotein E, bone mineral density of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in postmenopausal women with hip or lower forearm fracture

    DEFF Research Database (Denmark)

    Sennels, Henriette Pia; Sand, J C; Madsen, B

    2003-01-01

    are contradictory. The aim of this study was to examine the association between polymorphisms of APOE, BMD of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in a population of postmenopausal women with hip or lower forearm fractures admitted to a department of orthopaedic...... surgery and age-matched controls from the population register. The APOE genotypes of 327 women were studied: 73 with lower forearm fractures, 43 with hip fractures and 211 age-matched controls. The participants were not receiving antiosteoporotic treatment. Polymerase chain reaction restriction fragment....... In conclusion, this study showed no association between bone mass parameters (BMD, speed of sound (SOS), broadband ultrasound attenuation (BUA)), hip or lower forearm fracture and APOE genotypes in a population of postmenopausal women and age-matched controls....

  9. Evolução das fraturas intra-articulares desviadas do calcâneo com tratamento cirúrgico Evolution of calcaneus deviated intra-joint fractures surgically treate

    Directory of Open Access Journals (Sweden)

    Sidney Silva de Paula

    2006-01-01

    Full Text Available Fraturas do calcâneo correspondem a 2% do total de fraturas do corpo humano. Apresentam acentuada importância social e grande impacto econômico, pois ocorrem em indivíduos economicamente ativos. Para reconhecer a evolução das fraturas intra-articulares desviadas do calcâneo, um estudo retrospectivo é apresentado. A amostra constituiu-se de 71 doentes com fratura de calcâneo intra-articular desviada, 63 homens (88,73% e 8 mulheres (11,27%. A idade esteve entre 14 e 74 anos. Conforme a escala de ESSEX-LOPRESTI, 55 delas eram do tipo depressão articular (77,46% e 16 do tipo em língua (22,54%. A incisão mais usada foi a lateral em L (91,55%. Sessenta e uma das fraturas foram fixadas com placa "duplo H" (85,92%, 9 necessitaram apenas de parafusos (12,68% e uma delas foi fixada com fios de Kirschner. Sete fraturas necessitaram de enxerto ósseo (9,86%. O tempo médio de seguimento foi de 11,59 ± 6,72 meses. Complicações precoces estiveram presentes em 33,82% dos doentes sendo mais comum a infecção e a necrose de pele. Complicações tardias foram identificadas em 63,38% dos doentes, principalmente edema residual e artrose. A incidência de complicações tardias não esteve relacionada ao tipo de fratura. As fraturas do tipo depressão articular contribuíram para a maior limitação das atividades (p=0,0315. O ângulo de Böhler, medido no pós-operatório, apresentou relação direta com o resultado final e ângulos menores do que 20 graus determinam maior incidência de maus resultados (p=0,0111. Observando a escala AOFAS, 59,26% de todos os doentes, evoluíram com bons e excelentes resultados.Fractures of the calcaneus account for 2% of all human body fractures. They present a strong social importance and a great economical impact, because they affect economically active individuals. In order to recognize the evolution of calcaneus intra-joint fractures evolution, a retrospective study is presented here. The sample was constituted

  10. Aneurysmal bone cyst of the calcaneus.

    Science.gov (United States)

    Tequabo, Yodit; Admasie, Daniel; Gebeyaw, Alemneh; Yusuf, Nesredin

    2012-07-01

    Aneurysmal bone cyst (ABC) is a benign solitary bone lesion of unknown etiology. ABCs mainly occur in the long bones but only rarely in the bones of the feet. Few cases of ABC involving the calcaneum have been reported. We present a rare case of an ABC of the calcaneum in 18 year old Ethiopian female.

  11. Functional Adaptation of the Calcaneus in Historical Foot Binding.

    Science.gov (United States)

    Reznikov, Natalie; Phillips, Carina; Cooke, Martyn; Garbout, Amin; Ahmed, Farah; Stevens, Molly M

    2017-09-01

    The normal structure of human feet is optimized for shock dampening during walking and running. Foot binding was a historical practice in China aimed at restricting the growth of female feet for aesthetic reasons. In a bound foot the shock-dampening function normally facilitated by the foot arches is withdrawn, resulting in the foot functioning as a rigid extension of the lower leg. An interesting question inspiring this study regards the nature of adaptation of the heel bone to this nonphysiological function using the parameters of cancellous bone anisotropy and 3D fabric topology and a novel intertrabecular angle (ITA) analysis. We found that the trabecular microarchitecture of the normal heel bone, but not of the bound foot, adapts to function by increased anisotropy and preferred orientation of trabeculae. The anisotropic texture in the normal heel bone consistently follows the physiological stress trajectories. However, in the bound foot heel bone the characteristic anisotropy pattern fails to develop, reflecting the lack of a normal biomechanical input. Moreover, the basic topological blueprint of cancellous bone investigated by the ITA method is nearly invariant in both normal and bound foot. These findings suggest that the anisotropic cancellous bone texture is an acquired characteristic that reflects recurrent loading conditions; conversely, an inadequate biomechanical input precludes the formation of anisotropic texture. This opens a long-sought-after possibility to reconstruct bone function from its form. The conserved topological parameters characterize the generic 3D fabric of cancellous bone, which is to a large extent independent of its adaptation to recurrent loading and perhaps determines the mechanical competence of trabecular bone regardless of its functional adaptation. © 2017 American Society for Bone and Mineral Research. © 2017 American Society for Bone and Mineral Research.

  12. Abnormal attachments between a plantar aponeurosis and calcaneus

    Science.gov (United States)

    KALNIEV, MANOL ANASTASOV; KRASTEV, DIMO; KRASTEV, NIKOLAY; VIDINOV, KALIN; VELTCHEV, LUDMIL; MILEVA, MILKA

    2013-01-01

    Background and aims The plantar aponeurosis or fascia is a thick fascial seal located on the lower surface of the sole. It consists of three parts central, lateral, and medial. The central portion is the thickest. It is narrow behind and wider in front. The central portion has two strong vertical intermuscular septa which are directed upward into the foot. The lateral and medial portions are thinner. The medial portion is thinnest. The lateral portion is thin in front and thick behind. The main function of the plantar fascia is to support the longitudinal arch of the foot. In May 2013 during a routine dissection in the section hall of the Department of Anatomy and Histology in Medical University – Sofia, Bulgaria we came across a very interesting variation of the plantar aponeurosis. Materials and methods For the present morphological study tissues from a human corpse material were used. This unusual anatomical variation was photographed using a Nikon Coolpix 995 camera with a 3.34 Megapixels. Results We found some fibrous strands which started from the proximal portion of the plantar aponeurosis on the left foot. The fibrous strands resembled the tentacles of an octopus and started from the proximal portion of the aponeurosis. Two of fibrous strands were directed laterally to adipose tissue and one was directed medially and backward. The first lateral fibrous strand was divided into several fascicles. We found very few data in literature about the varieties of the plantar fascia. Conclusion It is very important to consider the occurrence of above mentioned variations in the plantar aponeurosis when surgical procedures are performed on the sole. PMID:26527947

  13. Estudo comparativo de propriedades biomecânicas da porção central do tendão calcâneo congelado e a fresco Comparative study on biomechanical properties of the central portion of frozen and fresh calcaneus tendon

    Directory of Open Access Journals (Sweden)

    Rodrigo Bezerra de Menezes Reiff

    2007-01-01

    Full Text Available Métodos de armazenamento de aloenxertos podem alterar certas características mecânicas dos tecidos. Com o objetivo de analisar a influência do fenômeno de congelamento e do tempo de armazenamento sobre as propriedades biomecânicas de tendões, os autores estudaram 40 tendões calcâneos obtidos de 20 cadáveres humanos com idade média de 41,95 anos, variando de 31 a 54 anos, sendo 17 do sexo masculino e três do sexo feminino. De cada cadáver foram retirados dois tendões, sendo que um foi testado a fresco e o contralateral congelado a - 85º C em freezer elétrico, durante um período de seis ou 12 semanas. Os corpos de prova foram submetidos a ensaios de tração em uma máquina de ensaios mecânicos Kratos K5002, fornecendo gráficos força-deformação. Foram analisados os parâmetros de força no limite de resistência máxima, rigidez, tensão no limite de resistência máxima, deformação relativa e módulo de elasticidade. Os resultados foram comparados e a analisados estatisticamente pelo método de "t-student", com índice de significância de 0,05, sendo que não houve diferença significativa nos valores obtidos entre os grupos. Concluímos que o congelamento a - 85º C não altera as propriedades biomecânicas de tendões, a despeito do tempo de armazenamento.Allograft storage methods can change some mechanical characteristics of tissues. With the objective of analyzing the influence of freezing phenomenon and storage time on tendons’ biomechanical properties, the authors studied 40 calcaneus tendons obtained from 20 human cadavers, with an average age of 41.95 years, ranging from 31 to 54 years old, being 17 males and three females. From each cadaver, two tendons were removed, one tested in its fresh state and the contralateral one frozen at -85º C in an electric freezer, during a period of six or 12 weeks. The bodies of evidence were submitted to traction assays in a Kratos K5002 mechanical assay machine, delivering

  14. 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.)

  15. [Progress in measurement of the calcaneus using ultrasonic methods in children and adolescents].

    Science.gov (United States)

    Jaworski, M; Lorenc, R S

    2000-01-01

    At present, Dual Energy X-ray Absorptiometry (DEXA) method is a reference method to diagnose osteoporosis. This method allows to measure bone density and bone mass, however bone quality can not be estimated. Quantitative ultrasound (QUS) method provides information about bone structure. The aim of our work was the evaluation of QUS method in healthy children, establishing reference values in cross-sectional study of healthy children aged 7-18 yrs and to examine the annual change of ultrasound parameters in prospective study at pubertal. Group of 530 girls and 369 boys was recruited from Warsaw schools, and right heel was measured with Achilles Plus apparatus. Measurements were repeated after 1 year, in a subgroup of 153 children aged 9-13 yrs. The method was adapted for paediatric measurements by using limiter of ultrasonic wave and pads for positioning foot in water chamber. Speed of sound (SOS) and broadband ultrasound attenuation (BUA) were measured and Stiffness index was calculated. Width of heel, at the same location as QUS measurement, was also measured using calipers. SOS, BUA and Stiffness values increased by age in boys and girls. BUA and Stiffness values were significantly higher in 15, 16 and 17 year old boys than in age-matched girls (in 18 yrs--only Stiffness). However, there were no significant sex differences in annual increase of SOS, BUA and Stiffness, although the biggest increase was observed between the age of 13-14 yrs for boys and 11-12 yrs for girls. That may reflect pubertal spurt of body growth but that relationship was not confirmed by annual increases calculated from cross-sectional data. Statistically significant correlation of SOS, BUA and Stiffness with body mass, height, body mass index (BMI) and heel width was observed. Normalization of SOS, BUA and Stiffness on heel width decreased force of that correlation but it was still statistically significant. Dynamics of SOS, BUA and Stiffness increase by age was higher in boys than in girls. This phenomenon is probably related to higher peak bone mass in men than in women, and lower risk of fracture in men, especially concerning hip. Increase of speed of sound, broadband ultrasound attenuation and stiffness index by age, and their correlations with body mass, height and body mass index reflects bone growth in children and adolescents. Broadband ultrasound attenuation and Stiffness index show sex differences in bone development in adolescence. Higher dynamics of the increase of speed of sound, broadband ultrasound attenuation and Stiffness index by age in boys confirms faster bone mass accumulation in boys than in girls.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. 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.

  19. 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.

  20. Avulsion of the tuberosity of the calcaneus, an unusual injurie: case ...

    African Journals Online (AJOL)

    Recent studies on the epidemiology of these specific fractures have demonstrated that avulsed calcaneal fractures account for 1.3% of all calcaneal fractures.It is therefore understandable that little has been written about these fractures. This type of injuries is usually caused by sudden muscular contraction of the Achilles ...

  1. 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.

  2. In vivo performance of a matrix-based quantitative ultrasound imaging device dedicated to calcaneus investigation.

    Science.gov (United States)

    Gomez, M A; Defontaine, M; Giraudeau, B; Camus, E; Colin, L; Laugier, P; Patat, F

    2002-10-01

    We developed a prototype of an ultrasound (US) bone matrix densitometer, the BEAM scanner, in the context of a European Space Agency research program. This device, which is a contact imaging device, was designed to overcome the limitations of immersion devices in space. Broadband US attenuation (BUA) and speed of sound (SOS) parameters were calculated from the radiofrequency (RF) signal. The principle aim of this study was to evaluate in vivo performance in direct comparison with a currently available device (UBIS 3000, DMS, France). The short-term precision of the BEAM scanner for BUA was estimated at 2.8%, whereas it was 2.3% with UBIS 3000. The short-term precision for SOS was 0.3%, and this was the same as the coefficient of variation (CV) of the UBIS 3000. CVs of 3.4% and 0.6% for midterm precision were found for BUA and SOS, respectively, and UBIS 3000 scores were 3% and 0.4%, respectively. This preliminary study demonstrates the high performance of the BEAM scanner and its new concept offers a wide range of improvements and new applications.

  3. Segmentation of Quantitative Ultrasonographic Images of the Calcaneus Using Elastic Deformation of the Flexible Fourier Contour

    National Research Council Canada - National Science Library

    Laugier, Pascal; Lefebvre, Francoise; Chappard, Christine; Roux, Christian

    2004-01-01

    ... Médecine, 75006 Paris, France. E-mail: laugier{at}lip.bhdc.jussieu.fr . Objective. This study investigated a new technique for automatic model-based segmentation of broadband ultrasound attenuation (BUA...

  4. Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

    Directory of Open Access Journals (Sweden)

    Farhang Babamahmoodi

    2015-01-01

    Full Text Available Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

  5. 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

  6. Axial compressive strength of human vertebrae trabecular bones classified as normal, osteopenic and osteoporotic by quantitative ultrasonometry of calcaneus

    Directory of Open Access Journals (Sweden)

    Reinaldo Cesar

    2017-06-01

    Full Text Available Abstract Introduction Biomechanical assessment of trabecular bone microarchitecture contributes to the evaluation of fractures risk associated with osteoporosis and plays a crucial role in planning preventive strategies. One of the most widely clinical technics used for osteoporosis diagnosis by health professionals is bone dual-energy X-ray absorptiometry (DEXA. However, doubts about its accuracy motivate the introduction of congruent technical analysis such as calcaneal ultrasonometry (Quantitative Ultrasonometry - QUS. Methods Correlations between Bone Quality Index (BQI, determined by calcaneal ultrasonometry of thirty (30 individuals classified as normal, osteopenic and osteoporotic, and elastic modulus (E and ultimate compressive strength (UCS from axial compression tests of ninety (90 proof bodies from human vertebrae trabecular bone, which were extracted from cadavers in the twelfth thoracic region (T12, first and fourth lumbar (L1 and L4. Results Analysis of variance (ANOVA showed significant differences for E (p = 0.001, for UCS (p = 0.0001 and BQI. Spearman’s rank correlation coefficient (rho between BQI and E (r = 0.499 and BQI and UCS (r = 0.508 were moderate. Discussion Calcaneal ultrasonometry technique allowed a moderate estimate of bone mechanical strength and fracture risk associated with osteoporosis in human vertebrae.

  7. Automatic detection of the boundary of the calcaneus from ultrasound parametric images using an active contour model; clinical assessment.

    Science.gov (United States)

    Lefebvre, F; Berger, G; Laugier, P

    1998-02-01

    This paper presents a computerized method for automated detection of the boundary of the os calcis on in vivo ultrasound parametric images, using an active dynamic contour model. The initial contour, defined without user interaction, is an iso-contour extracted from the textural feature space. The contour is deformed through the action of internal and external forces, until stability is reached. The external forces, which characterize image features, are a combination of gray-level information and second-order textural features arising from local cooccurrence matrices. The broadband ultrasound attenuation (BUA) value is then averaged within the contour obtained. The method was applied to 381 clinical images. The contour was correctly detected in the great majority of the cases. For the short-term reproducibility study, the mean coefficient of variation was equal to 1.81% for BUA values and 4.95% for areas in the detected region. Women with osteoporosis had a lower BUA than age-matched controls (p = 0.0005). In healthy women, the age-related decline was -0.45 dB/MHz/yr. In the group of healthy post-menopausal women, years since menopause, weight and age were significant predictors of BUA. These results are comparable to those obtained when averaging BUA values in a small region of interest.

  8. Quantitative bone ultrasound at phalanges and calcaneus in osteoporotic postmenopausal women: influence of age and measurement site.

    Science.gov (United States)

    Camozzi, Valentina; De Terlizzi, Francesca; Zangari, Monica; Luisetto, Giovanni

    2007-07-01

    Phalangeal and calcaneal quantitative ultrasound (QUS) measurements were tested in a postmenopausal osteoporotic population of a wide age range to assess their ability to identify subjects with vertebral fractures in a population of postmenopausal women with osteoporosis. A group of 127 osteoporotic women aged from 50 to 85 y, who had been postmenopausal for at least 5 y, were enrolled. All subjects underwent phalangeal and calcaneal QUS measurements, femoral neck and lumbar spine dual energy X-ray absorptiometry (DXA) measurements and lateral thoracic and lumbar spine radiography. Osteoporosis was defined on the basis of femoral neck or lumbar spine bone mineral density (BMD) T-score lower than -2.5 SD or of the presence of one or more vertebral atraumatic fractures, independently of BMD values. Fifty-two women had one or more vertebral fractures, while the remaining 75 had no evidence of previous fracture. Both QUS techniques were able to discriminate between fractured and nonfractured subjects in the whole group (p or = 70 y (n = 84) were considered separately, phalangeal QUS and lumbar spine BMD were able to discriminate vertebral fractures in the younger group (p < 0.05), whereas calcaneal QUS was able to discriminate vertebral fractures in the older one (p < 0.05). The results of this study raise an issue of the optimal use of different QUS techniques and different skeletal sites in the management of osteoporosis in early or late postmenopausal life.

  9. 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.

  10. Peritendinous calcinosis of calcaneus tendon associated with dermatomyositis: correlation between conventional radiograph, ultrasound, magnetic resonance imaging and gross surgical pathology; Calcinose peritendinea do tendao calcaneo associada a dermatomiosite: correlacao entre radiografia convencional, ultra-sonografia, ressonancia magnetica e macroscopia cirurgica

    Energy Technology Data Exchange (ETDEWEB)

    Rosa, Ana Claudia Ferreira; Gomide, Lidyane Marques de Paula; Lemes, Marcella Stival [Universidade Federal de Goias (UFG), Goiana, GO (Brazil). Faculdade de Medicina. Hospital das Clinicas; Costa, Edegmar Nunes; Rocha, Valney Luiz da [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Faculdade de Medicina. Dept. de Ortopedia; Machado, Marcio Martins; Santos Junior, Rubens Carneiro dos; Barros, Nestor de; Cerri, Giovanni Guido [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Faculdade de Medicina. Dept. de Radiologia; Sernik, Renato Antonio [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Inst. de Radiologia; Nunes, Rodrigo Alvarenga [Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG (Brazil). Faculdade de Ciencias Medicas; Albieri, Alexandre Daher [Hospital de Acidentados de Goiania, GO (Brazil)

    2006-01-15

    Interstitial calcinosis is an uncommon condition in which there is either localized or widely disseminated deposition of calcium in the skin, subcutaneous tissues, muscles, and tendons. Calcinosis is often associated with collagen diseases, scleroderma and dermatomyositis. The authors report a case of interstitial calcinosis associated with dermatomyositis studied with conventional radiograph, ultrasound and magnetic resonance imaging, and correlate the imaging findings with the results of surgical pathology gross examination. (author)

  11. 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 ...

  12. The prevalence of clinical signs of ankle instability in club rugby ...

    African Journals Online (AJOL)

    The forearm of the hand cupping the calcaneus supported the foot in 10° of plantar flexion. The foot position was checked with a goniometer. The subject was instructed to relax and to allow the researcher (EM) to move the ankle. The action performed was an anterior displacement or forward pull of the talus and calcaneus.

  13. Influence of endurance running on calcaneal bone stiffness in male and female runners.

    Science.gov (United States)

    Lara, Beatriz; Salinero, Juan José; Gutiérrez, Jorge; Areces, Francisco; Abián-Vicén, Javier; Ruiz-Vicente, Diana; Gallo-Salazar, César; Jiménez, Fernando; Del Coso, Juan

    2016-02-01

    The aim of this investigation was to determine the influence of endurance running on calcaneus bone stiffness in male and female runners. A total of 122 marathoners (longer distance runners, men = 101; women = 21) and 81 half-marathon and 10-km runners (shorter distance runners; men = 48; women = 33), competing in an international running event, underwent an ultrasonographic assessment of the right and left calcaneus. Calcaneus bone stiffness was estimated using the measurements of the speed of sound (SOS) and broadband ultrasound attenuation (BUA). Seventy-five age-matched sedentary people served as the control group. Male and female longer distance runners and shorter distance runners presented higher values than sedentary counterparts in SOS (P < 0.05), and calcaneus stiffness (P < 0.05). Although there were no significant differences between longer distance and shorter distance runners in the ultrasonographic variables, longer distance runners presented greater effects size in SOS (1.00 vs. 0.93 males; 1.10 vs. 0.77 females), BUA (0.62 vs. 0.25 males; 0.89 vs. 0.20 females) and calcaneus stiffness (0.88 vs. 0.66 males; 1.20 vs. 0.60 females) than shorter distance endurance runners. Calcaneus bone stiffness was higher in all endurance runners compared to a sedentary control population. The volume of ground reaction forces which occur during endurance running might induce the adaptation of the calcaneus bone.

  14. Sex differences in bone marrow density measured by quantitative ultrasonometry: For 20 year old college student

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Jeong [Dept. of Radiological Technology, Daejeon Health Institute of Technology, Daejeon (Korea, Republic of)

    2017-09-15

    The purpose of this study is to compare the bone marrow density measured by quantitative ultrasonometry (QUS) between men and women. Questionnaires for general characteristics were obtained from 104 participants, and then their both calcaneus was measured by using QUS. Sex differences for bone marrow density (BMD) were analyzed by an Independent t-test using the SPSS 19.0 program. Of 104 participants, women and men were 69(66.3%) and 35(33.7%), respectively. T-value of left calcaneus was high significantly in women than that in men(0.443 vs. 0.031, p=0.161) as well as that of right calcaneus(0.555 vs. 0.049, p=0.093). T-value of right calcaneus was high than that of left calcaneus in women and men (not significant, p>0.05). T-value of both calcaneus was increasing with physical activity. T-value of calcaneus was no statistically significant with age and body mass index. The BMD of women is high significantly more than that of men, and BMD is relation with physical activity.

  15. Management of aggressive giant cell tumor of calcaneal bone: A case report

    Directory of Open Access Journals (Sweden)

    Achmad Fauzi Kamal

    2016-01-01

    Conclusion: Wide excision total calcaneoctomy, bone allograft reconstruction and soft tissue coverage with sural flap is a good option for surgical management in aggressive GCT of calcaneus instead of amputation.

  16. Overset traethedsbrud i haelbenet

    DEFF Research Database (Denmark)

    Jeppesen, Katrine Arp; Palm, Henrik; Ebskov, Lars

    2009-01-01

    A stress fracture of the calcaneus is the result of rhythmically recurring sub-threshold traumata and is typically seen in athletes. The diagnosis is difficult because stress fractures are easily missed in traditional radiographs. It is therefore recommended to perform magnetic resonance imaging........ Treatment includes paracetamol and rest - and in severe cases plaster bandage and/or walker. Stress fracture of the calcaneus should be considered in cases with acute onset of severe and persistent heel pain in physically active individuals....

  17. Rearfoot posture of Australopithecus sediba and the evolution of the hominin longitudinal arch

    OpenAIRE

    Thomas C. Prang

    2015-01-01

    The longitudinal arch is one of the hallmarks of the human foot but its evolutionary history remains controversial due to the fragmentary nature of the fossil record. In modern humans, the presence of a longitudinal arch is reflected in the angular relationships among the major surfaces of the human talus and calcaneus complex, which is also known as the rearfoot. A complete talus and calcaneus of Australopithecus sediba provide the opportunity to evaluate rearfoot posture in an early hominin...

  18. [A rare cause of talalgia].

    Science.gov (United States)

    Bousbaa, Hicham; Ouahidi, Mohammed; Bennani, Mourad; Cherrad, Tawfik; Zejjari, Hassan; Kasmaoui, El Houssine; Louaste, Jamal; Rachid, Khalid; Amhajji, Laarbi

    2017-01-01

    Talalgie is one of the most common symptoms involving the foot. Intra-bone lipoma is one of the most rare bone tumors of the calcaneus. We report the case of a patient presenting with intermittent and spontaneous chronic heel pain. Clinical and radiological examinations confirmed the diagnosis of lipoma of the calcaneus. This study aimed to educate clinicians about the existence of this rare lesion.

  19. Pathomechanics of Post-Traumatic OA Development in the Military Following Articular Fracture

    Science.gov (United States)

    2017-10-01

    between fracture energy and articular comminution with KL grading. DISCUSSION: Fractures of the acetabulum are generally considered severe and... fractures of the acetabulum . REFERENCES: 1. Matta JM et. al. (1996) J Bone Joint Surg Am. 78(11):1632-45. 2. Marsh JL et. al. (2002) J Bone...distal radius, calcaneus, acetabulum , and tibia (plateau and plafond). 0 10 20 30 Fracture Energy (J) distal radius calcaneus acetabulum tibia

  20. Minimally invasive, endoscopic Achilles tendon reconstruction using semitendinosus and gracilis tendons with Endobutton stabilization.

    Science.gov (United States)

    Piontek, Tomasz; Bąkowski, Paweł; Ciemniewska-Gorzela, Kinga; Grygorowicz, Monika

    2016-06-03

    Plantaris tendon, peronus brevis tendon and flexor hallucis longus tendon augmentation, commonly used in Achilles tendon rupture, often lead to weakening of injured foot and they require the immobilization after the surgery. It is essential to develop the technique, which gives no such limitation and allows for immediate functional improvement. We present our method of minimally invasive, endoscopic Achilles tendon reconstruction using semitendinosus and gracilis tendons with Endobutton stabilization. Posterolateral and posteromedial portals were made approximately 3 cm above the posterosuperior part of the calcaneus to clean the area of the Achilles tendon endoscopically. Then the hamstrings are harvested and prepared for the "Endobutton" system. A midline incision of the skin is performed approximately 1 cm above the posterosuperior part of the calcaneus to approach to the posterosuperior part of the calcaneus. Then under fluoroscopy the calcaneus was drilled through using K-wire. The distal end of the graft equipped with an Endobutton loop was entered into the drilled tunnel in the calcaneus. Later, 8 consecutive skin incisions are performed. Proximal ends of the graft were brought out through the native Achilles tendon reaching medial and lateral skin incisions. The final step was to transfer and tie the graft ends through the most proximal skin incision. This minimally invasive, endoscopic technique allows reconstruction of the Achilles tendon using semitendinosus and gracilis tendons with Endobutton stabilization and can be used in so-called "difficult", resistant cases as a "salvage procedure".

  1. Successful intraosseous infusion in the critically ill patient does not require a medullary cavity.

    LENUS (Irish Health Repository)

    McCarthy, Gerard

    2012-02-03

    OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.

  2. Hind-foot correction and stabilization by pins in plaster after surgical release of talipes equino varus feet in older children

    Science.gov (United States)

    2010-01-01

    Congenital talipes equino varus (CTEV) is a three dimensional deformity and is one of the most common congenital abnormalities affecting the lower limb and can be challenging to manage. Hind-foot deformity is considered the most difficult to treat. Unfortunately, the calcaneus is often small and thus difficult to control during casting after surgical release in severe or relapsed cases. We used three pins to control and maintain the hind foot correction, after surgical release, during casting in 47 cases (59 feet). We introduced a modified, coronal plane, transverse calcaneal pin. This pin is inserted from medial to lateral through the calcaneus to correct the varus mal-positioning of the calcaneus in the sagittal plane and to provide a better control on the small sized, hind-foot during casting. We paid special attention to the final hind-foot deformity after surgery, and the results were favorable after the application of this transverse pin. PMID:20598129

  3. Hind-foot correction and stabilization by pins in plaster after surgical release of talipes equino varus feet in older children

    Directory of Open Access Journals (Sweden)

    Seleem Osama A

    2010-07-01

    Full Text Available Abstract Congenital talipes equino varus (CTEV is a three dimensional deformity and is one of the most common congenital abnormalities affecting the lower limb and can be challenging to manage. Hind-foot deformity is considered the most difficult to treat. Unfortunately, the calcaneus is often small and thus difficult to control during casting after surgical release in severe or relapsed cases. We used three pins to control and maintain the hind foot correction, after surgical release, during casting in 47 cases (59 feet. We introduced a modified, coronal plane, transverse calcaneal pin. This pin is inserted from medial to lateral through the calcaneus to correct the varus mal-positioning of the calcaneus in the sagittal plane and to provide a better control on the small sized, hind-foot during casting. We paid special attention to the final hind-foot deformity after surgery, and the results were favorable after the application of this transverse pin.

  4. In vitro kinematics of the axially loaded ankle complex in response to dorsiflexion and plantarflexion.

    Science.gov (United States)

    Hintermann, B; Nigg, B M

    1995-08-01

    The rotational movements of the tibia and calcaneus that occur with dorsiflexion-plantarflexion and axial loading were studied in cadaver foot-leg specimens using an unconstrained testing apparatus. Independent of the foot flexion position, significant internal rotation of the tibia and eversion of the calcaneus were noted after the ankle complex was axially loaded. Independent of loading, 10 degrees of dorsiflexion resulted in 0.1 degrees of eversion and 2.1 degrees of internal rotation of the tibia. Conversely, 10 degrees of plantarflexion resulted in 1.6 degrees of inversion and 1.3 degrees of external rotation of the tibia. The induced rotational movements of the tibia and the calcaneus differed significantly between the specimens. These results suggest that the foot "axes" did not change by axially loading the ankle complex and they support previous reports that the ankle complex uses different axes for dorsiflexion and plantarflexion.

  5. Determination of normal values for navicular drop during walking: a new model correcting for foot length and gender

    DEFF Research Database (Denmark)

    Nielsen, Rasmus G; Rathleff, Michael S; Simonsen, Ole H

    2009-01-01

    ABSTRACT: BACKGROUND: The navicular drop test is a measure to evaluate the function of the medial longitudinal arch, which is important for examination of patients with overuse injuries. Conflicting results have been found with regard to differences in navicular drop between healthy and injured...... on the navicular tuberosity and the line between the markers on calcaneus and first metatarsal head. The distance between the floor and the line in standing position between the markers on calcaneus and first metatarsal were added afterwards. RESULTS: 280 randomly selected participants without any foot problems...... to some extent, the disagreement between previous studies on navicular drop. Future studies should account for differences in these parameters....

  6. Overset traethedsbrud i haelbenet

    DEFF Research Database (Denmark)

    Jeppesen, Katrine Arp; Palm, Henrik; Ebskov, Lars

    2009-01-01

    A stress fracture of the calcaneus is the result of rhythmically recurring sub-threshold traumata and is typically seen in athletes. The diagnosis is difficult because stress fractures are easily missed in traditional radiographs. It is therefore recommended to perform magnetic resonance imaging....

  7. Routine MRI findings of the asymptomatic foot in diabetic patients with unilateral Charcot foot

    Directory of Open Access Journals (Sweden)

    Poll Ludger W

    2010-04-01

    Full Text Available Abstract Background Imaging studies of bones in patients with sensory deficits are scarce. Aim To investigate bone MR images of the lower limb in diabetic patients with severe sensory polyneuropathy, and in control subjects without sensory deficits. Methods Routine T1 weighted and T2-fat-suppressed-STIR-sequences without contrast media were performed of the asymptomatic foot in 10 diabetic patients with polyneuropathy and unilateral inactive Charcot foot, and in 10 matched and 10 younger, non-obese unmatched control subjects. Simultaneously, a Gadolinium containing phantom was also assessed for reference. T1 weighted signal intensity (SI was recorded at representative regions of interest at the peritendineal soft tissue, the tibia, the calcaneus, and at the phantom. Any abnormal skeletal morphology was also recorded. Results Mean SI at the soft tissue, the calcaneus, and the tibia, respectively, was 105%, 105% and 84% of that at the phantom in the matched and unmatched control subjects, compared to 102% (soft tissue, 112% (calcaneus and 64% (tibia in the patients; differences of tibia vs. calcaneus or soft tissue were highly significant (p Conclusion MR imaging did not reveal grossly abnormal bone marrow signalling in the limbs with severe sensory polyneuropathy, but occult sequelae of previous traumatic injuries.

  8. Endoscopic calcaneoplasty

    NARCIS (Netherlands)

    van Dijk, C. N.; van Dyk, G. E.; Scholten, P. E.; Kort, N. P.

    2001-01-01

    Endoscopic calcaneoplasty offers access to the retrocalcaneal space, thereby making it possible to remove inflamed retrocalcaneal bursa as well as the posterosuperior part of the calcaneus in applicable cases of painful hindfoot. In this study, endoscopic calcaneoplasty was performed in 21

  9. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis

    NARCIS (Netherlands)

    van Sterkenburg, M.N.; Muller, B.; Maas, M.; Sierevelt, I.N.; van Dijk, C.N.

    2010-01-01

    Background and purpose A retrocalcaneal bursitis is caused by repetitive impingement of the bursa between the Achilles tendon and the posterosuperior calcaneus. The bursa is situated in the posteroinferior corner of Kager's triangle (retrocalcaneal recess), which is a radiolucency with sharp borders

  10. 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.

  11. 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.

  12. Intra-articulaire calcaneusfracturen

    NARCIS (Netherlands)

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

    2008-01-01

    textabstractABSTRACT About 0.6% of all fractures is an intra-articular calcaneal fracture. Patients often have additional injuries, and returning to work can take up to one year. The diagnostics consist of plain, lateral and axial, radiographs of the calcaneus. In addition a CT-scan is performed in

  13. 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

  14. 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 ...

  15. Original Research Article Body Mass Index and Blood Pressure ...

    African Journals Online (AJOL)

    Erah

    overweight and under-nutrition among these students were determined according .... clinic. Before the height was measured, the subjects were asked to remove their shoes or sandals, and made to stand against the marked wall with their calcaneus, gluteus and occiput touching it .... terms of some cardiovascular risk factors.

  16. Bone status in rheumatoid arthritis assessed at peripheral sites by three different quantitative ultrasound devices

    DEFF Research Database (Denmark)

    Madsen, O R; Suetta, C; Egsmose, C

    2004-01-01

    sites in 27 women with RA (mean disease duration 15 years) and in 36 healthy women matched for age, height and weight. Speed of sound (SOS, m/s), broadband ultrasound attenuation (BUA, dB/MHz) and stiffness of the calcaneus were assessed by a Lunar Achilles device. Amplitude-dependent SOS (Ad-SOS, m...

  17. Finite Element Analysis of the Achilles Tendon While Running

    Directory of Open Access Journals (Sweden)

    Anițaș Răzvan

    2013-02-01

    Full Text Available Introduction: The Achilles tendon is the most frequent recipient of traumatic injuries. The aim of this study is to identify and describe the varying load at ankle level and especially at the Achilles tendon’s insertion on the calcaneus.

  18. Three-dimensional in vivo kinematics of the subtalar joint during dorsi-plantarflexion and inversion-eversion.

    Science.gov (United States)

    Goto, Akira; Moritomo, Hisao; Itohara, Tomonobu; Watanabe, Tetsu; Sugamoto, Kazuomi

    2009-05-01

    It is difficult to determine the kinematics of the subtalar joint because of its anatomical and functional complexity. The purpose of the study was to clarify the 3D kinematics of the subtalar joint in vivo. Subjects were four healthy female volunteers. Magnetic resonance imaging (MRI) sequences were acquired in seven positions during dorsi-plantarflexion (DPF) and in 10 positions during inversion-eversion (IE) at intervals of 10 degrees. MRI data of the talus and calcaneus in the neutral position were superimposed on images of the other positions using voxel-based registration, and relative motions and axes of rotation were visualized and quantitatively calculated. The calcaneus always rotated from dorsolateral to medioplantar during DPF and IE, and the motion plane was very similar to that of the entire foot in IE. The axes of rotation of the calcaneus relative to the talus during DPF and IE had a very close spatial relationship, running obliquely from antero-dorso-medial to postero-planto-lateral and penetrating the talar neck. The rotation angle around each of these calcaneal axes tended to be greater in IE (20 degrees +/- 2 degrees) than in DPF (16 degrees +/- 3 degrees). In DPF, motion of the calcaneus relative to the talus occurred predominantly around maximum dorsiflexion and plantarflexion, with little movement observed at intermediate positions. During IE, the calcaneus exhibited uninterrupted motion related to foot movement. The subtalar joint is essentially a uniaxial joint with a motion plane almost identical to that of IE of the entire foot. Knowledge of normal subtalar kinematics may be helpful when evaluating pathologic conditions.

  19. 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

  20. Ultrasound velocity and broadband attenuation as predictors of load-bearing capacities of human calcanei.

    Science.gov (United States)

    Han, S; Medige, J; Davis, J; Fishkin, Z; Mihalko, W; Ziv, I

    1997-01-01

    The main purpose of this study was to determine whether calcaneal ultrasound parameters, measured in the mediolateral direction, reflect load-bearing capacities of human calcanei. Broadband ultrasound attenuation (BUA) and ultrasound velocity (UV) were measured in 20 cadaveric calcanei with a mean age of 74.1 (SD 8.8). Normalized BUA (nBUA) was determined by dividing BUA by the calcaneal thickness obtained using a pulse-echo technique. The bone mineral density (BMD) of each calcaneus was measured by quantitative computed tomography. The calcanei were embedded in PMMA to simulate the midstance physiologic orientation during compressive testing in the load-bearing direction. The failure load, stiffness, and energy absorption were determined for each calcaneus. It was shown that BMD was well correlated with all ultrasound parameters (P 0.5).

  1. [Foot involvement in Paget's disease of bone].

    Science.gov (United States)

    Claustre, J; Blotman, F; Simon, L

    1976-01-01

    Paget's disease of the bones of the feet is not unusual. Twenty patients out of every hundred present the signs of Paget's disease in the foot bones. The calcaneus is the bone most often affected (18 cases) but the cuboid, the metatarsals, and the astragalus (often as well as the calcaneus) may also be affected. Paget's disease of the foot remains latent clinically: 2 patients complained of talalgia; a third had a deformation of the rear part of the foot which made it difficult to wear a shoe. Pagetic deformations of the lower limb affect the foot but without pain. They are often compensated for by putting more weight on the fore-foot in cases of shortening of the lower limb or on the external arch in cases of bowed deformation of the lower limb.

  2. 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.

  3. “Don Juan-Fracture” as a Hint to Aortic Isthmus Rupture

    Directory of Open Access Journals (Sweden)

    Sirilak Suksompong

    2014-01-01

    Full Text Available We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called “Don-Juan fracture,” and aortic rupture at the site of ligamentum arteriosum are discussed.

  4. Diagnostika a terapie patní kosti a souvisejících problémů z pohledu fyzioterapeuta

    OpenAIRE

    Margoliusová, Kateřina

    2017-01-01

    Title of Bachelor Thesis: Diagnosis and therapy of calcaneus - related problems from a physiotherapist's point of view Abstract of Bachelor Thesis: The actual number of diagnoses related to the calcaneum is vast. This thesis deals with the diagnostics and therapy of problems in the calcaneum area and the possibilities of their therapy with an enhanced focus on the area of the calcaneal tubercle. The work is divided into two parts. The theoretical section contains basic information concerning ...

  5. Unilateral Absence of Plantaris muscle in Ethiopian Cadavers – a case report

    OpenAIRE

    Hafte Assefa Beyene; Birhane Alem Berihu; Yared godefa; Gebrekidan Gebregzabher

    2016-01-01

    Plantaris is the largest muscle in mammals other than primates. It runs alongside the gastrosoleus complex, and continues along the medial aspect of the Achilles tendon (AT) before inserting onto the greater tuberosity of the calcaneus. The plantaris muscle is vestigial in human beings and has much clinical importance. It is known to present several anatomical variations in terms of its occurrence, origin, course, relation with surrounding neurovascular structures and insertion. It may be abs...

  6. Age-related decrements in bone mineral density in women over 65

    Science.gov (United States)

    Steiger, P.; Cummings, S. R.; Black, D. M.; Spencer, N. E.; Genant, H. K.

    1992-01-01

    Age-related changes in bone density contribute to the risk of fractures. To describe the relationship between age and bone mass in elderly women, we studied a large cohort of women over age 65 years who were recruited from population-based lists in four cities in the United States. Bone density in g/cm2 was measured by single-photon absorptiometry (SPA) and dual x-ray absorptiometry (DXA) at the distal and proximal radius, the calcaneus, the lumbar spine, and the proximal femur. Centralized data collection was used to control data quality and consistency. We found a strong inverse relationship between bone density and age for most sites. Decrements in bone density between women aged 65-69 years and women 85 years and older exceeded 16% in all regions except the spine, where the difference between the two age groups was 6%. Ward's triangle and the calcaneus exhibited the largest decrements, with 26 and 21%, respectively. The estimates of annual changes in bone mineral density by linear regression at sites other than the spine ranged from -0.82% at the femoral neck and trochanter to -1.30% at Ward's triangle. Correlations between the different regions ranged from r = 0.51 between the proximal radius and Ward's triangle to r = 0.66 between the distal radius and calcaneus. We conclude that the inverse relationship between age and bone mass measured by absorptiometry techniques in white women continues into the ninth decade of life. The relationship is strongest for bone density of Ward's triangle and the calcaneus and weakest for the spine.

  7. Measurement technique of calcaneal varus from axial view radiograph

    Directory of Open Access Journals (Sweden)

    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.

  8. [Complex injuries associated with somnambulism].

    Science.gov (United States)

    Sillesen, Nanna Hylleholt; Nielsen, Lisa Toft; Bonde, Christian

    2010-12-13

    Up to 3% of adults walk in their sleep and some perform complex behaviours. Treatment recommendations for sleepwalking are inconsistent. This case report describes a 64-year-old man who climbed out of a 2nd floor toilet window during somnambulism. He fell 6-8 meters and fractured the tibia, fibula, cervical columna, lumbal columna, calcaneus, costae and suffered a pneumothorax. Evidence to support sleepwalking treatment is lacking and besides benzodiazepines, prevention is the preferred treatment choice according to the literature.

  9. Ecomorphological analysis of the astragalo-calcaneal complex in rodents and inferences of locomotor behaviours in extinct rodent species

    OpenAIRE

    Samuel Ginot; Lionel Hautier; Laurent Marivaux; Monique Vianey-Liaud

    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 des...

  10. Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

    Directory of Open Access Journals (Sweden)

    Malkoc Melih

    2015-03-01

    Full Text Available Plantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.

  11. Primary Care Management of Plantar Fasciitis.

    Science.gov (United States)

    Melvin, Thomas J; Tankersley, Zach J; Qazi, Zain N; Jasko, John J; Odono, Russell; Shuler, Franklin D

    2015-01-01

    Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed.

  12. Lower Extremity Disorders among Men and Women in Army Basic Training and Effects of Two Types of Boots

    Science.gov (United States)

    1983-01-01

    highest percentages of the men’s sick call visits were made for treatment of blisters, chondromalacia patellae , and pes planus pain. Blisters... chondromalacia patellae , and stress reactions of the calcaneus accounted for the highest proportions of the women’s sick call visits. Among the men, the highest...proportions of days spent on restricted duty were due to chondromalacia patellae , lateral ankle sprains, and medial tibial flare stress reactions. The

  13. The medial oblique foot x-ray: identification of soft tissue shadows seen plantarly.

    Science.gov (United States)

    Lieber, G A

    1983-01-01

    A soft tissue shadow is present on oblique foot x-rays in the arc between the lateral process of the calcaneus and the styloid process of the fifth metatarsal. Surgical placement of metal wires, followed by x-ray examination, has conclusively shown the shadow to have two components, namely, the tendon of peroneus longus and the muscle belly and tendon of abductor digiti minimi. Double screen intensifying cassettes are highly recommended to obtain soft tissue resolution.

  14. New Lethal Skeletal Dysplasia with Dandy-Walker Malformation, Congenital Heart Defects, Abnormal Thumbs, Hypoplastic Genitalia, and Distinctive Facies

    Science.gov (United States)

    Stevens, Cathy A.; Lachman, Ralph S.

    2011-01-01

    We report on two sibs with a lethal form of bone dysplasia with distinctive skeletal findings including rhizomelic and mesomelic limb shortening, hooked clavicles, dumbbell femurs, and absence of talus and calcaneus ossification. Other clinical features include Dandy-Walker malformation, congenital heart defects, joint contractures, genital hypoplasia, and distinctive facial features. These sibs appear to have a previously undescribed skeletal dysplasia, which is most likely inherited in an autosomal recessive fashion. PMID:20602491

  15. Strategies for Managing Massive Defects of the Foot in High-Energy Combat Injuries of the Lower Extremity

    Science.gov (United States)

    2010-01-01

    distraction osteogenesis, bone segment short- ening/ rotationplasty , and fusion all have a role to play in salvaging massive bone defects in the foot...ipsilateral proximal tibia.34 Alternatively, the remaining calca- neal bone stock can be realigned for in situ fusion or rotationplasty avoiding the need...segmental loss of the calcaneus. (B) Lateral foot radiograph illustrating calcaneal ‘‘ rotationplasty ’’ to treat bone loss with an immediate subtalar

  16. Influence of arthrodeses on kinematics of the axially loaded ankle complex during dorsiflexion/plantarflexion.

    Science.gov (United States)

    Hintermann, B; Nigg, B M

    1995-10-01

    The purpose of this study was to quantify the effect of selective arthrodesis (stabilization) of the ankle, subtalar, and talonavicular joints on the rotational movement of the tibia and the calcaneus occurring with dorsiflexion/plantarflexion. Six cadaver foot-leg specimens were investigated using an unconstrained testing apparatus. Simulated ankle joint arthrodesis caused a large increase in tibial rotation and calcaneal eversion-inversion. Subtalar and talonavicular stabilization did not cause as large a rotation.

  17. Posterior Cruciate Ligament Retention or Substitution During Total Knee Arthroplasty Does Not Affect Long-Term Bone Mineral Density or Quality.

    Science.gov (United States)

    Ishii, Yoshinori; Noguchi, Hideo; Sato, Junko; Todoroki, Koji; Toyabe, Shin-Ichi

    2017-04-01

    Physical activity is recognized as one of the factors that influence bone mineral density (BMD) and bone quality after total knee arthroplasty (TKA). According to biomechanical analyses after posterior cruciate ligament (PCL) retaining (PCLR) and substituting (PCLS) TKA, each implant design has different kinematics and kinetics. The purposes of this study were: (1) to perform within-patient comparisons of the midterm and long-term effects of PCL retention in mobile-bearing TKA on proximal femur and tibia BMD and calcaneus bone quality measured using ultrasound and (2) to identify correlations between them. A prospective, quasi-randomized design was used. Thirty-seven patients (74 knees) who underwent bilateral TKA (PCLR on one side and PCLS on the other) were evaluated. Mean follow-up periods were 118 months (standard deviation 40) and 117 months (standard deviation 36) in knees with PCLR and PCLS implants, respectively. The BMDs of the total hip and proximal tibia and broadband ultrasound attenuation (BUA; dB/MHz) through the calcaneus were measured. The mean BMD of PCLR and PCLS were equivalent at the proximal hip and tibia. The BUA of the calcaneus was also the same between implants. There were significant correlations between the 3 anatomic sites. When measured approximately 10 years after TKA, PCL retention had no substantial effect on the BMD of the proximal femur and tibia, or on the bone quality of the calcaneus. The measurement of noninvasive BUA may predict BMD, although further analysis is required. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Histomorphological and biochemical properties of plantar soft tissue in diabetes.

    Science.gov (United States)

    Wang, Yak-Nam; Lee, Kara; Shofer, Jane B; Ledoux, William R

    2017-12-01

    Diabetes results in pathophysiological changes, leading to tissue that is unable to withstand and adapt to the same loads, resulting in breakdown. Certain locations are more susceptible to breakdown, yet differences between locations are largely not well understood. The authors performed a histological and biochemical analysis of isolated plantar adipose tissue at six relevant locations. Tissue from six plantar locations (hallux, first, third and fifth metatarsal heads, lateral midfoot and calcaneus) was taken from fresh cadaveric feet of older diabetic and older non-diabetic intact donors. Histomorphological and biochemical analysis of isolated plantar tissue from both diabetic and non-diabetic feet at six relevant locations was performed. The main differences found between diabetic and non-diabetic tissue were in the thickness of the septal walls and the elastin content. Diabetic tissue had significantly thicker septal walls and an increased elastin concentration. When comparing the calcaneus to other locations, although there were no differences found in the thickness of the septal walls of diabetic tissue, elastin content was lower in the calcaneous tissue compared to the non-calcaneus sites. Modifications in the structural and biochemical properties could translate to changes in the mechanical properties. This information could lead to an understanding of how the structural and biochemical changes result in an increase in susceptibility of tissue to breakdown with load at the different locations of the foot. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Fractal dimension analysis in digital periapical radiographs: A diagnostic indicator of osteoporosis in post-menopausal women

    Directory of Open Access Journals (Sweden)

    Mathivanan Kavitha

    2017-01-01

    Full Text Available Objectives: To assess the alveolar bone density by fractal dimension (FD analysis in radiovisiograph of postmenopausal women of mandibular posterior region and to correlate FD values with t-scores of quantitative ultrasound of the calcaneus bone. Materials and Methods: This study, approved by the institutional review board, included 40 participants, aged 45–60 years divided into two groups. Twenty postmenopausal women with osteoporosis comprised group 1, and 20 postmenopausal women without osteoporosis comprised group 2 based on bone mineral density assessment of ultrasound of the calcaneus bone. Digital dental radiograph of mandibular first molar were obtained and used for assessing alveolar bone density by FD analysis and were correlated with t-scores of ultrasound of calcaneus bone. Results: The mean FD values were evaluated using SPSS 14 version software, and were found to be 1.738 and 1.867 for group 1 and group 2, respectively, which was statistically significant (P 0.05. Conclusion: FD analysis using direct digital periapical radiographs is a novel method, which can be used for early diagnosis of osteoporosis in the alveolar bone.

  20. Rearfoot posture of Australopithecus sediba and the evolution of the hominin longitudinal arch.

    Science.gov (United States)

    Prang, Thomas C

    2015-12-02

    The longitudinal arch is one of the hallmarks of the human foot but its evolutionary history remains controversial due to the fragmentary nature of the fossil record. In modern humans, the presence of a longitudinal arch is reflected in the angular relationships among the major surfaces of the human talus and calcaneus complex, which is also known as the rearfoot. A complete talus and calcaneus of Australopithecus sediba provide the opportunity to evaluate rearfoot posture in an early hominin for the first time. Here I show that A. sediba is indistinguishable from extant African apes in the angular configuration of its rearfoot, which strongly suggests that it lacked a longitudinal arch. Inferences made from isolated fossils support the hypothesis that Australopithecus afarensis possessed an arched foot. However, tali attributed to temporally younger taxa like Australopithecus africanus and Homo floresiensis are more similar to those of A. sediba. The inferred absence of a longitudinal arch in A. sediba would be biomechanically consistent with prior suggestions of increased midtarsal mobility in this taxon. The morphological patterns in talus and calcaneus angular relationships among fossil hominins suggest that there was diversity in traits associated with the longitudinal arch in the Plio-Pleistocene.

  1. 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.

  2. 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.

  3. Fractal dimension of bone texture in radiographs correlates to ultrasound broadband attenuation T-score.

    Science.gov (United States)

    Bianciardi, Giorgio; Bisogno, Stefania; Bertoldi, Ilaria; Laurini, Lorella; Coviello, Giuseppe; Frediani, Bruno

    2013-01-01

    We aimed to measure the fractal dimension on x-ray images and ultrasonographic parameters of the os calcis of bone from 4 districts in osteoporotic patients and in control subjects, in order to test the hypothesis that ultrasonographic parameters correlate to the fractal dimension obtained on x-ray images. Fractal analysis on radiological images from 4 bone districts (proximal femur, calcaneus, metacarpus and 3rd phalanx) was performed in a study comparing ultrasonographic evaluation of the os calcis in severe osteoporotic patients and in control cases. We studied 86 x-ray-views from patients with severe reduction of ultrasound Stiffness Index and in healthy women. Ultrasound measurements of left os calcis were performed using the Lunar Achilles-Plus instrument. Fractal analysis was performed using the box-counting method. In healthy subjects, fractal dimension, D, measure of structural complexity, resulted close to the topological dimension (no fractal structure), TD, in femur (1.99±0.03)and phalanx (1.96±0.03), D differed significantly from TD in calcaneus (D=1.90±0.02; pfractal dimension and ultrasound broadband attenuation T-score correlated significantly in calcaneus and metacarpus (pfractal analysis on radiographic images may add useful structural information regarding the patients' skeleton using non invasive procedures.

  4. In vivo three-dimensional analysis of hindfoot kinematics in stage II PTTD flatfoot.

    Science.gov (United States)

    Xu, Jian; Zhang, Yijun; Muhammad, Hassan; Wang, Xu; Huang, Jiazhang; Zhang, Chao; Geng, Xiang; Ma, Xin

    2015-05-01

    This study aims to evaluate the rotation and translation of each joint in the hindfoot and compare the differences in healthy foot with that in stage II PTTD flatfoot by analyzing the reconstructive three-dimensional (3D) computed tomography (CT) image data during several extreme positions. CT scans of 20 healthy feet and 20 feet with stage II PTTD flatfoot were taken in maximal positions of plantarflexion, dorsiflexion, inversion, eversion, external rotation and internal rotation conditions. The images of the hindfoot bones were reconstructed into 3D models. The "twice registration" method was used to calculate the spatial changes of the talus relative to the calcaneus in the talocalcaneal joint, the navicular relative to the talus in talonavicular joint, and the cuboid relative to the calcaneus in the calcaneocuboid joint. Compared with normal participants, with the calcaneus relative to the talus, participants with stage II PTTD flatfoot presented more dorsiflexion (p plantarflexion to maximal dorsiflexion; more dorsiflexion (p plantarflexion to maximal dorsiflexion; more eversion (p  0.05). As previous studies shown, regarding both of the cadaveric foot and the live foot, hindfoot joint instability occurred in patients with stage II PTTD flatfoot.

  5. Efeitos no tornozelo da mielomeningocele pós-tenodese de Westin Effects of myelomeningocele in the ankle after Westin tenodesis

    Directory of Open Access Journals (Sweden)

    Patrícia Maria de Moraes Barros Fucs

    2007-12-01

    Full Text Available OBJETIVO: Avaliar o aumento do crescimento fibular em pacientes portadores de seqüela da mielomeningocele com deformidades em pé calcâneo e valgismo do tornozelo submetidos à tenodese de Westin. MÉTODOS: O estudo avaliou seis pacientes (12 pés portadores de seqüela de mielomeningocele, deambuladores comunitários, submetidos à tenodese do calcâneo na fíbula com pontos transósseos, seguindo a técnica originalmente descrita por Westin, no período de janeiro de 1996 a dezembro de 2000. RESULTADOS: A análise dos resultados da diferença de altura intermaleolar em pacientes com seqüela de mielomeningocele apresentando deformidade tipo pé calcâneo, submetidos ao tratamento cirúrgico com tenodese do calcâneo pela técnica de Westin, evidenciou crescimento do maléolo lateral importante quando comparado com as medidas pré-operatórias (p OBJECTIVE: To evaluate the increased fibular growth in patients with myelomeningocele sequelae with deformities in calcaneus foot and ankle valgus submitted to Westin tenodesis. METHODS: The study evaluated six patients (12 feet with myelomeningocele sequelae, ambulant, submitted to tenodesis of the calcaneus tendon in the fibula, with transbone stitches following the technique that was originally described by Westin, from January 1996 to December 2000. RESULTS: Analysis of the results of the intermaleolar height difference presenting calcaneus foot deformity and submitted to surgical treatment with calcaneus tendon tenodesis according to the Westin technique showed a major growth of the lateral malleolus when compared to pre-operative measurements (p < 0.05. Results also show that the lateral malleolus growth is not related to the patient age when he or she was submitted to surgery. All of the six patients presented different growth patterns along the follow-up. When the authors evaluated the correction of the valgus angle in the ankle, they found a decrease of the angle, with partial or total

  6. Biomechanical Analysis of Suture Anchor vs Tenodesis Screw for FHL Transfer.

    Science.gov (United States)

    Drakos, Mark C; Gott, Michael; Karnovsky, Sydney C; Murphy, Conor I; DeSandis, Bridget A; Chinitz, Noah; Grande, Daniel; Chahine, Nadeen

    2017-07-01

    Chronic Achilles injury is often treated with flexor hallucis longus (FHL) tendon transfer to the calcaneus using 1 or 2 incisions. A single incision avoids the risks of extended dissections yet yields smaller grafts, which may limit fixation options. We investigated the required length of FHL autograft and biomechanical profiles for suture anchor and biotenodesis screw fixation. Single-incision FHL transfer with suture anchor or biotenodesis screw fixation to the calcaneus was performed on 20 fresh cadaveric specimens. Specimens were cyclically loaded until maximal load to failure. Length of FHL tendon harvest, ultimate load, stiffness, and mode of failure were recorded. Tendon harvest length needed for suture anchor fixation was 16.8 ± 2.1 mm vs 29.6 ± 2.4 mm for biotenodesis screw ( P = .002). Ultimate load to failure was not significantly different between groups. A significant inverse correlation existed between failure load and donor age when all specimens were pooled (ρ = -0.49, P Anchor failure occurred mostly by suture breakage (n = 8). Adequate FHL tendon length could be harvested through a single posterior incision for fixation to the calcaneus with either fixation option, but suture anchor required significantly less graft length. Stiffness, fixation strength, and load to failure were comparable between groups. An inverse correlation existed between failure load and donor age. Younger specimens with screw fixation demonstrated significantly greater failure loads. Adequate harvest length for FHL transfer could be achieved with a single posterior incision. There was no difference in strength of fixation between suture anchor and biotenodesis screw.

  7. Calcaneocuboid joint and stability of the longitudinal arch of the foot at high and low gear push off.

    Science.gov (United States)

    Bojsen-Møller, F

    1979-08-01

    The calcaneocuboid joint was studied in ligamentous specimens of ten human feet, and in skeletons of two gorillas (Gorilla gorilla beringei), six chimpanzees (Pan troglodytes), three orangutans (Pongo pygmaeus) and 25 human feet. The movement of the transverse tarsal joint was further studied in a living foot on a walk-way with a glass plate inserted, and with an underlying mirror. In man the joint is shaped as an asymmetrical sector of one end of an hour-glass shaped surface of revolution with its main axis oriented longitudinally in the foot. The calcaneocuboid joint becomes close packed by a pronation of the forefoot in relation to the hind foot because of a congruency between the joint surfaces obtained in this position and because the calcaneus overhangs the cuboid dorsally and stops the movement. At low gear push off the foot is inverted and the calcaneocuboid joint loose packed. The stresses are absorbed across the fibular, postaxial border of the foot. At high high gear push off there is a functional pronation of the forefoot with a stabilization of the transverse tarsal joint and a more effective tightening of the plantar aponeurosis. The foot becomes a rigid lever for propulsion. In contrast to the human condition, the anthropoid calcaneus has an anteromedial extension associated with symmetry of the calcaneocuboid joint. The calcaneus does not overhang the cuboid and there appears to be no close packed position. Correspondingly, the anthropoid foot has a mid-tarsal break at each push off in addition to the metatarsophalangeal break.

  8. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study.

    Science.gov (United States)

    Wong, Yue Shuen

    2007-05-01

    Most studies of degenerative flatfoot have focused on the posterior tibial muscle, an extrinsic muscle of the foot. However, there is evidence that the intrinsic muscles, in particular the abductor hallucis (ABH), are active during late stance and toe-off phases of gait. The purpose of this study was to analyze the kinematic effect of a simulated contraction of the abductor hallucis muscle on a cadaver lower limb specimen. Eight below-knee cadaver specimens were prepared. The abductor hallucis muscle was exposed and the entire muscle-tendon unit excised. A suture secured to the calcaneal origin of the muscle and tendon was passed through a pulley at the ABH sesamoid attachment. The specimen was mounted on an experimental rig in a 'standing' position. Motions in the first metatarsal, tibia, and calcaneus were tracked using the 'Flock of Birds' motion analysis system (Ascension Technology, Burlington, VT). Muscle contraction was simulated by applying tension on the suture. All eight specimens showed an origin from the posteromedial calcaneus and an insertion at the tibial sesamoid. All specimens also demonstrated a fascial sling in the hindfoot, lifting the abductor hallucis muscle to give it an inverted 'V' shaped configuration. Simulated contraction of the abductor hallucis muscle caused flexion and supination of the first metatarsal, inversion of the calcaneus, and external rotation of the tibia, consistent with elevation of the arch. The abductor hallucis muscle acts as a dynamic elevator of the arch. Understanding this mechanism may change the way we understand and treat pes planus, posterior tibial tendon dysfunction, hallux valgus, and Charcot neuroarthropathy.

  9. Transient and long-time kinetic responses of the cadaveric leg during internal and external foot rotation.

    Science.gov (United States)

    Mait, Alexander R; Mane, Adwait; Forman, Jason L; Donlon, John Paul; Nie, Bingbing; Kent, Richard W

    2017-02-28

    The purpose of this study was to determine the long-time and transient characteristics of the moment generated by external (ER) and internal (IR) rotation of the calcaneus with respect to the tibia. Two human cadaver legs were disarticulated at the knee joint while maintaining the connective tissue between the tibia and fibula. An axial rotation of 21° was applied to the proximal tibia to generate either ER or IR while the fibula was unconstrained and the calcaneus was permitted to translate in the transverse plane. These boundary conditions were intended to allow natural motion of the fibula and for the effective applied axis of rotation to move relative to the ankle and subtalar joints based on natural articular motions among the tibia, fibula, talus, and calcaneus. A load cell at the proximal tibia measured all components of force and moment. A quasi-linear model of the moment along the tibia axis was developed to determine the transient and long-time loads generated by this ER/IR. Initially neutral, everted, inverted, dorsiflexed, and plantarflexed foot orientations were tested. For the neutral position, the transient elastic moment was 16.5N-m for one specimen and 30.3N-m for the other in ER with 26.3 and 32.1N-m in IR. The long-time moments were 5.5 and 13.2N-m (ER) and 9.0 and 9.5N-m (IR). These loads were found to be transient over time similar to previous studies on other biological structures where the moment relaxed as time progressed after the initial ramp in rotation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. The effect of goniometric alignment on passive ankle dorsiflexion range of motion among patients following ankle arthrodesis or arthroplasty.

    Science.gov (United States)

    Conley, Kelly A; Geist, Kathleen; Shaw, Jonathan N; Labib, Sameh A; Johanson, Marie A

    2012-06-01

    Goniometric measurement is a standard method used to quantify limited ankle dorsiflexion (DF). However, compensatory motion at the subtalar and midtarsal joints might also contribute to the amount of ankle DF obtained by goniometric measurements. The purpose of this study was to examine the effect of goniometric alignment on DF range of motion measurement among patients following ankle arthrodesis or arthroplasty and age- and gender-matched controls. A total of 22 participants were recruited to participate in this observational cohort study, including 7 patients following total ankle arthroplasty (2 male, 5 female; mean age = 67.5 years, standard deviation [SD] = 9.6 years), 4 patients following ankle arthrodesis (2 male, 2 female; mean age = 70.5 years, SD = 5.2 years), and 11 age- and gender-matched controls (4 male, 7 female; mean age 67.5 years, SD = 9.0 years). Two investigators measured and recorded ankle DF passive range of motion (PROM) using a randomly determined sequence of 2 alignment methods: (1) the distal aspect of the lateral calcaneus, and (2) the fifth metatarsal. One-sample t tests were performed to assess differences in ankle DF between the 2 different alignment methods. Significantly greater degrees of DF were obtained when aligning with the fifth metatarsal versus the lateral calcaneus on the patients' uninvolved sides and the randomly selected side of matched controls (P .05). This study found that more degrees of DF PROM are measured when aligning a goniometer with the fifth metatarsal versus the calcaneus on the uninvolved side of patients and matched controls. Diagnostic, Level IV.

  11. Influence of Estrogen Receptor α Polymorphisms on Bone Density in Response to Habitual Exercise in Japanese Postmenopausal Women

    OpenAIRE

    Kondo, Hiroyo; Fujino, Hidemi; Nagatomo, Fumiko; Ishihara, Akihiko

    2014-01-01

    Estrogen receptor α (ER α) is one of candidate genes for osteoporosis. This study examined the influence of ER α gene, PvuII, and XbaI genotypes on bone density of calcaneus in response to habitual exercise. ER α polymorphisms were detected using PvuII and XbaI restriction enzymes in 316 Japanese postmenopausal women. The bone density was significantly lower in the women carrying PP, pp, or xx genotype without habitual exercise than in the age-matched women without those genotypes. The women ...

  12. Normal osseous variants presenting as cystic or lucent areas on radiography and CT imaging: a pictorial overview

    Energy Technology Data Exchange (ETDEWEB)

    Wilde, Vally de; Maeseneer, Michel de E-mail: midema@village.uunet.be; Lenchik, Leon; Roy, Peter van; Beeckman, Paul; Osteaux, Michel

    2004-07-01

    We present a number of commonly encountered pseudolesions. These represent areas of the skeleton that are relatively radiolucent simulating an osteolytic or cystic lesion. Such areas discussed in this article include the superolateral humeral head, rhomboid fossa of the clavicle, scapular defect, supratrochlear foramen, biceps tendon insertion, vascular channel of the ulna, distal condylar area of the knee, 'bone in bone' disturbance, dorsal defect of the patella, metadiaphyseal area, 'Wards' triangle', inframalleolar fossa of the fibula, and anterior lytic defect of the calcaneus. We provide an overview of commonly encountered pseudolesions, that may lead to false positive diagnosis of an osteolytic or cystic lesion.

  13. Intraosseous Lipoma of the Maxilla in a Patient with Henoch-Schönlein Purpura: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Soysal Baş

    2017-12-01

    Full Text Available Intraosseous lipomas are rare benign tumors of the bone that are mostly seen in the metaphysis of long bones and the calcaneus. Intraosseous lipomas are generally asymptomatic, and surgically removed when they are symptomatic or cause cosmetic concerns. Intraosseous lipomas of the maxillary bone have rarely been reported. In this report, we present a case of maxillary intraosseous lipoma in an 11-year-old girl with Henoch-Schönlein purpura-a rare case reported for the first time in the literature.

  14. [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

    PURPOSE OF THE STUDY The aim of the study was to analyse the options for sustentacular screw placement in osteosynthesis of intra-articular fractures of the heel bone and to assess the effect of various screw positions on failure to maintain the reduction in the postoperative period. In addition, problems related to screw-end protrusion over the medial cortical bone or to screw penetration into the talocalcaneal joint were assessed. MATERIAL AND METHODS The group comprised 23 patients with a total of 25 intra-articular fractures of the heel bone treated by surgery. The procedure involved insertion of a sustentacular screw under fluoroscopic guidance. Post-operatively, screw position in the sustentacular fragment was evaluated on CT scans. During follow-up, attention was focused on the effect of screw placement on maintenance of fracture reduction, and clinical symptoms potentially associated with screw malposition were recorded. RESULTS All sustentacular screws were fixed sustentacular fragments. Seven screws (28%) were inserted in the talar shelf, seven (28%) were placed under and nine (36%) over the sustentaculum tali. Two screws penetrated into the talocalcaneal joint (8%). The end of a screw projecting by 2 mm over the medial wall of the calcaneus was found in 11 cases (44%). Two patients with screws penetrating into the talocalcaneal joint had problems. On the other hand, no clinical effect of a screw extending over the medial wall of the calcaneus was recorded. No significant association of screw position with late //delayed failure of fracture reduction was detected. DISCUSSION Although the ideal trajectory for a sustentacular screw have been defined using a model of the calcaneus, it is not easy to achieve optimal screw placement due to the complex anatomy of the calcaneus and limited possibilities of intra-operative control of screw insertion. Any sustentacular screw malposition is a potential risk factor, particularly if the screw has penetrated into the

  15. [Heel involvement in rheumatoid polyarthritis].

    Science.gov (United States)

    Bouysset, M; Tebib, J G; Vianey, J C; Berthier, M; Nemoz, J C; Chaumentin, G; Schnepp, J; Llorca, G; Bouvier, M

    1990-11-01

    Calcaneus involvement during the course of RA is poorly known. A clinical and radiological study of 408 consecutive rheumatoid feet are then reported. If talalgia was seldomly noted (3.7 p. cent), plantar calcaneitis was found in 29.7 p. cent as plantar spur. Similarly, posterior exostosis was displayed in 30.5 p. cent of patients. These radiological abnormalities are increased in RA but appeared more as a consequence of the statical modification of the foot secondary to RA process than as a direct involvement. Logical orthopedic therapeutics are then proposed.

  16. 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

  17. Mechanical properties of the human Achilles tendon, in vivo

    DEFF Research Database (Denmark)

    Kongsgaard, M; Nielsen, C H; Hegnsvad, S

    2011-01-01

    Ultrasonography has been widely applied for in vivo measurements of tendon mechanical properties. Assessments of human Achilles tendon mechanical properties have received great interest. Achilles tendon injuries predominantly occur in the tendon region between the Achilles-soleus myotendinous...... junction and Achilles-calcaneus osteotendinous junction i.e. in the free Achilles tendon. However, there has been no adequate ultrasound based method for quantifying the mechanical properties of the free human Achilles tendon. This study aimed to: 1) examine the mechanical properties of the free human...

  18. Intertarsal and tarsometatarsal arthrodesis using 2.0/2.7-mm or 2.7/3.5-mm hybrid dynamic compression plates.

    Science.gov (United States)

    Fettig, Arthur A; McCarthy, Robert J; Kowaleski, Michael P

    2002-01-01

    Proximal intertarsal or tarsometatarsal arthrodesis was performed in four dogs using either 2.0/2.7-mm or 2.7/3.5-mm hybrid dynamic compression plates. Mean radiographic follow-up time was 30.5 weeks (range, 15 to 60 weeks). Mean owner follow-up time was 40.5 weeks (range, 27 to 60 weeks). All cases went on to form stable, healed arthrodeses. Owners reported no noticeable lameness problems long term. Complications occurred in one case and included pressure sores and fracture of the calcaneus. Implant failure did not occur in any case.

  19. Lower extremity traction pins: indications, technique, and complications.

    Science.gov (United States)

    Althausen, Peter L; Hak, David J

    2002-01-01

    The placement of pins in the lower extremity for the purpose of skeletal traction is a basic skill required by an orthopedic surgeon. These pins are primarily used for the management of fractures and dislocations. Although simple, the insertion and care of these pins can be accompanied by severe complications including damage to neurovascular structures, physeal injury, ligamentous insult, fracture, and infection. We review the techniques of pin insertion at the distal femur, proximal tibia, and calcaneus to provide a foundation for residents and attendings alike so that unnecessary complications may be avoided and proper placement ensured.

  20. Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report

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    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.

  1. Reconstruction after external hemipelvectomy using tibia-hindfoot rotationplasty with calcaneo-sacral fixation.

    Science.gov (United States)

    Kong, George Yx; Rudiger, Hannes A; Ek, Eugene Th; Morrison, Wayne A; Choong, Peter Fm

    2008-01-21

    External hemipelvectomy is associated with high post operative morbidity and a poor functional outcome. We aim to explore a reconstruction technique to improve function and post operative appearance for patients who undergo external hemipelvectomy. We present a Case where extensive cancer involvement of pelvis and femur was managed with a novel surgical technique, which involved a calf sparing modified anterior flap hemipelvectomy combined with rotationplasty of the spared calf and fixation of calcaneus to the sacrum, thereby recreating a new thigh stump. Tibia-hindfoot rotationplasty result in good functional outcome and appearance for selected patients undergoing external hemipelvectomy with unaffected external iliac and femoral vessels.

  2. From toe to head: use of robust regression methods in stature estimation based on foot remains.

    Science.gov (United States)

    Pablos, Adrián; Gómez-Olivencia, Asier; García-Pérez, Alfonso; Martínez, Ignacio; Lorenzo, Carlos; Arsuaga, Juan Luis

    2013-03-10

    Stature estimation is a standard procedure in the fields of forensic and biological anthropology, bio-archaeology and paleoanthropology, in order to gain biological insights into the individuals/populations studied. The most accurate stature estimation method is based on anatomical reconstruction (i.e., the Fully method), followed by type I regression equations (e.g., ordinary least squares - OLS) based on long bones, preferably from the lower limb. In some cases, due to the fragmentary nature of the osseous material recovered, stature estimates have to rely on other elements, such as foot remains. In this study, we explore stature estimation based on different foot bones: the talus, calcaneus, and metatarsals 1-4 in Afro- and Euroamericans of both sexes. The approach undertaken in this study is novel for two reasons. First, individual estimates for each bone are provided, and tarsals and metatarsals are combined in order to obtain more accurate estimates. Second, robust statistical methods based on type I regression equations are used, namely least trimmed squares (LTS). Our results show that the best individual bones for estimating stature are the first and second metatarsal and both the talus and the calcaneus. The combination of a tarsal and a metatarsal bone slightly improves the accuracy of the stature estimate. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. Human calcanei from the Middle Pleistocene site of Sima de los Huesos (Sierra de Atapuerca, Burgos, Spain).

    Science.gov (United States)

    Pablos, Adrián; Martínez, Ignacio; Lorenzo, Carlos; Sala, Nohemi; Gracia-Téllez, Ana; Arsuaga, Juan Luis

    2014-11-01

    The existence of calcanei in the fossil record prior to modern humans and Neandertals is very scarce. This skeletal element is fundamental to understanding the evolution of the morphology of the foot in human evolution. Here we present and metrically and comparatively describe 29 calcaneus remains from the Middle Pleistocene site of Sima de los Huesos (SH) (Sierra de Atapuerca, Burgos, Spain). These calcanei belong to 15 individuals (nine adults, two adolescents and four immature individuals). The metric and morphological differences in the calcanei among Middle and Late Pleistocene hominins tend to be subtle. However, the calcanei from SH are broad and robust with large articular surfaces and most significantly, exhibit a very projected sustentaculum tali. A biomechanical and phylogenetic interpretation is proffered to explain the observed morphology of these calcanei. It has been possible to propose tentative sex assignments for the SH calcanei based on size, using methods similar to those used to establish sex from the talus bones from SH. The estimation of stature based on the calcaneus provides a mean of 175.3 cm for males and 160.6 for females, which is similar to that obtained using other skeletal parts from the site. In sum, the SH calcanei are robust with a proportionally long tubercle and a projected sustentaculum tali, which are traits shared by Neandertals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Three-dimensional innate mobility of the human foot bones under axial loading using biplane X-ray fluoroscopy.

    Science.gov (United States)

    Ito, Kohta; Hosoda, Koh; Shimizu, Masahiro; Ikemoto, Shuhei; Nagura, Takeo; Seki, Hiroyuki; Kitashiro, Masateru; Imanishi, Nobuaki; Aiso, Sadakazu; Jinzaki, Masahiro; Ogihara, Naomichi

    2017-10-01

    The anatomical design of the human foot is considered to facilitate generation of bipedal walking. However, how the morphology and structure of the human foot actually contribute to generation of bipedal walking remains unclear. In the present study, we investigated the three-dimensional kinematics of the foot bones under a weight-bearing condition using cadaver specimens, to characterize the innate mobility of the human foot inherently prescribed in its morphology and structure. Five cadaver feet were axially loaded up to 588 N (60 kgf), and radiographic images were captured using a biplane X-ray fluoroscopy system. The present study demonstrated that the talus is medioinferiorly translated and internally rotated as the calcaneus is everted owing to axial loading, causing internal rotation of the tibia and flattening of the medial longitudinal arch in the foot. Furthermore, as the talus is internally rotated, the talar head moves medially with respect to the navicular, inducing external rotation of the navicular and metatarsals. Under axial loading, the cuboid is everted simultaneously with the calcaneus owing to the osseous locking mechanism in the calcaneocuboid joint. Such detailed descriptions about the innate mobility of the human foot will contribute to clarifying functional adaptation and pathogenic mechanisms of the human foot.

  5. Movement of the human foot in 100 pain free individuals aged 18-45: implications for understanding normal foot function.

    Science.gov (United States)

    Nester, Christopher J; Jarvis, Hannah L; Jones, Richard K; Bowden, Peter D; Liu, Anmin

    2014-01-01

    Understanding motion in the normal healthy foot is a prerequisite for understanding the effects of pathology and thereafter setting targets for interventions. Quality foot kinematic data from healthy feet will also assist the development of high quality and research based clinical models of foot biomechanics. To address gaps in the current literature we aimed to describe 3D foot kinematics using a 5 segment foot model in a population of 100 pain free individuals. Kinematics of the leg, calcaneus, midfoot, medial and lateral forefoot and hallux were measured in 100 self reported healthy and pain free individuals during walking. Descriptive statistics were used to characterise foot movements. Contributions from different foot segments to the total motion in each plane were also derived to explore functional roles of different parts of the foot. Foot segments demonstrated greatest motion in the sagittal plane, but large ranges of movement in all planes. All foot segments demonstrated movement throughout gait, though least motion was observed between the midfoot and calcaneus. There was inconsistent evidence of movement coupling between joints. There were clear differences in motion data compared to foot segment models reported in the literature. The data reveal the foot is a multiarticular structure, movements are complex, show incomplete evidence of coupling, and vary person to person. The data provide a useful reference data set against which future experimental data can be compared and may provide the basis for conceptual models of foot function based on data rather than anecdotal observations.

  6. MRI in long-term evaluation of reconstructed hind-feet of land-mine trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Sanal, Hatice Tuba [Department of Radiology, Gulhane Military Medical Academy, Ankara (Turkey)], E-mail: tubasanal@yahoo.com; Bulakbasi, Nail; Kocaoglu, Murat; Yildirim, Duzgun [Department of Radiology, Gulhane Military Medical Academy, Ankara (Turkey)

    2007-08-15

    Introduction: The purpose of this study was to assess the flap reconstructed hind feet of patients with MRI who were traumatized by land-mine. Materials and methods: T1 and T2 weighted images were obtained in 7 patients, 12 months later the reconstruction of their hind feet by myocutaneous flaps after land-mine trauma. Results: In all patients T2 signal intensities of the myocutaneous flaps were slightly high compared to normal undisturbed muscle. Slight vascular engorgement was noted in the vicinity of the flaps in all cases. There were ankle joint ankylose (n = 1), tarsal coalition (n = 3), sklerosis within the calcaneus (n = 1), bone cortex irregularities (n = 3), absence of calcaneus (n = 4), deformity in talus and bone marrow edema (n = 1), navicular edema (n = 2), remodeling in the superior aspect of talus neck (n = 2), absence of talus (n = 2), talocalcaneal ankylose (n = 1), small collection in the superior aspect of flap (n = 1), drenage canules (n = 1). Conclusion: In reconstructed hind feet by myocutaneus flaps done for land-mine traumas, MRI presents useful information by displaying detailed anatomy of the flaps, bones, joints, soft tissues and associated complications.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. New dental and postcranial material of Agerinia smithorum (Primates, Adapiformes) from the type locality Casa Retjo-1 (early Eocene, Iberian Peninsula).

    Science.gov (United States)

    Femenias-Gual, Joan; Marigó, Judit; Minwer-Barakat, Raef; Moyà-Solà, Salvador

    2017-12-01

    New material attributed to Agerinia smithorum from Casa Retjo-1 (early Eocene, NE Iberian Peninsula), consisting of 13 isolated teeth and a fragment of calcaneus, is studied in this work. These fossils allow the first description of the calcaneus and the upper premolars for the genus Agerinia, as well as the first description of the P2 and M2 for A. smithorum. The newly recovered lower teeth are virtually identical to the holotype of A. smithorum and are clearly distinguishable from the other species of Agerinia. The upper teeth also show clear differences with Agerinia marandati. The morphology of the calcaneal remains reveals that A. smithorum practiced a moderately active arboreal quadrupedal mode of locomotion, showing less leaping proclivity than notharctines but more than asiadapids. All the morphological features observed in the described material reinforce the hypothesis of a single lineage consisting of the species A. smithorum, A. marandati, and Agerinia roselli. Furthermore, the phylogenetic analysis developed in this work, which incorporates the newly described remains of A. smithorum, maintains the position of Agerinia as closely related to sivaladapids and asiadapids. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Degenerative lumbar listhesis and bone mineral density in elderly women. The study of osteoporotic fractures.

    Science.gov (United States)

    Vogt, M T; Rubin, D A; San Valentin, R; Palermo, L; Kang, J D; Donaldson, W F; Nevitt, M; Cauley, J A

    1999-12-01

    A cross-sectional and prospective study. To investigate the association between lumbar listhesis in elderly white women and bone mineral density at the spine, hip, radius, and calcaneus. Several types of degenerative spinal changes have been found to be associated with high bone mineral density at the spine and other body sites. Lateral radiographs of the lumbar spine for 1400 elderly women enrolled in the Study of Osteoporotic Fractures were digitized. Listhesis (antero and retro) was assessed at L3-L4, L4-L5, and L5-S1. Bone mineral density was measured at the spine, hip, calcaneus, and the distal and proximal radius. After adjusting the data for age and body mass index, retrolisthesis at L3-L4, L4-L5, and L5-S1 was associated with mean spinal bone mineral density levels that were 9% to 13% higher compared with those levels in women with no listhesis (P anterolisthesis at L3-L4 was 12% higher (P anterolisthesis at that level. This study suggests that retrolisthesis, like other spinal degenerative diseases, is associated with increased spinal bone mineral density. Anterolisthesis, however, may involve a different etiology, because its association with bone mineral density varies by spinal level.

  14. 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.

  15. Comparison of computed tomographic and standard radiographic determination of tibial torsion in the dog.

    Science.gov (United States)

    Apelt, Detlef; Kowaleski, Michael P; Dyce, Jonathan

    2005-01-01

    To compare the effect of internal tibial rotation on the computed tomographic (CT) and standard radiographic assessment of tibial torsion (TT) in dogs. In vitro study. Cadaveric canine hind limbs (6 pairs). The cranial cruciate ligament was transected, and caudo-cranial radiographic and transverse CT images were obtained with the femur and tibiae in a neutral position, and after 15 degrees internal tibial rotation. Radiographic TT was determined by measuring the distance (d) between the calcaneus and the sulcus of the talus. CT determination of TT was performed using the proximal transcondylar and the distal cranial tibial axes. The distance (d) in the 2 groups and the difference in the CT determination of TT between groups were compared with a hypothetical mean value of 0 mm and 0 degrees, respectively. The mean distance (d) for the neutral radiographic group was not significantly different from 0 (P=.473); however, for the 15 degree group it was significantly different (P<.0001). The difference in the CT determination of TT did not differ from 0 (P=.317). The standard radiographic technique does not discriminate between internal TT and internal rotation of the tibia. Thus, dogs with normal tibial conformation can be depicted by radiography as torsed, whereas dogs with TT may be misinterpreted as normal because of arbitrary positioning. Lateral displacement of the medial border of the calcaneus on a caudo-cranial radiograph should not be used as the sole arbiter of TT before surgical correction.

  16. [Assessment of plantar fasciitis using shear wave elastography].

    Science.gov (United States)

    Zhang, Lining; Wan, Wenbo; Zhang, Lihai; Xiao, Hongyu; Luo, Yukun; Fei, Xiang; Zheng, Zhixin; Tang, Peifu

    2014-02-01

    To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis. The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion. The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126). SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.

  17. An osteomalacia related to phosphate diabetes - bone scintigraphy with SPECT/CT contribution; Une osteomalacie liee a un diabete phosphore - role de la scintigraphie osseuse couplee a la TEMP-TDM

    Energy Technology Data Exchange (ETDEWEB)

    Ruyer, A.; Granier, P.; Mourad, M. [Centre Hospitalier Antoine-Gayraud, Service de Medecine Nucleaire, 11 - Carcassonne (France)

    2009-12-15

    We report the case of a 59-year-old woman, investigated for disabling pain of the left thigh, unrelated to any traumatic event. Interrogation had found diffuse pain of myalgia-type and arthralgia-type for approximately a year without local inflammatory signs and insufficiency fractures of both calcaneus two years before. The Technetium {sup 99m}-labeled hydroxy-methylene diphosphonate ({sup 99m}Tc-H.D.P.) whole-body bone scintigraphy evidenced multiple hot spots on the higher third of left femur, rib cage, sternum, scapula, pelvis, right hip and both calcaneus. Moreover, a more diffuse and heterogeneous prominent uptake appeared on rib cage, spine and pelvis. These images suggested a diffuse metastatic disease of the skeleton. The single photon emission computerized tomography guided by computerized tomography (SPECT/CT), centered on lumbar spine, pelvis and the upper end of femurs showed that the multiple hot spots were in fact bone fractures. These findings pointed diagnosis to a metabolic disease. The clinical context was in favour of an osteomalacia. Further explorations showed an osteomalacia related to phosphate diabetes. A thorough work-up did not reveal any known aetiology. To date, idiopathic phosphate diabetes seems the most likely diagnosis. Nuclear medicine input in osteomalacia is discussed. (authors)

  18. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty.

    Science.gov (United States)

    Matsumoto, T; Takayama, K; Ishida, K; Hayashi, S; Hashimoto, S; Kuroda, R

    2017-05-01

    The aim of this study was to compare the post-operative radiographic and clinical outcomes between kinematically and mechanically aligned total knee arthroplasties (TKAs). A total of 60 TKAs (30 kinematically and 30 mechanically aligned) were performed in 60 patients with varus osteoarthritis of the knee using a navigation system. The angles of orientation of the joint line in relation to the floor, the conventional and true mechanical axis (tMA) (the line from the centre of the hip to the lowest point of the calcaneus) were compared, one year post-operatively, on single-leg and double-leg standing long leg radiographs between the groups. The range of movement and 2011 Knee Society Scores were also compared between the groups at that time. The angles of orientation of the joint line in the kinematic group changed from slight varus on double-leg standing to slight valgus with single-leg standing. The mechanical axes in the kinematic group passed through a neutral position of the knee in the true condition when the calcaneus was considered. The post-operative angles of flexion and functional activity scores were significantly better in the kinematic than in the mechanical group (p leg standing, and more neutral weight-bearing in tMA than a mechanically aligned TKA. Cite this article: Bone Joint J 2017;99-B:640-6. ©2017 The British Editorial Society of Bone & Joint Surgery.

  19. How does static stretching influence the tendons mechanical response?

    Science.gov (United States)

    Rossetto, Nathalia Polisello; Fabbro, Inácio Maria Dal; Piedade, Sérgio Rocha

    2013-01-01

    Analyze in vitro the mechanical response of bovine calcaneus tendons subjected to static stretching in three different intervals (15, 30, 45 s). Six groups of bovine calcaneus tendons (n=10) were formed according to the static stretching protocol: three different intervals (15, 30, 45 s) and initial stretching percentage (2.5% and 3.5%). The control group (n=10) did not perform prior stretching. At the end of the stretching tests, the specimens were subjected to stress rupture tests. The values for force relaxation presented stability after the 30(th) second (p<0.0001) at both levels of deformation. Greater force relaxation (p<0.0026) and the least tensile strength (p=0.0123) was observed in the group that was subjected to the highest stretch percentage (3.5%). No difference was observed between the rupture parameters of the stretch and control groups. The variables, stretch duration and percentage did not demonstrate interaction. In relation to force relaxation, the 30 second interval seems to be the most effective when stretching tendons. This fact should be considered when establishing new clinical stretching protocols. Laboratory investigation.

  20. Analysis of the talocrural and subtalar joint motions in patients with medial tibial stress syndrome.

    Science.gov (United States)

    Akiyama, Kei; Noh, Byungjoo; Fukano, Mako; Miyakawa, Shumpei; Hirose, Norikazu; Fukubayashi, Toru

    2015-01-01

    The rearfoot motion during sports activities in patients with the medial tibial stress syndrome (MTSS) is unknown. This study aimed to investigate the difference in kinematics of the rearfoot in MTSS patients (eight male soccer players) and control participants (eight male soccer players) during a forward step. Sixteen male soccer players, including eight players with MTSS, participated. Forward step trials were recorded with cineradiographic images obtained at a sampling rate of 60 Hz. Geometric bone models of the tibia and talus/calcaneus were created from computed tomography scans of the distal part of one lower limb. Following a combination of approaches, anatomical coordinate systems were embedded in each bone model. The talocrural joint motion (relative motion of the talus with respect to the tibia) and subtalar joint motion (relative motion of the calcaneus with respect to the talus) were examined. A significantly larger range of internal/external rotation and inversion/eversion motion was observed in the subtalar joint of MTSS patients compared to healthy controls (P angles during the forward step. Our results indicate that the range of subtalar joint motion is greater in patients with MTSS during the stance phase of the forward step. The kinematic results obtained of this study may have important clinical implications and add quantitative data to an in vivo database of MTSS patients.

  1. 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.

  2. Reflex sympathetic dystrophy/complex regional pain syndrome, type 1

    Directory of Open Access Journals (Sweden)

    S.H. Botha

    2004-02-01

    Full Text Available Complex regional pain syndrome (CPRS, type 1 is a pain disorder that develops unpredictably and can follow a minor injury. A 12-year-old boy presented with severe pain in the feet and could not walk or stand weight bearing. Normal X-rays showed osteopenic changes and radiolucent lines, which appeared to be stress fractures. Three-phase bone scintigraphy showed no uptake in the left lower leg on the blood pool phase or on the immediate or delayed images. This indicated typical CPRS type 1 in children. The uptake in the right foot was increased and the stress fracture and other illness could not be differentiated. Computed tomography was done to exclude stress fractures. Only osteopenic changes in both calcaneus bones were found and there was no evidence of cortical stress fractures. Magnetic resonance images revealed oedema in the calcaneus and talus bones of both feet. The patient received epidural narcotic infusion with sympathetic blockage for 1 week combined with extensive physiotherapy. The blood pool phase of the bone scan became normal within 2 weeks, and increased uptake in both feet was noticed. The patient was followed up with MRI every 3 months and the bone marrow oedema disappeared after 6 months.

  3. Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects.

    Science.gov (United States)

    Rao, Smita; Baumhauer, Judith F; Tome, Josh; Nawoczenski, Deborah A

    2009-05-29

    The purpose of this study was to compare in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and asymptomatic control subjects. Segmental foot motion during walking and step descent was assessed using a multi-segment foot model in 30 patients with midfoot arthritis and 20 age, gender and BMI matched controls. Peak and total range of motion (ROM), referenced to subtalar neutral, were examined for each of the following dependent variables: 1st metatarso-phalangeal (MTP1) dorsiflexion, 1st metatarsal (MT1) plantarflexion, ankle dorsiflexion, calcaneal eversion and forefoot abduction. The results showed that, compared to level walking, step descent required greater MTP1 dorsiflexion (pplantarflexion (pdorsiflexion (pdorsiflexion (pdorsiflexion (pplantarflexion excursion compared to control subjects (p=0.03). However, during step descent, both groups showed similar MT1 plantarflexion excursion. During walking, patients with midfoot arthritis showed similar calcaneus eversion excursion compared to control subjects. However, during step descent, patients with midfoot arthritis showed significantly greater calcaneus eversion excursion compared to control subjects (p=0.03). Independently or in combination, these motions may contribute to articular stress and consequently to symptoms in patients with midfoot arthritis.

  4. Ankle and subtalar kinematics during dorsiflexion-plantarflexion activities.

    Science.gov (United States)

    Yamaguchi, Satoshi; Sasho, Takahisa; Kato, Hideyuki; Kuroyanagi, Yuji; Banks, Scott A

    2009-04-01

    Understanding the effect of weightbearing on subtalar and ankle joint kinematics is critical for the diagnosis and treatment of foot disorders. However, dynamic in vivo kinematics of these joints are not well studied. The purpose of this study was to compare in vivo kinematics during nonweightbearing and weightbearing activities in healthy subjects. Seven healthy subjects with a mean age of 32 (range, 23 to 42) years were enrolled. Oblique lateral fluoroscopic images of nonweightbearing and weightbearing dorsiflexion-plantarflexion activities were recorded. Three dimensional subtalar, ankle, and ankle-subtalar joint complex kinematics were determined using 3D-2D model registration techniques with 3D bone models and single-plane fluoroscopy. During the weightbearing activity from 20 degrees dorsiflexion to 15 degrees plantarflexion, the subtalar joint was significantly more everted, dorsiflexed, and abducted, and the calcaneus showed a significantly more posterior position, than during the nonweightbearing activity. The ankle joint was significantly more plantarflexed and adducted during the weightbearing activity than the nonweightbearing activity. The ankle-subtalar joint complex was significantly more everted, and the calcaneus showed significantly greater posterior position than the nonweightbearing activity. These observations provide basic quantitative descriptions of weightbearing and nonweightbearing kinematics for healthy joints. These data can serve as the basis for comparison with pathologic feet for both diagnostic and therapeutic purposes.

  5. Bone lead (Pb) content at the tibia is associated with thinner distal tibia cortices and lower volumetric bone density in postmenopausal women

    Science.gov (United States)

    Wong, Andy K.O.; Beattie, Karen A.; Bhargava, Aakash; Cheung, Marco; Webber, Colin E.; Chettle, David R.; Papaioannou, Alexandra; Adachi, Jonathan D.

    2016-01-01

    Conflicting evidence suggests that bone lead or blood lead may reduce areal bone mineral density (BMD). Little is known about how lead at either compartment affects bone structure. This study examined postmenopausal women (N = 38, mean age 76 ± 8, body mass index (BMI): 26.74 ± 4.26 kg/m2) within the Hamilton cohort of the Canadian Multicentre Osteoporosis Study (CaMos), measuring bone lead at 66% of the non-dominant leg and at the calcaneus using 109Cadmium X-ray fluorescence. Volumetric BMD and structural parameters were obtained from peripheral quantitative computed tomography images (200 μm in-plane resolution, 2.3 ± 0.5 mm slice thickness) of the same 66% site and of the distal 4% site of the tibia length. Blood lead was measured using atomic absorption spectrometry and blood-to-bone lead partition coefficients (PBB, log ratio) were computed. Multivariable linear regression examined each of bone lead at the 66% tibia, calcaneus, blood lead and PBB as related to each of volumetric BMD and structural parameters, adjusting for age and BMI, diabetes or antiresorptive therapy. Regression coefficients were reported along with 95% confidence intervals. Higher amounts of bone lead at the tibia were associated with thinner distal tibia cortices (−0.972 (−1.882, −0.061) per 100 μg Pb/g of bone mineral) and integral volumetric BMD (−3.05 (−6.05, −0.05) per μg Pb/g of bone mineral). A higher PBB was associated with larger trabecular separation (0.115 (0.053, 0.178)), lower trabecular volumetric BMD (−26.83 (−50.37, −3.29)) and trabecular number (−0.08 (−0.14, −0.02)), per 100 μg Pb/g of bone mineral after adjusting for age and BMI, and remained significant while accounting for diabetes or use of antiresorptives. Total lead exposure activities related to bone lead at the calcaneus (8.29 (0.11, 16.48)) and remained significant after age and antiresorptives-adjustment. Lead accumulated in bone can have a mild insult on bone structure; but

  6. Anatomy and arthrokinematics of the human ankle and intertarsal joints; Anatomie und Kinematik der Sprunggelenke des Menschen

    Energy Technology Data Exchange (ETDEWEB)

    Pretterklieber, M.L. [Vienna Univ. (Austria). Pathologisch-Anatomisches Inst.

    1999-01-01

    In the ankle (talocrural) joint, the lower end of the tibia and fibula embrace the trochlea tali. Thus, an approximately uniaxial joint is formed which permits dorsiflexion and plantarflexion of the foot against the leg. Due to the geometry of the trochlea tali, conjunct lateral rotation of the fibula against the tibia occurs at the tibiofibular articulations synchronously with active dorsiflexion at the ankle joint. Movements at the talocrural joints are mainly limited by the opposing muscles as well as by strong collateral ligaments. Talus and calcaneus form a functional unit connected by posterior and anterior articulations. The posterior articulation is the subtalar (talocalcaneal) joint; in the anterior articulation, talar facets of the calcaneus together with the posterior surface of the navicular and the superior fibrocartilaginous surface of the plantar calcaneonavicular ligament form a concavity for the talar head. Thus, the talocalcaneonavicular joint is a compound and - like the subtalar joint - a multiaxial articulation. On the weightbearing foot, the distal tarsus and metatarsus are pronated and supinated against the talus in order to maintain plantigrade contact. When the foot is off the ground, these movements are modified to eversion and inversion, also involving the calcaneocuboid joint. In addition, movements between the calcaneus and cuboid also occur during pronative or supinative changes between the fore- and hindfoot. Limitation of movements is due to leg muscles as well as strong ligaments. Finally, the cuneonavicular, cuboideonavicular, intercuneiform and cuneocuboid joints permit some additional alterations of the loaded foot in contact with the ground. (orig.) [Deutsch] Der Komplex der Sprunggelenke stellt die Verbindung von Unterschenkel und Fuss des Menschen her. In der Articulation talocruralis, dem oberen Sprunggelenk, stehen die distalen Enden von Tibia und Fibula mit der Trochlea tali im Gelenkkontakt. In diesem von starken

  7. 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

  8. Modifying the Rizzoli foot model to improve the diagnosis of pes-planus: application to kinematics of feet in teenagers.

    Science.gov (United States)

    Portinaro, Nicola; Leardini, Alberto; Panou, Artemisia; Monzani, Valerio; Caravaggi, Paolo

    2014-01-01

    A number of multi-segment foot protocols have been proposed to obtain measurements of clinical value. In the clinical assessment of foot pathologies and deformities, such as in the pes-planus, the frontal-plane alignment of the calcaneus and the dynamic properties of the medial longitudinal arch are critical parameters though often neglected by the majority of foot protocols. The aim of the present work is to modify an established foot protocol to obtain static and kinematic measures more consistent with corresponding clinical observations. Moreover, while many papers have reported kinematic data from varying populations, few investigations have focussed on young participants from same-age cohorts. A 6-camera motion capture system was employed to track the shank, rear-, mid- and fore-foot segments in the left and right leg of 10 children (13.1 ± 0.8 years) during gait. Three markers were attached to each segment thus allowing for triplanar motion of five joints to be described according to the Rizzoli Foot Model. An additional marker was attached to the posterior bottom of the calcaneus to enhance measurement of frontal-plane orientation. Description of the medial longitudinal arch angle was redefined to be more consistent with rearfoot orientation and to common clinical assessments. A novel 3-marker description of the hallux segment was implemented to improve robustness in calculating 1(st) metatarso-phalangeal joint rotations. Foot segments kinematics showed good inter- participant repeatability and overall consistency with previous similar reports. 15 out of 20 feet showed neutral or slightly valgus orientation of the calcaneus. Relatively large medial longitudinal arch angles (mean 186 ± 16 deg) were found in the present young population. Both measurements were reasonably in accordance with the relevant clinical observations of these feet. Modifications to a widely used multisegmental foot kinematic model were implemented to improve robustness and

  9. Bone mineral density in patients with destructive arthrosis of the hip joint.

    Science.gov (United States)

    Okano, Kunihiko; Aoyagi, Kiyoshi; Enomoto, Hiroshi; Osaki, Makoto; Chiba, Ko; Yamaguchi, Kazumasa

    2014-05-01

    Recent reports have shown the existence of subchondral insufficiency fracture in rapidly destructive arthrosis of the hip joint (RDA), and the findings suggest that osteopenia is related to the pathogenesis of the rapid progression of this disease. Therefore, we measured bone mineral density (BMD) in RDA patients. We measured BMD of the lumbar spine, radius, and calcaneus using dual-energy X-ray absorptiometry in 19 patients with RDA and 75 with osteoarthritis of the hip (OA) and compared BMD at different skeletal sites between RDA and OA patients. No significant differences were observed in BMD of the lumbar spine, ultradistal radius, mid-radius, and calcaneous between the RDA and OA groups. Our data suggest that RDA is not accompanied by generalized osteoporosis. Factors other than generalized bone status, for example, BMD around the affected hip joint before destruction, need to be analyzed to elucidate the pathophysiological mechanism of RDA.

  10. Peripheral bone mineral density and different intensities of physical activity in children 6-8 years old: the Copenhagen School Child Intervention study

    DEFF Research Database (Denmark)

    Hasselstrøm, H; Karlsson, K M; Hansen, S E

    2007-01-01

    This study aimed to evaluate the association between objectively measured habitual physical activity and calcaneal and forearm bone mineral density (BMD, g/cm(2)), one mechanically more loaded and one less loaded skeletal region, in children aged 6-8 years. BMD was measured in 297 boys and 265...... girls by peripheral dual-energy X-ray absorptiometry in the forearm and calcaneus. An accelerometer registered the level of physical activity during 4 days (2 weekdays and the weekend). Weight, height, and skinfold thickness were measured. In order to establish thresholds (count . min(-1)) for bone......-stimulating physical activity, we evaluated different definitions of vigorous physical activity. The boys had 3.2% higher distal forearm bone mineral content (BMC, P

  11. On the comparison between MRI and US imaging for human heel pad thickness measurements

    DEFF Research Database (Denmark)

    Matteoli, Sara; Corbin, Nadège Corbin; Wilhjelm, Jens E.

    2011-01-01

    The human heel pad thickness, defined as the shortest distance between the calcaneus and heel skin, is one of the intrinsic factor which must be taken into account when investigating the biomechanics of the heel pad. US and MRI are the preferable imaging modalities used to measure the heel pad...... thickness as they are both ionizing-free radiations. The aim of this paper is to measure the bone to skin distance of nine heel pad phantoms from MRI and US images, and to compare the results with a true value (TV) in order to find the errors. Paired sample t-test was used to compare the measurements......1530 (P-value=0.402). Results confirm the necessity to investigate on the real speed of sound for the heel pad tissues, in order to have realistic measurements when dealing with human heel pads. __________________________________________________________________________________________________________...

  12. Apophysitis of the lower limbs: imaging findings; Apofisites dos membros inferiores: aspectos de imagem

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Priscila Rodrigues; Santos, Durval C. Barros; Longo, Carlos Henrique; Luna, Rodrigo de Castro; Kim, Nelson Ji Tae; Rosemberg, Laercio A.; Funari, Marcelo Gusmao Buarque [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil). Dept. de Imagem]. E-mail: pill-rb@uol.com.br

    2005-07-01

    Apophyses are secondary ossification centers that appear during growth. These ossification centers are under traction forces because of insertion of muscles and ligaments. When traction stress become greater in magnitude and frequency irritation of physis (growth plate) may occur resulting in apophysitis. Apophysitis injuries typically occur in active adolescents and usually presents as peri-articular pain associated with growth, skeletal immaturity, repetitive microtrauma and muscle-tendon imbalance. The most common types of apophysitis of the include Osgood-Schlatter disease (tibial tuberosity), apophysitis of the hip (iliac crest, ischial tuberosity), Sever's disease (posterior calcaneus), Sindig-Larsen-Johansson syndrome (inferior patella), and Iselin's disease (fifth metarsal base). The aim of this study was to show the main magnetic resonance imaging and X-rays findings in patients with these diseases and to discuss the frequent differential diagnosis. (author)

  13. Indications and anatomic landmarks for the application of lower extremity traction: a review.

    Science.gov (United States)

    DeFroda, S F; Gil, J A; Born, C T

    2016-12-01

    Fractures of the lower extremity, particularly of the femur and acetabulum, may be difficult to immobilize with splinting alone. These injuries may be best stabilized with the application of various types of skeletal traction. Often, traction is applied percutaneously in an emergent setting, making the knowledge of both superficial and deep anatomy crucial to successful placement. Review was performed via PubMed search as well as referencing the Orthopaedic literature. Relevant articles to the anatomy of the knee, ankle and calcaneus as they pertain to traction placement were referenced in compiling the optimal recommendations for traction placement. By palpating and marking superficial landmarks and observing specific anatomic relationships, safe application of traction pins can be performed while minimizing iatrogenic injury to vital anatomic structures, and avoiding intra-articular placement which could potentially lead to joint infection.

  14. Gait Analysis by Multi Video Sequence Analysis

    DEFF Research Database (Denmark)

    Jensen, Karsten; Juhl, Jens

    2009-01-01

    The project presented in this article aims to develop software so that close-range photogrammetry with sufficient accuracy can be used to point out the most frequent foot mal positions and monitor the effect of the traditional treatment. The project is carried out as a cooperation between...... the Orthopaedic Surgery in Northern Jutland and the Laboratory for Geoinformatics, Aalborg University. The superior requirements on the system are that it shall be without heavy expenses, be easy to install and easy to operate. A first version of the system is designed to measure the navicula height...... and the calcaneus angle during gait. In the introductory phase of the project the task has been to select, purchase and draw up hardware, select and purchase software concerning video streaming and to develop special software concerning automated registration of the position of the foot during gait by Multi Video...

  15. Osteochondral graft from the pre-achilles area for replacement of articular surface defects

    Science.gov (United States)

    Kuznetsov, V. V.; Pahomov, I. A.; Prohorenko, V. M.; Sadovoy, M. A.; Korel, A. V.; Zaydman, A. M.; Repin, A. V.; Gudi, S. M.; Korochkin, S. B.

    2017-09-01

    We substantiate a new technique for obtaining osteochondral autograft to replace osteochondral defects resulting from various lesions of the talar trochlea by means of morphological examination of the following microslides: talar cartilage (cadaver material), cartilage portion of the pre-achilles zone of the calcaneum, lateral femoral condyle, and necrotic area of the talus. Examination of the specimens of the pre-achilles cartilage of the calcaneus revealed a large number of poorly differentiated chondroblasts in the homogeneously stained extracellular matrix; the presence of all zones (superficial zone, zone of columnar structures, and "tidemark"). This is indicative of structural and functional preservation of this cartilage, which therefore can be considered as an autograft material.

  16. Calcaneal Fractures and Böhler’s Angle

    Directory of Open Access Journals (Sweden)

    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

  17. [Effect of milk product with soy isoflavones on quality of life and bone metabolism in postmenopausal Spanish women: randomized trial].

    Science.gov (United States)

    García-Martín, Antonia; Quesada Charneco, Miguel; Alvárez Guisado, Alejandro; Jiménez Moleón, José Juan; Fonollá Joya, Juristo; Muñoz-Torres, Manuel

    2012-02-04

    To analyze the effects of nutritional intervention with a milk product enriched with soy isoflavones on quality of life and bone metabolism in postmenopausal Spanish women. We performed a double-blind controlled randomized trial in ninety-nine postmenopausal women. Group S women (n=48) were randomized to consume milk product enriched with soy isoflavone (50 mg/day) while group C (n=51) consumed product control for 12 months. Parameters of quality of life (Cervantes scale), markers of bone metabolism and bone mass estimated by ultrasound of the calcaneus (QUS) were evaluated. Overall, there was an improvement in the domains menopause (P=.015) and vasomotor symptoms (Pmilk products increases levels of 25-OH-vitamin D and decreases bone metabolism markers. Additional supplementation with soy isoflavones seems to improve quality of life and bone mass in Spanish postmenopausal women. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  18. Extended foot-ankle musculoskeletal models for application in movement analysis.

    Science.gov (United States)

    Malaquias, Tiago M; Silveira, Carolina; Aerts, Wouter; De Groote, Friedl; Dereymaeker, Greta; Vander Sloten, Jos; Jonkers, Ilse

    2017-02-01

    Multibody simulations of human motion require representative models of the anatomical structures. A model that captures the complexity of the foot is still lacking. In the present work, two detailed 3D multibody foot-ankle models generated based on CT scans using a semi-automatic tool are described. The proposed models consists of five rigid segments (talus, calcaneus, midfoot, forefoot and toes), connected by five joints (ankle, subtalar, midtarsal, tarsometatarsal and metatarsophalangeal), one with 15DOF and the other with 8DOF. The calculated kinematics of both models were evaluated using gait trials and compared against literature, both presenting realistic results. An inverse dynamic analysis was performed for the 8DOF model, again presenting feasible dynamic results.

  19. Limb salvage treatment for congenital deficiency of the tibia.

    Science.gov (United States)

    Wada, Akifusa; Fujii, Toshio; Takamura, Kazuyuki; Yanagida, Haruhisa; Urano, Noriko; Yamaguchi, Toru

    2006-01-01

    Nine limb salvage treatments were performed in 7 patients with congenital deficiency of the tibia. All feet showed equinovarus deformity and were centralized in a slightly equinus position by placing the distal end of the fibula into the posterior facet of the calcaneus. Tibiofibular fusion was performed in 4 patients with partial deficiency, and fibular transfer (fibular centralization; Brown procedure) in 5 with complete deficiency of the tibia. Callus distraction lengthening was performed repeatedly for leg-length discrepancy on either the femur or the centralized fibula. Satisfactory functional and cosmetic results were obtained in all limbs with partial deficiency, whereas in limbs with completely deficiency, none of the 5 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture, and persistent ligamentous instability. Nevertheless, in these 5 cases, all patients were ultimately able to withstand weight-bearing.

  20. Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of the Literature.

    Science.gov (United States)

    McLeod, Jacob M; Ng, Alan; Kruse, Dustin L; Stone, Paul A

    Osteonecrosis, although commonly occurring in the hip, can also affect the leg and foot. In the foot, it most commonly occurs in the talus. The incidence of osteonecrosis occurring in the tibia is relatively rare. We report a case of a woman who presented to our clinic with ankle pain that was idiopathic in nature. Subsequent magnetic resonance imaging showed findings consistent with osteonecrosis of the bilateral distal tibias and several other lesions located in the shoulder, hip, and calcaneus. The present report also serves as a review of both etiology and treatment of osteonecrosis as it relates to the lower extremity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Roentgenographic appearance of ossification centers in the Japanese fetus, stillborn and neonatal death infants, Hiroshima and Nagasaki

    Energy Technology Data Exchange (ETDEWEB)

    Kawamoto, Sadahisa

    1964-01-01

    A roentgenographic study of the presence of the ossification centers has been made on a total of 235 cases of miscarriage, therapeutic abortion, stillbirth and neonatal death according to criteria of sex, length of gestational age, and weight at birth. The cases were aged from 16 to 42 gestational weeks. The weight of the cases ranged from 110 g to 3780 g at birth. The order of appearance of the eight centers in fetal life was as follows: Ischium, pubis, calcaneus, talus, distal epiphysis of femur, hyoid, proximal epiphysis of tibia, and cuboid bone. Some of the eight ossification centers appeared earlier in girls than in boys of the same gestational age and birth weight. The osseous development of Japanese fetuses and infants weighing over 2000 g was judged less mature than in similar Caucasian and Negro subjects. 10 references, 1 figure, 6 tables.

  2. MRI appearances of the anterior fibulocalcaneus muscle: a rare anterior compartment muscle

    Energy Technology Data Exchange (ETDEWEB)

    Upadhyay, Bhavin [Basildon and Thurrock University Hospitals NHS Foundation Trust, Imaging Department, Essex (United Kingdom); Amiras, Dimitri [Imperial College Health Care NHS Trust, Imaging Department, London (United Kingdom)

    2015-05-01

    MRI of a 62-year-old female presenting with ankle pain demonstrated an accessory muscle within the anterior compartment of the lower leg. The muscle originated from the fibula and anterior crural septum. The tendon passed anterior to the lateral malleolus and inserted at the critical angle of Gissane on the calcaneus. This muscle was initially described in the anatomic literature by Lambert and Atsas in 2010. To our knowledge, this is the first time the MRI appearances of this muscle has been described in the radiological literature. Awareness of the fibulocalcaneal muscle is important as it may represent a cause of ankle pain. In addition, the tendon could potentially be harvested for use in reconstructive procedures. (orig.)

  3. Computed tomography of calcaneal fractures

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. Surgical Management of Calcaneal Malunion

    Directory of Open Access Journals (Sweden)

    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.

  5. In vivo measurements of ultrasound transmission through the human proximal femur.

    Science.gov (United States)

    Barkmann, Reinhard; Laugier, Pascal; Moser, Urs; Dencks, Stefanie; Klausner, Michael; Padilla, Frédéric; Haiat, Guillaume; Heller, Martin; Glüer, Claus-C

    2008-07-01

    Quantitative ultrasound (QUS) measurements can be used to estimate osteoporotic fracture risk. The commonly used variables are the speed of sound (SOS) and the frequency dependent sound attenuation (broadband ultrasound attenuation, [BUA]) of a wave propagating through the bone, preferably the calcaneus. The technology, so far, is less suitable for direct measurement in vivo at the spine or the femur for prediction of bone mineral density (BMD) or fracture risk at the main osteoporotic fracture sites. To improve the clinical performance of QUS, we built a device for direct QUS measurements at the human femur in vivo. In vivo images of ultrasound transmission at one of the main fracture sites, the proximal femur, could be acquired. The estimated precision of SOS measurements of 0.5% achieved at the femur is comparable with the precision of peripheral QUS devices.

  6. Foot segmental mobility during subphases of running: Comparative study between two striking patterns.

    Science.gov (United States)

    Peters, Helen; Deschamps, Kevin; Matricali, Giovanni Arnoldo; Staes, Filip

    2017-03-01

    The literature lacks comparative data regarding foot segmental mobility in rearfoot (RFS) and midfoot striking (MFS) patterns. The aim of the study is to quantify the foot segmental mobility during distinct subphases of stance in presence of both striking patterns. Twelve participants were instructed to run barefoot at a constant speed of 3.3m/s on a 10-m walkway, while adopting a RFS and a MFS pattern. Multi-segment foot mobility during the impact phase, the absorption phase and the generation phase was subsequently calculated and compared between both conditions. In the impact phase of the MFS trials, a higher sagittal plane range of motion was observed between shank and calcaneus (RFS=6.2°, MFS=14.5°, pfoot. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Population distance between Dakshina Kannada (South India) and Gujarati (North India) population using infracranial nonmetric traits.

    Science.gov (United States)

    Nayak, S R; Kumar, Madhan; Krishnamurthy, A; Prabhu, Latha V; D'Costa, Sujatha; Ramanathan, Lakshmi A; Potu, Bhagath K; Gorantla, Vasavi R

    2007-01-01

    Infracranial nonmetric variations have been considered for determining population distance between different regions and continents, in recent times. We studied different infracranial nonmetric traits from the Dakshina Kannada (South India) region to compare with the data available from the Gujarati (North India) region. The mean measure of divergence between the two different geographic regions showed significant variation. In our study, the incidence like i) Allen's fossa of the femur, ii) plaque formation in the upper end of the femur, iii) exostosis in trochanteric fosse of femur, iv) third trochanter of femur, v) os trigonum of talus, vi) medial talar facet, vii) peroneal tubercle of calcaneus, viii) bipartite transverse foramen in the cervical vertebra, too showed significant side difference.

  8. Spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Omar, Hythem [Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX (United States); Saini, Vikram [Center for Infection and Inflammation Imaging Research, Johns Hopkins University, Baltimore, MD (United States); Wadhwa, Vibhor [Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR (United States); Liu, George [Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX (United States); Chhabra, Avneesh, E-mail: avneesh.chhabra@utsouthwestern.edu [Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX (United States)

    2016-11-15

    Highlights: • The Spring ligament complex is an important stabilizer of medial arch of foot. • Of all SLC components, the integrity of Supero-Medial band is the most important. • Associated pathologies with SLC instability include PTT injury, pes planovalgus and sinus tarsi syndrome. • Conservative and operative management are viable depending on pes planovalgus progression. - Abstract: The spring (plantar calcaneonavicular) ligament complex connects the calcaneus and navicular bone of the foot and serves as the primary static stabilizer of the medial longitudinal arch of the foot. In this article, we describe the normal anatomy of the spring ligament complex, illustrate 3T magnetic resonance imaging appearances in its normal and abnormal states, and discuss the pathological associations with relevant case examples.

  9. Influence of walking with talus taping on the ankle dorsiflexion passive range of motion.

    Science.gov (United States)

    Kang, Min-Hyeok; Kim, Ji-Won; Kim, Moon-Hwan; Park, Tae-Jin; Park, Ji-Hyuk; Oh, Jae-Seop

    2013-08-01

    [Purpose] This study investigated the effects of walking with talus taping on the ankle dorsiflexion passive range of motion (DF PROM) in individuals with limited ankle DF PROM. [Subjects] Fifteen ankles with limited DF PROM were examined. [Methods] After rigid strapping tape was applied to the ankles from the talus to the calcaneus, progressing posteriorly and inferiorly, the subjects walked on a walkway for 10 min. Using a goniometer, the ankle DF PROM was measured with the knee extended before and after walking with talus taping. The difference in ankle DF PROM between before and after walking with talus taping was analyzed using the paired t-test. [Results] The ankle DF PROM was significantly increased after walking with talus taping. [Conclusion] Our findings indicate that walking with talus taping is effective for increasing the ankle DF PROM in individuals with limited ankle DF PROM.

  10. 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.

  11. Transient dystonic toe-walking: differentiation from cerebral palsy and a rare explanation for some unexplained cases of idiopathic toe-walking.

    Science.gov (United States)

    Newman, Christopher J; Ziegler, Anne-Lise; Jeannet, Pierre-Yves; Roulet-Perez, Eliane; Deonna, Thierry W

    2006-02-01

    We report on seven children (five males, two females) who presented with marked, often asymmetrical, toe-walking from onset of independent walking, associated with abnormal foot postures and increased tone at the ankles with characteristics of dystonia. Most of the children had presented with unusual pre-walking locomotion and a mild delay in independent walking. They did not fit into the usual categories of 'habitual' toe-walking or congenital short tendo calcaneus but nor did they have the clinical signs of spastic diplegia or of a peripheral neuromuscular disease. Normalization occurred progressively in the second to fourth years of life. The children were re-examined several years later (1 to 11y) and were normal. We believe that their persistent toe-walking corresponded to a variant of 'transient focal dystonia of infancy'. Knowledge of its existence may justify a period of observation without special investigations, surgery, or casting.

  12. Validation of a novel ultrasound measurement of achilles tendon length

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Riecke, Anja Falk; Boesen, Anders

    2014-01-01

    PURPOSE: A clinically applicable and accurate method for measuring Achilles tendon length is needed to investigate the influence of elongation of the Achilles tendon after acute rupture. The purpose of this study was to develop and validate an ultrasonographic (US) length measurement...... of the Achilles tendon-aponeurosis complex. METHODS: Both legs of 19 non-injured subjects were examined by magnetic resonance imaging (MRI) and US. The length from calcaneus to the medial head of m. Gastrocnemius was measured by three independent US examiners. Repeated US measurements were performed and compared...... to be further assessed in the setting of acute Achilles tendon rupture. CLINICAL RELEVANCE: This new ultrasound measurement might allow for length measurement of ruptured Achilles tendons in the acute and chronic state after rupture. LEVEL OF EVIDENCE: II....

  13. Osteoporosis and Osteopathy Markers in Patients with Mastocytosis

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    Nilüfer Alpay Kanıtez

    2015-03-01

    Full Text Available OBJECTIVE: Osteoporosis, osteosclerosis, and lytic bone lesions have been observed in patients with systemic mastocytosis (SM. We examined bone mineral density (BMD biochemical turnover markers and serum tryptase levels in SM, which is considered a rare disease. METHODS: Seventeen adult patients (5 females, 12 males; median age: 33 years, range: 20-64 with mastocytosis were included in this study. We investigated the value of quantitative ultrasound (QUS of the calcaneus in the assessment of BMD in SM patients, as well as BMD of the lumbar spine (L1-L4, femoral neck, and distal radius using dual energy x-ray absorptiometry (DXA and plasma tryptase levels, biochemical markers of bone turnover. RESULTS: At lumbar spine L1-L4, the femoral neck, and the distal radius or as calcaneus stiffness, 12 of 17 patients had T-scores of less than -1 at least at 1 site, reflecting osteopenia. Three of 17 patients had T-scores showing osteoporosis (T-score <-2.5. There was no relationship between DXA and bone lesion severity. We also found a significant positive correlation between tryptase levels and disease severity, as well as between disease severity and pyridinoline (p<0.01 by Spearman’s test. CONCLUSION: DXA and calcaneal QUS may not be appropriate techniques to assess bone involvement in SM patients because of the effects of osteosclerosis. This study further shows that the osteoclastic marker pyridinoline is helpful in patients with severe disease activity and sclerotic bone lesions to show bone demineralization.

  14. Suture-Only Repair Versus Suture Anchor–Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump

    Science.gov (United States)

    Boin, Michael A.; Dorweiler, Matthew A.; McMellen, Christopher J.; Gould, Gregory C.; Laughlin, Richard T.

    2017-01-01

    Background: Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Hypothesis: Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Study Design: Controlled laboratory study. Methods: Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor–augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. Results: The suture anchor–augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor–augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor–augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Clinical Relevance: Our results support the use of suture anchor–augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes. PMID:28203592

  15. Suture-Only Repair Versus Suture Anchor-Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump: A Biomechanical Comparison.

    Science.gov (United States)

    Boin, Michael A; Dorweiler, Matthew A; McMellen, Christopher J; Gould, Gregory C; Laughlin, Richard T

    2017-01-01

    Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Controlled laboratory study. Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor-augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. The suture anchor-augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P suture anchor-augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P Suture anchor-augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Our results support the use of suture anchor-augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.

  16. BONE MINERAL DENSITY IN PHYSICALLY ACTIVE WOMEN ASSESSED BY ULTRASOUND DESINTOMETRY

    Directory of Open Access Journals (Sweden)

    Ana Marijanac

    2015-05-01

    Full Text Available Osteoporosis is a disease characterized by low bone mass and density. Physical activity has a positive effect on bone tissue, and it is recommended to prevent bone loss which comes with age. Methods: In purpose of determining bone mineral density in women who are physically active we examined 35 women divided into two groups – subjects who are premenopausal (n=20, 43.52 ± 7.56 years, and subjects who are postmenopausal (n=15, 55.89 ± 5.48. The subjects exercised Pilates method twice a week for one hour. Bone mineral density measurements were done by ultrasound densitometer „Sahara“ through the calcaneus. We get the data of the estimated bone density and T-score for right and left foot separate. Results: According to results premenopausal women have normal bone density, and postmenopausal values represent osteopenia, according to the WHO. There is no subjects who established osteoporosis. Discussion: Previous investigations have confirmed that physical activity is important for the preservation of the bone quality. Increasing steps, using simple everyday tasks, can prevent decrease in BMD in postmenopausal women (Muir et al., 2013, Ashe et al, 2008. There’s difference in the density of the calcaneus between physically active and those who are not, measured by ultrasound densitometry (Vainionpää et al, 2005. We use quantitative ultrasound densitometry to describe BMI of women who exercise Pilates and support the finding that physical activity is one of the ways that may prevent the BMD loss. These research was done as a part of long-term project entitled „Impact of physical activity of the working population“ which is co-financed by Provincial Secretariat for Science and Technological Development.

  17. 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.

  18. The subtalar joint complex of Australopithecus sediba.

    Science.gov (United States)

    Prang, Thomas C

    2016-01-01

    The hominin talus has figured prominently in previous studies of the functional morphology of the talocrural joint, but the talocalcaneal and talonavicular joints have received comparatively less attention despite their functional importance as components of the subtalar joint complex. An associated complete talus and calcaneus attributed to the Malapa Hominin 2 (MH2) individual of Australopithecus sediba offers the opportunity to evaluate the subtalar joint complex in an early hominin. Furthermore, detailed morphological comparisons of A. sediba to other fossil hominins such as Australopithecus africanus have not yet been conducted. Here I quantify joint curvatures and angular measurements among extant hominoids and fossil hominins to evaluate the functional morphology of the subtalar joint complex of A. sediba. Australopithecus sediba uniquely combines talocalcaneal joint morphology indicative of mobility with specializations of the talonavicular joint that provide medial midtarsal stabilization. Multivariate analyses of talus and calcaneus variables show that A. sediba is most similar to extant gorillas in the morphology of the subtalar joint complex. In contrast, other hominins, such as OH 8, are more similar to modern humans. The morphological similarity between MH2 (U.W. 88-98/99) and specimens from Sterkfontein, Member 4 (StW 88, StW 102, StW 352) in morphologies of the talonavicular and talocalcaneal joints suggests that A. sediba may have possessed a foot that was functionally similar to that of A. africanus. This combination of morphologies in the A. sediba foot is probably derived among hominins and suggests that arboreality may have been adaptively significant for southern African Australopithecus. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Effectiveness of myofascial release in the management of plantar heel pain: a randomized controlled trial.

    Science.gov (United States)

    Ajimsha, M S; Binsu, D; Chithra, S

    2014-06-01

    Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain (PHP). However, it is unclear whether myofascial release (MFR) can improve the outcomes in this population. To investigate whether myofascial release (MFR) reduces the pain and functional disability associated with plantar heel pain (PHP) in comparison with a control group receiving sham ultrasound therapy (SUST). Randomized, controlled, double blinded trial. Nonprofit research foundation clinic in India. Sixty-six patients, 17 men and 49 women with a clinical diagnosis of PHP were randomly assigned into MFR or a control group and given 12 sessions of treatment per client over 4 weeks. The Foot Function Index (FFI) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in FFI scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation. The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<0.001). Patients in the MFR and control groups reported a 72.4% and 7.4% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 60.6% in the follow-up at week 12 in the MFR group compared to the baseline. The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (P<0.05). This study provides evidence that MFR is more effective than a control intervention for PHP. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  2. Bone quantitative ultrasound measurements in relation to the metabolic syndrome and type 2 diabetes mellitus in a cohort of elderly subjects at high risk of cardiovascular disease from the PREDIMED study.

    Science.gov (United States)

    Bulló, M; Garcia-Aloy, M; Basora, J; Covas, M I; Salas-Salvado, J

    2011-12-01

    The aim of this study is to determine whether metabolic syndrome, its individual components, or the presence of type 2 diabetes mellitus are associated with a better bone status estimated by quantitative ultrasound at the calcaneus. Cross-sectional study. Outpatient clinics. 251 elderly subjects at high cardiovascular risk from the PREDIMED study were included. MetS was defined according to the ATPIII diagnosis criteria. Calcaneus quantitative ultrasound (QUS) assessment was performed using the Sahara system. Subjects with MetS showed significantly lower 24-hour urinary deoxypyridinoline/creatinine (u-DPD/creatinine) levels and higher broadband ultrasound attenuation, and a tendency to higher bone mineral density (BMD) and quantitative ultrasound index (QUI) than their counterparts. Individuals with type 2 diabetes mellitus (T2DM) showed a significantly higher bone broadband ultrasound attenuation (BUA) and QUI than their non-diabetic counterparts, despite they shown a higher prevalence of osteoporotic fractures. Multiple linear regression analyses showed that quantitative ultrasound parameters were positively associated with the metabolic syndrome and T2DM. Of the bone biochemical markers, only u-DPD/creatinine was related to MetS, abdominal obesity, hypertriglyceridemia component of the MetS, and the number of features that define the MetS. This is the first study showing a positive association between MetS or T2DM with better bone status and lower bone resorption markers measured by quantitative ultrasound. Our results suggest that metabolic abnormalities have a positive effect on healthy bone in elderly subjects at high risk of cardiovascular disease.

  3. Human lead metabolism: Chronic exposure, bone lead and physiological models

    Science.gov (United States)

    Fleming, David Eric Berkeley

    Exposure to lead is associated with a variety of detrimental health effects. After ingestion or inhalation, lead may be taken up from the bloodstream and retained by bone tissue. X-ray fluorescence was used to make in vivo measurements of bone lead concentration at the tibia and calcaneus for 367 active and 14 retired lead smelter workers. Blood lead levels following a labour disruption were used in conjunction with bone lead readings to examine the endogenous release of lead from bone. Relations between bone lead and a cumulative blood lead index differed depending on time of hiring. This suggests that the transfer of lead from blood to bone has changed over time, possibly as a result of varying exposure conditions. A common polymorphism in the δ-aminolevulinate dehydratase (ALAD) enzyme may influence the distribution of lead in humans. Blood lead levels were higher for smelter workers expressing the more rare ALAD2 allele. Bone lead concentrations, however, were not significantly different. This implies that a smaller proportion of lead in blood is distributed to tissue for individuals expressing the ALAD2 allele. The O'Flaherty physiological model of lead metabolism was modified slightly and tested with input from the personal exposure histories of smelter workers. The model results were consistent with observation in tern of endogenous exposure to lead and accumulation of lead in cortical bone. Modelling the calcaneus as a trabecular bone site did not reproduce observed trends. variations in lead metabolism between different trabecular sites may therefore be significant. The model does not incorporate a genetic component, and its output did not reflect observed differences in this respect. This result provides further support for the influence of the ALAD polymorphism on lead metabolism. Experimental trials with a digital spectrometer revealed superior energy resolution and count throughput relative to the conventional X-ray fluorescence system. The associated

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Ultrasonography of ankle ligaments

    Energy Technology Data Exchange (ETDEWEB)

    Peetrons, P.A. [C.H. Moliere-Longchamp, Dept. of Radiology, Brussels (Belgium); Silvestre, A. [Hopital Militaire Laveran, Dept. of Radiology, Marseilles (France); Cohen, M. [Hoptial Saint-Joseph, Dept. of Radiology, Marseilles (France); Creteur, V. [C.H. Moliere-Longchamp, Dept. of Radiology, Brussels (Belgium)

    2002-02-01

    The lateral collateral ligament of the ankle is a complex of 3 ligaments: The anterior and posterior talofibular ligaments and the calcaneofibular ligament; these ligaments work together to support the lateral aspect of the ankle. The anterior talofibular (ATF) ligament (Fig. 1) runs from the anterior of the talus. The probe is placed in a slightly oblique position from the malleolus toward the forefoot. The ligament is hyperechoic when its fibres are perpendicular to the ultrasound beam (anisotropy artifact is present in ligaments as well as in tendons). It is approximately 2 mm thick and, during examination, must be straight and tight from one insertion point to the other, as seen in Fig. 2. The posterior talofibular (PTF) ligament, which runs from the posterior part of the malleolus to the posterior part of the talus, is difficult to see on US, being partially or sometimes completely hidden by the malleolus. The calcaneofibular ligament forms the middle portion of the lateral collateral ligament. It is tight between the inferior part of the lateral malleolus and the calcaneus, and runs in a slightly posterior oblique direction toward the heel (Fig. 3). The ligament lies on the deep surface of the fibular tendons, forming a hammock to fall deep on the calcaneus surface (Fig. 4). The calcaneofibular ligament is approximately 2-3 nun thick and is hyperechoic in the distal two-thirds only because of the obliquity of the proximal part. When examining this ligament, it is mandatory that the ankle be flexed dorsally; this stretches the ligament so that it can be seen clearly. (author)

  6. In vitro ultrasound measurement at the human femur.

    Science.gov (United States)

    Padilla, F; Akrout, L; Kolta, S; Latremouille, C; Roux, C; Laugier, P

    2004-11-01

    Measurements of broadband ultrasonic attenuation (BUA) represent an established means of skeletal status assessment in osteoporosis. Today, the skeletal site that is the most widely used clinically is the calcaneus (heel bone). However, we hypothesized that fracture risk predictions could be improved if ultrasound measurements were performed directly at the main site of fracture, e.g., the proximal femur. The goal of this paper is to demonstrate in vitro the feasibility of quantitative ultra sound (QUS) imaging at the upper part of fee femur, and to investigate the relationships of BUA to bone mineral density (BMD). Forty-four excise human femurs were measured in transmission with a pair of focused 0.5-MHz central frequency transducers. Two-dimensional scans were performed, and the radio frequency (rf) signals were recorded at each measurement point. A data acceptance criterion for region of interest (ROI) selection was established based on the linearity of the frequency-dependent attenuation. Five measurements with repositioning were performed on each sample to determine the reproducibility. Dual energy x-ray absorptiometry (DXA) scans have been performed on the samples for BMD measurements: Three ROIs were selected in the specimens: greater, trochanter intertrochanteric, and femoral neck regions. Coefficient of variations were in the range 1.6% to 2.5%. The determination coefficients (r(2)) between BUA and BMD in site-matched ROIs were 0.81, 0.78, and 0.73, respectively, for the greater trochanteric, intertrochanteric, and femoral neck regions. Our results are consistent with data previously shown at the calcaneus and demonstrate the feasibility of QUS measurements at the femur in vitro, with reasonable reproducibility.

  7. EFFECT OF ORTHOTICS AND FOOTWEAR ON STATIC REARFOOT KINEMATICS

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    Molly Winkelmeyer

    2006-09-01

    Full Text Available This study examined the effect of foot orthotics and footwear on static rearfoot kinematics. Thirty-four subjects (5 males, 29 females from physical therapy clinics and the college community gave informed consent to participate. Subject age was 42 (18 years; subject height was 1.7 (0.1 meters; subject body mass was 72.6 (12.1 kg. Markers were placed on specific sites of the lower leg and calcaneus to determine the rearfoot angle. Rearfoot angle was measured with a goniometer and digitized with video-based software (Ariel Performance Analysis System. A calcaneal mold was utilized to determine the position of the calcaneus in the shod conditions. Static rearfoot angles were measured in the following conditions: barefoot (B, barefoot with the calcaneal mold (BM, barefoot with the calcaneal mold plus the orthotic (BMO, shod with the calcaneal mold (SM, and shod with the calcaneal mold plus the orthotic (SMO. An independent t-test analyzed differences between each condition as measured with the APAS and goniometer. A one-way analysis of variance (ANOVA was utilized to determine statistically significant differences among the 5 foot conditions (p 0.05 between the APAS and goniometer measurements within each condition. One-way ANOVA showed a significant difference (p < 0.01 among the five conditions as measured by APAS. Post-hoc analysis determined that the difference between BM and SM; and the BM and SMO conditions were significantly different (p < 0.01. It was observed that the orthotic slightly decreased the amount of calcaneal eversion in the standing position. The shoes worn in the study, though neutral in construction, did significantly alter rearfoot kinematics in comparison to BM

  8. Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury

    Energy Technology Data Exchange (ETDEWEB)

    Gorbachova, Tetyana; Wang, Peter S.; Hu, Bing [Einstein Medical Center Philadelphia, Department of Radiology, Philadelphia, PA (United States); Horrow, Jay C. [Drexel University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA (United States)

    2016-06-15

    To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI. The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 1/2 year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05. PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %). PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle. (orig.)

  9. [MRI changes of Achilles tendon and hindfoot in experienced runners and beginners during training and after a (half)-marathon competition].

    Science.gov (United States)

    Freund, W; Billich, C; Brambs, H-J; Weber, F; Schütz, U H

    2011-08-01

    Marathon running is gaining in popularity. Its benefits regarding the cardiovascular system as well as the metabolism are beyond doubt. However, whether or not there are detrimental side effects to the musculoskeletal system such as wear and tear is an unsolved question. We therefore prospectively looked at beginners and experienced runners at a city marathon during training and after the competition for lesions to the Achilles tendon (AT) or hindfoot. 73 healthy subjects were prospectively included in our study. They were recruited from the applicants of the city marathon or half-marathon. They underwent an initial clinical orthopaedic as well as three magnetic resonance (MRI) examinations. The MRI were conducted at the time point of study enrolment, near the end of training and directly (up to 72 hours) after the run. MRI evaluation (fat saturated T (2)-weighted sagittal STIR sequence) was performed by two independent experienced radiologists blinded to the clinical context. The results were compared for subgroups of runners, also a factorial analysis was performed. Statistical results were deemed significant for p ≤ 0.05. 32 women and 41 men were included. In the end there were 53 finishers and 20 non-finishers; 28 seasoned runners and 25 novices. 57 runners had no foot complaints, while 14 had foot pain during training and 13 during the marathon. Mean body weight was 71.6 kg, height was 173 cm, age was 40.2 years. Mean AT diameter was 7.0 mm and showed no change during training or after the marathon. There was no significant influence of gender on other variables investigated. There was a significant and positive correlation between AT diameter and weight (r = 0.37), also AT and height (r = 0.34), while there was negative correlation between height and signal intensity of calcaneus (r = -0.50). The signal intensity of the AT decreased during training. The signal intensity of the calcaneus decreased from inclusion until after the marathon

  10. Fracture surgery of the extremities with the intra-operative use of 3D-RX: a randomized multicenter trial (EF3X-trial).

    Science.gov (United States)

    Beerekamp, M Suzan H; Ubbink, Dirk Th; Maas, Mario; Luitse, Jan Sk; Kloen, Peter; Blokhuis, Taco Jm; Segers, Michiel Jm; Marmor, Meir; Schep, Niels Wl; Dijkgraaf, Marcel Gw; Goslings, J Carel

    2011-07-06

    Posttraumatic osteoarthritis can develop after an intra-articular extremity fracture, leading to pain and loss of function. According to international guidelines, anatomical reduction and fixation are the basis for an optimal functional result. In order to achieve this during fracture surgery, an optimal view on the position of the bone fragments and fixation material is a necessity. The currently used 2D-fluoroscopy does not provide sufficient insight, in particular in cases with complex anatomy or subtle injury, and even an 18-26% suboptimal fracture reduction is reported for the ankle and foot. More intra-operative information is therefore needed.Recently the 3D-RX-system was developed, which provides conventional 2D-fluoroscopic images as well as a 3D-reconstruction of bony structures. This modality provides more information, which consequently leads to extra corrections in 18-30% of the fracture operations. However, the effect of the extra corrections on the quality of the anatomical fracture reduction and fixation as well as on patient relevant outcomes has never been investigated.The objective of this study protocol is to investigate the effectiveness of the intra-operative use of the 3D-RX-system as compared to the conventional 2D-fluoroscopy in patients with traumatic intra-articular fractures of the wrist, ankle and calcaneus. The effectiveness will be assessed in two different areas: 1) the quality of fracture reduction and fixation, based on the current golden standard, Computed Tomography. 2) The patient-relevant outcomes like functional outcome range of motion and pain. In addition, the diagnostic accuracy of the 3D-RX-scan will be determined in a clinical setting and a cost-effectiveness as well as a cost-utility analysis will be performed. In this protocol for an international multicenter randomized clinical trial, adult patients (age > 17 years) with a traumatic intra-articular fracture of the wrist, ankle or calcaneus eligible for surgery will be

  11. Fracture Surgery of the extremities with the intra-operative use of 3D-RX: A randomized multicenter trial (EF3X-trial

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    Marmor Meir

    2011-07-01

    Full Text Available Abstract Background Posttraumatic osteoarthritis can develop after an intra-articular extremity fracture, leading to pain and loss of function. According to international guidelines, anatomical reduction and fixation are the basis for an optimal functional result. In order to achieve this during fracture surgery, an optimal view on the position of the bone fragments and fixation material is a necessity. The currently used 2D-fluoroscopy does not provide sufficient insight, in particular in cases with complex anatomy or subtle injury, and even an 18-26% suboptimal fracture reduction is reported for the ankle and foot. More intra-operative information is therefore needed. Recently the 3D-RX-system was developed, which provides conventional 2D-fluoroscopic images as well as a 3D-reconstruction of bony structures. This modality provides more information, which consequently leads to extra corrections in 18-30% of the fracture operations. However, the effect of the extra corrections on the quality of the anatomical fracture reduction and fixation as well as on patient relevant outcomes has never been investigated. The objective of this study protocol is to investigate the effectiveness of the intra-operative use of the 3D-RX-system as compared to the conventional 2D-fluoroscopy in patients with traumatic intra-articular fractures of the wrist, ankle and calcaneus. The effectiveness will be assessed in two different areas: 1 the quality of fracture reduction and fixation, based on the current golden standard, Computed Tomography. 2 The patient-relevant outcomes like functional outcome range of motion and pain. In addition, the diagnostic accuracy of the 3D-RX-scan will be determined in a clinical setting and a cost-effectiveness as well as a cost-utility analysis will be performed. Methods/design In this protocol for an international multicenter randomized clinical trial, adult patients (age > 17 years with a traumatic intra-articular fracture of the

  12. Sonographically guided deep plantar fascia injections: where does the injectate go?

    Science.gov (United States)

    Maida, Eugene; Presley, James C; Murthy, Naveen; Pawlina, Wojciech; Smith, Jay

    2013-08-01

    To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment

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

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    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

  14. 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

  15. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial.

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    Renan-Ordine, Rômulo; Alburquerque-Sendín, Francisco; de Souza, Daiana Priscila Rodrigues; Cleland, Joshua A; Fernández-de-Las-Peñas, César

    2011-02-01

    A randomized controlled clinical trial. To investigate the effects of trigger point (TrP) manual therapy combined with a self-stretching program for the management of patients with plantar heel pain. Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain. However, it is not known if the inclusion of soft tissue therapy can further improve the outcomes in this population. Sixty patients, 15 men and 45 women (mean ± SD age, 44 ± 10 years) with a clinical diagnosis of plantar heel pain were randomly divided into 2 groups: a self-stretching (Str) group who received a stretching protocol, and a self-stretching and soft tissue TrP manual therapy (Str-ST) group who received TrP manual interventions (TrP pressure release and neuromuscular approach) in addition to the same self-stretching protocol. The primary outcomes were physical function and bodily pain domains of the quality of life SF-36 questionnaire. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation. Outcomes of interest were captured at baseline and at a 1-month follow-up (end of treatment period). Mixed-model ANOVAs were used to examine the effects of the interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. The 2 × 2 mixed-model analysis of variance (ANOVA) revealed a significant group-by-time interaction for the main outcomes of the study: physical function (P = .001) and bodily pain (P = .005); patients receiving a combination of self-stretching and TrP tissue intervention experienced a greater improvement in physical function and a greater reduction in pain, as compared to those receiving the self-stretching protocol. The mixed ANOVA also revealed significant

  16. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

    Science.gov (United States)

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

    2013-01-01

    Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

  17. Early decrements in bone density after completion of neoadjuvant chemotherapy in pediatric bone sarcoma patients

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    Hardes Jendrik

    2010-12-01

    Full Text Available Abstract Background Bone mineral density (BMD accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this cross-sectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dual-energy x-ray absorptiometry (DXA after completion of neoadjuvant chemotherapy. Methods DXA measurements of the lumbar spine (L2-4, both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years. Mean Z-scores, areal BMD (g/cm2, calculated volumetric BMD (g/cm3 and bone mineral content (BMC, g were determined. Results Lumbar spine mean Z-score was -0.14 (95% CI: -0.46 to 0.18, areal BMD was 1.016 g/cm2 (95% CI: 0.950 to 1.082 and volumetric BMD was 0.330 g/cm3 (95% CI: 0.314 to 0.347 which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36, the difference between the affected and non-affected femoral neck was 12.1% (95% CI: -16.3 to -7.9 in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7% (95% CI: -29.3 to -14.0 for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from ρ = 0.55 to ρ = 0.80. Conclusions The tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis

  18. Three-dimensional morphology of heel fat pad: an in vivo computed tomography study

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    Campanelli, Valentina; Fantini, Massimiliano; Faccioli, Niccolò; Cangemi, Alessio; Pozzo, Antonio; Sbarbati, Andrea

    2011-01-01

    Heel fat pad cushioning efficiency is the result of its structure, shape and thickness. However, while a number of studies have investigated heel fat pad (HFP) anatomy, structural behavior and material properties, no previous study has described its three-dimensional morphology in situ. The assessment of the healthy, unloaded, three-dimensional morphology of heel pad may contribute to deepen the understanding of its role and behavior during locomotion. It is the basis for the assessment of possible HFP morphological modifications due to changes in the amount or distribution of the loads normally sustained by the foot. It may also help in guiding the surgical reconstruction of the pad and in improving footwear design, as well as in developing a correct heel pad geometry for finite element models of the foot. Therefore the purpose of this study was to obtain a complete analysis of HFP three-dimensional morphology in situ. The right foot of nine healthy volunteers was scanned with computed tomography. A methodological approach that maximizes reliability and repeatability of the data was developed by building a device to lock the foot in a neutral position with respect to the scan planes during image acquisition. Scan data were used to reconstruct virtual three-dimensional models for both the calcaneus and HFP. A set of virtual coronal and axial sections were extracted from the three-dimensional model of each HFP and processed to extract a set of one- and two-dimensional morphometrical measurements for a detailed description of heel pad morphology. The tissue exhibited a consistent and sophisticated morphology that may reflect the biomechanics of the foot support. HFP was found to be have a crest on its anterior dorsal surface, flanges on the sides and posteriorly, and a thick portion that reached and covered the posterior surface of the calcaneus and the achilles tendon insertion. Its anterior internal portion was thinner and a lump of fat was consistently present in

  19. ANALYSIS AND PLANNING OF HINDFOOT DEFORMITY CORRECTION IN SAGITTAL PLANE

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    L. N. Solomin

    2017-01-01

    Full Text Available Background. The disadvantage of the known methods of analysis and planning of hindfoot deformities in the sagittal plaBackground. Long bone deformity planning is well established. However, there are not well described methods of analysis and planning of hindfoot deformities in the sagittal plane. Such planning is made even more difficult with concomitant deformation of the midfoot and/or ankle contracture or malpositioned arthrodesis. The aim of our study was to develop a universal method of analysis and planning of the calcaneus correction, based on the normally derived reference lines and angles.Methods. We analyzed 65 standing lateral foot films in normal adults, 23-54 years old were analyzed. We drew the talus joint line (points “a” and “b” – Line 1. We drew a second line, (Line 2 the calcaneal line, which starts at the back of the calcaneal tuberosity (point “d”, drawn perpendicular to a line from top to bottom of the calcaneal tuberosity. The intersection of the calcaneal line and the talar joint line form point (c anteriorly. We measured lines ab, ac and cd, and their ratios: ac/ab, and cd/ab.Results. Talar joint line (Line 1 and calcaneal line (Line 2 intersect at a point (c, forming an angle 15.2° (±3.4°. The ratio ac/ab = 2.56 (± 1.1. The ratio cd/ab = 4.59 (±1.0. These ratios are constants for calculating the idealized joint lines for deformity planning. For deformity cases, draw Line 1, the talar joint line ab. Extend that line anteriorly to (c, which is a distance ab×2.56 from point (a. From (c, draw an idealized calcaneal line, Line-2, at an angle 15° to Line 1. Place (d on this line, at a distance ab×4.59 from point (c. Next, draw the deformed calcaneal line (Line 3 and point (d1 where it exits the calcaneal tuberosity. Use the same technique and landmarks as for drawing the normal calcaneal line. The intersection of Lines 2 and 3 is the apex of the deformity. Rotate the piece containing Line 3 around this

  20. Dietary Silicon Intake of Korean Young Adult Males and Its Relation to their Bone Status.

    Science.gov (United States)

    Choi, Mi-Kyeong; Kim, Mi-Hyun

    2017-03-01

    Accumulated data suggests a positive effect of silicon on bone health; however, limited research exists on the silicon content of foods. To further the understanding of the relationship between dietary silicon intake and bone health, a food composition database of commonly consumed foods in Korea is required. For quantitative data on the intake levels of silicon, we analyzed the silicon content of 365 food items commonly consumed in Korea using inductively coupled plasma-atomic emission spectrometry following microwave-assisted digestion. To investigate the dietary silicon intake status and to examine the potential role of dietary silicon intake in the bone status of men, a total of 400 healthy Korean adult males aged 19-25 were observed for their diet intake and calcaneus bone density using the 24-h recall method and quantitative ultrasound, respectively. Clinical markers reflecting bone metabolism such as serum total alkaline phosphatase, N-mid osteocalcin, and type 1 collagen C-terminal telopeptide concentrations were also analyzed. Silicon intake of the subjects was estimated as 37.5 ± 22.2 mg/day. Major food sources of dietary silicon in the Korean male were cereal and cereal products (25.6 % of total silicon intake), vegetables (22.7 %), beverages and liquors (21.2 %), and milk and milk products (7.0 %). Silicon intake correlated positively with age, weight, energy intake, protein intake, calcium intake, and alcohol intake. After adjusted for age, weight, energy intake, protein intake, calcium intake, alcohol intake, smoking cigarettes, and regular exercise status, daily total silicon intake had no correlation with calcaneus bone density and the bone metabolism markers, but silicon intake from vegetables had a positive correlation with serum total alkaline phosphatase activity, a bone formation maker. These findings show the possible positive relationship between dietary silicon intake from vegetables and the bone formation of young adult males. Further

  1. 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

  2. Radiographic identification of the primary lateral ankle structures.

    Science.gov (United States)

    Haytmanek, C Thomas; Williams, Brady T; James, Evan W; Campbell, Kevin J; Wijdicks, Coen A; LaPrade, Robert F; Clanton, Thomas O

    2015-01-01

    Lateral ankle ligament injuries rank among the most frequently observed athletic injuries, requiring repair or reconstruction when indicated. However, there is a lack of quantitative data detailing the ligament attachment sites on standard radiographic views. To quantitatively describe the anatomic attachment sites of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) on standard radiographic views with respect to reproducible osseous landmarks to assist with intraoperative and postoperative assessment of lateral ankle ligament repairs and reconstructions. Descriptive laboratory study. Twelve nonpaired, fresh-frozen cadaveric foot and ankle specimens were dissected to identify the origins and insertions of the 3 primary lateral ankle ligaments. Ligament footprint centers were marked with 2-mm stainless steel spheres shallowly embedded at the level of the cortical bone prior to obtaining standard lateral and mortise radiographs. Measurements were performed twice by 2 blinded raters independently to calculate mean distances and assess reliability via intraclass correlation coefficients (ICCs). Radiographic measurements demonstrated excellent reproducibility between raters (all interobserver ICCs>0.97) and across trials (all intraobserver ICCs>0.99). On the lateral view, the ATFL fibular attachment (mean±SD) was 8.4±1.8 mm proximal and anterior to the inferior tip of the lateral malleolus and attached on the talus 13.8±2.0 mm proximal and anterior to the apex of the lateral talar process. The CFL originated 5.0±1.4 mm superior and anterior to the inferior tip of the lateral malleolus and inserted on the calcaneus 18.5±4.6 mm posterior and superior to the posterior point of the peroneal tubercle. On the mortise view, the ATFL origin was 4.9±1.4 mm proximal to the inferior tip of the lateral malleolus and inserted on the talus 9.0±2.1 mm medial and superior of the apex of the lateral talar process

  3. The Heel Pad in Congenital Idiopathic Clubfoot: Implications of Empty Heel for Clinical Severity Assessment.

    Science.gov (United States)

    Adegbehingbe, Olayinka O; Asuquo, J E; Joseph, Mejabi O; Alzahrani, Mohammed; Morcuende, Jose A

    2015-01-01

    Clubfoot has been evaluated in many ways, including the most common classifications of clubfoot, described by Caterrall and Piraniis based on six clinical signs. The purpose of this study was to gain better understanding of the heel pad in relation to the term "empty heel", and to propose modification of clubfoot severity scoring system based on "empty heel". A combination of prospective study of 79 clubfoot patients treated with Ponseti method and literature review of heel pad anatomy and biomechanics. The setting was a university teaching hospital. The ethical research committee approved study protocol and informed consent of patients' parent obtained. The selection criteria included patients' diagnosed congenital idiopathic clubfoot, age One hundred and thirty-two clubfeet in 79 patients (56 males, 23 females) completed Ponseti protocol. The median age at presentation was 5.2 months (range 0.1-23.7 months). The mean right foot abduction after correction 57.30 (S.D. 9.20), and for the left foot, was 56.30 (S.D. 9.40). The mean right foot dorsiflexion was -13.70 (S.D. 18.40) before correction while after correction, it was 20.00 (S.D. 4.50) and for the left, the mean was -8.50 (S.D. 9.60) before correction and 21.00 (S.D. 4.30) after correction. Eighteen (22.8%) patients (10 bilateral, 9 unilateral) had clubfeet with empty heel score above zero point at initial full correction (ppad is a solid complex structure existing in normal, moderate and severe atrophied form. Heel pad is attached tightly to calcaneus without a cavity for the calcaneus to drop. Heel pad probably could replace "empty heel" in modify Pirani scoring system. Clinical indication for repeat tenotomy should be based on equinus, not on the feeling of an empty heel, and families can be advised that the heel pad has a tendency to remodel over time to a normal shape. Level II. Empty heel feeling at initial full correction of congenital idiopathic clubfoot based on Ponseti protocol is not indication for

  4. Bone structure assessed by HR-pQCT, TBS and DXL in adult patients with different types of osteogenesis imperfecta.

    Science.gov (United States)

    Kocijan, R; Muschitz, C; Haschka, J; Hans, D; Nia, A; Geroldinger, A; Ardelt, M; Wakolbinger, R; Resch, H

    2015-10-01

    Bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) was assessed in adult patients with mild, moderate, and severe osteogenesis imperfecta (OI). The trabecular bone score (TBS), bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and dual X-ray and laser (DXL) at the calcaneus were likewise assessed in patients with OI. Trabecular microstructure and BMD in particular were severely altered in patients with OI. OI is characterized by high fracture risk but not necessarily by low BMD. The main purpose of this study was to assess bone microarchitecture and BMD at different skeletal sites in different types of OI. HR-pQCT was performed in 30 patients with OI (mild OI-I, n = 18 (41.8 [34.7, 55.7] years) and moderate to severe OI-III-IV, n = 12 (47.6 [35.3, 58.4] years)) and 30 healthy age-matched controls. TBS, BMD by DXA at the lumbar spine and hip, as well as BMD by DXL at the calcaneus were likewise assessed in patients with OI only. At the radius, significantly lower trabecular parameters including BV/TV (p = 0.01 and p < 0.0001, respectively) and trabecular number (p < 0.0001 and p < 0.0001, respectively) as well as an increased inhomogeneity of the trabecular network (p < 0.0001 and p < 0.0001, respectively) were observed in OI-I and OI-III-IV in comparison to the control group. Similar results for trabecular parameters were found at the tibia. Microstructural parameters were worse in OI-III-IV than in OI-I. No significant differences were found in cortical thickness and cortical porosity between the three subgroups at the radius. The cortical thickness of the tibia was thinner in OI-I (p < 0.001), but not OI-III-IV, when compared to controls. Trabecular BMD and trabecular bone microstructure in particular are severely altered in patients with clinical OI-I and OI-III-IV. Low TBS and DXL and their significant associations to HR-pQCT parameters of trabecular bone support this conclusion.

  5. Factors influencing uncertainties of in vivo bone lead measurement using a (109)Cd K X-ray fluorescence clover leaf geometry detector system.

    Science.gov (United States)

    Behinaein, Sepideh; Chettle, David R; Marro, Leonora; Malowany, Morie; Fisher, Mandy; Fleming, David E B; Healey, Norm; Inskip, Mike; Arbuckle, Tye E; McNeill, Fiona E

    2014-12-01

    A (109)Cd K X-ray fluorescence (KXRF) measurement system consisting of four detectors in clover-leaf geometry is a non-invasive, low-radiation-dose method of measuring bone lead concentration. Its high precision in estimating the bone lead content makes it a promising tool for the determination of the low levels of lead currently found in the general population. After developing the clover-leaf geometry system, the system was used for the first time in a major survey in 2008 to measure the lead levels of 497 smelter employees (an occupationally exposed group with high lead levels). Since the delivered effective dose of the bone lead system in clover-leaf geometry is small (on the order of nSv), the technique can be used to measure the bone lead of sensitive populations such as the elderly and children. This detector system was used from 2009 to 2011, in a pilot study that measured the bone lead concentration of 263 environmentally exposed individuals (termed the EG group) residing in Toronto, Ontario, Canada. In this paper, the factors that influence uncertainties in lead content in tibia (cortical bone) and calcaneus (trabecular bone) are discussed based on gender, age, and body mass index (BMI) by using analysis of variance (ANOVA) and multiple linear regression models. Results from the two study groups (the EG group versus the occupationally exposed smelter employees) are compared where appropriate (i.e. for males older than 20). Results from univariate analyses showed that females have higher tibia uncertainty compared to males. We observed significant differences for both calcaneus and tibia uncertainty measures (p < 0.0005) among different age groups, where the uncertainties were highest in the lowest age group (<11 years). Lastly, and perhaps most significantly, we found that the product of source activity and measurement time influenced the precision of measurements greatly, and that this factor alone could account for the higher uncertainties observed for

  6. 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

  7. [Bone mineral density, biochemical bone turnover markers and factors associated with bone health in young Korean women].

    Science.gov (United States)

    Park, Young Joo; Lee, Sook Ja; Shin, Nah Mee; Shin, Hyunjeong; Kim, Yoo Kyung; Cho, Yunjung; Jeon, Songi; Cho, Inhae

    2014-10-01

    This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women. Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report. The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score≤-2) and 14.3% women had higher BMD (Z-score≥0) than women of same age. BTMs were not significantly different between high-BMD (Z-score≥0) and low-BMD (Z-scoreexercise in health beliefs, lower bone health self-efficacy and promoting behaviors. Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

  8. Influence of Estrogen Receptor α Polymorphisms on Bone Density in Response to Habitual Exercise in Japanese Postmenopausal Women

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    Hiroyo Kondo

    2014-01-01

    Full Text Available Estrogen receptor α (ERα is one of candidate genes for osteoporosis. This study examined the influence of ERα gene, PvuII, and XbaI genotypes on bone density of calcaneus in response to habitual exercise. ERα polymorphisms were detected using PvuII and XbaI restriction enzymes in 316 Japanese postmenopausal women. The bone density was significantly lower in the women carrying PP, pp, or xx genotype without habitual exercise than in the age-matched women without those genotypes. The women carrying Pp genotype without habitual exercise had normal bone density compared to those without Pp genotype. The women carrying PPxx or ppxx polymorphism without habitual exercise had low bone density compared to those with habitual exercise. Thus, the reduction of bone density was attenuated in the women carrying PPxx or ppxx with habitual exercise. In addition, habitual exercise was highly effective for the bone density in the women carrying xx homozygote. These findings indicate that analyses of XbaI and PvuII polymorphisms of ERα may be useful to predict the effect of exercise on bone density, and habitual exercise attenuates the reduction of bone density in women with some genotypes.

  9. 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).

  10. Os Trigonum Syndrome: Two Case Reports Focusing On Possible Risk Factors

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    Senem Şaş

    2016-09-01

    Full Text Available An accessory bone, Os trigonum is placed at the poste­rior of talus. Os trigonum occurs as ossification center be­tween 7-13 years at the posterior of talus and combines with talus within a year. However, this combination does not occur in 7 % of population that results in Os trigonum syndrome. Os trigonum syndrome is a clinic disorders that can cause posterior foot pain. This bone causes back foot pain as a result of compression between talus and calcaneus. These symptoms are seen as a result of re­petitive strain or traumas that are frequently seen in balle­rinas and soccer players with the force of ankle to plantar flexion. People with Os trigonum are generally stated to be asymptomatic, however due to additional risk factors that cause posterior foot pain such as overuse or occupa­tional one can call this syndrome to be symptomatic. In this study two different cases with symptomatic Os trigo­num are reported one due to wearing of high heel shoes and other due to occupational overuse (farming. In this report we present two cases of an 18 years and a 65 years old who have back foot pain and diagnosed with os trigonum syndrome with the review of current lit­erature.

  11. Heel pain--operative results.

    Science.gov (United States)

    Baxter, D E; Thigpen, C M

    1984-01-01

    In 6 years through 1982, the authors performed 34 operative cases in 26 patients with recalcitrant heel pain. The operative procedure involves an isolated neurolysis of the mixed nerve supplying the abductor digiti quinti muscle as it passes beneath the abductor hallucis muscle and beneath the medial ridge of the calcaneus. The deep fascia of the abductor hallucis muscle is released routinely, and an impinging heel spur or tight plantar fascia is partially removed or released if it is causing entrapment of the nerve. The biomechanical pathogenesis of heel pain in relation to pes planus and pes cavus predisposing to an entrapment neuropathy is described, and the anatomy of the heel in relation to the nerve distribution is clarified and well illustrated. Of the 34 operated heels, 32 had good results and two had poor results. Heel pain can cause total disability in the working population and may jeopardize one's employment or professional athletic career. The authors believe operative treatment has a place in the care of recalcitrant heel pain and that an entrapment neuropathy is an etiological factor in heel pain.

  12. Arthroscopy-assisted fracture fixation.

    Science.gov (United States)

    Atesok, Kivanc; Doral, M Nedim; Whipple, Terry; Mann, Gideon; Mei-Dan, Omer; Atay, O Ahmet; Beer, Yiftah; Lowe, Joseph; Soudry, Michael; Schemitsch, Emil H

    2011-02-01

    the purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures.

  13. New experiences in treating postburn talipes equinovarus associated with bone and joint pathologic changes.

    Science.gov (United States)

    Liu, Tianyi; Wang, Danru; Qian, Yunliang; Shi, Yaoming; Guan, Wenxiang

    2009-09-01

    This article aims to solve the problem of postburn talipes equinovarus associated with bone and joint pathologic changes by simplified and modified techniques. In addition to lengthening the shortened Achilles tendon and the contracted scar above it, we performed triple arthrodesis directly on the densely scarred, deformed foot without replacing the scar tissue with normal tissue tube or flap. Only the proximal scar-periosteum wound edge of the curved incision, 2 cm distal to the conventional one, was elevated to expose the bones to be excised. The two excised wedge-shaped bone blocks, one on the dorsum and the other on the lateral side of the deformed foot, were composed of a larger part of the talus and lesser parts of the navicular, cuboid and calcaneus bones. All the patients who could not stand or walk without crutches pre-operatively obtained a good operative result, which enabled them to do so without crutches postoperatively. We conclude that the scar tissue can be elevated without risk of necrosis if it is still attached firmly to the underlying periosteum, and arthrodesis can be done under it. Incision wound healing and bone union is not exclusively a problem.

  14. MRI multiplanar reconstruction in the assessment of congenital talipes equinovarus

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    Wang Chen [Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala (Sweden)]|[Department of Diagnostic Radiology, Uppsala Univ. (Sweden); Petursdottir, S.; Rehnberg, L. [Department of Orthopaedics, Uppsala University Hospital, Uppsala (Sweden); Leifsdottir, I. [Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala (Sweden); Ahlstroem, H.

    1999-04-01

    Background. Magnetic resonance imaging (MRI) has been shown to be a useful tool in the evaluation of the complex deformities which are present in congenital talipes equinovarus (clubfoot). Objective. To evaluate MRI with the multiplanar reconstruction (MPR) technique as a new method for assessment of clubfoot. Materials and methods. Seven infants with 11 clubfeet were studied by using three-dimensional gradient-echo MR sequences. MPR was performed from the acquired image data in orthogonal, single and double oblique planes to demonstrate the complex deformities in clubfoot. Three angles (talar body-neck angle, talocalcaneal left-right angle and the talocalcaneal superior-inferior angle) were defined for measuring the medial angulation of the talar neck and the rotation of the calcaneus in relation to the talus. Results. The method clearly demonstrated the pathological anatomy of the clubfeet, especially the talonavicular articulations. Dislocation of the navicular bone was observed in 9 of the 11 feet. The angle measurements were easily conducted with MPR, and these angles differed considerably among the patients. Conclusions. The information provided by this method is useful for classification of the severity of clubfoot deformities. (orig.) With 5 figs., 1 tab., 16 refs.

  15. Assessment of enthesopathy in patients with fibromyalgia by using new sonographic enthesitis index.

    Science.gov (United States)

    Ozkan, Fuat; Bakan, Betul; Inci, Mehmet Fatih; Kocturk, Fatih; Cetin, Gozde Yildirim; Yuksel, Murvet; Sayarlioglu, Mehmet

    2013-08-01

    The aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). This study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Student's t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P FM patients and 3.7 ± 3.22 among healthy controls (P 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. Misdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

  16. MECHANISMS FOR TRICEPS SURAE INJURY IN HIGH PERFORMANCE FRONT ROW RUGBY UNION PLAYERS: A KINEMATIC ANALYSIS OF SCRUMMAGING DRILLS

    Directory of Open Access Journals (Sweden)

    Carol A. Flavell

    2013-03-01

    Full Text Available The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS, greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players

  17. Osteometric sex determination of burned human skeletal remains.

    Science.gov (United States)

    Gonçalves, D; Thompson, T J U; Cunha, E

    2013-10-01

    Sex determination of human burned skeletal remains is extremely hard to achieve because of heat-related fragmentation, warping and dimensional changes. In particular, the latter is impeditive of osteometric analyses that are based on references developed on unburned bones. New osteometric references were thus obtained which allow for more reliable sex determinations. The calcined remains of cremated Portuguese individuals were examined and specific standard measurements of the humerus, femur, talus and calcaneus were recorded. This allowed for the compilation of new sex discriminating osteometric references which were then tested on independent samples with good results. Both the use of simple section points and of logistic regression equations provided successful sex classification scores. These references may now be used for the sex determination of burned skeletons. Its reliability is highest for contemporary Portuguese remains but nonetheless these results have important repercussion for forensic research. More conservative use of these references may also prove valuable for other populations as well as for archaeological research. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  18. The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study.

    Science.gov (United States)

    Ziai, Pejman; Benca, Emir; von Skrbensky, Gobert; Graf, Alexandra; Wenzel, Florian; Basad, Erhan; Windhager, Reinhard; Buchhorn, Tomas

    2013-06-01

    Peroneal tendons are known as active stabilizer in acute ankle sprain while an intact ankle mortise and intact lateral ligaments are required for passive stability of the ankle joint. The goal of this study is to determine the peroneal tendons as passive stabilizer in case of lateral ligament instability. Twelve (12) human lower leg cadaver specimens underwent a torsion simulation in the testing system, 858 Mini Bionix(®) (MTS(®) Systems Corporation, Eden Prairie, MN, USA) and a specially designed mounting platform for the specimens. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation during plantar flexion and hindfoot inversion. The resisting torque around mechanical tibial axis was recorded which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: ATFL (anterior talofibular ligament) in combination with CFL (calcaneofibular ligament), followed by peroneus longus tendon and finally peroneus brevis tendon. The combined lateral ATFL and CFL instability shows a decrease of the resisting torque which ensures stability in ankle sprain trauma. Only a transection of PLT with existing lateral dual-ligament instability results in a significant decrease in torque (p lesion in ankle sprain trauma. A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in diagnostic and treatment for ankle instability.

  19. Multiple abnormalities in the feet and associated changes elsewhere in the skeleton: The case of 3A-7 from a Capsian Site in Algeria.

    Science.gov (United States)

    Jackes, M; Parent, M; Lubell, D

    2017-05-01

    A skeleton with a number of abnormalities is described involving full discussion of alternative diagnoses. In this complex case, the primary diagnosis is of avulsion of the stem of the bifurcate ligament causing a fracture of the anterior process of the calcaneus. The bilateral fracture identified in Skeleton 3A-7 from Site 12, a Capsian site in Algeria, is a result of the feet being inverted and plantar flexed: the fracture is prone to non-union, which is asymmetrical here. There is also a separate anatomical variation of the feet, 3rd cuneiform and 3rd metatarsal coalition, which was not the cause of trauma. The bifurcate ligament is a major stabilizer of the lateral transverse talar joint, and the trauma could lead to further issues: however, multiple other traumatic changes in 3A-7 most likely occurred at the same time, rather than as the result of pre-existing foot trauma. The asymmetry of the calcaneal condition and asymmetry of the sequelae of the original trauma led to long bone asymmetry, the result of locomotor difficulties. Copyright © 2017 Elsevier GmbH. All rights reserved.

  20. Thermographic Imaging of the Superficial Temperature in Racing Greyhounds before and after the Race

    Directory of Open Access Journals (Sweden)

    Mari Vainionpää

    2012-01-01

    Full Text Available A total of 47 racing greyhounds were enrolled in this study on two race days (in July and September, resp. at a racetrack. Twelve of the dogs participated in the study on both days. Thermographic images were taken before and after each race. From the images, superficial temperature points of selected sites (tendo calcaneus, musculus gastrocnemius, musculus gracilis, and musculus biceps femoris portio caudalis were taken and used to investigate the differences in superficial temperatures before and after the race. The thermographic images were compared between the right and left legs of a dog, between the raced distances, and between the two race days. The theoretical heat capacity of a racing greyhound was calculated. With regard to all distances raced, the superficial temperatures measured from the musculus gastrocnemius were significantly higher after the race than at baseline. No significant differences were found between the left and right legs of a dog after completing any of the distances. Significant difference was found between the two race days. The heat loss mechanisms of racing greyhounds during the race through forced conduction, radiation, evaporation, and panting can be considered adequate when observing the calculated heat capacity of the dogs.

  1. Sex estimation from the tarsal bones in a Portuguese sample: a machine learning approach.

    Science.gov (United States)

    Navega, David; Vicente, Ricardo; Vieira, Duarte N; Ross, Ann H; Cunha, Eugénia

    2015-05-01

    Sex estimation is extremely important in the analysis of human remains as many of the subsequent biological parameters are sex specific (e.g., age at death, stature, and ancestry). When dealing with incomplete or fragmented remains, metric analysis of the tarsal bones of the feet has proven valuable. In this study, the utility of 18 width, length, and height tarsal measurements were assessed for sex-related variation in a Portuguese sample. A total of 300 males and females from the Coimbra Identified Skeletal Collection were used to develop sex prediction models based on statistical and machine learning algorithm such as discriminant function analysis, logistic regression, classification trees, and artificial neural networks. All models were evaluated using 10-fold cross-validation and an independent test sample composed of 60 males and females from the Identified Skeletal Collection of the 21st Century. Results showed that tarsal bone sex-related variation can be easily captured with a high degree of repeatability. A simple tree-based multivariate algorithm involving measurements from the calcaneus, talus, first and third cuneiforms, and cuboid resulted in 88.3% correct sex estimation both on training and independent test sets. Traditional statistical classifiers such as the discriminant function analysis were outperformed by machine learning techniques. Results obtained show that machine learning algorithm are an important tool the forensic practitioners should consider when developing new standards for sex estimation.

  2. Association of serum leptin with bone mineral density in postmenopausal osteoporotic females.

    Science.gov (United States)

    Tariq, Saba; Baig, Mukhtiar; Tariq, Sundus; Shahzad, Muhammad

    2017-04-01

    Present study was designed to find out whether leptin is a predictor of bone mass density (BMD) in premenopausal women (PMW) and postmenopausal osteoporotic women (PMOPW) or it has no association with BMD. One hundred and ninety two women (98 PMOPW and 94 PMW) were recruited for this study. The control group was BMI matched with osteoporotic subjects. BMD assessment was done on calcaneus by peripheral ultrasound bone densitometry and T scores were determined. Serum leptin levels were measured by enzyme-linked immunosorbent assay (ELISA). Serum leptin and BMD values were significantly different in both groups (leptin, 18.56 ± 8.65 ng/ml versus 21.64 ± 9.80 ng/ml, p = 0.02) and (BMD, -0.70 ± 0.19 versus -3.17 ± 0.59, p = 0.000), respectively. In PMOPW serum leptin and BMD were considerably correlated with weight (lep, r = 0.53, p = leptin level was not found to be the predictor of BMD in both groups. The present results indicate that body weight and BMI have an impact on BMD while serum leptin is not associated with BMD in PMW and PMOPW.

  3. Bone Mineral Density During Total Contact Cast Immobilization for a Patient With Neuropathic (Charcot) Arthropathy

    Science.gov (United States)

    Hastings, Mary K; Sinacore, David R; Fielder, Faye A; Johnson, Jeffrey E

    2014-01-01

    Background and Purpose Diabetes mellitus (DM)-related neuropathic arthropathy of the foot is a destructive bone and joint process. The effect of cast immobilization and non–weight bearing on bone loss has not been well studied. The purpose of this case report is to describe the changes in bone mineral density (BMD) of the calcaneus in the feet of a patient with acute neuropathic arthropathy during total contact cast immobilization. Case Description The patient was a 34-year-old woman with type 1 DM, renal failure requiring dialysis, and a 7-week duration of neuropathic arthropathy of the midfoot. Intervention included total contact casting and minimal to no weight bearing for 10 weeks, with transition to therapeutic footwear. Ultrasound-derived estimates of BMD were taken of both involved and uninvolved calcanei. Outcome Bone mineral density decreased for the involved foot (from 0.25 g/cm2 to 0.20 g/cm2) and increased for the uninvolved foot (from 0.27 g/cm2 to 0.31 g/cm2) during casting. Discussion The low initial BMD and further loss during casting suggest the need for transitional bracing and a well-monitored return to full activity to minimize the risk of recurrence and progression of foot deformity. PMID:15733049

  4. Dioxin-like compounds are not associated with bone strength measured by ultrasonography in Inuit women from Nunavik (Canada): results of a cross-sectional study.

    Science.gov (United States)

    Paunescu, Alexandra-Cristina; Ayotte, Pierre; Dewailly, Eric; Dodin, Sylvie

    2013-01-01

    Bone strength in Inuit people appears lower than that of non-Aboriginals. Inuit are exposed to persistent organic pollutants including dioxin-like compounds (DLCs) through their traditional diet that comprises predatory fish and marine mammal fat. Results from experimental and population studies suggest that some DLCs can alter bone metabolism and increase bone fragility. This cross-sectional descriptive study was conducted to examine the relationship between the stiffness index (SI) and plasma concentrations of total DLCs or specific dioxin-like polychlorinated biphenyls (DL-PCBs) in Inuit women of Nunavik (Northern Quebec, Canada). SI was determined by ultrasonography at the right calcaneus of 194 Inuit women aged 35-72 years who participated to Qanuippitaa? How Are We? Nunavik Inuit Health Survey in 2004. Plasma total DLC levels were quantified by measuring the aryl hydrocarbon receptor-mediated transcriptional activity elicited by plasma sample extracts in a cell-based reporter gene assay. Plasma concentrations of DL-PCBs nos. 105, 118, 156, 157, 167 and 189 were measured by gas chromatography-mass spectrometry. We used multiple linear regression analyses to investigate relations between total DLCs or specific DL-PCBs and SI, taking into consideration several potential confounders. Neither total plasma DLCs nor specific DL-PCBs were associated with SI after adjustment for several confounders and covariates. Our results do not support a relation between exposure to DLCs and bone strength measured by ultrasonography in Inuit women of Nunavik.

  5. Dioxin-like compounds are not associated with bone strength measured by ultrasonography in Inuit women from Nunavik (Canada: results of a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Alexandra-Cristina Paunescu

    2013-05-01

    Full Text Available Background. Bone strength in Inuit people appears lower than that of non-Aboriginals. Inuit are exposed to persistent organic pollutants including dioxin-like compounds (DLCs through their traditional diet that comprises predatory fish and marine mammal fat. Results from experimental and population studies suggest that some DLCs can alter bone metabolism and increase bone fragility. Objective. This cross-sectional descriptive study was conducted to examine the relationship between the stiffness index (SI and plasma concentrations of total DLCs or specific dioxin-like polychlorinated biphenyls (DL-PCBs in Inuit women of Nunavik (Northern Quebec, Canada. Methods. SI was determined by ultrasonography at the right calcaneus of 194 Inuit women aged 35–72 years who participated to Qanuippitaa? How Are We? Nunavik Inuit Health Survey in 2004. Plasma total DLC levels were quantified by measuring the aryl hydrocarbon receptor–mediated transcriptional activity elicited by plasma sample extracts in a cell-based reporter gene assay. Plasma concentrations of DL-PCBs nos. 105, 118, 156, 157, 167 and 189 were measured by gas chromatography–mass spectrometry. We used multiple linear regression analyses to investigate relations between total DLCs or specific DL-PCBs and SI, taking into consideration several potential confounders. Results. Neither total plasma DLCs nor specific DL-PCBs were associated with SI after adjustment for several confounders and covariates. Conclusion. Our results do not support a relation between exposure to DLCs and bone strength measured by ultrasonography in Inuit women of Nunavik.

  6. Bone mass of Spanish school children: impact of anthropometric, dietary and body composition factors.

    Science.gov (United States)

    Lavado-Garcia, Jesus M; Calderon-Garcia, Julian F; Moran, Jose M; Canal-Macias, Maria Luz; Rodriguez-Dominguez, Trinidad; Pedrera-Zamorano, Juan D

    2012-03-01

    The purpose of this study was to: (a) determine the relationship between quantitative ultrasound (QUS) results and anthropometric, dietary and body composition factors and establish reference ranges for amplitude-dependent speed of sound (Ad-SoS) in the phalanges and broadband ultrasound attenuation (BUA) in the calcaneus of children from Extremadura, Spain, and (b) to present reference curves for this population. Healthy children (n = 245), aged 4-16 years, were included (124 girls and 121 boys). Phalangeal and calcaneal QUS measurements were performed using DBM Sonic Bone Profiler and McCue CUBA Clinical ultrasound devices, respectively. Weight, height and body mass index (BMI) were evaluated by anthropometric methods. Fat percentage, fat mass, lean mass (FFM) and total body water (TBWater) were evaluated by bioelectrical impedance measurements using a Holtain body composition analyzer. Food intake was evaluated by a 7-day food record. A gender analysis revealed that Ad-SoS and BUA parameters increased significantly with age and that both positively correlated with age, weight, height, BMI, FFM and TBWater. For both genders, Ad-SoS showed significant and positive correlations with age, weight, height, BMI, FFM, BUA and TBWater.

  7. 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.

  8. Treatment of acute achilles tendon rupture with the panda rope bridge technique.

    Science.gov (United States)

    Yin, Liangjun; Wu, Yahong; Ren, Changsong; Wang, Yizhong; Fu, Ting; Cheng, Xiangjun; Li, Ruidong; Nie, Mao; Mu, Yuan

    2018-01-16

    Although nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described. Patient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively. PBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6. The PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Estudo da perda da tensao do enxerto de tendão calcâneo bovino

    Directory of Open Access Journals (Sweden)

    Sergio Rocha Piedade

    2008-04-01

    Full Text Available Lesion of the anterior cruciate ligament (ACL in the knee is a problem that affects animals as well as humans and may evolve with joint instability that is often symptomatic and incapacitating. The main option for ligament substitution is the autologous tendon graft. The graft undergoes tensioning during ACL reconstructive surgery to reestablish the normal laxity of the ACL- deficient knee. Although graft tensioning plays a fundamental role in postoperative clinical evolution, ideal tensioning levels have not been established in the literature. Therefore, graft elongation that may occur over time is still one of the main reasons for ligament reconstruction failure. In this study, ten bovine calcaneus tendons underwent two successive assays of physiological tensioning for a maximum deformation of 2.5% of the initial tendon length, maintained for 600s with force (N values recorded at zero time (initial, 300s and 600s. At the end of the first assay, the tendon returned to its initial length and was maintained at rest for 300s and then the next tensioning assay was initiated, repeating the previous procedure. Statistical analysis revealed that tendon elongation is more pronounced during the initial 300s, reflecting a more accentuated decline in the tension values of the graft. Therefore, 300s after tensioning and fixing the graft, the surgeon can assess with more precision if the tensioning level was adequate.

  10. Chondroblastoma: A clinical and radiological study of 104 cases

    Energy Technology Data Exchange (ETDEWEB)

    Bloem, J.L.; Mulder, J.D.

    1985-06-01

    The clinical and radiographic findings in 104 patients with chondroblastoma are presented. Pain was an almost constant presenting complaint, often accompanied in the case of para-articular lesions by impaired function of an adjacent joint. The majority (80%) were in long bones with a mean age of presentation of 16 years. The characteristic radiological image of these lesions was an eccentric radiolucency, having a sharply defined sclerotic margin and containing areas of calcification in approximately a third of cases. They were always related to a growth plate. Nearly half were confined to the affected epiphysis or apophysis itself, but most of the remainder had traversed the growth plate to involve also the adjacent metaphysis. The bones around the knee and the proximal ends of the humerus and femur were the sites of predilection. A minority (20%) affected flat bones and short tubular bones of the hand and foot, with a peculiar affinity for the calcaneus and talus. The mean age of presentation of these was 28 years. The radiological pattern was similar, except for a greater tendency to expand the affected bone. Complications included the formation of a secondary aneurysmal bone cyst in 16 cases (10 of them in long bones), one malignant chondroblastoma, and one fibrosarcoma developing after radiation of the original chondroblastoma.

  11. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis

    Science.gov (United States)

    Muller, Bart; Maas, Mario; Sierevelt, Inger N; van Dijk, C Niek

    2010-01-01

    Background and purpose A retrocalcaneal bursitis is caused by repetitive impingement of the bursa between the Achilles tendon and the posterosuperior calcaneus. The bursa is situated in the posteroinferior corner of Kager's triangle (retrocalcaneal recess), which is a radiolucency with sharp borders on the lateral radiograph of the ankle. If there is inflammation, the fluid-filled bursa is less radiolucent, making it difficult to delineate the retrocalcaneal recess. We assessed whether the radiographic appearance of the retrocalcaneal recess on plain digital (filmless) radiographs could be used in the diagnosis of a retrocalcaneal bursitis. Methods Whether or not there was obliteration of the retrocalcaneal recess (yes/no) on 74 digital weight-bearing lateral radiographs of the ankle was independently assessed by 2 observers. The radiographs were from 24 patients (25 heels) with retrocalcaneal bursitis (confirmed on endoscopic calcaneoplasty); the control group consisted of 50 patients (59 heels). Results The sensitivity of the test was 83% for observer 1 and 79% for observer 2. Specificity was 100% and 98%, respectively. The kappa value of the interobserver reliability test was 0.86. For observer 1, intraobserver reliability was 0.96 and for observer 2 it was 0.92. Interpretation On digital weight-bearing lateral radiographs of a retrocalcaneal bursitis, the retrocalcaneal recess has a typical appearance. PMID:20450438

  12. A new RF transmit coil for foot and ankle imaging at 7T MRI.

    Science.gov (United States)

    Santini, Tales; Kim, Junghwan; Wood, Sossena; Krishnamurthy, Narayanan; Farhat, Nadim; Maciel, Carlos; Raval, Shailesh; Zhao, Tiejun; Ibrahim, Tamer S

    2017-09-08

    A four-channel Tic-Tac-Toe (TTT) transmit RF coil was designed and constructed for foot and ankle imaging at 7T MRI. Numerical simulations using an in-house developed FDTD package and experimental analyses using a homogenous phantom show an excellent agreement in terms of B1(+) field distribution and s-parameters. Simulations performed on an anatomically detailed human lower leg model demonstrated an B1(+) field distribution with a coefficient of variation (CV) of 23.9%/15.6%/28.8% and average B1(+) of 0.33μT/0.56μT/0.43μT for 1W input power (i.e., 0.25W per channel) in the ankle/calcaneus/mid foot respectively. In-vivo B1(+) mapping shows an average B1(+) of 0.29μT over the entire foot/ankle. This newly developed RF coil also presents acceptable levels of average SAR (0.07W/kg for 10g per 1W of input power) and peak SAR (0.34W/kg for 10g per 1W of input power) over the whole lower leg. Preliminary in-vivo images in the foot/ankle were acquired using the T2-DESS MRI sequence without the use of a dedicated receive-only array. Copyright © 2017. Published by Elsevier Inc.

  13. Bone density, ultrasound measurements and body composition in early ankylosing spondylitis.

    Science.gov (United States)

    Toussirot, E; Michel, F; Wendling, D

    2001-08-01

    In this cross-sectional study, we evaluated bone density using both dual-energy X-ray absorptiometry (DEXA) and quantitative ultrasound (QUS) techniques and examined the changes in body composition in patients with ankylosing spondylitis (AS). Seventy-one patients were compared with seventy-one sex- and age-matched controls. Bone mineral density (BMD) was evaluated at the lumbar spine and femoral neck with a Lunar device. Total body measurements were also performed, giving BMD and bone mineral content (BMC) of the whole body, and fat and lean masses. Broadband ultrasound attenuation (BUA), speed of sound and stiffness were measured at the calcaneus using an Achilles ultrasound device. The patients had significantly lower lumbar spine, femoral neck and total body BMD as compared with controls (all P talalgia in AS did not influence the QUS values. These results confirm that AS patients have decreased BMD values at both the spine and femur, and also in total body measurements, reflecting a generalized bone loss. On the contrary, soft tissue composition does not seem to be influenced by the disease. QUS parameters were found to be similar between patients and controls, suggesting that the QUS method did not provide additive information to DEXA. As it is thought that QUS provides information about qualitative properties of bone, the normal results of QUS values in our patient series argue against modifications in AS bone micro-architecture.

  14. Localized accumulation of lead within and among bones from lead-dosed goats

    Energy Technology Data Exchange (ETDEWEB)

    Cretacci, Yan [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, P.O. Box 509, Albany, NY 12201-0509 (United States); Department of Environmental Health Sciences, School of Public Health, The University at Albany, P.O. Box 509, Albany, NY 12201-0509 (United States); Parsons, Patrick J., E-mail: pparsons@wadsworth.org [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, P.O. Box 509, Albany, NY 12201-0509 (United States); Department of Environmental Health Sciences, School of Public Health, The University at Albany, P.O. Box 509, Albany, NY 12201-0509 (United States)

    2010-01-15

    The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia Pb levels were found to correlate strongly with the cumulative Pb dose (r{sup 2}=0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the noninvasive measurement of lead in bone by XRF methods are discussed.

  15. Differential vulnerability of 3 rapidly conducting somatosensory pathways in the dog with vitamin B6 neuropathy.

    Science.gov (United States)

    Schaeppi, U; Krinke, G

    1985-09-01

    In anesthetized dogs with chronically implanted cortical electrodes somatic sensory-evoked potentials (SEPs) were produced by electrical stimulation at neural, muscular or cutaneous sites of the contralateral hind leg. Stimulation of the tibial nerve at the calcaneus or of the short flexor muscles of the hind paw caused SEPs having characteristics following activation of rapidly conducting afferents from muscle spindles. Stimulation of the glabrous skin of the central pad resulted in SEPs arriving after a more protracted latency evidently related to activation of afferents from Merkel cells, Krause and Pacinian corpuscles known to be located at these sites. Stimulation of the hairy skin from the dorsal surface of the hindpaw produced a further type of SEP presumably resulting from activation of afferents from receptors of tylotrich hair follicles. Vitamin B6-induced neuropathy involves the selective degeneration of the largest neurons in the spinal ganglia and of associated long peripheral and central neurites performing rapid impulse transmission. In the course of vitamin B6 neuropathy the relatively slow impulse transmission following stimulation of the central pad was more severely impaired than the faster one after activation of afferents from muscle spindles or receptors from hair follicles. This allows us to conclude that in the dog afferents from the glabrous skin of the central pad conduct centrally via the dorsal columns, susceptible to vitamin B6 intoxication, while muscle and hair receptor afferents ascend in the dorsal spinocerebellar and spinocervical tract, respectively, which are vitamin B6 resistant.

  16. 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.

  17. Pediatric calcaneal fractures

    Directory of Open Access Journals (Sweden)

    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.

  18. 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)

  19. [Clinical application of lateral superior genicular composite tissue flap].

    Science.gov (United States)

    Liu, Yong; Zhang, Chengjin; Fu, Xingmao; Wang, Jianli; Sui, Zhiqiang; Zhang, Xuetao; Wang, Lei

    2015-03-01

    To investigate the clinical effect of lateral superior genicular composite tissue flap for tissue defect. The axis line of flap is the lateral thigh vertical midline. The cutaneous branch is inserted 4 cm near the femoral lateral epicondylus. The anterior border is the elongation line along patellar lateral border. The posterior margin is the hinder margin of femoral biceps. The lower border is the horizontal line along the upper line of patella. The composite flaps were used in 18 cases with soft tissue defects in extremities, 11 cases with clacaneus tenden defects and 16 cases with bony nonunion. Results From Mar. 2002 to Sept. 2013, 45 cases were treated with the composite tissue flaps. The flaps size ranged from 6 cm x 3 cm to 17cm x 9 cm. All the flaps survived completely. Blood supply crisis happened in 2 cases, which was released by reanastomosis. The patients were followed up for 1 - 2. 5 years with satisfactory aesthetic and functional results. All the bone defect and nonunion were healed. Good healing was also achieved in donor sites. 8 months after operation, knee joint function is evaluated as good by hospital special surgery knee score (HSS). Lateral superior genicular compostie tissue flap can be used to reconstruct soft tissue defect, bone defect and tenden calcaneus defect in one stage.

  20. THE INFLUENCE OF LATERALITY ON DIFFERENT PATTERNS OF ASYMMETRICAL FOOT PRESSURE AND MUSCLE ACTIVATION DURING A GAIT CYCLE IN MANUAL PUSHING.

    Science.gov (United States)

    Sanjaya, Kadek Heri; Lee, Soomin; Shimomura, Yoshihiro; Katsuura, Tetsuo

    2014-12-01

    This study investigated laterality of manual pushing during a gait cycle by measuring pushing force, muscular activation and foot pressure. Subjects were 17 healthy young adult males; (11 right-handed [RH], and 6 left-handed [LH]). They pushed a force plate while walking on a treadmill at 1.5, 3, and 4 km/h. Electromyogram (EMG) data were collected bilaterally from the tibialis anterior, soleus, lumbar erector spinae and triceps brachii. To measure foot pressure, ten pressure sensors were attached bilaterally on five points of the sole. Symmetry assessment was performed by comparing bilateral data and cross-correlation function (CCF). Gait cycle duration was found to be symmetrical in all conditions. LH subjects demonstrated asymmetry in calcaneus contact duration to control ankle flexion, whereas RH were symmetrical. Velocity affected tibialis anterior muscle time lag and soleus muscle CCF coefficients, mainly in LH. We found that triceps brachii muscle CCF coefficients in LH subjects were affected by increasing velocity. Results indicated that LH and RH did not mirror each other, since both had distinct characteristics. Furthermore these asymmetries were not strictly associated with the preferred side, indicating that generalisation of preferred side to whole-body coordination should be avoided, since we could not separate one side from the other.

  1. The role of the medial ligaments in lateral stabilization of the ankle joint: an in vitro study.

    Science.gov (United States)

    Ziai, Pejman; Benca, Emir; Skrbensky, Gobert V; Wenzel, Florian; Auffarth, Alexander; Krpo, Selma; Windhager, Reinhard; Buchhorn, Tomas

    2015-07-01

    The deltoid ligament complex is known as medial stabilizer in the ankle against pronation/eversion. Lateral dual-ligament laxity often results in chronic ankle instability with recurring ankle sprain trauma. The goal of this study is to examine the lateral stabilizing role of the deltoid ligament complex against supination/inversion in case of existing lateral ligament instability. A torsion simulation was performed on 12 fresh human lower leg cadaver specimens in a loading frame and a specially designed mounting platform. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation on specimen in plantar flexion and hindfoot inversion. The measured variable was the resisting torque recorded around mechanical tibial axis, which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: anterior talofibular ligament (ATFL) in combination with calcaneofibular ligament (CFL), followed by anterior tibiotalar ligament and posterior tibiotalar ligament and finally tibiocalcaneal ligament (TCL). The combined lateral ATFL and CFL instability showed a decrease in the resisting torque, which ensures stability in ankle sprain trauma. Only a transection of TCL (superficial layer of deltoid ligament complex) with existing lateral dual-ligament instability results in a significant decrease in torque (pankle joint in case of repetitive sprain trauma at a present lateral ligament lesion. Diagnostics of and treatment for lateral ligament instability need to consider the deltoid ligament complex,especially TCL in clinical routine.

  2. 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.

  3. 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.

  4. Surgical treatment for myelodysplastic clubfoot,

    Directory of Open Access Journals (Sweden)

    Alexandre Zuccon

    2014-12-01

    Full Text Available Objective:To analyze the results from surgical treatment of 69 cases of clubfoot in 43 patients with myelodysplasia according to clinical and radiographic criteria, at our institution between 1984 and 2004.Methods:This was a retrospective study involving analysis of medical files, radiographs and consultations relating to patients who underwent surgical correction of clubfoot. The surgical technique consisted of radical posteromedial and lateral release with or without associated talectomy.Results:The patients' mean age at the time of the surgery was four years and two months, and the mean length of postoperative follow-up was seven years and two months. Satisfactory results were achieved in 73.9% of the feet and unsatisfactory results in 26.1% (p < 0.0001.Conclusion:Residual deformity in the immediate postoperative period was associated with unsatisfactory results. Opening of the Kite (talocalcaneal angle in feet that only underwent posteromedial and lateral release, along with appropriate positioning of the calcaneus in cases that underwent talectomy, was the radiographic parameter that correlated with satisfactory results.

  5. A device for in vivo measurements of quantitative ultrasound variables at the human proximal femur.

    Science.gov (United States)

    Barkmann, Reinhard; Laugier, Pascal; Moser, Urs; Dencks, Stefanie; Klausner, Michael; Padilla, Frédéric; Haïat, Guilleaume; Glüer, Claus-C

    2008-01-01

    Quantitative ultrasound (QUS) at the calcaneus has similar power as a bone mineral density (BMD)- measurement using DXA for the prediction of osteoporotic fracture risk. Ultrasound equipment is less expensive than DXA and free of ionizing radiation. As a mechanical wave, QUS has the potential of measuring different bone properties than dual X-ray absorptiometry (DXA,) which depends on X-ray attenuation and might be developed into a tool of comprehensive assessment of bone strength. However, site-specific DXA at the proximal femur shows best performance in the prediction of hip fractures. To combine the potential of QUS with measurements directly at the femur, we developed a device for in vivo QUS measurements at this site. Methods comprise ultrasound transmission through the bone, reflection from the bone surface, and backscatter from the inner trabecular structure. The complete area of the proximal femur can be scanned except at the femoral head, which interferes with the ilium. To avoid edge artifacts, a subregion of the proximal femur in the trochanteric region was selected as measurement region. First, in vivo measurements demonstrate a good signal to noise ratio and proper depiction of the proximal femur on an attenuation image. Our results demonstrate the feasibility of in vivo measurements. Further improvements can be expected by refinement of the scanning technique and data evaluation method to enhance the potential of the new method for the estimation of bone strength.

  6. An Ultrasonic Backscatter Instrument for Cancellous Bone Evaluation in Neonates

    Directory of Open Access Journals (Sweden)

    Chengcheng Liu

    2015-09-01

    Full Text Available Ultrasonic backscatter technique has shown promise as a noninvasive cancellous bone assessment tool. A novel ultrasonic backscatter bone diagnostic (UBBD instrument and an in vivo application for neonatal bone evaluation are introduced in this study. The UBBD provides several advantages, including noninvasiveness, non-ionizing radiation, portability, and simplicity. In this study, the backscatter signal could be measured within 5 s using the UBBD. Ultrasonic backscatter measurements were performed on 467 neonates (268 males and 199 females at the left calcaneus. The backscatter signal was measured at a central frequency of 3.5 MHz. The delay (T1 and duration (T2 of the backscatter signal of interest (SOI were varied, and the apparent integrated backscatter (AIB, frequency slope of apparent backscatter (FSAB, zero frequency intercept of apparent backscatter (FIAB, and spectral centroid shift (SCS were calculated. The results showed that the SOI selection had a direct influence on cancellous bone evaluation. The AIB and FIAB were positively correlated with the gestational age (|R| up to 0.45, P10 µs. Moderate positive correlations (|R| up to 0.45, P10 µs. The T2 mainly introduced fluctuations in the observed correlation coefficients. The moderate correlations observed with UBBD demonstrate the feasibility of using the backscatter signal to evaluate neonatal bone status. This study also proposes an explicit standard for in vivo SOI selection and neonatal cancellous bone assessment.

  7. Dioxin-like compounds are not associated with bone strength measured by ultrasonography in Inuit women from Nunavik (Canada): results of a cross-sectional study

    Science.gov (United States)

    Paunescu, Alexandra-Cristina; Ayotte, Pierre; Dewailly, Éric; Dodin, Sylvie

    2013-01-01

    Background Bone strength in Inuit people appears lower than that of non-Aboriginals. Inuit are exposed to persistent organic pollutants including dioxin-like compounds (DLCs) through their traditional diet that comprises predatory fish and marine mammal fat. Results from experimental and population studies suggest that some DLCs can alter bone metabolism and increase bone fragility. Objective This cross-sectional descriptive study was conducted to examine the relationship between the stiffness index (SI) and plasma concentrations of total DLCs or specific dioxin-like polychlorinated biphenyls (DL-PCBs) in Inuit women of Nunavik (Northern Quebec, Canada). Methods SI was determined by ultrasonography at the right calcaneus of 194 Inuit women aged 35–72 years who participated to Qanuippitaa? How Are We? Nunavik Inuit Health Survey in 2004. Plasma total DLC levels were quantified by measuring the aryl hydrocarbon receptor–mediated transcriptional activity elicited by plasma sample extracts in a cell-based reporter gene assay. Plasma concentrations of DL-PCBs nos. 105, 118, 156, 157, 167 and 189 were measured by gas chromatography–mass spectrometry. We used multiple linear regression analyses to investigate relations between total DLCs or specific DL-PCBs and SI, taking into consideration several potential confounders. Results Neither total plasma DLCs nor specific DL-PCBs were associated with SI after adjustment for several confounders and covariates. Conclusion Our results do not support a relation between exposure to DLCs and bone strength measured by ultrasonography in Inuit women of Nunavik. PMID:23730628

  8. Association of a common allelic polymorphism (C677T) in the methylene tetrahydrofolate reductase gene with a reduced risk of osteoporotic fractures. A case control study in Danish postmenopausal women

    DEFF Research Database (Denmark)

    Jørgensen, H L; Madsen, J S; Madsen, B

    2002-01-01

    of this study was to investigate the influence of this mutation on peripheral measures of bone density and on the odds ratios (OR) for hip and lower forearm fracture in a case control study of Danish postmenopausal women. A total of 74 women with lower forearm fracture, 41 women with hip fracture, and 207 age...... homozygotic for the C-allele with those homozygotic for the T-allele: lower forearm fracture OR = 3.93 (1.25; 12.40, P = 0.02), hip fracture OR = 6.99 (l.35; 36.92, P = 0.02) and the fractures combined OR = 4.33 (1.73; 10.81, P = 0.002). In this study, the MTHFR (C677T) genotypes were not significantly...... associated with BMD at the lower forearm or with ultrasound parameters measured at the calcaneus. However, a significant increase in the odds ratio of fracture was found for the wild-type C-allele....

  9. Efficacy of computed tomography guided radiofrequency ablation forosteoid osteomas in 31 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hoon; Ahn, Joong Mo; Lee, Joon Woo; Lee, Guen Young; Lee, Eu Gene; Oh, Joo Han; Cho, Hwan Seong; Kang, Heung Sik [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-04-15

    To present the clinical outcome of computed tomography (CT) guided radiofrequency ablation (RFA) for osteoid osteoma. Thirty-one patients (M:F = 23:8, mean age: 20 years, range: 4-54 years) who underwent RFA for clinically suspected osteoid osteoma from May 2004 to December 2013 were retrospectively reviewed. RFA was done in all cases under CT guidance by one of three radiologists in our department. Electronic medical records and images were retrospectively reviewed in all patients. Lesions were located in femur (n = 20), tibia (n = 5), fibula (n = 2), humerus (n = 3), talus (n = 2), and calcaneus (n = 1). On discharge, 27 of 33 cases showed complete remission of pain (82%). One major complication (compartment syndrome) and 2 minor complications (reactive synovitis, minimal skin burn at electrode insertion site) were observed. On the last follow-up (0-78 months, mean: 12.6 months) 27 of 33 cases were successfully treated (82%) and had no more complaints. 3 cases presented remaining pain (9%). In 3 cases relapse occurred (9%) and RFA was repeated in 1 case. The repeated treatment was successful. CT-guided RFA is an effective method for the treatment of osteoid osteoma.

  10. 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.

  11. The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial.

    Directory of Open Access Journals (Sweden)

    Iwona Sulowska

    Full Text Available The objective of this study was to evaluate the influence of two kinds of plantar short foot muscles exercise on foot posture and fundamental movement patterns in long-distance runners.A parallel group non-blinded trial with 6-week follow-up.Twenty five long-distance runners aged 22-35 years. They were divided into two groups. In group 1 (n = 13 subjects performed the exercise "Vele's Forward Lean" and "Reverse Tandem Gait" and in Group 2 (n = 12 the "Short Foot Exercise." The runners performed the exercises daily for 6 weeks. The Foot Posture Index (FPI-6 and The Functional Movement Screen (FMS tests were performed twice: at baseline and after 6 weeks of the exercise.A significant improvement was observed in FPI -6 (talar head palpation in Group 1, and inversion/eversion of the calcaneus in Group 2. Also in Group 1 a significant improvement was noted in FMS tests: deep squat, active straight leg raise and in total score.Short foot muscles strengthening exercises have beneficial effect on functional movement patterns and on foot posture, therefore they should be included as a part of daily training program of runners.Australian New Zealand Clinical Trials Registry ACTRN12615001200572.

  12. 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

  13. In vivo measurement of lead in the bones of smelter workers using the four-element 'clover-leaf' geometry detector system

    Energy Technology Data Exchange (ETDEWEB)

    Behinaein, Sepideh; Chettle, David R; Egden, Lesley M [Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Ontario, L8S 4K1 (Canada); Atanackovic, Jovica [AECL, Chalk River Laboratories, Dosimetry Services, K0J 1J0, Ontario (Canada); Fleming, David E B [Department of Physics, Mount Allison University, Sackville, New Brunswick, E4L 1E6 (Canada); Nie, Linda H [School of Health Sciences, Purdue University, West Lafayette, IN 47907 (United States); Richard, Norbert; Stever, Susan, E-mail: behinas@mcmaster.ca [Occupational Health Services, Xstrata Zinc, Brunswick Smelter, Belledune, New Brunswick, E8G 2M1 (Canada)

    2011-02-07

    A total of 497 smelter employees from New Brunswick participated in a bone lead survey conducted by McMaster University in 2008 to examine the efficiency of lead exposure control programmes and a four-element 'clover-leaf' geometry detector system. Nearly 42% of the subjects had participated in both the previous surveys performed in 1994 and 1999. After developing the clover-leaf geometry system in 2006, the reliability of the system based on examining the consistency of four detectors and improving the minimum detection limit (MDL) was tested for the first time in 2008 by measuring lead levels of a large population that was occupationally exposed to lead. The Z test was used to study the distribution of the lead concentration calculated based on K{sub {alpha}} and K{sub {beta}} lead x-rays, where the results were broadly consistent with a normal distribution criterion, with relatively small means and standard deviations of between 1 and 2. The MDL of the clover-leaf geometry system was improved on average for tibia and calcaneus by a factor of 3.1 compared to the 1999 and 1994 surveys in which a conventional system (one detector) was used. Furthermore, by comparing the results of the three mentioned surveys, the 2008 results were found to represent the highest precision.

  14. 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.

  15. Additional diagnostic value of digital radiology in plantar fasciitis diagnosis

    Directory of Open Access Journals (Sweden)

    Marcel Prasetyo

    2017-08-01

    Full Text Available Background: Ultrasonography (USG is regarded as the gold standard to differentiate normal plantar fascia and plantar fasciitis. Conventional radiography or plain X-ray is typically used to exclude differential diagnosis. Lately, conventional radiography has been digitalized and leads to better visualization of the soft tissue. However, it is not known whether digital radiography evaluation for calcaneus area, both qualitative and quantitative, has a similar diagnostic value as USG findings. Therefore, this study aimed to evaluate whether there is a strong correlation between digital radiographic and USG findings for diagnosing plantar fasciitis.Methods: This is a cross sectional study examining adult patients (>18 years old presenting with inferior heel pain. Plantar aponeurosis thickness was measured by digital radiography and ultrasonography; measurement was performed three times in each modality, and the average value was recorded. Fat stranding, presence of calcaneal enthesophyte, and microfracture were also evaluated in digital radiography. Measurement results were classified into plantar fasciitis diagnosis using the cut-off value 4 mm.Results: There was no significant correlation between plantar aponeurosis thickness measured by digital radiography and by ultrasonography (r=0.069, p=0.688. There was no significant association between plantar fasciitis diagnosis by digital radiography and ultrasonography (p=0.162. However, digital radiography showed good sensitivity to detect plantar fasciitis using a cut-off value of >4 mm plantar fascia thickness.Conclusion: Digital radiography might be used to aid definitive diagnosis for plantar fasciitis.

  16. Correlation between the outcome of extracorporeal shockwave therapy and pretreatment MRI findings for chronic plantar fasciitis.

    Science.gov (United States)

    Maki, Masahiro; Ikoma, Kazuya; Imai, Kan; Kido, Masamitsu; Hara, Yusuke; Arai, Yuji; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2015-05-01

    The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) findings before extracorporeal shockwave therapy (ESWT) and the treatment outcome of ESWT. This study examined 50 feet with chronic plantar fasciitis. The scores before ESWT and after a six-month follow-up were investigated using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale and the Visual Analog Scale (VAS). MRI before ESWT was used for image evaluation. MRI revealed thickening of the plantar fascia (PF), and an investigation was conducted regarding the findings of a high-signal-intensity area (HSIA) inside the PF, edema near the PF, and bone marrow edema (BME) of the calcaneus. The average JSSF score and VAS score improved significantly at follow-up. In total, 44 feet were noted in the improved group. MRI revealed that the average amounts of PF thickening did not significantly differ between the improved group and the non-improved group. HSIA, edema near the PF, and BME were observed in 36, 41, and 11 feet in the improved group, respectively; and 2, 4, and 2 feet in the non-improved group, respectively. An HSIA in the PF predicted symptom improvement more easily than other MRI findings. IV.

  17. Sonographic evaluation of plantar fasciitis and relation to body mass index

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemir, Huseyin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)]. E-mail: ozdemir@firat.edu.tr; Yilmaz, Erhan [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Murat, Ayse [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Karakurt, Lokman [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Poyraz, A. Kursad [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Ogur, Erkin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)

    2005-06-01

    Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m{sup 2} in patients with heel pain and 25 kg/m{sup 2} in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis.

  18. Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

    Science.gov (United States)

    Yamakado, Kotaro

    2013-01-01

    We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging. PMID:23875139

  19. Skeletal Adaptation to Daily Activity: A Biochemical Perspective

    Science.gov (United States)

    Whalen, Robert T.; Dalton, Bonnie (Technical Monitor)

    2002-01-01

    Musculoskeletal forces generated by normal daily activity on Earth maintain the functional and structural properties of muscle and bone throughout most of one's adult life. A reduction in the level of cumulative daily loading caused by space flight, bed rest or spinal cord injury induces rapid muscle atrophy, functional changes in muscle, and bone resorption in regions subjected to the reduced loading. Bone cells in culture and bone tissue reportedly respond to a wide variety of non-mechanical and mechanical stimuli ranging, from electromagnetic fields, and hormones to small amplitude, high frequency vibrations, fluid flow, strain rate, and stress/strain magnitude. However, neither the transduction mechanism that transforms the mechanical input into a muscle or bone metabolic response nor the characteristics, of the loading history that directly or indirectly stimulates the cell is known. Identifying the factors contributing to the input stimulus will have a major impact on the design of effective countermeasures for long duration space flight. This talk will present a brief overview of current theories of bone remodeling and functional adaptation to mechanical loading. Work from our lab will be presented from the perspective of daily cumulative loading on Earth and its relationship to bone density and structure. Our objective is to use the tibia and calcaneus as model bone sites of cortical and cancellous bone adaptation, loaded daily by musculoskeletal forces in equilibrium with the ground reaction force. All materials that will be discussed are in the open scientific literature.

  20. Infectious Spondylodiscitis, Epidural Phlegmon, and Psoas Abscess Complicating Diabetic Foot Infection: A Case Report.

    Science.gov (United States)

    Nicolosi, Nicole; Pratt, Christina

    2016-01-01

    Few published case reports have cited vertebral osteomyelitis as a sequela of a diabetic foot infection. The purpose of the present report is to increase awareness of a potentially severe complication of diabetic foot ulceration: vertebral osteomyelitis and associated pathologic features. We present the case of a 63-year-old male with right calcaneal osteomyelitis who developed acute onset lower back pain with concomitant fever and chills. Magnetic resonance imaging revealed L4-L5 vertebral osteomyelitis, a T9-L1 epidural abscess, and a right psoas muscle abscess secondary to hematogenous seeding from the calcaneus. The patient underwent right partial calcanectomy, spinal and right psoas abscess incision and drainage, and direct lumbar interbody fusion of L4-L5 with a right iliac crest allograft. All bone, blood, and abscess cultures were positive for methicillin-resistant Staphylococcus aureus. After the surgery, the patient's pain resolved in his back and hip and he regained full right lower extremity function. The 1-year follow-up examination revealed that the patient had vertebral arthritis but was able to perform his activities of daily living with a walker and cane. It is important to recognize the potential complications of diabetic foot ulcerations and be aware of the identifying symptoms and treatment options for this condition to prevent significant morbidity and mortality. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Modified Thomas splint-cast combination for the management of limb fractures in small equids.

    Science.gov (United States)

    Ladefoged, Søren; Grulke, Sigrid; Busoni, Valeria; Serteyn, Didier; Salciccia, Alexandra; Verwilghen, Denis

    2017-04-01

    To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). Retrospective case series. Client owned horses and donkeys. Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure. © 2017 The American College of Veterinary Surgeons.

  2. Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis.

    Science.gov (United States)

    Allen, Latricia L; Kalmar, Garrett; Driver, Vickie R

    2016-06-01

    We report a case of calcaneal osteomyelitis that was surgically resected from a patient with diabetes and peripheral vascular disease. A 91-year-old male with history of type 2 diabetes, peripheral vascular disease, balloon angioplasty, and recent (2 months ago) stent of the superficial femoral artery presented to the emergency department with a left heel wound infection probed to bone. The patient reported having been on intravenous Zosyn for several months via an outside infectious disease provider for clinical suspicion of osteomyelitis, but noted no improvement. This report includes information regarding the clinical examination and imaging findings, which were used to assess this high-risk patient. Our patient underwent a partial calcanectomy and completed a 6-week course of intravenous antibiotics. The purpose of this case report is to illustrate limb preservation in a high-risk patient with compromised vascular supply who underwent a partial calcanectomy for treatment of calcaneal osteomyelitis. The patient underwent surgical resection of the calcaneus without complications and healed unremarkably with the ability to ambulate while wearing an ankle foot orthosis with a custom shoe. This report was authorized for publication as an educational report to contribute to generalizable knowledge and does not include any patient health information. Copyright © 2016. Published by Elsevier Inc.

  3. Bone mineral density in women of a low socioeconomic level using DMPA for contraception in rural Upper Egypt.

    Science.gov (United States)

    Hussein, Mostafa; Mahran, Dalia G; Farouk, Osama A; El-Assal, Maher A; Fathallah, Mohammad M; Romih, Mahmoud S

    2010-07-01

    To evaluate the effect of long-term use of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD). A cross-sectional study was performed with 150 women using DMPA and 136 women using nonhormonal methods of contraception in rural Sohag Governorate, Upper Egypt. Socioeconomic scores were measured using the 1983 Fahmy and El Sherbeny system, model II. The mineral density of the left calcaneus was measured by ultrasonographically. If the overall mean T score was significantly lower for the DMPA than for the control group, osteopenia and osteoporosis were more prevalent among DMPA users only for participants of the lowest socioeconomic level. There was a mild negative correlation between duration of DMPA use and T score, and when contraception duration was considered the differences in T scores between the DMPA and control groups were significant. Prescribing DMPA only for the short term to women of a low socioeconomic level and counseling them about its effect on bone density may be a practical approach. Copyright (c) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects

    Energy Technology Data Exchange (ETDEWEB)

    Pascual Huerta, Javier [Department of Podiatry, Universidad Europea de Madrid (Spain)]. E-mail: javier.pascual@uem.es; Alarcon Garcia, Juan Maria [Ultrasound Unit, Hospital Nuestra Senora de America, Madrid (Spain)

    2007-06-15

    Purpose: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. Material and methods: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1 cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. Results: There were statistically significant differences in plantar fascia thickness at the four different locations (p < 0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1 cm proximal to the insertion. At origin and 1 cm distal to insertion weight was an independent predictor of plantar fascia thickness. Conclusions: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1 cm proximal to the insertion is influenced by sex and thickness at origin and at 1 cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.

  5. The Association between Coffee Consumption and Bone Status in Young Adult Males according to Calcium Intake Level.

    Science.gov (United States)

    Choi, Mi-Kyeong; Kim, Mi-Hyun

    2016-07-01

    The purpose of this study was to investigate the association between coffee consumption and bone status (bone mineral density and bone metabolism-related markers) according to calcium intake level in Korean young adult males. Healthy and nonsmoking males (19-26 years, n = 330) participated in this study. Anthropometric measurements, dietary habits, and nutrient intakes were surveyed. Bone status of the calcaneus was measured by using quantitative ultrasound (QUS). Bone metabolism-related markers including serum total alkaline phosphatase activity (TALP), N-mid osteocalcin (OC), and type 1 collagen C-terminal telopeptide (1CTP) were analyzed. The subjects were divided into two groups based on daily calcium intake level: a calcium-sufficient group (calcium intake ≥ 75% RI, n = 171) and a calcium-deficient group (calcium intake coffee consumption: no-coffee, less than one serving of coffee per day, and one or more servings of coffee per day. There were no significant differences in height, body weight, body mass index, energy intake, or calcium intake among the three coffee consumption subgroups. QUS parameters and serum 1CTP, TALP, and OC were not significantly different among either the two calcium-intake groups or the three coffee consumption subgroups. Our results may show that current coffee consumption level in Korean young men is not significantly associated with their bone status and metabolism according to the calcium intake level.

  6. Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

    Science.gov (United States)

    Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

    2015-08-01

    This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (phip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (pdiscriminant equation of surface area; female<0

  7. An HLA class-II allele frequent in Eskimos and Amerindians is found in the Tyrolean Ice Man.

    Science.gov (United States)

    Fischer, G F; Fae, I; Mann, D; Kriks, D; Jäger, W; Platzer, W; Mayr, W R; Volc-Platzer, B

    2001-07-01

    DNA was extracted from specimens derived from the calcaneus of the Tyrolean Ice Man under sterile conditions in a laboratory, where no DNA extractions and PCR experiments had been performed before. Agarose gel electrophoresis and ethidium bromide staining did not reveal any evidence of genomic DNA in the preparation obtained, indicating a high degree of DNA degradation. Nevertheless, we performed PCR amplifications with this sample using primer pairs specific for HLA class II alleles. HLA-DRB and DQB1 alleles were amplified in a nested PCR approach. In one of the reactions, we observed a distinct amplification product, which we directly sequenced. By comparing the obtained nucleotide sequence with a database of HLA alleles we assigned the HLA-DRB1*1402 type to the amplified sample. None of the investigators involved possesses this allele, indicating that no contamination with modern DNA had occurred. The HLA-DRB1*1402 allele is extremely rare in Europe, but is common in Inuits and South American Indians and has previously only once been identified in the laboratory.

  8. [Étienne Destot (1864-1918): the first radioanatomist in Lyon, France].

    Science.gov (United States)

    Viard, B; Trost, O; Trouilloud, P; Salomon, C

    2014-03-01

    Destot was born in Dijon, France, in 1864. He began his education in Burgundy, then he started his preclinical curriculum in Lyon, France, from 1884. He had to leave Lyon, and spent some times in Algeria to treat a tuberculosis. He came back in Lyon as a resident in 1886. Destot worked as an assistant in the laboratory of anatomy of Leo Testut in 1880. His thesis, in 1892, analyzed mortality in the departments of surgery of the Lyon hospitals. The polemical results he presented compromised his surgical career. He went on as prosector by Leo Testut, and then became electrician-physician in 1895 (electrotherapy and galvanotherapy). Étienne Destot of Lyon, France, developed in 1895 the first radiography room ever at the Hôtel-Dieu of Lyon, France. Wilhelm Röntgen discovered the X-rays in the same year, and Destot felt his discovery could revolutionize the approach of anatomy and traumatology. He studied wrist, ankle and calcaneus fractures, and described a new anatomy: "traumatic anatomy". For example, he focused on the posterior talar surface hollow in posterior tarsus fractures. He proposed the term of "thalamus" for this articular surface; this term is nowadays widely used by the clinicians. He introduced the term of "third malleolus" to describe the posterior part of the distal extremity of the tibia. He was the first author to analyze the normal and pathological movements of the scaphoid bone and the lunatum in wrist extension. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. 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.

  10. The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial.

    Science.gov (United States)

    Sulowska, Iwona; Oleksy, Łukasz; Mika, Anna; Bylina, Dorota; Sołtan, Jarosław

    2016-01-01

    The objective of this study was to evaluate the influence of two kinds of plantar short foot muscles exercise on foot posture and fundamental movement patterns in long-distance runners. A parallel group non-blinded trial with 6-week follow-up. Twenty five long-distance runners aged 22-35 years. They were divided into two groups. In group 1 (n = 13) subjects performed the exercise "Vele's Forward Lean" and "Reverse Tandem Gait" and in Group 2 (n = 12) the "Short Foot Exercise." The runners performed the exercises daily for 6 weeks. The Foot Posture Index (FPI-6) and The Functional Movement Screen (FMS) tests were performed twice: at baseline and after 6 weeks of the exercise. A significant improvement was observed in FPI -6 (talar head palpation in Group 1, and inversion/eversion of the calcaneus in Group 2). Also in Group 1 a significant improvement was noted in FMS tests: deep squat, active straight leg raise and in total score. Short foot muscles strengthening exercises have beneficial effect on functional movement patterns and on foot posture, therefore they should be included as a part of daily training program of runners. Australian New Zealand Clinical Trials Registry ACTRN12615001200572.

  11. Evaluation of tarsal navicular stress fracture fixation using intraoperative O-arm computed tomography.

    Science.gov (United States)

    Hsu, Andrew R; Lee, Simon

    2014-12-01

    Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Therapeutic, Level IV: Case Report. © 2014 The Author(s).

  12. A biomechanical analysis of the effects of low-Dye taping on arch deformation during gait.

    Science.gov (United States)

    Yoho, Robert; Rivera, Julian J; Renschler, Robert; Vardaxis, Vassilios G; Dikis, Jeffrey

    2012-12-01

    The low-Dye technique serves to limit hindfoot pronation and medial arch collapse. Few studies exist that investigate the effects on medial arch deformation from a biomechanical perspective. Kinematic data was collected using a Motion Analysis System. Foot function of 21 healthy adults was assessed during the stance phase of gait. Subjects were evaluated prior to and immediately following the low-Dye tape application, as well as at 48 h. Foot deformation was assessed during the stance phase of gait using the calcaneus, navicular and 1st metatarsal head markers to calculate the medial longitudinal arch angle (MLA) and the dynamic arch height index (dAHI). Paired t-tests were used to assess low-Dye tape effectiveness. There was a significant 19.3% reduction in MLA immediately after application of the tape. However only 4.01% reduction remained in deformation after 48 h. The MLA deformation findings were consistent with the AHI change, showing a significant change in the arch deformation between Pre and Post0 low-Dye taping. The effects were short-lived. There are measurable changes to medial arch height and amount of arch height deformation during gait following low-Dye taping. Although changes were present immediately after application, results were diminished 48 h after application. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Grizzly bears (Ursus arctos horribilis) and black bears (Ursus americanus) prevent trabecular bone loss during disuse (hibernation).

    Science.gov (United States)

    McGee-Lawrence, Meghan E; Wojda, Samantha J; Barlow, Lindsay N; Drummer, Thomas D; Castillo, Alesha B; Kennedy, Oran; Condon, Keith W; Auger, Janene; Black, Hal L; Nelson, O Lynne; Robbins, Charles T; Donahue, Seth W

    2009-12-01

    Disuse typically causes an imbalance in bone formation and bone resorption, leading to losses of cortical and trabecular bone. In contrast, bears maintain balanced intracortical remodeling and prevent cortical bone loss during disuse (hibernation). Trabecular bone, however, is more detrimentally affected than cortical bone in other animal models of disuse. Here we investigated the effects of hibernation on bone remodeling, architectural properties, and mineral density of grizzly bear (Ursus arctos horribilis) and black bear (Ursus americanus) trabecular bone in several skeletal locations. There were no differences in bone volume fraction or tissue mineral density between hibernating and active bears or between pre- and post-hibernation bears in the ilium, distal femur, or calcaneus. Though indices of cellular activity level (mineral apposition rate, osteoid thickness) decreased, trabecular bone resorption and formation indices remained balanced in hibernating grizzly bears. These data suggest that bears prevent bone loss during disuse by maintaining a balance between bone formation and bone resorption, which consequently preserves bone structure and strength. Further investigation of bone metabolism in hibernating bears may lead to the translation of mechanisms preventing disuse-induced bone loss in bears into novel treatments for osteoporosis.

  14. Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women

    Science.gov (United States)

    Phipps, Kathy R; Orwoll, Eric S; Mason, Jill D; Cauley, Jane A

    2000-01-01

    Objective To determine whether fluoridation influences bone mineral density and fractures in older women. Design Multicentre prospective study on risk factors for osteoporosis and fractures. Setting Four community based centres in the United States. Participants 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Main outcome measures Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Results Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n=3218) and women with no exposure during the past 20 years (n=2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm2, Pfluoridated drinking water does not increase the risk of fracture. PMID:11021862

  15. 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.

  16. Die Osteonekrose des Fußes: Eine Übersicht

    Directory of Open Access Journals (Sweden)

    Schenk S

    2007-01-01

    Full Text Available Die Osteonekrose (ON am Fuß ist eine heterogene Gruppe von Krankheitsbildern, die sich deutlich hinsichtlich Klinik, Verlauf, Prädilektionsalter und Prognose unterscheiden. Ebenso sind die Ursachen für diese Erkrankungen vielfältig: Neben idiopathischen finden sich auch posttraumatische und postoperative Formen. Seltene Ursachen sind Kollagenosen, Stoffwechselerkrankungen wie Diabetes mellitus und Kortikoidtherapie. ON finden sich gehäuft nach Nierentransplantationen. Je nach Ursache tritt eine ON gehäuft in typischer Lokalisation auf. Idiopathische Formen findet man am Os naviculare pedis – Morbus Köhler 1 (MK1, an den Metatarsaleköpfchen – Morbus Köhler 2, "Freiberg’s disease" (MK2, an den Sesambeinen und an der Apophyse des Calcaneus. Operationsbedingte Fälle sind gehäuft am Metatarsaleköpfchen 1 nach Versorgung eines Hallux valgus lokalisiert, posttraumatische Nekrosen am Talus. In diesem Artikel werden die idiopathischen Formen hinsichtlich Klinik und Therapie näher beleuchtet. Bezüglich der Therapie gibt es konservative und operative Ansätze. Die wissenschaftlichen Daten zur Behandlung von idiopathischen Nekrosen sind spärlich, die Behandlungsstrategien jedoch einheitlich und allgemein anerkannt.

  17. Evaluation of the effectiveness of toe board energy-absorbing material for foot, ankle, and lower leg injury reduction.

    Science.gov (United States)

    Patalak, John P; Stitzel, Joel D

    2018-02-17

    Since 2000, numerous improvements have been made to the National Association for Stock Car Auto Racing, Incorporated (NASCAR®) driver restraint system, resulting in improved crash protection for motorsports drivers. Advancements have included seats, head and neck restraints (HNRs), seat belt restraint systems, driver helmets, and others. These enhancements have increased protection for drivers from severe crash loading. Extending protection to the driver's extremities remains challenging. Though the drivers' legs are well contained for lateral and vertical crashes, they remain largely unrestrained in frontal and frontal oblique crashes. Sled testing was conducted for the evaluation of an energy-absorbing (EA) toe board material to be used as a countermeasure for leg and foot injuries. Testing included baseline rigid toe boards, tests with EA material-covered toe boards, and pretest positioning of the 50th percentile male frontal Hybrid III anthropomorphic test device (ATD) lower extremities. ATD leg and foot instrumentation included foot acceleration and tibia forces and moments. The sled test data were evaluated using established injury criteria for tibial plateau fractures, leg shaft fractures, and calcaneus, talus, ankle, and midfoot fractures. A polyurethane EA foam was found to be effective in limiting axial tibia force and foot accelerations when subjected to frontal impacts using the NASCAR motorsport restraint system.

  18. 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.

  19. MR imaging findings of intraosseous lipoma

    Energy Technology Data Exchange (ETDEWEB)

    Park, Young Chan; Lee, Young Hwan; Jung, Kyung Jae; Sung, Nak kwan; Chung, Duck Soo; Kim, Ok Dong [School of Medicine, Catholic University of Taegu-Hyosung, Taegu (Korea, Republic of); Lee, Jongmin [School of Medicine, Kyungpllk National University, Taegu (Korea, Republic of); Cho, Kil Ho [College of Medicine, Yeungnam University, Taegu (Korea, Republic of)

    2000-09-01

    To evaluate the MR imaging findings of intraosseous lipoma. The MR imaging findings of 12 cases of intraosseous lipoma were retrospectively analyzed with regard to internal signal intensity, enhancement patterns, the presence of calcification and the status of the margin. The findings relating to these last two features were compared with those of plain films and CT. Six tumors were located in the calcaneus, three in the tibia, two in the ilium, and one in the carpal lunate. A fat component was clearly identified in all cases, but no lesion was purely fatty. Cyst formation was noted in four cases, and hyperintense portions different from the cystic area were seen on T2WI in ten. Contrast enhancement was observed in four patients, and although plain film and CT images revealed, in all cases, the presence of calcification, in two cases this was not demonstrated y MRI. In all cases, however, MRI showed well-defined tumoral margins. MRI clearly depicts fat and other components related to the involutional changes occurring in cases of intraosseous lipoma. The information these images provide is useful for the diagnosis and histologic classification of intraosseous lipoma. (author)

  20. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures

    Energy Technology Data Exchange (ETDEWEB)

    Mennel, Emilie A. [University of Texas Southwestern Medical School, Dallas, Texas (United States); John, Susan D. [Department of Radiology, University of Texas-Houston Medical School, 6431 Fannin-MSB2.100, Houston, TX 77030 (United States)

    2003-01-01

    We report the case of a 23-month-old male with hypotonia, developmental delay, and complex seizures. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. Sclerosis also involved the anterior ribs, iliac crests, talus, and calcaneus. The skull and vertebral bodies appeared unaffected. Blood lead levels were normal. We believe that this constellation of clinical and radiographic abnormalities closely resembles osteosclerotic metaphyseal dysplasia (OMD) due to an autosomal recessive defect. Characteristic skeletal findings were instrumental in determining the diagnosis. OMD is a very rare sclerosing bone disorder, first described in 1993. The syndrome is characterized clinically by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase, and late-onset spastic paraplegia. We encountered a young child with these neurologic symptoms who displayed sclerotic metaphyseal changes on hand radiographs obtained to determine the bone age. Lead poisoning, a known cause of metaphyseal sclerosis, was initially suspected. Careful analysis of the metaphyseal bone changes helped to distinguish this bone dysplasia from lead poisoning and other causes of metaphyseal sclerosis. (orig.)

  1. Determinants of Bone Strength Estimated by Calcaneal Ultrasonography in Inuit Women from Nuuk (Greenland

    Directory of Open Access Journals (Sweden)

    Alexandra-Cristina Paunescu

    2014-01-01

    Full Text Available This study was conducted to identify determinants of bone strength estimated by quantitative ultrasonography (QUS at the calcaneus of Greenlandic Inuit women. A total of 153 Inuit women from Nuuk, aged from 49 to 64 years, participated in the first QUS measurement (year 2000 with an Achilles Lunar instrument (speed of sound (SOS; broadband ultrasound attenuation (BUA; stiffness index (SI. A second measurement was performed two years later (year 2002 in 121 participants. Several factors known to be associated with bone strength were recorded at baseline for 118 of them. Determinants of QUS parameters were identified using an automatic (stepwise selection of variables in linear regression. Significant determinants of baseline QUS measurements were age and body weight for all QUS parameters, height for BUA and SI, and hormone replacement therapy (HRT use for SI. Significant predictors of follow-up QUS measurements were baseline QUS values, the smoking status and HRT use for all QUS parameters, omega-3/omega-6 PUFA content ratio of erythrocytes membrane phospholipids (BUA and SI, and menopausal status (BUA. Several modifiable dietary factors, such as a diet rich in omega-3 PUFAs and lifestyle factors (i.e., smoking, taking HRT, were shown to determine QUS parameters after a follow-up of two years.

  2. Successful treatment of a fracture of a huge Achilles tendon ossification with autologous hamstring tendon graft and gastrocnemius fascia flap: a case report.

    Science.gov (United States)

    Ishikura, Hisatoshi; Fukui, Naoshi; Takamure, Hiroshi; Ohashi, Satoru; Iwasawa, Mitsuyasu; Takagi, Kentaro; Horita, Ayako; Saito, Ikuo; Mori, Toshihito

    2015-11-24

    Fracture of an ossified Achilles tendon is a rare entity, and no standard treatment has been established. This is the first report to describe the use of a hamstring tendon graft and gastrocnemius fascia flap for Achilles tendon reconstruction. We present the case of a 50-year-old woman with fracture of an ossified Achilles tendon. She presented to our clinic with acute right hindfoot pain, which started suddenly while going up the stairs. Plain radiography and magnetic resonance imaging revealed a massive ossification on the right Achilles tendon extending over 14 cm in length; the ossification was fractured at 5 cm proximal to the calcaneus insertion. Surgical treatment included removal of the ossified tendon and reconstruction with an autologous hamstring tendon graft and gastrocnemius fascia flap. One year after surgery, she was able to walk with little pain or discomfort and to stand on her right tiptoe. Our novel surgical procedure may be useful in the treatment of fractured ossified Achilles tendons and large Achilles tendon defects.

  3. Preditores espaço-temporais do andar para testes de capacidade funcional em pacientes com doença de Parkinson Gait spatial and temporal predictors for functional capacity tests in Parkinson's disease patients

    Directory of Open Access Journals (Sweden)

    MDR Sánchez-Arias

    2008-10-01

    Full Text Available OBJETIVOS: Determinar quais parâmetros espaço-temporais são preditores do andar de indivíduos com doença de Parkinson idiopática para os testes de resistência aeróbia e agilidade, propostos pela bateria de testes da American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD. MATERIAIS E MÉTODOS: Foram selecionados seis homens e seis mulheres com comprometimento e estágio da doença em níveis leve e moderado, que realizaram os testes de agilidade e resistência aeróbia, conforme o protocolo da AAHPERD, e andaram 8m sobre uma passarela. Uma câmera digital registrou uma passada central. Marcadores foram fixados no quinto metatarso e na face lateral do calcâneo do membro inferior direito e no primeiro metatarso e na face medial do calcâneo do membro inferior esquerdo. As variáveis dependentes selecionadas foram: tempo nos testes de agilidade e resistência e as variáveis cinemáticas (comprimento da passada - CP, cadência - CAD, duração da passada - DP, duração da fase de duplo suporte - DDS, duração do suporte simples - SS, duração da fase de balanço - DB e velocidade da passada - VP. RESULTADOS: Para agilidade, o teste de Pearson apontou correlação estatisticamente significativa entre as variáveis CP (r=-0,70; pOBJECTIVE: To determine which spatial and temporal parameters are predictors of the gait pattern of individuals with idiopathic Parkinson's disease, for the aerobic endurance and agility tests included in the battery of tests of the AAHPERD protocol. METHODS: Six men and six women with mild and moderate impairment and disease stage were selected. They performed agility and aerobic endurance test in accordance with the AAHPERD protocol, and walked 8 m on a walkway. A digital video camera recorded one central stride. Markers were attached to the fifth metatarsal and lateral face of the calcaneus of the right leg and to the first metatarsal and medial face of the calcaneus of the left leg. The

  4. 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

    Full Text Available OBJETIVO: Identificar técnica cirúrgica com melhor resultado para tratamento de fraturas intra-articulares do calcâneo tipo Sanders II e III. MÉTODOS: Revisão sistemática da literatura de estudos clínicos randomizados comparativos de cirurgias de fraturas intra-articulares do calcâneo Sanders II e III, avaliados pelo questionário da American Orthopaedic Foot and Ankle Society (AOFAS. Os estudos foram identificados e recuperados nas bases de dados LILACS, MEDLINE/Pubmed, Biblioteca Cochrane, SciELO, Embase, Science Direct, Scopus, Journals@Ovid, ISI Web of Knowledge, Evidence Based Medicine, além de consulta às referências dos estudos acessados. RESULTADOS: foram identificados três trabalhos randomizados avaliando três técnicas cirúrgicas: fixador externo, fixação percutânea com fio de Kirschner e fixação com parafuso canulado. Todas as técnicas compararam tratamento com redução aberta e fixação com placa e parafuso. Obteve-se as seguintes médias (AOFAS: 86,23 (placa e parafuso, 88,2 (fixação externa, 90,6 (fixação percutânea com fio de Kirschner e 87,2 (fixação com parafuso canulado. CONCLUSÃO: fixação percutânea com fio de Kirschner apresentou melhores resultados e menor número de complicações, porém as evidências são insuficientes para afirmar superioridade desse tratamento em relação a outras técnicas cirúrgicas.OBJECTIVE: This paper's aim is to compare and figure out what is the most effective surgical technique for Sanders II and III intrarticular fractures. METHODS: Clinical comparative randomized clinical trial on surgical treatment of the intrarticular fractures of the calcaneus (Sanders types II and III were evaluated by questionnaire of the American Orthopaedic Foot and Ankle Society. The identification and search of the studies used the following databases - LILACS, MEDLINE/PubMed, Cochrane Library, SciELO, EMBASE, Science Direct, Scopus, Journals@Ovid, ISI Web of Knowledge, Evidence

  5. Treatment of Decubitis Ulcer Stage IV in the Patient with Polytrauma and Vertical Share Pelvic Fracture, Diagnosed Entherocollitis and Deep Wound Infection with Clostridium Difficile with Combined Negative Pressure Wound Therapy (NPWT) and Faecal Management System: Case Report.

    Science.gov (United States)

    Stojmenski, Slavcho; Merdzanovski, Igor; Gavrilovski, Andrej; Pejkova, Sofija; Dzokic, Gjorge; Tudzarova, Smilja

    2017-06-15

    The aim of this paper was to present a case with the successful treatment of decubitis ulcer stage IV in the patient with polytrauma and vertical share pelvic fracture and diagnosed entherocollitis combined with deep wound infection with Clostridium difficile treated with combined Negative Pressure Wound Therapy (NPWT) and faecal management system. Patient D.S.1967 treated on Traumatology Clinic after tentamen suicide on 9.2.2015 with diagnosis: brain contusion; contusion of thoracal space; vertical share pelvic fracture; open fracture type II of the right calcaneus; fracture of the left calcaneus; fracture on the typical place of the left radius; fracture of the right radius with dislocation. As a first step during the treatment in Intensive care unit we perform transcondylar extension of the left leg, and in that time we cannot operate because of the brain contusion. Four weeks after this treatment we intent to perform stabilisation of the pelvic ring, fixation of both arms, and fixation of both calcanear bones. But at the time before performing the saurgery, the patient got an intensive enterocollitis from Escherichia colli and Clostridium difficile, and during the inadequate treatment of enterocollitis she got a big decubitus on both gluteal regia Grade IV and deep muscular necrosis. Several times we perform a necrectomy of necrotic tissue but the wound become bigger and the infection have a progressive intention. In that time we used VAK system for 6 weeks combined with faecal management system and with local necrectomy and system application of Antibiotics and Flagyl for enterocollitis in doses prescripted from specialists from Infective clinic. This new device to manage faecal deep decubital infection and enterocollitis with Clostridium difficile are considered as adequate. 8Flexi-Seal® FMS has been also used. After two months we succeed to minimize the gluteal wound on quoter from the situation from the beginning and we used for next two months wound

  6. Deltoid ligament reconstruction: a novel technique with biomechanical analysis.

    Science.gov (United States)

    Haddad, Steven L; Dedhia, Sunil; Ren, Yupeng; Rotstein, Jason; Zhang, Li-Qun

    2010-07-01

    Deltoid ligament insufficiency has been shown to decrease tibiotalar contact area and increase peak pressures within the lateral ankle mortise. This detrimental effect may create an arthritic ankle joint if left unresolved. Reconstructive efforts thus far have been less than satisfactory. We describe a novel technique that reconstructs both main limbs of the deltoid ligament in anatomic orientation while providing secure graft fixation. Six pairs of fresh frozen cadaveric lower extremities were utilized. Matched right and left lower limbs (one pair) were allocated either to a deltoid reconstruction group or an intact deltoid group. The anterior tibial tendon was chosen as the graft for ligament reconstruction, and was harvested from the ipsilateral specimen. Tunnels were created in the distal tibia at the deltoid origin, and at the talus (deep) and calcaneus (superficial) deltoid insertions. Following measurement, the graft was cut to the appropriate size and endobuttons weaved into both tendon ends. The graft ends were passed through the talus and calcaneus respectively. The residual graft loop was then routed through the tibial tunnel and secured proximally with a cancellous screw post and spiked washer. Following specimen mounting, a multiaxis testing apparatus with three separate motors allowed three planes (dorsiflexion/plantarflexion; inversion/eversion; and internal/external rotation) of motion. Angular rotations and linear translations of the tibia in the X-Y-Z directions were measured for a given torque in external/internal rotation, dorsiflexion/plantarflexion, or eversion/inversion, under a constant velocity of 2 degrees per second. Testing consisted of a 2 Nm preload for 20 cycles in internal rotation/external rotation and inversion/eversion prior to data collection of 10 cycles at this level of torque. Similarly, a preload of 1 Nm for 20 cycles was used in dorsiflexion/plantarflexion prior to data collection of 10 cycles at this torque level. Data were

  7. Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series.

    Science.gov (United States)

    Witt, Bryan L; Hyer, Christopher F

    2012-01-01

    Achilles tendinopathy is a clinical diagnosis characterized as a triad of symptoms including pain, swelling, and impaired performance of the diseased tendon. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Achilles tendinosis is viewed microscopically as disorganized collagen, abnormal neovascularization, necrosis, and mucoid degeneration. Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. This disease is initially treated conservatively with activity modification, custom orthotic devices, heel lifts, and immobilization. After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. The Arthrex SutureBridge(®) (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire(®) (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. This hourglass pattern of FiberWire(®) provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. The patients were followed up for approximately 2 years' duration. There were no intraoperative or postoperative complications. At final follow-up there was no evidence of Achilles tendon ruptures or device failures. All patients were able to return to their activities of daily living without the use of assistive devices. The patients' average visual analog pain scale was 1 (range 0 to 4), and their average foot functional index score was 3.41 (range 0

  8. 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.

  9. RELATIONSHIP BETWEEN TRAINING VOLUME AND BONE MINERAL DENSITY CHANGES IN ELDERLY WOMEN

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    Juan José Rábade Espinosa

    Full Text Available ABSTRACT Introduction: Several studies have analyzed the relationship between physical activity and bone density. However, the prescription of exercise is not entirely clear as to the type, quantity and intensity. Objective: The objective of this study was to determine if there is a relationship between the amount of exercise and changes in bone mineral density. Methods: Fifty-two women, members of the Municipal Program of Physical Activity for Seniors, voluntarily underwent two ultrasonographies of the calcaneus within a 6-month interval. During this period, all physical activity was recorded. Afterwards, a lineal correlation study was carried out between the amount of exercise and bone changes, expressed as T-Score variation, first in total number of participants and then in groups. Considering the average body weight obtained for all women, two groups were created ("light" 69 kg. Later, women who had participated in less than 72% of the targeted program were excluded from both groups, and the differences between the groups "light and trained" and "heavy and trained" were analyzed. To do so, the nonparametric Mann-Whitney U test was used. Results: A significant relationship of r= -0.59 was found between the total amount of exercise and the T-Score variation in the group of women above 69 kg. Significant differences were found between the "light and trained" group and the "heavy and trained" group with respect to the variation of T-Score. Conclusion: The effect of exercise on bone mineral density is determined, somehow, by body weight. This interaction is due, possibly, to mechanical demands difference.

  10. Effects of Bone Young’s Modulus on Finite Element Analysis in the Lateral Ankle Biomechanics

    Directory of Open Access Journals (Sweden)

    W. X. Niu

    2013-01-01

    Full Text Available Finite element analysis (FEA is a powerful tool in biomechanics. The mechanical properties of biological tissue used in FEA modeling are mainly from experimental data, which vary greatly and are sometimes uncertain. The purpose of this study was to research how Young’s modulus affects the computations of a foot-ankle FEA model. A computer simulation and an in-vitro experiment were carried out to investigate the effects of incremental Young’s modulus of bone on the stress and strain outcomes in the computational simulation. A precise 3-dimensional finite element model was constructed based on an in-vitro specimen of human foot and ankle. Young’s moduli were assigned as four levels of 7.3, 14.6, 21.9 and 29.2 GPa respectively. The proximal tibia and fibula were completely limited to six degrees of freedom, and the ankle was loaded to inversion 10° and 20° through the calcaneus. Six cadaveric foot-ankle specimens were loaded as same as the finite element model, and strain was measured at two positions of the distal fibula. The bone stress was less affected by assignment of Young’s modulus. With increasing of Young’s modulus, the bone strain decreased linearly. Young’s modulus of 29.2 GPa was advisable to get the satisfactory surface strain results. In the future study, more ideal model should be constructed to represent the nonlinearity, anisotropy and inhomogeneity, as the same time to provide reasonable outputs of the interested parameters.

  11. Can Repeated Ponseti Management for Relapsed Clubfeet Produce the Outcome Comparable With the Case Without Relapse? A Clinical Study in Term of Gait Analysis.

    Science.gov (United States)

    Liu, Yu-Bin; Jiang, Shu-Yun; Zhao, Li; Yu, Yan; Zhao, Da-Hang

    2017-09-22

    The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet. Thirty-seven patients (53 feet) were retrospectively identified from our database according to the inclusion and exclusion criteria. Among the 37 patients, 17 cases (25 relapsed clubfeet) were assigned to group I, whereas 20 cases (28 clubfeet without relapse) were assigned to group II. Clinical examination, gait analysis, and kinematic gait deviation criteria from Texas Scottish Rite Hospital for Children were used for evaluation. There was statistically significant difference in the parameters of foot length, stride length, and single limb support time (%gait cycle) between the 2 groups (P0.05). There was no statistically significant difference in peak hip, knee, and ankle flexion moment, peak knee valgus moment, and peak ankle power (P>0.05). No statistically significant difference was found in equinus and calcaneus gait, increased ankle dorsiflexion, foot drop, and internal foot progression angle (P>0.05). Repeated Ponseti method for relapsed clubfeet can yield good or excellent clinical results. We recommend repeated Ponseti method as the treatment choice for relapsed clubfeet in the early stage. Level III-retrospective comparative study.

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

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    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.)

  13. Heel pain syndrome: electrodiagnostic support for nerve entrapment.

    Science.gov (United States)

    Schon, L C; Glennon, T P; Baxter, D E

    1993-01-01

    A local entrapment neuropathy has been proposed as one of the etiologies of heel pain, but it has never been documented by electrodiagnostic studies. Primary symptoms in patients suspected of having a neurologic basis for their heel pain include neuritic medial heel pain and radiation either proximally or distally. On physical examination, all patients in our series had reproduction of their symptomatology with palpation over the proximal aspect of the abductor hallucis and/or the origin of the plantar fascia from the medial tubercle of the calcaneus. Twenty-seven patients (20 women and seven men; average age 49) with these clinical characteristics were examined by electromyography and motor/sensory/mixed nerve conduction studies. Bilateral heel signs and symptoms were present in 11 patients. Ten of the patients had a significant history of back pain with referral to the legs. In 23 of the 38 symptomatic heels, abnormalities were identified in the lateral and/or the medial plantar nerves. The number of abnormal values per heel ranged from one to four, with a mean of 2.1. The most common finding was involvement of the medial nerve (57%). Thirty percent of the heels had isolated findings in the lateral plantar nerve and 13% had abnormalities in both plantar nerves. Two patients had electrophysiologic evidence of active S1 radiculopathy, with ipsilateral evidence of plantar nerve entrapment suggesting a "double crush" syndrome. The results of this study support the presence of abnormalities of plantar nerve function in a selected group of patients with neuritic heel pain.

  14. Single-Stage Bipedicle Local Tissue Transfer and Skin Graft for Achilles Tendon Surgery Wound Complications.

    Science.gov (United States)

    Dekker, Travis J; Avashia, Yash; Mithani, Suhail K; Matson, Andrew P; Lampley, Alexander J; Adams, Samuel B

    2017-02-01

    Achilles tendon and posterior heel wound complications are difficult to treat. These typically require soft tissue coverage via microvascular free tissue transfer at a tertiary referral center. Here, we describe coverage of a series of posterior heel and Achilles wounds via simple, local tissue transfer, called a bipedicle fasciocutaneous flap. This flap can be performed by an orthopaedic foot and ankle surgeon, without resources of tertiary/specialized care or microvascular support. Three patients with separate pathologies were treated with a single-stage bipedicle fasciocutaneous local tissue transfer. Case 1 was a patient with insertional wound breakdown after Achilles debridement and repair to the calcaneus. Case 2 was a heel venous stasis ulcer with calcaneal exposure in a diabetic patient with vasculopathy. Case 3 was a patient with wound breakdown following midsubstance Achilles tendon repair. All three cases were treated with a single-stage bipedicle local tissue transfer for posterior ankle and heel wound complications. All 3 patients demonstrated complete healing of the posterior defect, lateral ankle skin graft recipient site, and the skin graft donor site after surgery. Case 3 had a subsequent recurrent ulceration after initial healing. This was superficial and healed with local wound care. All patients regained full preoperative range of motion and were able to ambulate independently without modified footwear. The bipedicled fasciocutaneous flap described here offers a predictable single stage procedure that can be accomplished by an orthopaedic foot and ankle surgeon without resources of a tertiary care center for posterior foot and ankle defects. This flap can be performed with short operative times and can be customized to facilitate defect coverage. The flap is durable to withstand local tissue stresses required for early ambulation. Despite its reliability, patients require careful follow-up to manage underlying comorbid conditions that may

  15. Guided tissue regeneration with heterologous materials in primary subtalar arthrodesis: a case report.

    Science.gov (United States)

    Frangez, Igor; Kasnik, Tea; Cimerman, Matej; Smrke, Dragica Maja

    2016-05-03

    Calcaneal fractures are relatively rare and difficult to treat. Treatment options vary based on the type of fracture and the surgeon's experiences. In recent years, surgical procedures have increasingly been used due to the better long-term results. We present a case where guided tissue regeneration was performed in a calcaneal fracture that needed primary subtalar arthrodesis. We used the principles of guided tissue regeneration from oral surgery to perform primary subtalar arthrodesis and minimize the risk of non-union. We used a heterologous collagen membrane, which acts as a mechanical barrier and protects the bone graft from the invasion of unwanted cells that could lead to non-union. The collagenous membrane also has osteoconductive properties and is therefore able to increase the osteoblast proliferation rate. A 62-year-old Caucasian woman sustained multiple fractures of her lower limbs and spine after a fall from a ladder. Her left calcaneus had a comminuted multifragmental fracture (Sanders type IV) with severe destruction of the cartilage of her subtalar joint and depression of the Böhler's angle. Therefore, we performed primary arthrodesis of her subtalar joint with elevation of the Böhler's angle using a 7.3 mm titanium screw, a heterologous cortico-cancellous collagenated pre-hydrated bone mix, a heterologous cancellous collagenated bone wedge, and a heterologous collagen membrane (Tecnoss®, Italy). The graft was fully incorporated 12 weeks after the procedure and a year and a half later our patient walks without limping. We present a new use of guided tissue regeneration with heterologous materials that can be used to treat extensive bone defects after bone injuries. We believe that guided tissue regeneration using heterologous materials, including a heterologous collagen membrane that presents a mechanical barrier between soft tissues and bone as well as a stimulative component that enhances bone formation, could be more often used in bone surgery.

  16. Status of bone mineral content and body composition in boys engaged in intensive physical activity.

    Science.gov (United States)

    Madić, Dejan; Obradović, Borislav; Smajić, Miroslav; Obradović, Jelena; Marić, Dusan; Bosković, Ksenija

    2010-05-01

    It is well known that physical activity has an anabolic effect on bone tissue. But there is a lack of information about the effect of intensive physical activity in childhood, particularly at the prepubertal stage. To examine the influence of training on body composition and bone mineral density we have studied a group of prepubertal soccer players as well as a group of inactive prepubertal boys at the starting phase of their peak bone mass acquisition. A total of 62 healthy prepubertal boys took part in this study. They were divided into two groups. The first one consisted of 32 soccer players (aged 10.7 +/- 0.5 years), who had been playing football for at least 1 year (10-15 h per week). The second group a control group 30 boys (aged 11.2 +/- 0.7 years) doing 1.5 h per week physical activity at school. Body composition was assessed by a Body Fat Analyzer "BES 200 Z". Bone mineral density measurements of the left and the right calcaneus were done by using ultrasound densitometer "Sahara" (Hologic, Inc., MA, USA). There were significant differences between soccer players and the control group in fat mass (p = 0.01). Besides, a significant difference was determined between the group of athletes and the control group in bone mineral density of both calcaneal bones (p = 0.01). The results of this study confirm the significant effects of physical activity on reducing body mass and increasing bone density. Considering that football training can be very easily implemented in the broader population of children and young people, which does not apply to many other sports, it should be used more in the prevention of obesity and osteoporosis.

  17. [Body composition and bone mineral density of prepubertal boys involved in different kinesiologic treatments].

    Science.gov (United States)

    Obradović, Borislav; Madić, Dejan; Milosević, Zoran; Maksimović, Nebojsa; Mikalacki, Milena; Kovacev-Zavisić, Branka

    2009-01-01

    It is well known that physical activity has an anabolic effect on the bone tissue. But there is a lack of information about the effect of intensive physical activity in childhood, particularly at the prepubertal stage. The type, frequency, intensity, and duration of activity that best produce the desired increases in mass and strength of human bones have not yet been well determined. To examine the influence of different kinesiological treatments on body composition and bone mineral density we studied a group of prepubertal boys at the starting phase of their peak bone mass acquisition. 90 healthy prepubertal boys took part in this study. The sport group consisted of 28 swimmers (aged 10.80.8) and 32 soccer players (aged 10.70.5), who had been training their chosen high-level sport activity for at least 1 year (8-12 h per week for swimmers, 10-15 h per week for soccer players). 30 boys (aged 11.2 +/- 0.7) doing 1.5 h per week of physical activity in school served as a control group. Bone mineral density measurements of the left and right calcaneus were done by ultrasound densitometer "Sahara". The body composition was assessed by Body Fat Analyser "BES 200 Z". There were significant differences between soccer players and control group as regards fat mass and bone mineral density (p<.01). Besides, significant differences were determined between a group of swimmers and control group as regads fat mass (p<.03), while the differences in bone mineral density were not very obvious (p<.67).

  18. Mechanisms for triceps surae injury in high performance front row rugby union players: a kinematic analysis of scrummaging drills.

    Science.gov (United States)

    Flavell, Carol A; Sayers, Mark G L; Gordon, Susan J; Lee, James B

    2013-01-01

    The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS), greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players. Key pointsFront rowers exhibited patterns of single leg weight bearing, in a position of greater ankle plantar flexion and knee extension at toe off during scrummaging, which is a risk position for TS injury.Front rowers also exhibited greater acceleration at the ankle, knee, and hip joints, and greater changes in ankle ROM from toe strike to toe off during attacking scrum drills.These reported accelerations and joint displacements may be risk factors for TS injury, as the ankle is accelerating into plantar flexion at final push off and the muscle is shortening from an elongated state.

  19. Rabbit Achilles tendon full transection model – wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery

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    Gabriella Meier Bürgisser

    2016-09-01

    Full Text Available After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization, or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization, while in the other groups (3 and 12 weeks a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011, and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points. Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand.

  20. Reliable measurement of 3D foot bone angles based on the frame-of-reference derived from a sole of the foot

    Science.gov (United States)

    Kim, Taeho; Lee, Dong Yeon; Park, Jinah

    2016-03-01

    Clinical management of foot pathology requires accurate and robust measurement of the anatomical angles. In order to measure a 3D angle, recent approaches have adopted a landmark-based local coordinate system to establish bone angles used in orthopedics. These measurement methods mainly assess the relative angle between bones using a representative axis derived from the morphological feature of the bone and therefore, the results can be affected by bone deformities. In this study, we propose a method of deriving a global frame-of-reference to acquire consistent direction of the foot by extracting the undersurface of the foot from the CT image data. The two lowest positions of the foot skin are identified from the surface to define the base plane, and the direction from the hallux to the fourth toe is defined together to construct the global coordinate system. We performed the experiment on 10 volumes of foot CT images of healthy subjects to verify that the proposed method provides reliable measurements. We measured 3D angles for talus-calcaneus and talus-navicular using facing articular surfaces of paired bones. The angle was reported in 3 projection angles based on both coordinate systems defined by proposed global frame-of-reference and by CT image planes (saggital, frontal, and transverse). The result shows that the quantified angle using the proposed method considerably reduced the standard deviation (SD) against the angle using the conventional projection planes, and it was also comparable with the measured angles obtained from local coordinate systems of the bones. Since our method is independent from any individual local shape of a bone, unlike the measurement method using the local coordinate system, it is suitable for inter-subject comparison studies.

  1. An evaluation of frailty factors among elderly and their mutual links in elderly women in the Olomouc region

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    Tereza Kaplanová

    2017-03-01

    Full Text Available Background: Ageing has a significant impact on the functional status and capacity in physical, cognitive, sensory and nutritional areas. The age-related changes include changes in body composition as well as changes in the musculoskeletal system including a significant loss of muscle mass and demineralization of bone. Objective: The aim of this study was to evaluate the relationship between selected parameters of frailty factors in older women from the Olomouc region. Methods: The research group consisted of 225 women (aged 60-81 years attending University of the Third Age at the Faculty of Physical Culture, Palacký University Olomouc and women from senior clubs in Olomouc. Body composition was assessed by multifrequency bioelectrical impedance. Muscle strength in the hand flexors was evaluated using a digital pinch grip. Information on bone density was obtained through local densitometer. To verify the strength of relation between variables Pearson correlation coefficients were calculated. Results: Relationship between body composition, muscle strength and bone density proved to be statistically significant. Moderate positive correlation was found between the grip strengths of both hands, bone density of both calcaneus and the amount of fat-free mass, muscle mass, cell mass and the size of the basal metabolic rate in range from .41 to .49. The relationship between muscle strength and bone density was weak (r < .30 but statistically significant. Conclusions: These results confirm the relationship between aspects of the frailty of elderly women, especially the relationship between muscle strength, bone density and selected parameters of body composition.

  2. The postcranial skeletal maturation of Australopithecus sediba.

    Science.gov (United States)

    Cameron, Noel; Bogin, Barry; Bolter, Debra; Berger, Lee R

    2017-07-01

    In 2008, an immature hominin defined as the holotype of the new species Australopithecus sediba was discovered at the 1.9 million year old Malapa site in South Africa. The specimen (MH1) includes substantial post-cranial skeletal material, and provides a unique opportunity to assess its skeletal maturation. Skeletal maturity indicators observed on the proximal and distal humerus, proximal ulna, distal radius, third metacarpal, ilium and ischium, proximal femur and calcaneus were used to assess the maturity of each bone in comparison to references for modern humans and for wild chimpanzees (Pan troglodytes). In comparison to humans the skeletal maturational ages for Au. sediba correspond to between 12.0 years and 15.0 years with a mean (SD) age of 13.1 (1.1) years. In comparison to the maturational pattern of chimpanzees the Au. sediba indicators suggest a skeletal maturational age of 9-11 years. Based on either of these skeletal maturity estimates and the body length at death of MH1, an adult height of 150-156 cm is predicted. We conclude that the skeletal remains of MH1 are consistent with an ape-like pattern of maturity when dental age estimates are also taken into consideration. This maturity schedule in australopiths is consistent with ape-like estimates of age at death for the Nariokotome Homo erectus remains (KMN-WT 15000), which are of similar postcranial immaturity to MH1. The findings suggest that humans may have distinctive and delayed post-cranial schedules from australopiths and H. erectus, implicating a recent evolution of somatic and possibly life history strategies in human evolution. © 2017 Wiley Periodicals, Inc.

  3. Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating.

    Science.gov (United States)

    Muia, Esther N; Wright, Hattie H; Onywera, Vincent O; Kuria, Elizabeth N

    2016-01-01

    Limited data are available on the female athlete triad (Triad) in athletes from minority groups. We explored subclinical and clinical Triad components amongst adolescent elite Kenyan athletes (n = 61) and non-athletes (n = 49). Participants completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Ultrasound assessed calcaneus bone mineral density (BMD). Eating Disorder Inventory subscales and the Three-Factor Eating Questionnaire's cognitive dietary restraint subscale measured disordered eating (DE). EA was lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal ∙ kg FFM(-1) ∙ d(-1), P = 0.003). More athletes were identified with clinical low EA (17.9% vs. 2.2%, OR = 9.5, 95% CI 1.17-77, P = 0.021) and clinical menstrual dysfunction (32.7% vs. 18.3%, χ(2) = 7.1, P = 0.02). Subclinical (75.4% vs. 71.4%) and clinical DE (4.9% vs. 10.2%, P = 0.56) as well as BMD were similar between athletes and non-athletes. More athletes had two Triad components than non-athletes (8.9% vs. 0%, OR = 0.6, 95% CI 0.5-6.9, P = 0.05). Kenyan adolescent participants presented with one or more subclinical and/or clinical Triad component. It is essential that athletes and their entourage be educated on their energy needs including health and performance consequences of an energy deficiency.

  4. Imaging features of foot osteoid osteoma

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    Shukla, Satyen; Clarke, Andrew W.; Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)

    2010-07-15

    We performed a retrospective review of the imaging of nine patients with a diagnosis of foot osteoid osteoma (OO). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) had been performed in all patients. Radiographic features evaluated were the identification of a nidus and cortical thickening. CT features noted were nidus location (affected bone - intramedullary, intracortical, subarticular) and nidus calcification. MRI features noted were the presence of an identifiable nidus, presence and grade of bone oedema and whether a joint effusion was identified. Of the nine patients, three were female and six male, with a mean age of 21 years (range 11-39 years). Classical symptoms of OO (night pain, relief with aspirin) were identified in five of eight (62.5%) cases (in one case, the medical records could not be retrieved). In five patients the lesion was located in the hindfoot (four calcaneus, one talus), while four were in the mid- or forefoot (two metatarsal and two phalangeal). Radiographs were normal in all patients with hindfoot OO. CT identified the nidus in all cases (89%) except one terminal phalanx lesion, while MRI demonstrated a nidus in six of nine cases (67%). The nidus was of predominantly intermediate signal intensity on T1-weighted (T1W) sequences, with intermediate to high signal intensity on T2-weighted (T2W) sequences. High-grade bone marrow oedema, limited to the affected bone and adjacent soft tissue oedema was identified in all cases. In a young patient with chronic hindfoot pain and a normal radiograph, MRI features suggestive of possible OO include extensive bone marrow oedema limited to one bone, with a possible nidus demonstrated in two-thirds of cases. The presence or absence of a nidus should be confirmed with high-resolution CT. (orig.)

  5. A non-invasive prevention program model for the assessment of osteoporosis in the early postmenopausal period: a pilot study on FRAX(®) and QUS tools advantages.

    Science.gov (United States)

    Villa, P; Lassandro, A P; Moruzzi, M C; Amar, I D; Vacca, L; Di Nardo, F; De Waure, C; Pontecorvi, A; Scambia, G

    2016-02-01

    The study analyses the performances of FRAX algorithm and quantitative ultrasound (QUS) tool in relationship to the dual-energy X-ray absorptiometry (DXA) categorization to identify patients at risk of osteoporosis during menopause and to reach new thresholds for recommending the first DXA examination. Retrospective cohort study. Two hundred eighty-two postmenopausal patients filled out a questionnaire which determined their FRAX index and performed a bone evaluation by QUS of the calcaneus to determine their stiffness index (SI). Thereafter, they underwent assessments by the gold-standard DXA bone examination. Statistically significant correlations were observed between FRAX (calculated without BMD) and both QUS and DXA diagnosis. FRAX mean indices of risk corresponding to the diagnosis of osteoporosis by QUS and DXA were similar. Receiver operating characteristic (ROC) curve analysis showed that both FRAX and QUS tests were sufficiently accurate in predicting the alteration of bone mineral composition. The ROC curves of QUS allowed us to identify, in our population, SI cutoff for normal patients (SI > 90.5) and for patients having osteoporosis (SI < 78.5). We selected a cutoff screening value from FRAX ROC curve for major clinical fracture (2.94). The following diagnostic algorithm demonstrated that the use of FRAX test alone has a sensitivity of 85.3 % and a specificity of 33.8 % while the use of QUS exam alone showed a sensitivity of 81.3 % and a specificity of 45.1 %. When considering the capacity of QUS exam in combination with FRAX test, the final algorithm showed a sensitivity of 69.4 % and a specificity of 57.7 %. The use of QUS test with adjusted cutoffs offers a similar performance to the FRAX test alone in terms of sensitivity. The combined use of the tests reduces the sensibility but increases the specificity and adds clinical information related to the bone status of the patient.

  6. Magnetic resonance imaging of the ankle in female ballet dancers en pointe.

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    Russell, Jeffrey A; Shave, Ruth M; Yoshioka, Hiroshi; Kruse, David W; Koutedakis, Yiannis; Wyon, Matthew A

    2010-07-01

    Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion (en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study. To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects. Nine female ballet dancers (age, 21+/-2.9 years; dance experience, 16+/-4.1 years; en pointe dance experience, 7+/-4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe. Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda's process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects. This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers.

  7. Assessment of female ballet dancers' ankles in the en pointe position using high field strength magnetic resonance imaging.

    Science.gov (United States)

    Russell, Jeffrey A; Yoshioka, Hiroshi

    2016-08-01

    The en pointe position of the ankle in ballet is extreme. Previously, magnetic resonance imaging (MRI) of ballet dancers' ankles en pointe was confined to a low field, open MR device. To develop a reproducible ankle MRI protocol for ballet dancers en pointe and to assess the positions of the key structures in the dancers ankles. Six female ballet dancers participated; each was randomly assigned to stand en pointe while one of her feet and ankles was splinted with wooden rods affixed with straps or to begin with the ankle in neutral position. She lay in an MR scanner with the ankle inside a knee coil for en pointe imaging and inside an ankle/foot coil for neutral position imaging. Proton density weighted images with and without fat suppression and 3D water excitation gradient recalled echo images were obtained en pointe and in neutral position in sagittal, axial, and coronal planes. We compared the bones, cartilage, and soft tissues within and between positions. No difficulties using the protocol were encountered. En pointe the posterior articular surface of the tibial plafond was incongruent with the talar dome and rested on the posterior talus. The posterior edge of the plafond impinged Kager's fat pad. All participants exhibited one or more small ganglion cysts about the ankle and proximal foot, as well as fluid accumulation in the flexor and fibularis tendon sheaths. Our MRI protocol allows assessment of female ballet dancers' ankles in the extreme plantar flexion position in which the dancers perform. We consistently noted incongruence of the talocrural joint and convergence of the tibia, talus, and calcaneus posteriorly. This protocol may be useful for clinicians who evaluate dancers. © The Foundation Acta Radiologica 2015.

  8. Lumbar spondylosis, lumbar spinal stenosis, knee pain, back muscle strength are associated with the locomotive syndrome: Rural population study in Japan.

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    Chiba, Daisuke; Tsuda, Eiichi; Wada, Kanichiro; Kumagai, Gentaro; Sasaki, Eiji; Nawata, Atsushi; Nakagomi, Sho; Takahashi, Ippei; Nakaji, Shigeyuki; Ishibashi, Yasuyuki

    2016-05-01

    To comprehensively investigate the clinical and physical factors associating with locomotive syndrome (Loc-S); the locomotorium-disability for daily life. 647 volunteers participated (247 males, 400 females, Age: 58.4 ± 11.0, BMI: 22.5 ± 3.3). Three self-assessment questionnaires were administered: 1) "25-question Geriatric Locomotive Function Scale" (GFLS-25) for evaluating Loc-S (GLFS-25 ≥ 16 defined as Loc-S); 2) "diagnostic support tool for LSS" (LSS-DST) for evaluating the prevalence of lumbar spinal stenosis (LSS); 3) Knee injury and Osteoarthritis Outcome Score (KOOS). Plain radiographs of the bilateral knees and lumbar spine were evaluated, and the severity of lumbar spondylosis (LS) and knee osteoarthritis (KOA) defined by Kellgren-Lawrence grade. Bone status was evaluated by using the osteo-sono assessment index (OSI) at the calcaneus. Isometric muscle strength of trunk and leg (Nm/kg, both extension and flexion) were evaluated. Linear regression analysis was performed to elucidate the factors concerned with GFLS-25 including age, sex, and BMI. Thirty-nine subjects (6.0%, 13 males, 26 females) were defined as having Loc-S. Single regression model showed that age, height, BMI, skeletal muscle mass, OSI, LSS, KOOS, the severity of LS and KOA, and trunk- and leg-muscle strength were correlated with the degree of GLFS-25. Stepwise multiple regression model showed that sex, height, LSS, KOOS, the severity of LS, and back muscle strength were significantly correlated with that of GLFS-25. In this cross-sectional study, pain status associated with LSS and knee joint, structural severity for LS, and back muscle strength primarily affected the degree of GFLS-25. For managing Loc-S, we must pay more intensive attention to these factors. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  9. Longitudinal deficiency of the fibula. Operative treatment.

    Science.gov (United States)

    Fulp, T; Davids, J R; Meyer, L C; Blackhurst, D W

    1996-05-01

    We reviewed the results of early amputation and prosthetic fitting in twenty-five children (thirty-one extremities) who had longitudinal deficiency of the fibula and were managed between 1977 and 1992. The median age at the time of the initial operation was thirteen months (range, eight months to nine years and eight months). The median duration of follow-up was eight years and ten months (range, two years and six months to sixteen years and eleven months). A Syme amputation was performed on fifteen extremities (thirteen children), and a modified Boyd amputation (which included resection of the distal tibial physis) was performed on sixteen extremities (thirteen children). (One child had a Syme amputation on one side and a Boyd amputation on the other and is thus included in both groups). In twenty-seven extremities, simultaneous excision of the fibular anlage was performed to prevent the development of a deformity secondary to the potential tethering effect. In twelve extremities, a diaphyseal osteotomy of the tibia also was performed to correct tibial bowing and to improve the mechanical alignment of the extremity. At the time of follow-up, the patients who had had a Syme amputation had more problems related to reformation of the calcaneus, instability of the heel pad, prosthetic suspension, and excessive length of the residual extremity. The modified Boyd amputation improved the function of the heel pad and the prosthetic suspension and provided the optimum length of the residual extremity. We also found that an early diaphyseal osteotomy of the tibia to correct severe bowing improved prosthetic fitting. This study did not support the concept that early resection of the fibular anlage or a diaphyseal osteotomy of the tibia prevents the development of hypoplasia of the lateral femoral condyle and associated genu valgum deformity.

  10. Vitamin D and Musculoskeletal Status in Nova Scotian Women Who Wear Concealing Clothing

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    Jo M. Welch

    2012-05-01

    Full Text Available Bone and muscle weakness due to vitamin D deficiency is common among Muslim women who reside in sunny, equatorial countries. The purpose of this study was to determine if living in a northern maritime location additionally disadvantages women who wear concealing clothes. A cross-sectional matched pair design was used to compare women who habitually wore concealing clothing with women who dressed according to western norms. Each premenopausal hijab-wearing woman (n = 11 was matched by age, height, weight and skin tone with a western-dressed woman. Subjects were tested by hand grip dynamometry to assess muscular strength and by quantitative ultrasound at the calcaneus to assess bone status. Nutritional intake was obtained by 24 h recall. Serum 25-hydroxyvitamin D (s-25(OHD status was determined in seven matched pairs. The hijab group had lower s-25(OHD than women who wore western clothes (40 ± 28 vs. 81 ± 32 nmol/L, p = 0.01. Grip strength in the right hand was lower in the hijab-wearing women (p = 0.05 but this appeared to be due to less participation in intense exercise. Bone status did not differ between groups (p = 0.9. Dietary intake of vitamin D was lower in the hijab-wearers (316 ± 353 vs. 601 ± 341 IU/day, p = 0.001. This pilot study suggests that women living in a northern maritime location appear to be at risk for vitamin D insufficiency and therefore should consider taking vitamin D supplements.

  11. Effect of age and disease on bone mass in Japanese patients with schizophrenia

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    Sugawara Norio

    2012-02-01

    Full Text Available Abstract Background There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. Methods We recruited patients (n = 362, aged 48.8 ± 15.4 (mean ± SD years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV. Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. Results Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. Conclusions Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

  12. The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients

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    Ioannis A. Ignatiadis

    2011-01-01

    Full Text Available The authors present their experience with the use of sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. This paper is a review of these flaps carried out between 2003 and 2008. The series consists of 16 patients, 11 men and 5 women with an average age of 41 years (17-81 and with a follow-up period between 2 and 7 years. The etiology was major velocity accident in six cases, diabetes mellitus with osteomyelitis after ORIF for fractures (2, work accident in five, and another two cases with complications of lower limb injuries. The defect areas were located on calcaneus, malleolar area, tarsal area and lower tibia. Associated risk factors in the patients for the flap performance were diabetes (five patients and cigarette smoking (ten patients.The technique is based on the use of a reverse-flow island sural flap combined with other flaps in three cases (cross-leg, peroneal, gastrocnemius. The anatomical structures which constituted the pedicle were the superficial and deep fascia, the sural nerve, the lesser saphenous vein and skin.The flap was viable in all 15 patients. On 8 cases was achieved direct closure, on three cases occurred a superficial necrosis and was skin grafted, on one case was observed partial necrosis which was treated with a second flap (posterior tibial perforator flap and another one occurred delayed skin healing.The sural fasciocutaneous flap is useful for the treatment of severe and complex injuries and their complications in diabetic and non diabetic lower limbs. Its technical advantages are easy dissection, preservation of more important vascular structures in the limb and complete coverage of the soft tissue defects in just one operation without the need of microsurgical anastomosis. Thus this flap offers excellent donor sites for repairing soft tissue defects in foot and ankle.

  13. [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.

  14. Polyunsaturated fatty acids and calcaneal ultrasound parameters among Inuit women from Nuuk (Greenland: a longitudinal study

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    Alexandra-Cristina Paunescu

    2013-06-01

    Full Text Available Background. The traditional diet of Inuit people comprises large amounts of fish and marine mammals that are rich in omega-3 polyunsaturated fatty acids (PUFAs. Results from in vitro studies, laboratory animal experiments and population studies suggest that omega-3 PUFA intake and a high omega-3/omega-6 ratio exert a positive effect on bone health. Objective. This longitudinal study was conducted to examine the relationship between omega-3 and omega-6 PUFA status and quantitative ultrasound (QUS parameters in Greenlandic Inuit women. Methods. The study included 118 Inuit women from Nuuk (Greenland, aged 49–64 years, whose QUS parameters measured at baseline (year 2000, along with PUFA status and covariates, and follow-up QUS measurements 2 years later (year 2002. QUS parameters [speed of sound (SOS; broadband ultrasound attenuation (BUA] were measured at the right calcaneus with a water-bath Lunar Achilles instrument. Omega-3 and omega-6 PUFA contents of erythrocyte membrane phospholipids were measured after transmethylation by gas chromatography coupled with a flame ionization detector. Relationships between QUS parameters and different PUFAs were studied in multiple linear regression models. Results. Increasing values of EPA, DHA and the omega-3/omega-6 PUFA ratio were associated with increased BUA values measured at follow-up (year 2002. These associations were still present in models adjusted for several confounders and covariates. We found little evidence of associations between PUFAs and SOS values. Conclusion. The omega-3 PUFA intake from marine food consumption seems to have a positive effect on bone intrinsic quality and strength, as revealed by higher BUA values in this group of Greenlandic Inuit women.

  15. Stress Fractures of the Foot and Ankle in Athletes

    Science.gov (United States)

    Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.

    2014-01-01

    Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete. Study Design: Clinical review. Level of Evidence: Level 5. Results: Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving. Conclusion: A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient. PMID:25364480

  16. Differences in foot kinematics between young and older adults during walking.

    Science.gov (United States)

    Arnold, John B; Mackintosh, Shylie; Jones, Sara; Thewlis, Dominic

    2014-02-01

    Our understanding of age-related changes to foot function during walking has mainly been based on plantar pressure measurements, with little information on differences in foot kinematics between young and older adults. The purpose of this study was to investigate the differences in foot kinematics between young and older adults during walking using a multi-segment foot model. Joint kinematics of the foot and ankle for 20 young (mean age 23.2 years, standard deviation (SD) 3.0) and 20 older adults (mean age 73.2 years, SD 5.1) were quantified during walking with a 12 camera Vicon motion analysis system using a five segment kinematic model. Differences in kinematics were compared between older adults and young adults (preferred and slow walking speeds) using Student's t-tests or if indicated, Mann-Whitney U tests. Effect sizes (Cohen's d) for the differences were also computed. The older adults had a less plantarflexed calcaneus at toe-off (-9.6° vs. -16.1°, d = 1.0, p = plane range of motion (ROM) of the midfoot (11.9° vs. 14.8°, d = 1.3, p = plane ROM of the metatarsus (3.2° vs. 4.3°, d = 1.1, p = 0.006) compared to the young adults. Walking speed did not influence these differences, as they remained present when groups walked at comparable speeds. The findings of this study indicate that independent of walking speed, older adults exhibit significant differences in foot kinematics compared to younger adults, characterised by less propulsion and reduced mobility of multiple foot segments. Copyright © 2013 Elsevier B.V. All rights reserved.

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

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    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.)

  18. Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases

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    Kienast B

    2010-02-01

    Full Text Available Abstract Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82, 104 patients were male (67,1%. Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5% the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92. Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.

  19. Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases

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    Kiene J

    2009-01-01

    Full Text Available Abstract The methods for ankle arthrodesis differ significantly, probably a sign that no method is clearly superior to others. In the last ten years there is a clear favour toward internal fixation. We retrospectively evaluate the technique and evaluate the clinical long term results of external fixation in a triangular frame. Patients and Methods From 1994 to 2001 a consecutive series of 95 patients with end stage arthritis of the ankle joint were treated. Retrospectively the case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues and the clinical examination before arthrodesis. Mean age at the index procedure was 45.4 years (18-82, 67 patients were male (70.5%. Via a bilateral approach the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted with approximately 8 cm distance in the distal tibia, one in the neck of the talus and one in the dorsal calcaneus. The fixator was removed after approximately 12 weeks. Follow up examination at mean 4.4 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs. Results: Due to different complications, 8 (8.9% further surgical procedures were necessary including 1 below knee amputation. In 4 patients a non-union of the ankle arthrodesis developed (4.5%. The mean AOFAS score improved from 20.8 to 69.3 points. Conclusion Non-union rates and clinical results of arthrodesis by triangular external fixation of the ankle joint do not differ to internal fixation methods. The complication rate and the reduced patient comfort reserve this method mainly for infected arthritis and complicated soft tissue situations.

  20. Appendicular bone mass and knee and hand osteoarthritis in Japanese women: a cross-sectional study

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    Moji Kazuhiko

    2002-10-01

    Full Text Available Abstract Background It has been reported that there is an inverse association between osteoarthritis (OA and osteoporosis. However, the relationship of bone mass to OA in a Japanese population whose rates of OA are different from Caucasians remains uncertain. Methods We studied the association of appendicular bone mineral density (second metacarpal; mBMD and quantitative bone ultrasound (calcaneus; stiffness index with knee and hand OA among 567 Japanese community-dwelling women. Knee and hand radiographs were scored for OA using Kellgren-Lawrence (K/L scales. In addition, we evaluated the presence of osteophytes and of joint space narrowing. The hand joints were examined at the distal and proximal interphalangeal (DIP, PIP and first metacarpophalangeal/carpometacarpal (MCP/CMC joints. Results After adjusting for age and body mass index (BMI, stiffness index was significantly higher in women with K/L scale, grade 3 at CMC/MCP joint compared with those with no OA. Adjusted means of stiffness index and mBMD were significantly higher in women with definite osteophytes at the CMC/MCP joint compared to those without osteophytes, whereas there were no significant differences for knee, DIP and PIP joints. Stiffness index, but not mBMD, was higher in women with definite joint space narrowing at the CMC/MCP joint compared with those with no joint space narrowing. Conclusions Appendicular bone mass was increased with OA at the CMC/MCP joint, especially among women with osteophytes. Our findings suggest that the association of peripheral bone mass with OA for knee, DIP or PIP may be less clearcut in Japanese women than in other populations.

  1. Status of bone mineral content and body composition in boys engaged in intensive physical activity

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    Madić Dejan

    2010-01-01

    Full Text Available Background/Aim. It is well known that physical activity has an anabolic effect on bone tissue. But there is a lack of information about the effect of intensive physical activity in childhood, particularly at the prepubertal stage. To examine the influence of training on body composition and bone mineral density we have studied a group of prepubertal soccer players as well as a group of inactive prepubertal boys at the starting phase of their peak bone mass acquisition. Methods. A total of 62 healthy prepubertal boys took part in this study. They were divided into two groups. The first one consisted of 32 soccer players (aged 10.7 ± 0.5 years, who had been playing football for at least 1 year (10-15 h per week. The second group a control group 30 boys (aged 11.2 ± 0.7 years doing 1.5 h per week physical activity at school. Body composition was assessed by a Body Fat Analyzer 'BES 200 Z'. Bone mineral density measurements of the left and the right calcaneus were done by using ultrasound densitometer 'Sahara' (Hologic, Inc., MA, USA. Results. There were significant differences between soccer players and the control group in fat mass (p = 0.01. Besides, a significant difference was determined between the group of athletes and the control group in bone mineral density of both calcaneal bones (p = 0.01. Conclusion. The results of this study confirm the significant effects of physical activity on reducing body mass and increasing bone density. Considering that football training can be very easily implemented in the broader population of children and young people, which does not apply to many other sports, it should be used more in the prevention of obesity and osteoporosis.

  2. MRI signal changes of the bone marrow in HIV-infected patients with lipodystrophy: correlation with clinical parameters

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    Garcia, Ana I.; Tomas, Xavier; Pomes, Jaume; Amo, Montserrat del [Hospital Clinic, Department of Radiology, Barcelona (Spain); Milinkovic, Ana; Perez, Inaki; Mallolas, Josep [IDIBAPS-Hospital Clinic, Department of Infectious Diseases, Barcelona (Spain); Rios, Jose [Hospital Clinic, Department of Biostatistics, Barcelona (Spain); Vidal-Sicart, Sergi [Hospital Clinic, Department of Nuclear Medicine, Barcelona (Spain)

    2011-10-15

    To assess the prevalence, imaging appearance, and clinical significance, of bone marrow MR signal changes in a group of human immunodeficiency virus (HIV)-infected patients with lipodystrophy syndrome. Twenty-eight HIV-infected patients with lipodystrophy syndrome treated with highly active antiretroviral therapy, and 12 HIV-negative controls underwent MRI of the legs. Whole-body MRI, SPECT/CT, and a complete radiographic skeletal survey were obtained in subjects with signal changes in bone marrow. MRI and clinical evaluations were reviewed 6 months after baseline to determine changes after switching from thymidine analogs (TA) to tenofovir-DF (TDF). MRI results correlated with clinical parameters. We observed foci of a serous-like pattern (low signal and no enhancement on T1-weighted, high signal on T2-weighted images) in 4 out of 28 patients (14.3%) and an intermediate signal on T1-weighted images in 4 out of 28 patients (14.3%). Serous-like lesions were located in the lower limbs and scattered in the talus, calcaneus, femurs, and humeral bones; they showed slight uptake on SPECT bone scans and were normal on CT and radiographs. Patients with serous-like lesions had significantly lower peripheral and total fat at baseline than other groups (P < 0.05). No changes at 6 months were observed on MRI, and the serous-like lesion group showed good peripheral fat recovery after changing drug treatment. A serous-like MRI pattern is observed in the peripheral skeletons of HIV-infected patients with lipodystrophy, which correlates with peripheral lipoatrophy, and should not be misdiagnosed as malignant or infectious diseases. Although the MR lesions did not improve after switching the treatment, there was evidence of lipoatrophy recovery. (orig.)

  3. Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot.

    Science.gov (United States)

    Caravaggi, Carlo; Cimmino, Marzio; Caruso, Sebastiano; Dalla Noce, Sergio

    2006-01-01

    Involvement of the ankle joint in Charcot osteoarthropathy may be associated with severe instability and fracture or collapse of the talus. Recalcitrant ulceration may result over the lateral malleolus, increasing the risk of major amputation. This study evaluated ankle arthrodesis with a compressive intramedullary nail in 14 patients with diabetes affected by Charcot of the ankle. The mean patient age was 58 +/- 12 years, and the mean duration of diabetes was 17 +/- 5 years. Transcutaneous oxygen pressures were > or = 50 mm Hg in all patients, indicating a good distal blood supply. A below-knee amputation had previously been suggested because of severe ankle joint instability. None of the patients were able to walk without a brace. Four patients had an ulceration that had healed before the index procedure. All procedures were performed in the quiescent phase of the disease. After a mean follow-up of 18 +/- 4 months, 10 patients (71.4%) achieved a solid arthrodesis, returning to walking with protective shoes. Three patients (21.4%) developed breakage of the calcaneus screws, necessitating removal of the screws in 2 cases and removal of the entire nail in 2 cases. These 3 patients went on to fibrous union that allowed walking with a brace. One patient (7.2%) required a below-knee amputation because of postoperative osteomyelitis of the distal tibia. The data from our study demonstrate a high rate of limb salvage (92.8%), suggesting that this device is safe and effective in the treatment of Charcot arthropathy of the ankle.

  4. Ligament structures in the tarsal sinus and canal.

    Science.gov (United States)

    Li, Shu-Yuan; Hou, Zhi-Dian; Zhang, Peng; Li, Hong-Liang; Ding, Zi-Hai; Liu, Yu-Jie

    2013-12-01

    The concrete anatomy and functional characteristics of the subtalar ligaments have been a matter of debate that some believe has hampered the progress of clinical ligament reconstruction. In 32 fresh-frozen cadaver feet, the course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured and photographed both from the portal of the tarsal sinus and from a posterior view. The IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint. The results of this study show that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal. The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.

  5. Vitamin D and Musculoskeletal Status in Nova Scotian Women Who Wear Concealing Clothing

    Science.gov (United States)

    Ojah, Rani C. I.; Welch, Jo M.

    2012-01-01

    Bone and muscle weakness due to vitamin D deficiency is common among Muslim women who reside in sunny, equatorial countries. The purpose of this study was to determine if living in a northern maritime location additionally disadvantages women who wear concealing clothes. A cross-sectional matched pair design was used to compare women who habitually wore concealing clothing with women who dressed according to western norms. Each premenopausal hijab-wearing woman (n = 11) was matched by age, height, weight and skin tone with a western-dressed woman. Subjects were tested by hand grip dynamometry to assess muscular strength and by quantitative ultrasound at the calcaneus to assess bone status. Nutritional intake was obtained by 24 h recall. Serum 25-hydroxyvitamin D (s-25(OH)D) status was determined in seven matched pairs. The hijab group had lower s-25(OH)D than women who wore western clothes (40 ± 28 vs. 81 ± 32 nmol/L, p= 0.01). Grip strength in the right hand was lower in the hijab-wearing women (p = 0.05) but this appeared to be due to less participation in intense exercise. Bone status did not differ between groups (p= 0.9). Dietary intake of vitamin D was lower in the hijab-wearers (316 ± 353 vs. 601 ± 341 IU/day, p= 0.001). This pilot study suggests that women living in a northern maritime location appear to be at risk for vitamin D insufficiency and therefore should consider taking vitamin D supplements. PMID:22690323

  6. Effect of taping on multi-segmental foot kinematic patterns during walking in persons with chronic ankle instability.

    Science.gov (United States)

    Dingenen, Bart; Deschamps, Kevin; Delchambre, Frauke; Van Peer, Evelien; Staes, Filip F; Matricali, Giovanni A

    2017-09-01

    To evaluate multi-segmental foot kinematic patterns in chronic ankle instability (CAI) participants during walking, and to investigate the influence of high-Dye and low-Dye taping on these kinematic patterns. Cross-sectional study. Kinematic data of 12 non-injured controls and 15 CAI participants were measured with a three-dimensional motion analysis system during barefoot walking. In addition, the CAI participants walked with high-Dye and low-Dye taping. A rigid Plug-in gait model and the Rizzoli 3D Multi-Segment Foot Model were used to measure multi-segmental foot kinematic patterns. One-dimensional statistical parametric mapping was used to compare barefoot walking of the control and CAI group, and to evaluate differences between walking barefoot and walking with high-Dye and low-Dye taping within the CAI group. Compared to the control group, CAI participants showed a decreased ankle dorsiflexion during loading response (p=0.025) and a more inverted calcaneus in relation to the shank during the initial swing phase (p=0.024). A more inverted position of the metatarsus in relation to the midfoot was observed after low-Dye taping during almost the entire stance phase (p=0.017). No significant differences were found for high-Dye taping. Significant differences in kinematic patterns were found in the ankle joint and rearfoot, but not in the mid- and forefoot in CAI participants. The application of low-Dye taping resulted in a significantly increased inverted position of the forefoot, which can be considered as a less desirable effect for patients with CAI. No other effects of high-Dye and low-Dye taping on kinematic patterns were revealed. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  7. The influence of lifestyle, menstrual function and oral contraceptive use on bone mass and size in female military cadets

    Directory of Open Access Journals (Sweden)

    Tendy Susan

    2007-08-01

    Full Text Available Abstract Purpose To determine the influence of menstrual irregularity, oral contraceptive use and other factors on bone mineral density (BMD and bone size at different skeletal sites in 135 college-aged fit women. Methods Menstrual history, oral contraceptive use, exercise history, and nutritional factors including calcium, caffeine, and alcohol intake as well as tobacco use were determined by written survey. Height, weight and fitness levels were measured. Spine and hip BMD were measured by dual x-ray absorptiometry (DXA, calcaneus BMD by peripheral DXA, and tibial bone mineral content (BMC and size by peripheral Quantitative Computed Tomography (pQCT. Results The mean age was 18.4 ± 0.8 years. Weight and prior exercise were positively related to BMD at most skeletal sites and to tibial bone size. Milk intake was positively related to calcaneal BMD, tibial BMC and cortical thickness. Fracture history was an important predictor of spine, hip and heel BMD. Women who had ≥ 10 menstrual cycles in the year prior to BMD measurement had higher BMD at all sites as well as a greater tibial mineral content and cortical thickness than women who had oligomenorrhea/amenorrhea (≤ 9 cycles in the prior year; all p p p = 0.04, smaller tibial periosteal circumference and lower tibial mineral content (p Conclusion In a population of fit, college-aged women, OC use and oligomenorrhea were associated with reduced BMD and bone size. Weight, as well as prior exercise and milk intake was positively related to bone density and size at some skeletal sites. Understanding these relationships would help improve skeletal health in young women.

  8. 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.

  9. Types of subtalar joint facets.

    Science.gov (United States)

    Jung, Min-Ho; Choi, Byoung Young; Lee, Ji Yong; Han, Chang Sung; Lee, Jin Suk; Yang, Young Chul; Cho, Byung Pil

    2015-08-01

    Articular facets of the clinical subtalar joint (CSTJ) were analyzed using a total of 118 (right 57, left 61) dry, paired calcanei and tali from 68 Korean adult cadavers. The CSTJ facets were classified into the following three types depending on their continuity: type A, all three facets are separated; type B, the anterior and middle facets are partially connected; and type C, the anterior and middle facets are fused to form a single facet. The continuity between the anterior and middle facets was represented by the degree of separation (DS), which ranged between 2.00 (type A) and 1.00 (type C). Type A was most common (39.0 %) in calcanei and rarest (11.0 %) in tali. Matching of calcaneus-talus pairs yielded five combined types: A-A (11.0 %), A-B (28.0 %), B-B (18.6 %), B-C (13.6 %), and C-C (28.8 %). The mean DS was slightly greater in calcanei (1.53) than in tali (1.32), and decreased in the order of types A-A, A-B, B-B, B-C, and C-C. The intersecting angles between the anterior and middle facets, which are related to the mobility of the CSTJ, were inversely related to the DS. These findings indicate that the anterior and middle facets are fused more frequently in tali than in calcanei, and combinations of different CSTJ facet types (A-B, B-C) exist over 40 % of feet. Our results indicate that types with a smaller DS (such as B-C and C-C) are relatively mobile but less stable compared to those with a greater DS (such as A-A and A-B).

  10. [The effect of different types of sports and athletes' age on the pathological changes of the musculoskeletal system].

    Science.gov (United States)

    Achkasov, E E; Puzin, S N; Litvinenko, A S; Kurshev, V V; Bezuglov, E N

    2014-01-01

    Our aim was to determine the most common musculoskeletal diseases, depending on the type of sports and athletes' age. The results of examination of 976 athletes aged from 16 to 42 years (average age - 28,9±2,3) with musculoskeletal diseases were analyzed. Medical diagnostic procedures included clinical, laboratory, instrumental (radiography, magnetic resonance imaging, ultrasound) investigations and functional testing (goniometry, manual muscle testing). Majority of patients were diagnosed to have diseases of the knee (17.9%) and ankle joints (11.3%), the heel bone (12.9%), Achilles tendon (10.2%), post-traumatic musculoskeletal diseases (16.2%), degenerative-dystrophic diseases of the spine (12.8%). In the young age group (16 to 20 years) post-traumatic disorders were most common. In the middle-age group (21 to 30 years) along with post-traumatic disorders diseases of the knee frequently occurred. For athletes over 30 years old, along with diseases of the knee spinal diseases were found to occur 2-3 times more frequently in comparison with other age groups. Injuries which are more common for different types of sports were identified: acute traumas - competitive sports, diseases of the calcaneus - sports with running and jumping (athletics, volleyball, soccer), disease of ankle joints - sport with sharp change in movement direction (hockey, figure skating), disease of the knee - sports with high load of the knee joint (figure skating, gymnastics, volleyball, diseases of bones and joints of the upper extremity - tennis, disease of spine - weightlifting. pathological changes in the musculoskeletal system depend on the type of sports and the age of athletes. The combination of age and risk factors associated with type of sport increases the possibility of development of these diseases of the musculoskeletal system.

  11. Sonographic evaluation of plantar fasciitis

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu [Eulji College of Medicine Eulji Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1{+-}1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5{+-}0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0{+-}0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis.

  12. Finite element analysis of plantar fascia during walking: a quasi-static simulation.

    Science.gov (United States)

    Chen, Yen-Nien; Chang, Chih-Wei; Li, Chun-Ting; Chang, Chih-Han; Lin, Cheng-Feng

    2015-01-01

    The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis. © The Author(s) 2014.

  13. Rabbit Achilles tendon full transection model – wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery

    Science.gov (United States)

    Meier Bürgisser, Gabriella; Calcagni, Maurizio; Bachmann, Elias; Fessel, Gion; Snedeker, Jess G.; Giovanoli, Pietro

    2016-01-01

    ABSTRACT After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. PMID:27635037

  14. Fetal development of the pulley for muscle insertion tendons: A review and new findings related to the tensor tympani tendon.

    Science.gov (United States)

    Rodríguez-Vázquez, Jose Francisco; Honkura, Yohei; Katori, Yukio; Murakami, Gen; Abe, Hiroshi

    2017-01-01

    The existence of hard tissue pulleys that act to change the direction of a muscle insertion tendon is well known in the human body. These include (1) the trochlea for the extraocular obliquus superior muscle, (2) the pterygoid hamulus for the tensor veli palatini muscle, (3) the deep sulcus on the plantar aspect of the cuboid bone for the peroneus longus tendon, (4) the lesser sciatic notch for the obturator internus muscle, and (5) the bony trochleariformis process for the tensor tympani muscle tendon. In addition, (6) the stapedius muscle tendon shows a lesser or greater angulation at the pyramidal eminence of the temporal bone. Our recent studies have shown that the development of pulleys Nos. 1 and 2 can be explained by a change in the topographical relationship between the pulley and the tendon, that of pulley No. 3 by the rapidly growing calcaneus pushing the tendon, and that of pulley No. 4 by migration of the insertion along the sciatic nerve and gluteus medius tendon. Therefore, in Nos. 1-4, an initially direct tendon curves secondarily and obtains an attachment to the pulley. In case No. 6, the terminal part of the stapedius tendon originates secondarily from the interzone mesenchymal tissue of the incudostapedial joint. In the case of pulley No. 5, we newly demonstrated that its initial phase of development was similar to No. 6, but the tensor tympani tendon achieved a right-angled turn under guidance by a specific fibrous tissue and it migrated along the growing malleus manubrium. Copyright © 2016 Elsevier GmbH. All rights reserved.

  15. Medial subtalar dislocation: Case report

    Directory of Open Access Journals (Sweden)

    Manojlović Radovan

    2010-01-01

    Full Text Available Introduction. Subtalar dislocation (SI is a term that refers to an injury in which there is dislocation of the talonavicular and talocalcanear joint, although the tibiotalar joint is intact. Case Outline. A case of medial subtalar dislocation as a result of basketball injury, so-called 'basketball foot', is presented. Closed reposition in i.v. anaesthesia was performed with the patient in supine position and a knee flexed at 90 degrees. Longitudinal manual traction in line of deformity was carried out in plantar flexion. The reposition continued with abduction and eversion simultaneously increasing dorsiflexion. It was made in the first attempt and completed instantly. Rehabilitation was initiated after 5 weeks of immobilization. One year after the injury, the functional outcome was excellent with full range of motion and the patient was symptom-free. For better interpretation of roentgenogram, bone model of subtalar dislocation was made using the cadaver bone. Conclusion. Although the treatment of such injury is usually successful, diagnosis can be difficult because it is a rare injury, and moreover, X-ray of the injury can be confusing due to superposition of bones. Radiograms revealed superposition of the calcaneus, tarsal and metatarsal bones which was radiographically visualized in the anterior-posterior projection as one osseous block inward from the talus, and on the lateral view as in an osteal block below the tibial bone. Prompt recognition of these injuries followed by proper, delicately closed reduction under anaesthesia is crucial for achieving a good functional result in case of medial subtalar dislocation.

  16. Estimation of stride length in level walking using an inertial measurement unit attached to the foot: a validation of the zero velocity assumption during stance.

    Science.gov (United States)

    Peruzzi, A; Della Croce, U; Cereatti, A

    2011-07-07

    In a variety of applications, inertial sensors are used to estimate spatial parameters by double integrating over time their coordinate acceleration components. In human movement applications, the drift inherent to the accelerometer signals is often reduced by exploiting the cyclical nature of gait and under the hypothesis that the velocity of the sensor is zero at some point in stance. In this study, the validity of the latter hypothesis was investigated by determining the minimum velocity of progression of selected points of the foot and shank during the stance phase of the gait cycle while walking at three different speeds on level ground. The errors affecting the accuracy of the stride length estimation resulting from assuming a zero velocity at the beginning of the integration interval were evaluated on twenty healthy subjects. Results showed that the minimum velocity of the selected points on the foot and shank increased as gait speed increased. Whereas the average minimum velocity of the foot locations was lower than 0.011 m/s, the velocity of the shank locations were up to 0.049 m/s corresponding to a percent error of the stride length equal to 3.3%. The preferable foot locations for an inertial sensor resulted to be the calcaneus and the lateral aspect of the rearfoot. In estimating the stride length, the hypothesis that the velocity of the sensor can be set to zero sometimes during stance is acceptable only if the sensor is attached to the foot. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Effect of deep stripping massage alone or with eccentric resistance on hamstring length and strength.

    Science.gov (United States)

    Forman, Jeffrey; Geertsen, Lisbeth; Rogers, Michael E

    2014-01-01

    Many studies have evaluated the effects of different interventions on hamstring length. However, little research has been conducted on the effects of deep stripping massage strokes (DSMS) alone, or combined with eccentric resistance, on hamstring length and strength. To determine: 1) if DSMS have an effect on hamstring length and strength and 2) if the effects on hamstring length and strength are any different when DSMS are combined with eccentric exercise. 89 Community College students and community members between the ages of 18 and 62 volunteered for the study. Of these, 64 demonstrated tight hamstrings on either one or both sides as defined by supine, passive terminal knee extension of ≤75° and participated in the study. Strength was assessed by pressing the posterior calcaneus into a strain gauge for approximately 5 s while seated with the knee flexed to 90°. On their tighter side, participants were administered longitudinal DSMS during 15, 10-s bouts of eccentric resistance with an elastic resistance band. On their other hamstring, participants were administered 15, 10-s longitudinal DSMS while lying passive. All massage strokes were performed at a depth of 7 out of 10 on a verbal pressure scale index. Afterwards, the hamstring flexibility and strength tests were repeated. Both DSMS with eccentric resistance (10.7%) and DSMS alone (6.3%) resulted in improved (p affected by either treatment. These results suggest that DSMS increases hamstring length in less than 3 min but has no affect on strength. Furthermore, combining DSMS with eccentric resistance produces more hamstring flexibility gains than DSMS alone and does not affect strength. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Geographic variation in gorilla limb bones.

    Science.gov (United States)

    Jabbour, Rebecca S; Pearman, Tessa L

    2016-06-01

    Gorilla systematics has received increased attention over recent decades from primatologists, conservationists, and paleontologists. Studies of geographic variation in DNA, skulls, and teeth have led to new taxonomic proposals, such as recognition of two gorilla species, Gorilla gorilla (western gorilla) and Gorilla beringei (eastern gorilla). Postcranial differences between mountain gorillas (G. beringei beringei) and western lowland gorillas (G. g. gorilla) have a long history of study, but differences between the limb bones of the eastern and western species have not yet been examined with an emphasis on geographic variation within each species. In addition, proposals for recognition of the Cross River gorilla as Gorilla gorilla diehli and gorillas from Tshiaberimu and Kahuzi as G. b. rex-pymaeorum have not been evaluated in the context of geographic variation in the forelimb and hindlimb skeletons. Forty-three linear measurements were collected from limb bones of 266 adult gorillas representing populations of G. b. beringei, Gorilla beringei graueri, G. g. gorilla, and G. g. diehli in order to investigate geographic diversity. Skeletal elements included the humerus, radius, third metacarpal, third proximal hand phalanx, femur, tibia, calcaneus, first metatarsal, third metatarsal, and third proximal foot phalanx. Comparisons of means and principal components analyses clearly differentiate eastern and western gorillas, indicating that eastern gorillas have absolutely and relatively smaller hands and feet, among other differences. Gorilla subspecies and populations cluster consistently by species, although G. g. diehli may be similar to the eastern gorillas in having small hands and feet. The subspecies of G. beringei are distinguished less strongly and by different variables than the two gorilla species. Populations of G. b. graueri are variable, and Kahuzi and Tshiaberimu specimens do not cluster together. Results support the possible influence of

  19. Lower limb stress fractures in sport: Optimising their management and outcome

    Science.gov (United States)

    Robertson, Greg A J; Wood, Alexander M

    2017-01-01

    Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting. PMID:28361017

  20. 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.

  1. Effects of deficiency of Kelch-like ECH-associated protein 1 on skeletal organization: a mechanism for diminished nuclear factor of activated T cells cytoplasmic 1 during osteoclastogenesis.

    Science.gov (United States)

    Sakai, Eiko; Morita, Masanobu; Ohuchi, Masahiro; Kido, Mizuho A; Fukuma, Yutaka; Nishishita, Kazuhisa; Okamoto, Kuniaki; Itoh, Ken; Yamamoto, Masayuki; Tsukuba, Takayuki

    2017-09-01

    Kelch-like ECH-associated protein 1 (Keap1) binds to nuclear factor E2 p45-related factor 2 (Nrf2), a transcription factor for antioxidant enzymes, to suppress Nrf2 activation. The role of oxidative stress in many diseases supports the possibility that processes that are associated with Nrf2 activation might offer therapeutic potential. Nrf2 deficiency induces osteoclastogenesis, which is responsible for bone loss, by activating receptor activator of NF-κB ligand (RANKL)-mediated signaling; however, the effects of Keap1 deficiency remain unclear. By using Keap1-deficient newborn mice, we observed that talus and calcaneus bone formation was partially retarded and that osteoclast number was reduced in vivo without severe gross abnormalities. In addition, Keap1-deficient macrophages were unable to differentiate into osteoclasts in vitro via attenuation of RANKL-mediated signaling and expression of nuclear factor of activated T cells cytoplasmic 1 (NFATc1), a key transcription factor that is involved in osteoclastogenesis. Furthermore, Keap1 deficiency up-regulated the expression of Mafb , a negative regulator of NFATc1. RANKL-induced mitochondrial gene expression is required for down-regulation of IFN regulatory factor 8 (IRF-8), a negative transcriptional regulator of NFATc1. Our results indicate that Keap1 deficiency down-regulated peroxisome proliferator-activated receptor-γ coactivator 1β and mitochondrial gene expression and up-regulated Irf8 expression. These results suggest that the Keap1/Nrf2 axis plays a critical role in NFATc1 expression and osteoclastogenic progression.-Sakai, E., Morita, M., Ohuchi, M., Kido, M. A., Fukuma, Y., Nishishita, K., Okamoto, K., Itoh, K., Yamamoto, M., Tsukuba, T. Effects of deficiency of Kelch-like ECH-associated protein 1 on skeletal organization: a mechanism for diminished nuclear factor of activated T cells cytoplasmic 1 during osteoclastogenesis. © FASEB.

  2. Vitamin D and musculoskeletal status in Nova Scotian women who wear concealing clothing.

    Science.gov (United States)

    Ojah, Rani C I; Welch, Jo M

    2012-05-01

    Bone and muscle weakness due to vitamin D deficiency is common among Muslim women who reside in sunny, equatorial countries. The purpose of this study was to determine if living in a northern maritime location additionally disadvantages women who wear concealing clothes. A cross-sectional matched pair design was used to compare women who habitually wore concealing clothing with women who dressed according to western norms. Each premenopausal hijab-wearing woman (n = 11) was matched by age, height, weight and skin tone with a western-dressed woman. Subjects were tested by hand grip dynamometry to assess muscular strength and by quantitative ultrasound at the calcaneus to assess bone status. Nutritional intake was obtained by 24 h recall. Serum 25-hydroxyvitamin D (s-25(OH)D) status was determined in seven matched pairs. The hijab group had lower s-25(OH)D than women who wore western clothes (40 ± 28 vs. 81 ± 32 nmol/L, p= 0.01). Grip strength in the right hand was lower in the hijab-wearing women (p = 0.05) but this appeared to be due to less participation in intense exercise. Bone status did not differ between groups (p= 0.9). Dietary intake of vitamin D was lower in the hijab-wearers (316 ± 353 vs. 601 ± 341 IU/day, p= 0.001). This pilot study suggests that women living in a northern maritime location appear to be at risk for vitamin D insufficiency and therefore should consider taking vitamin D supplements.

  3. Nutrient intake and bone health status of Korean male college students as related to smoking situations.

    Science.gov (United States)

    Bae, Yun-Jung; Cho, Hye-Kyung; Kim, Mi-Hyun

    2008-01-01

    The purpose of this study was to compare the dietary habits, nutrient intake, bone mineral density (BMD) and bone metabolism in Korean male collegians as related to smoking situation. One hundred sixty one young adult males at the age of 20-26 participated in this study. The subjects were divided into four groups: non smoker (n=42), light smoker (n=34), moderate smoker (n=49) and heavy smoker (n=36). The anthropometric characteristics, smoking situations, dietary habits and nutrient intakes were observed. Bone status of the calcaneus was measured by using quantitative ultrasound (QUS). Bone metabolism markers including serum alkaline phosphatase activity (ALP) and N-mid osteocalcin (OC) were analyzed. There were no significant differences in height, weight, BMI, energy and calcium intake among the four groups. Iron intake of moderate and heavy smoker was significantly lower than that of light smoker. Heavy smokers consumed significantly lower vitamin C than moderate smokers, and their coffee consumption and lifetime alcohol consumption were significantly highest among the 4 groups. QUS parameters and serum ALP were not significantly different among the four groups. Serum OC levels were significantly lower in heavy and non smoker group compared to the moderate smoker group. In conclusion, heavy smokers in young male collegians had undesirable lifestyle and dietary habits, like as high consumption of coffee and alcohol, and low intake of Fe and vitamin C. Although, there was no significant difference in their current bone status from the other groups, these undesirable factors with heavy smoking may affect their bone health in the long term.

  4. 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.

  5. Transmissions within the tarsal gearbox.

    Science.gov (United States)

    Wolf, Peter; Stacoff, Alex; Luechinger, Roger; Boesiger, Peter; Stuessi, Edgar

    2008-01-01

    The dependence of the movements of the calcaneus, cuboid, navicular, and talus on each other have been described as the tarsal gearbox. To provide a basis of its modeling, data on transmissions between tarsal joint rotations within this gearbox are required. The feasibility of tibiocalcaneal rotations to predict tarsal joint rotations is of interest because a meaningful relation would allow the use of common motion analysis with skin markers to investigate rearfoot kinematics. We performed linear regression analyses between tarsal joint and tibiocalcaneal rotations on the basis of magnetic resonance imaging of tibia and tarsal bone positions during quasi-static foot pronation and supination. In the frontal plane and transverse planes, linear models were found to predict tarsal joint rotations quite well (r(2) = 0.83-0.97 for the frontal plane and r(2) = 0.73-0.95 for the transverse plane). For each degree of talocalcaneal rotation, there was 1.8 degrees of talonavicular rotation in the frontal plane and 1.6 degrees in the transverse plane; each degree of talocalcaneal rotation resulted in 0.6 degrees of calcanealcuboid rotation in the frontal plane and 0.7 degrees in the transverse plane; each degree of calcaneocuboid rotation resulted in 3 degrees of talonavicular rotation in the frontal plane and 2.8 degrees in the transverse; each degree of tibiocalcaneal rotation resulted in 0.9 degrees of talocalcaneal rotation in the frontal plane and 0.9 degrees in the transverse plane; and each degree of tibiocalcaneal rotation resulted in 1.6 degrees of talonavicular rotation in the frontal plane and 1.3 degrees in the transverse plane. The present study provides a basis on which the tarsal gearbox in the frontal and the transverse planes under quasi-static conditions can be modeled. Furthermore, it is concluded that tibiocalcaneal rotations are practical for predicting tarsal joint rotations during quasi-static motions.

  6. Osteocutaneous pedicle flap transfer for salvage of transtibial amputation after severe lower-extremity injury.

    Science.gov (United States)

    Vallier, Heather A; Fitzgerald, Steven J; Beddow, Meghan E; Sontich, John K; Patterson, Brendan M

    2012-03-07

    A conventional transtibial amputation may not be possible when the zone of injury involves the proximal part of the tibia, or in cases of massive tibial bone and/or soft-tissue loss. The purpose of this study was to examine the outcomes of salvage of a transtibial amputation level with a rotational osteocutaneous pedicle flap from the ipsilateral hindfoot. Fourteen patients who had an osteocutaneous pedicle flap from the ipsilateral foot were included in the study. Twelve patients were followed for more than twenty-four months (mean, 60.2 months) and were evaluated with use of the Sickness Impact Profile (SIP), Musculoskeletal Function Assessment (MFA), and a 100-ft (30.48-m) timed walking test. There were ten men and four women with mean age of 43.2 years. Thirteen patients had a type-IIIB open tibial fracture, and one had extensive soft-tissue loss secondary to a burn. Four patients were treated for infection after the index procedure. There were no nonunions of the tibia to the calcaneus. Three patients underwent late reconstructive procedures to improve prosthetic fit. No patient required subsequent revision to a more proximal amputation level. Mean knee flexion was 139°. A novel technique has been developed to salvage a transtibial amputation level with use of a rotational osteocutaneous flap from the hindfoot. In the absence of adequate tibial length and/or soft-tissue coverage to salvage the entire limb or to perform a conventional-length transtibial amputation, this technique is a highly functional alternative that does not require microvascular free tissue transfer.

  7. Multiple bony lesions other than femoral heads on {sup 99m}Tc-MDP bone scan in patients with avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Young; Yang, Seoung Oh; Moon, Dae Hyuk; Ryu, Jin Sook; Weon, Young Cheol; Shin, Myung Jin; Lee, Soo Ho; Lee, Hee Kyung [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Chun, Hae Kyung [St. Francisco Hospital, Seoul (Korea, Republic of)

    1997-03-01

    To evaluate the clinical significance of the multiple increased uptake lesions other than in femoral heads as seen on whole body bone scan in patients with avascular necrosis of femoral heads. One hundred and seventy three patients with clinical diagnosis of avascular necrosis of the emoral head underwent a bone scan using Tc-99m MDP. Increased uptake lesions other than in femoral heads were evaluated, including frequency and common sites of in volvement, and correlated with clinical information and plain radiographic findings. Two hundred patients without AVN, who had undergone a bone scan, were included as a control group. Increased uptake lesions in extrafemoral head locations were found in 36 of 173 patients(20.8%); the location of 79 lesions was other than the femoral head. This result is statistically different from patients without avascular necrosis of femoral head(p<0.0001). The most common site of involvement was the knee joint area(62.5%). Other lesions were located in the mid-shafts of the long bones of the lower extremities, calcaneus, proximal humerus, etc., in order of decreasing frequency. Plain radiographs of 17 lesions were nonspecific, except for three lesions showing definite changes associated with avascular necrosis. The risk factors included alcoholism, the prolonged use of steroids, renal transplantation, herbal medication and working as a working as deep-sea diver. Most patients did not complain of pain, except for two with irreversible osteonecrotic changes as seen on plain radiograph. in patients with avascular necrosis of the femur, increased uptake lesions other than in the femoral head as seen on bone scan, may represent the early stage of osteonecrosis, which shows a characteristic appearance on bone scan. In order to aveid possible misdiagnoses of multiple extrafemoral lesions as bony metastasis or traumatic lesions, in patients with avascular necrosis of the femur these should be carefully evaluated.

  8. Management of Metatarsus Adductus, Bean-Shaped Foot, Residual Clubfoot Adduction and Z-shaped Foot in Children, with Conservative Treatment and Double Column Osteotomy of the First Cuneiform and the Cuboid

    Directory of Open Access Journals (Sweden)

    Hassan Najdi

    2015-10-01

    Full Text Available Metatarsus adductus is a deformity located at Lisfranc’s joint in a pure transverse plane. It is spontaneously corrected for the majority of newborns. In rare toddler cases, it demonstrates a clinical stiffness and results in Z-shaped foot, where valgus of the heel creates equilibration of resistant metatarsus adductus. Although, recurrent metatarsus adductus varus is observed in treated idiopathic clubfeet, usually in children over three years, but presence of heel's valgus is related to the surgical overcorrection of the heel’s varus. Conservative treatment is advocated in flexible metatarsus adductus. Surgery is performed after conservative treatment fail, and in walking patient. Soft tissue releases, osteotomies of metatarsals and lateral epiphysiodesis of the metatarsal base gave good results on short term, but deformity recurrence and foot growth disturbance couldn't be avoided. Although, osteotomies carried out proximal to the Lisfranc's joint: opening wedge osteotomy of medial cuneiform, calcaneocuboid fusion and the anterior resection of calcaneus, gave permanent correction, but they act only on one of the sides of deformity. Therfore, the theory of elongated lateral column associated with a shortened medial column is crucial in dealing with this deformity: combining opening wedge osteotomy of cuneiform with closing wedge osteotomy of cuboid described by Jawish et al. in children after 4 years allows in all causes of metatarsus adductus stiffness a lateral shifting of forefoot. Concerning the associated heel’s valgus, it is corrected in Z-shaped foot after the double osteotomy cuneiform/ cuboid. However, in complicated treated clubfoot a particular treatment for the posterior tarsal is necessary.

  9. Effects of the National School Lunch Program on Bone Growth in Japanese Elementary School Children.

    Science.gov (United States)

    Kohri, Toshiyuki; Kaba, Naoko; Itoh, Tatsuki; Sasaki, Satoshi

    2016-01-01

    The Japanese school lunch program with milk was designed to supply 33-50% of the necessary nutrients per day and 50% of the recommended dietary allowance for calcium, which is difficult to obtain from Japanese meals. Although this program contributes to the mental and physical development of children, the effect of these meals on the bone growth in children remains unknown. Therefore, we compared the effect of school lunch with milk on bone growth between elementary school children attending schools that did not enforce the school lunch with milk program (box-lunch group) and those attending schools that did enforce the program (school-lunch group). The study subjects included fourth-grade children during the 2009-2013 school years, of whom 329 children were in the school-lunch group and 484 children in the box-lunch group. The bone area ratio of the right calcaneus was evaluated using quantitative ultrasound (Benus III). Dietary intakes were assessed using brief self-administered diet history questionnaires. The subjects were asked to record their activities for 3 d so that the mean physical activity intensity and the time spent sleeping could be estimated. The bone area ratios (%) were significantly higher in the school-lunch group than in the box-lunch group (males 31.0±0.3 vs. 30.3±0.2; females 30.6±0.2 vs. 29.7±0.2). This tendency did not change even after adjustment for confounding factors associated with bone growth. The results suggest that nutrients supplied by the Japanese school lunch program contributed to increased bone growth in elementary school children.

  10. Hormone replacement therapy may reduce the return of endogenous lead from bone to the circulation

    Energy Technology Data Exchange (ETDEWEB)

    Webber, C.E.; Beaumont, L.F.; Gordon, C.L. [McMaaster Univ., Hamilton, Ontario (Canada)] [and others

    1995-12-01

    Hormone replacement therapy (HRT) in postmenopausal women suppress the increase in bone resorption expected as circulating levels of endogenous estrogen decline. We tested the hypothesis that bone lead content might remain elevated in women on HRT. Fifty-six women who at recruitment were on average 3.5 years postmenopausal were placed on calcium supplementations. Six months later, 33 of these women were prescribed either low dose or moderate dose hormone replacement in addition to the calcium supplementation. After approximately 4 years of hormone replacement, lead content was measured at the tibia and calcaneus by in vivo fluorescence excitation, and lead concentrations were measured in serum, whole blood, and urine. Women not taking hormones had significantly lower lead concentrations in cortical bone compared to all women on HRT (p=0.007). Tibia lead content (mean {plus_minus} SD) for women on calcium only was 11.13 {plus_minus}6.22 {mu}g/g bone mineral. For women on HRT, tibia bone lead was 19.37 {plus_minus}8.62 {mu}g/g bone mineral on low-dose HRT and 16.87 {plus_minus} 11.68 {mu}g/g bone mineral on moderate-dose HRT. There were no differences between groups for lead concentrations measured in trabecular bone, whole blood, serum, or urine. Hormone replacement maintains cortical bone lead content. In women not on HRT, there will be a perimenopausal release of lead from bone. 27 refs., 1 fig., 1 tab.

  11. Treatment of Osteoid Osteomas Using a Navigational Bipolar Radiofrequency Ablation System

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, Adam N., E-mail: wallacea@mir.wustl.edu; Tomasian, Anderanik, E-mail: tomasiana@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Chang, Randy O., E-mail: changr@wusm.wustl.edu [Washington University School of Medicine (United States); Jennings, Jack W., E-mail: jenningsj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

    2016-05-15

    BackgroundPercutaneous CT-guided radiofrequency ablation is a safe and effective minimally invasive treatment for osteoid osteomas. This technical case series describes the use of a recently introduced ablation system with a probe that can be curved in multiple directions, embedded thermocouples for real-time monitoring of the ablation volume, and a bipolar design that obviates the need for a grounding pad.MethodsMedical records of all patients who underwent radiofrequency ablation of an osteoid osteoma with the STAR Tumor Ablation System (DFINE; San Jose, CA) were reviewed. The location of each osteoid osteoma, nidus volume, and procedural details were recorded. Treatment efficacy and long-term complications were assessed at clinical follow-up.ResultsDuring the study period, 18 osteoid osteomas were radiofrequency ablated with the multidirectional bipolar system. Lesion locations included the femur (50 %; 9/18), tibia (22 %; 4/18), cervical spine (11 %; 2/18), calcaneus (5.5 %; 1/18), iliac bone (5.5 %; 1/18), and fibula (5.5 %; 1/18). The median nidus volume of these cases was 0.33 mL (range 0.12–2.0 mL). All tumors were accessed via a single osseous channel. Median cumulative ablation time was 5 min and 0 s (range 1 min and 32 s–8 min and 50 s). All patients with clinical follow-up reported complete symptom resolution. No complications occurred.ConclusionSafe and effective CT-guided radiofrequency ablation of osteoid osteomas can be performed in a variety of locations using a multidirectional bipolar system.

  12. Validation of a novel ultrasound measurement of achilles tendon length.

    Science.gov (United States)

    Barfod, Kristoffer Weisskirchner; Riecke, Anja Falk; Boesen, Anders; Hansen, Philip; Maier, Jens Friedrich; Døssing, Simon; Troelsen, Anders

    2015-11-01

    A clinically applicable and accurate method for measuring Achilles tendon length is needed to investigate the influence of elongation of the Achilles tendon after acute rupture. The purpose of this study was to develop and validate an ultrasonographic (US) length measurement of the Achilles tendon-aponeurosis complex. Both legs of 19 non-injured subjects were examined by magnetic resonance imaging (MRI) and US. The length from calcaneus to the medial head of m. Gastrocnemius was measured by three independent US examiners. Repeated US measurements were performed and compared to MRI measurements. Intra-rater and inter-rater reliability and the agreement between MRI and US were determined. Data were evaluated using the intraclass correlation coefficient (ICC), the standard error of the measurement (SEM) and the minimal detectable change (MDC). Intra-rater reliability of US assessment showed no significant differences between test days: ICC 0.96, SEM 4 mm and MDC 10 mm. Inter-rater reliability showed a systematic difference between US observers of 2-5 mm (p = 0.001-0.036); ICC 0.97, SEM 3 mm and MDC 9 mm. MRI measurements were on average 4 mm longer than US (p = 0.001). The novel ultrasound measurement showed good reliability and accuracy. For comparison between groups of non-injured subjects differences of more than 4 mm can be detected. For repeated assessment of individual subjects differences of more than 10 mm can be detected. The measurement needs to be further assessed in the setting of acute Achilles tendon rupture. This new ultrasound measurement might allow for length measurement of ruptured Achilles tendons in the acute and chronic state after rupture. II.

  13. Endoscopic-assisted achilles tendon reconstruction with free hamstring tendon autograft for chronic rupture of achilles tendon: clinical and isokinetic evaluation.

    Science.gov (United States)

    El Shazly, Ossama; Abou El Soud, Maged M; El Mikkawy, Dalia M E; El Ganzoury, Ibrahim; Ibrahim, Ayman Mohamed

    2014-05-01

    To evaluate the clinical and functional outcome of endoscopic-assisted reconstruction of chronic ruptures of the Achilles tendon using free hamstring tendon autograft. We present a case series of 15 patients who had chronic ruptures of the Achilles tendon (>6 weeks earlier) and underwent endoscopic-assisted reconstruction with a free hamstring autograft. The graft loop was passed through and fixed to the proximal stump of the tendon. The graft was then passed through suture to the distal stump and finally inserted into a tunnel in the anterior calcaneus to the Achilles tendon insertion and fixed with an bioabsorbable interference screw. The mean follow-up period was 27 months (SD, 3 months; range, 24 to 33 months). All patients underwent magnetic resonance imaging preoperatively, immediately postoperatively, and at follow-up 2 years postoperatively. All patients were functionally evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) score for the hindfoot preoperatively and postoperatively. Calf muscle power was evaluated by isokinetic strength testing at 2 years' follow-up. The mean size of the gap on preoperative magnetic resonance imaging was 49 mm (SD, 9 mm). The mean preoperative AOFAS score was 32.6 (SD, 7.5). There was a statistically significant improvement in the postoperative AOFAS score after 2 years to 90.8 (SD, 3.54) (P Achilles tendon reconstruction with free hamstring tendon autograft for chronic ruptures of the Achilles tendon showed good to excellent results in all patients. Isokinetic testing showed a nonsignificant deficit between the involved and uninvolved sides at 2 years' follow-up. Level IV, therapeutic cases series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Muscle Trigger Points and Pressure Pain Sensitivity Maps of the Feet in Women with Fibromyalgia Syndrome.

    Science.gov (United States)

    Tornero-Caballero, Maria C; Salom-Moreno, Jaime; Cigarán-Méndez, Margarita; Morales-Cabezas, Matilde; Madeleine, Pascal; Fernández-de-Las-Peñas, César

    2016-10-01

    OBJECTIVE : To investigate the presence of trigger points (TrPs) in feet musculature and topographical pressure sensitivity maps of the feet as well as the relationship between TrPs, pressure pain maps, and clinical variables in women with fibromyalgia (FMS). METHODS : Fifty-one FMS women and 24 comparable healthy women participated. TrPs within the flexor hallucis brevis, adductor hallucis, dorsal interossei, extensor digitorum brevis, and quadratus plantae, as well as external and internal gastrocnemius, were explored. Pressure pain thresholds (PPTs) were assessed in a blind manner over seven locations on each foot. Topographical pressure sensitivity maps of the plantar region were generated using the averaged PPT of each location. RESULTS : The prevalence rate of foot pain was 63% (n = 32). The number of active TrPs for each FMS woman with foot pain was 5 ± 1.5 without any latent TrPs. Women with FMS without foot pain and healthy controls had only latent TrPs (2.2 ± 0.8 and 1.5 ± 1.3, respectively). Active TrPs in the flexor hallucis brevis and adductor hallucis muscles were the most prevalent. Topographical pressure pain sensitivity maps revealed that FMS women with foot pain had lower PPT than FMS women without pain and healthy controls, and higher PPT on the calcaneus bone (P < 0.001). CONCLUSIONS : The presence of foot pain in women with FMS is high. The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in these patients. FMS women suffering foot pain showed higher pressure hypersensitivity in the plantar region than those FMS women without pain. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients.

    Science.gov (United States)

    Rigby, Ryan B; Cottom, James M; Vora, Anand

    2013-01-01

    Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the

  16. [PART-KESSLER TECHNIQUE WITH SUTURE ANCHOR IN REPAIR OF SPONTANEOUS Achilles TENDON RUPTURE].

    Science.gov (United States)

    Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo

    2016-02-01

    To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor can supply strong strain and decrease the shear forces of suture. So part-Kessler technique with suture anchor is successful in repairing spontaneous Achilles tendon rupture.

  17. Prevalence of low trauma fractures in long-term kidney transplant patients with preserved renal function

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    J.W.R. Braga Júnior

    2006-01-01

    Full Text Available We evaluated the prevalence of low bone mineral density (BMD and osteoporotic fractures in kidney transplantation (KT patients and determined risk factors associated with osteoporotic fractures. The study was conducted on 191 patients (94 men and 97 women with first KT for 3 years or more presenting stable and preserved renal function (serum creatinine levels lower than 2.5 mg/dl. KT patients were on immunosuppressive therapy and the cumulative doses of these drugs were also evaluated. BMD was determined by dual-energy X-ray absorptiometry at multiple sites (spine, femur and total body. Quantitative ultrasound of the calcaneus (broadband ultrasound attenuation, speed of sound, and stiffness index, SI was also performed. Twenty-four percent (46 of all patients had either vertebral (29/46 or appendicular (17/46 fractures. We found osteoporosis and osteopenia in 8.5-13.4 and 30.9-35.1% of KT patients, respectively. Women had more fractures than men. In women, prevalent fractures were associated with diabetes mellitus [OR = 11.5, 95% CI (2.4-55.7], time since menopause [OR = 3.7, 95% CI (1.2-11.9], femoral neck BMD [OR = 1.99, 95% CI (1.4-2.8], cumulative dose of steroids [OR = 1.1, 95% CI (1.02-1.12] and low SI [OR = 1.1, 95% CI (1.0-1.2]. In men, fractures were associated with lower lumbar spine BMD [OR = 1.75, 95% CI (1.1-2.7], lower SI [OR = 1.1, 95% CI (1.03-1.13], duration of dialysis [OR = 1.3, 95% CI (1.13-2.7], and lower body mass index [OR = 1.24, 95% CI (1.1-1.4. Our results demonstrate high prevalence of low BMD and osteoporotic fractures in patients receiving a successful kidney transplant and indicate the need for specific intervention to prevent osteoporosis in this population.

  18. Understanding the links among neuromedin U gene, beta2-adrenoceptor gene and bone health: an observational study in European children.

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    Francesco Gianfagna

    Full Text Available Neuromedin U, encoded by the NMU gene, is a hypothalamic neuropeptide that regulates both energy metabolism and bone mass. The beta-2 adrenergic receptor, encoded by the ADRB2 gene, mediates several effects of catecholamine hormones and neurotransmitters in bone. We investigated whether NMU single nucleotide polymorphisms (SNPs and haplotypes, as well as functional ADRB2 SNPs, are associated with bone stiffness in children from the IDEFICS cohort, also evaluating whether NMU and ADRB2 interact to affect this trait. A sample of 2,274 subjects (52.5% boys, age 6.2 ± 1.8 years from eight European countries, having data on calcaneus bone stiffness index (SI, mean of both feet and genotyping (NMU gene: rs6827359, rs12500837, rs9999653; ADRB2 gene: rs1042713, rs1042714, was studied. After false discovery rate adjustment, SI was significantly associated with all NMU SNPs. rs6827359 CC homozygotes showed the strongest association (recessive model, Δ= -1.8, p=0.006. Among the five retrieved haplotypes with frequencies higher than 1% (range 2.0-43.9%, the CCT haplotype (frequency=39.7% was associated with lower SI values (dominant model, Δ= -1.0, p=0.04 as compared to the most prevalent haplotype. A non-significant decrease in SI was observed in in ADRB2 rs1042713 GG homozygotes, while subjects carrying SI-lowering genotypes at both SNPs (frequency = 8.4% showed much lower SI than non-carriers (Δ= -3.9, p<0.0001; p for interaction=0.025. The association was more evident in preschool girls, in whom SI showed a curvilinear trend across ages. In subgroup analyses, rs9999653 CC NMU or both GG ADRB2 genotypes were associated with either lower serum calcium or β-CrossLaps levels (p=0.01. This study in European children shows, for the first time in humans, a role for NMU gene through interaction with ADRB2 gene in bone strength regulation, more evident in preschool girls.

  19. AN EVALUATION OF THE REARFOOT POSTURE IN INDIVIDUALS WITH PATELLOFEMORAL PAIN SYNDROME

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    Wendy Gilleard

    2004-11-01

    Full Text Available Structural abnormalities of the foot may cause abnormal subtalar joint compensatory motion in order to attain normal function of the lower extremity during gait although studies have not been conclusive. Current conflict in the literature may be related to the differing measures focused on the varying protocols and also the absence of a control group in some studies. This study investigated the rearfoot posture including Subtalar Joint Neutral Position (STJN and Relaxed Calcaneal Standing (RCS measurements in patellofemoral pain syndrome (PFPS and healthy subjects. The angle of STJN during non-weight bearing position and the two dimensional (2D rearfoot RCS posture was measured using a goniometer in 14 healthy females and 13 females with PFPS. The RCS posture was also measured three dimensionally (3D by attaching external markers to a tibia shell and the calcaneus and videoing with a four-camera three-dimensional motion analysis system. A one way ANOVA was used to assess the differences between the groups. The 2D and 3D RCS were significantly different between the groups (p ¡Ü 0.001 with mean -0.23¡ã ¡À 1.35¡ã , 2.52¡ã ¡À 3.11¡ã for the control group and 2.35¡ã ¡À 1.4¡ã, 7.02¡ã ¡À 3.33¡ã for the clinical group respectively. STJN showed a slight rearfoot varus (although significant p = 0.04 in PFPS (-2.20¡ã ¡À 1.51¡ã compared to the control group (-1.00¡ã ¡À 1.36¡ã. Negative values indicated inversion and positive values indicated eversion. The 2D and 3D RCS showed a significantly more everted posture of the rearfoot for the PFPS group. Subtalar joint varus may contribute to the increased eversion during relaxed standing in the PFPS group. Rearfoot measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS.

  20. 2D and 3D assessment of sustentaculum tali screw fixation with or without Screw Targeting Clamp.

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    De Boer, A Siebe; Van Lieshout, Esther M M; Vellekoop, Leonie; Knops, Simon P; Kleinrensink, Gert-Jan; Verhofstad, Michael H J

    2017-10-26

    Precise placement of sustentaculum tali screw(s) is essential for restoring anatomy and biomechanical stability of the calcaneus. This can be challenging due to the small target area and presence of neurovascular structures on the medial side. The aim was to evaluate the precision of positioning of the subchondral posterior facet screw and processus anterior calcanei screw with or without a Screw Targeting Clamp. The secondary aim was to evaluate the added value of peroperative 3D imaging over 2D radiographs alone. Twenty Anubifix™ embalmed, human anatomic lower limb specimens were used. A subchondral posterior facet screw and a processus anterior calcanei screw were placed using an extended lateral approach. A senior orthopedic trauma surgeon experienced in calcaneal fracture surgery and a senior resident with limited experience in calcaneal surgery performed screw fixation in five specimens with and in five specimens without the clamp. 2D lateral and axial radiographs and a 3D recording were obtained postoperatively. Anatomical dissection was performed postoperatively as a diagnostic golden standard in order to obtain the factual screw positions. Blinded assessment of quality of fixation was performed by two surgeons. In 2D, eight screws were considered malpositioned when placed with the targeting device versus nine placed freehand. In 3D recordings, two additional screws were malpositioned in each group as compared to the golden standard. As opposed to the senior surgeon, the senior resident seemed to get the best results using the Screw Targeting Clamp (number of malpositioned screws using freehand was eight, and using the targeting clamp five). In nine out of 20 specimens 3D images provided additional information concerning target area and intra-articular placement. Based on the 3D assessment, five additional screws would have required repositioning. Except for one, all screw positions were rated equally after dissection when compared with 3D examinations

  1. Procedures for rat in situ skeletal muscle contractile properties.

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    MacIntosh, Brian R; Esau, Shane P; Holash, R John; Fletcher, Jared R

    2011-10-15

    There are many circumstances where it is desirable to obtain the contractile response of skeletal muscle under physiological circumstances: normal circulation, intact whole muscle, at body temperature. This includes the study of contractile responses like posttetanic potentiation, staircase and fatigue. Furthermore, the consequences of disease, disuse, injury, training and drug treatment can be of interest. This video demonstrates appropriate procedures to set up and use this valuable muscle preparation. To set up this preparation, the animal must be anesthetized, and the medial gastrocnemius muscle is surgically isolated, with the origin intact. Care must be taken to maintain the blood and nerve supplies. A long section of the sciatic nerve is cleared of connective tissue, and severed proximally. All branches of the distal stump that do not innervate the medial gastrocnemius muscle are severed. The distal nerve stump is inserted into a cuff lined with stainless steel stimulating wires. The calcaneus is severed, leaving a small piece of bone still attached to the Achilles tendon. Sonometric crystals and/or electrodes for electromyography can be inserted. Immobilization by metal probes in the femur and tibia prevents movement of the muscle origin. The Achilles tendon is attached to the force transducer and the loosened skin is pulled up at the sides to form a container that is filled with warmed paraffin oil. The oil distributes heat evenly and minimizes evaporative heat loss. A heat lamp is directed on the muscle, and the muscle and rat are allowed to warm up to 37°C. While it is warming, maximal voltage and optimal length can be determined. These are important initial conditions for any experiment on intact whole muscle. The experiment may include determination of standard contractile properties, like the force-frequency relationship, force-length relationship, and force-velocity relationship. With care in surgical isolation, immobilization of the origin of the

  2. Direct assessment of 3D foot bone kinematics using biplanar X-ray fluoroscopy and an automatic model registration method.

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    Ito, Kohta; Hosoda, Koh; Shimizu, Masahiro; Ikemoto, Shuhei; Kume, Shinnosuke; Nagura, Takeo; Imanishi, Nobuaki; Aiso, Sadakazu; Jinzaki, Masahiro; Ogihara, Naomichi

    2015-01-01

    Quantifying detailed 3-dimensional (3D) kinematics of the foot in contact with the ground during locomotion is crucial for understanding the biomechanical functions of the complex musculoskeletal structure of the foot. Biplanar X-ray fluoroscopic systems and model-based registration techniques have recently been employed to capture and visualise 3D foot bone movements in vivo, but such techniques have generally been performed manually. In the present study, we developed an automatic model-registration method with biplanar fluoroscopy for accurate measurement of 3D movements of the skeletal foot. Three-dimensional surface models of foot bones were generated prior to motion measurement based on computed tomography. The bone models generated were then registered to biplanar fluoroscopic images in a frame-by-frame manner using an optimisation technique, to maximise similarity measures between occluding contours of the bone surface models with edge-enhanced fluoroscopic images, while avoiding mutual penetration of bones. A template-matching method was also introduced to estimate the amount of bone translation and rotation prior to automatic registration. We analysed 3D skeletal movements of a cadaver foot mobilized by a robotic gait simulator. The 3D kinematics of the calcaneus, talus, navicular and cuboid in the stance phase of the gait were successfully reconstructed and quantified using the proposed model-registration method. The accuracy of bone registration was evaluated as 0.27 ± 0.19 mm and 0.24 ± 0.19° (mean ± standard deviation) in translation and rotation, respectively, under static conditions, and 0.36 ± 0.19 mm and 0.42 ± 0.30° in translation and rotation, respectively, under dynamic conditions. The measurement was confirmed to be sufficiently accurate for actual analysis of foot kinematics. The proposed method may serve as an effective tool for understanding the biomechanical function of the human foot during locomotion.

  3. Role of a NSAID in the apparent cure of a fungal mycetoma.

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    Dupont, B; Datry, A; Poirée, S; Canestri, A; Boucheneb, S; Fourniols, E

    2016-06-01

    We report the case of a fungal mycetoma due to Madurella mycetomatis that failed to respond to surgery and antifungal treatment but responded strongly to the addition of a non-steroidal anti-inflammatory drug (NSAID). This African patient was born in Mauritania in 1972. He was a herdsman, living close to the Senegal River. The first nodules appeared on the left foot at the age of 13years (1985). The patient suffered frequent flare-ups with the appearance of black grains and underwent surgery in 1988 and 1992 in Senegal. After remission for several months after surgery, new fistulae occurred. The patient emigrated to France in 1995 and underwent a third surgical intervention in 1996. M. mycetomatis was cultured from the black grains. The patient was otherwise in good health, with no diabetes, and HIV tests were negative. We saw the patient for the first time in 2005, at which time he had flare-ups every two to three months. Imaging disclosed an absence of bone involvement. The patient underwent a fourth operation in October, 2005, and voriconazole treatment was initiated. A new flare-up occurred in February, 2006. CT, MRI, and PET scans revealed calcaneus and tarsal involvement, and posaconazole then replaced voriconazole. Flucytosine was added four months later, due to an absence of improvement. New flares-ups occurred and a fifth surgical intervention was performed in September, 2006. The pain, which had been present for three years, worsened; the patient had to stop working and was no longer able to walk without crutches. Amputation of the foot was considered. Empiric treatment with a NSAID, diclofenac (Voltaren(®); 100mg/day), was added to the antifungal treatment in November 2006, to treat the patient's pain and inflammation. A major improvement was observed within one week. The patient was able to walk without crutches one month later. After two months, clinical examination was normal: no pain, inflammation, nodules or fistulae. Flucytosine was stopped after

  4. [Clinical research of correlation between osteonecrosis and steroid].

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    Li, Zi-rong; Sun, Wei; Qu, Hui; Zhou, Yi-xiong; Dou, Bao-xin; Shi, Zhen-cai; Zhang, Nian-fei; Cheng, Xiao-guang; Wang, Da-li; Guo, Wan-shou

    2005-08-15

    To explore the correlation between the dosage of corticosteroid, time of onset and incidence of osteonecrosis (ON) in patients with SARS. From July 2003 to January 2004, general survey carried out for ON in 551 patients with SARS. Five hundred and fifty-one patients except 12 were administrated by corticosteroid from 80 mg to 30 000 mg. The age of patients was (33 +/- 9) years old ranging from 19 to 59 years old. One hundred and thirty-one were male, and four hundred and twenty were female. MRI and X-ray film were taken in all patients including both hips, knees, shoulders, ankles and wrists. CT scan was taken in partial patients. Common classification system were used for staging of hip (ARCO), knee (Lotka) and shoulder (Cruess). Independent test, rank-sum test and multiple factor logistic regression analysis were used for statistical analysis. No osteonecrosis was detected in 12 patients without corticosteroid. Osteonecrosis was detected in 176 patients (32.7 percent) among 539 patients. There were ON of femoral head in 130 cases (210 hips), ON of knee in 98 cases (130 knees), ON of humeral head in 21 cases (36 shoulders), ON of talus and calcaneus in 16 cases (26 ankles), ON of scaphoid and lunate in 11 cases (17 wrists), ON of patella in 3 cases (4 patella), ON of ilium in 1 case and bone infarction (femur, tibia) in 18 cases. One hundred and nineteen cases (195 hips) with ONFH were in stage I (IA 45 hips, IB 77 hips, IC 73 hips). Eleven cases (15 hips) were in stage II. All osteonecrosis of the knee and humoral head was stage I. Thirty-four patients with ON had one joint affected, 45 patients had 2 joints, 93 patients had more than 3 joints. The dosage of corticosteroid was (5842 +/- 4988) mg in ON group and (2719 +/- 2571) mg in non-ON group (P corticosteroid occurred osteonecrosis. ON is frequently multiple focuses. The actual time of onset of ON is early of steroid used. MRI is golden standard for early diagnosis of ON. The patients who were treated with a

  5. Optimized lower leg injury probability curves from postmortem human subject tests under axial impacts.

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    Yoganandan, Narayan; Arun, Mike W J; Pintar, Frank A; Szabo, Aniko

    2014-01-01

    Derive optimum injury probability curves to describe human tolerance of the lower leg using parametric survival analysis. The study reexamined lower leg postmortem human subjects (PMHS) data from a large group of specimens. Briefly, axial loading experiments were conducted by impacting the plantar surface of the foot. Both injury and noninjury tests were included in the testing process. They were identified by pre- and posttest radiographic images and detailed dissection following the impact test. Fractures included injuries to the calcaneus and distal tibia-fibula complex (including pylon), representing severities at the Abbreviated Injury Score (AIS) level 2+. For the statistical analysis, peak force was chosen as the main explanatory variable and the age was chosen as the covariable. Censoring statuses depended on experimental outcomes. Parameters from the parametric survival analysis were estimated using the maximum likelihood approach and the dfbetas statistic was used to identify overly influential samples. The best fit from the Weibull, log-normal, and log-logistic distributions was based on the Akaike information criterion. Plus and minus 95% confidence intervals were obtained for the optimum injury probability distribution. The relative sizes of the interval were determined at predetermined risk levels. Quality indices were described at each of the selected probability levels. The mean age, stature, and weight were 58.2±15.1 years, 1.74±0.08 m, and 74.9±13.8 kg, respectively. Excluding all overly influential tests resulted in the tightest confidence intervals. The Weibull distribution was the most optimum function compared to the other 2 distributions. A majority of quality indices were in the good category for this optimum distribution when results were extracted for 25-, 45- and 65-year-olds at 5, 25, and 50% risk levels age groups for lower leg fracture. For 25, 45, and 65 years, peak forces were 8.1, 6.5, and 5.1 kN at 5% risk; 9.6, 7.7, and 6.1 k

  6. Reduced quantitative ultrasound bone mineral density in HIV-infected patients on antiretroviral therapy in Senegal.

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    Amandine Cournil

    Full Text Available BACKGROUND: Bone status in HIV-infected patients on antiretroviral treatment (ART is poorly documented in resource-limited settings. We compared bone mineral density between HIV-infected patients and control subjects from Dakar, Senegal. METHODS: A total of 207 (134 women and 73 men HIV-infected patients from an observational cohort in Dakar (ANRS 1215 and 207 age- and sex-matched controls from the general population were enrolled. Bone mineral density was assessed by quantitative ultrasound (QUS at the calcaneus, an alternative to the reference method (i.e. dual X-absorptiometry, often not available in resource-limited countries. RESULTS: Mean age was 47.0 (±8.5 years. Patients had received ART for a median duration of 8.8 years; 45% received a protease inhibitor and 27% tenofovir; 84% had undetectable viral load. Patients had lower body mass index (BMI than controls (23 versus 26 kg/m(2, P<0.001. In unadjusted analysis, QUS bone mineral density was lower in HIV-infected patients than in controls (difference: -0.36 standard deviation, 95% confidence interval (CI: -0.59;-0.12, P = 0.003. Adjusting for BMI, physical activity, smoking and calcium intake attenuated the difference (-0.27, CI: -0.53;-0.002, P = 0.05. Differences in BMI between patients and controls explained a third of the difference in QUS bone mineral density. Among patients, BMI was independently associated with QUS bone mineral density (P<0.001. An association between undetectable viral load and QUS bone density was also suggested (β = 0.48, CI: 0.02;0.93; P = 0.04. No association between protease inhibitor or tenofovir use and QUS bone mineral density was found. CONCLUSION: Senegalese HIV-infected patients had reduced QUS bone mineral density in comparison with control subjects, in part related to their lower BMI. Further investigation is needed to clarify the clinical significance of these observations.

  7. Risk factors that may adversely modify the natural history of the pediatric pronated foot.

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    Napolitano, C; Walsh, S; Mahoney, L; McCrea, J

    2000-07-01

    Flatfoot is one of the most common conditions seen in pediatric podiatry practice. There is no universally accepted definition for flatfoot. Flatfoot is a term used to describe a recognizable clinical deformity created by malalignment at several adjacent joints. Clinically, a flatfoot is one that has a low or absent longitudinal arch. Determining flexibility (physiologic) or rigidity (pathologic) is the first step in management. A flexible flat foot will have an arch that is present in open kinetic chain (off weight-bearing) and lost in closed kinetic chain (weight-bearing). A rigid flatfoot has loss of the longitudinal arch height in open and closed kinetic chain. According to Mosca, "The anatomic characteristics of a flatfoot are excessive eversion of the subtalar complex during weight-bearing with plantarflexion of the talus, plantarflexion of the calcaneus in relation to the tibia, a dorsiflexed and abducted navicular and a supinated forefoot." Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life. When evaluating an infant for a pronated condition, the examiner must also consider other risk factors that may affect the foot in its overall development. These contributing factors will play a role in the development of a treatment plan. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions. The authors realize other less significant factors exist but are not as detrimental to the foot as the primary ones discussed in depth. The primary risk factors that affect the pronated foot have been outlined. The clinician should always examine for these conditions when presented with a child exhibiting pronatory changes. A thorough explanation to the parents as to the consequential effects of these risk factors and their effects on the pediatric pronated foot is paramount to

  8. Tibiofibular torsion in congenital clubfoot.

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    Farsetti, Pasquale; Dragoni, Massimiliano; Ippolito, Ernesto

    2012-01-01

    Tibiofibular torsion was measured by computed tomography in three series of patients affected by congenital clubfoot who were treated with different protocols. The normal leg of unilateral deformities served as the control. For the bilateral cases, only the right side was included in the study. The angle between the bicondylar axis of the tibia and the bimalleolar axis was the index of tibiofibular torsion. There were 34 clubfeet in the first series, treated with a posteromedial release, and 40 clubfeet in the second series, treated with a modified Ponseti method, whereas the third series included 16 clubfeet, treated with the original Ponseti method. All 90 clubfeet were graded at birth as group 3 according to the Manes classification. No patient had previous treatment. The patients of the first and the second series were followed up to maturity, whereas the patients of the third series were followed up to a maximum of 11 years of age. In the congenital clubfoot, the tibia and the fibula were externally rotated, in comparison with the normal leg; in fact, the average value of the angle of tibiofibular torsion was 32.2° in the first series, 23.9° in the second series, and 21.1° in the third series. In the normal tibiae, the average value of the angle of tibiofibular torsion was 21.4°. The difference between the first series and the normal controls was statistically significant, as was the difference between the first one and the other two series. The value of the tibiofibular torsion angle seems to be related to the manipulation technique used to treat clubfoot: when the manipulation does not allow a progressive eversion of the talus underneath the calcaneus, the external tibial torsion increases. At follow-up, an intoeing gait was present in seven treated clubfeet of the first series. In all of them except one, the highest value of the external tibial torsion angle was observed, with a low value of the Kite's angle and/or residual forefoot adduction. In the

  9. Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women.

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    Gerber, V; Krieg, M A; Cornuz, J; Guigoz, Y; Burckhardt, P

    2003-01-01

    Malnutrition, a risk factor for osteoporotic fractures, is frequent in elderly people and, is underdiagnosed and undertreated. There are only few studies on the nutritional status of elderly people in Europe. The Mini Nutritional Assessment (MNA) is a non invasive and validated questionnaire to evaluate nutritional status in elderly people, classified in three groups: 1 degree score 17 and 24: well-nourished, with a maximum of 30 points. Quantitative ultrasound of bone (QUS) is a method for assessing quality of bone which can be easily performed in nursing homes. Therefore, these two tests allowed to study the relationships between nutritional status and ultrasonic parameters of bone in 78 institutionalized women aged 86 +/- 6 years, living in 11 nursing homes around Lausanne (Switzerland). All were assessed by the MNA, had a measurement of the tricipital skin fold and of the grip strength. Functional status was evaluated by the scale "Activity of Daily Living" (ADL), and serum albumin level was measured when permitted. All had QUS of the calcaneus (with an Achilles, GE Lunar). The measured parameters are the Broadband Ultrasound Attenuation (BUA), attenuation of a band of ultrasonic frequencies through the medium, expressed in dB/MHz, and the Speed of Sound (SOS), speed of the ultrasounds through the medium, expressed in m/s. A third parameter, the stiffness index (SI), expressed as a percentage of the values obtained by the manufacturer in a young population and derived from BUA and SOS, was calculated automatically : SI = (0.67xBUA) + (0.28xSOS) - 420, expressed in percent compared to a young adult population (%YA). Fifteen percent of the women were undernourished and 58% were at risk of malnutrition. As expected, compared with the well-nourished minority, undernourished subjects had significant lower body mass index (BMI), tricipital skin fold (TSF), ADL score and albumin level (p institutionalized elderly persons in our country, and the ultrasound parameters

  10. Polymorphisms in genes involved in the NF-κB signalling pathway are associated with bone mineral density, geometry and turnover in men.

    Science.gov (United States)

    Roshandel, Delnaz; Thomson, Wendy; Pye, Stephen R; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Huhtaniemi, Ilpo T; Adams, Judith E; Ward, Kate A; Bartfai, Gyorgy; Casanueva, Felipe F; Finn, Joseph D; Forti, Gianni; Giwercman, Aleksander; Han, Thang S; Kula, Krzysztof; Lean, Michael E; Pendleton, Neil; Punab, Margus; Wu, Frederick C; Holliday, Kate L; O'Neill, Terence W

    2011-01-01

    In this study, we aimed to investigate the association between single nucleotide polymorphisms (SNPs) within two genes involved in the NF-κB cascade (GPR177 and MAP3K14) and bone mineral density (BMD) assessed at different skeletal sites, radial geometric parameters and bone turnover. Ten GPR177 SNPs previously associated with BMD with genome-wide significance and twelve tag SNPs (r(2)≥0.8) within MAP3K14 (±10 kb) were genotyped in 2359 men aged 40-79 years recruited from 8 centres for participation in the European Male Aging Study (EMAS). Measurement of bone turnover markers (PINP and CTX-I) in the serum and quantitative ultrasound (QUS) at the calcaneus were performed in all centres. Dual energy X-ray absorptiometry (DXA), at the lumbar spine and hip, and peripheral quantitative computed tomography (pQCT), at the distal and midshaft radius, were performed in a subsample (2 centres). Linear regression was used to test for association between the SNPs and bone measures under an additive genetic model adjusting for study centre. We validated the associations between SNPs in GPR177 and BMD(a) previously reported and also observed evidence of pleiotrophic effects on density and geometry. Rs2772300 in GPR177 was associated with increased total hip and LS BMD(a), increased total and cortical vBMD at the radius and increased cortical area, thickness and stress strain index. We also found evidence of association with BMD(a), vBMD, geometric parameters and CTX-I for SNPs in MAP3K14. None of the GPR177 and MAP3K14 SNPs were associated with calcaneal estimated BMD measured by QUS. Our findings suggest that SNPs in GPR177 and MAP3K14 involved in the NF-κB signalling pathway influence bone mineral density, geometry and turnover in a population-based cohort of middle aged and elderly men. This adds to the understanding of the role of genetic variation in this pathway in determining bone health.

  11. The ESR1 (6q25 locus is associated with calcaneal ultrasound parameters and radial volumetric bone mineral density in European men.

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    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 countries, participating in the European Male Ageing Study (EMAS. The associations between SNPs and measured bone parameters were tested under an additive genetic model adjusting for centre using linear regression.2468 men, mean (SD aged 59.9 (11.1 years had QUS measurements performed and bone turnover marker levels measured. A subset of 628 men had DXA and pQCT measurements. Multiple independent SNPs showed significant associations with BMD using all three measurement techniques. Most notably, rs1999805 was associated with a 0.10 SD (95%CI 0.05, 0.16; p = 0.0001 lower estimated BMD at the calcaneus, a 0.14 SD (95%CI 0.05, 0.24; p = 0.004 lower total hip BMD(a, a 0.12 SD (95%CI 0.02, 0.23; p = 0.026 lower lumbar spine BMD(a and a 0.18 SD (95%CI 0.06, 0.29; p = 0.003 lower trabecular BMD at the distal radius for each copy of the minor allele. There was no association with serum levels of bone turnover markers and a single SNP which was associated with cortical density was also associated with cortical BMC and thickness.Our data replicate previous associations found between SNPs in the 6q25 locus and BMD(a at the hip and extend these data to include associations with calcaneal ultrasound parameters and radial volumetric BMD.

  12. [Principles of OSG arthrodesis in cases of joint infection].

    Science.gov (United States)

    Schmidt, H G K; Hadler, D; Gerlach, U-J; Schoop, R

    2005-12-01

    A chronic empyema of the ankle joint often develops after an open fracture or surgery. In the case of the destruction of the joint due to an infection, an arthrodesis should be performed. Normally we use an external fixator with two bone-nails placed into the calcaneus and two into the tibia. The arthrodesis is distracted and Septopal is permanently implemented. At 4-6 weeks after surgery the Septopal is removed, with distraction being reduced and a cancellous bone-graft taken from the dorsal iliac crest is performed to fill the bony defect. After bone healing, the external fixator is removed and the patient mobilized in a brace. Initially, weight-bearing is limited to 10 kg but is increased gradually to full weight. The brace is used for 6-9 months; later the patient is mobilized in orthopaedic shoes. In difficult cases, also in combination with a malposition which has to be corrected or a lengthening of the lower limb, we use the Ilizarov fixator. From 1993 to 2003 we performed arthrodeses of the ankle joint due to infectious destruction in 107 cases. In 82.2%, the empyema was caused by a fracture of the ankle joint and the following treatment. In 58% of the patients, we saw associated diseases such as obesity, alcohol abuse, diabetes and malposition of the foot. In 55% we found Staphylococcus aureus. In 86%, we used the external AO-fixator, in 14% the Ilizarov fixator. The patient retained the fixator for an average of 128 days. In our study, 92.1% of the 101 patients who had completed therapy showed a good stability an average of 4.5 years after the arthrodesis. In 5% we found partial stability, while three patients had to be amputated. In 57 patients (56.4), an arthrosis of the tarsal bones was found, and 38 patients (54.3%) of the 70 patients who at the time of the arthrodesis were still working could return to work.

  13. [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

  14. The influence of ibandronate treatment on bone density and biochemical bone markers in patients with osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Ingmar Ipach

    2012-09-01

    Full Text Available Osteogenesis imperfecta (OI is characterized by different signs including increased bone fragility, short stature, blue sclera, abnormal tooth growth and often secondary immobility. No curative therapy has been found for this rare disease up to now, and different pharmacological substances have been tried as treatment for severe forms of OI. Promising results were seen with intravenous bisphosphonates in the treatment of patients with OI. The aim of present study was to show the effect of intravenous ibandronate therapy on bone density and bone metabolism markers. We analyzed the data of 27 patients with the diagnosis of OI who were treated off-label with intravenous ibandronate. Ibandronate was administered by intravenous infusion every three months at a dosage of 0.3-2 mg. Bone turnover markers and bone density were measured before starting therapy and every three months during treatment. Bone density was measured by using an ultrasound imaging system providing an accurate image of the calcaneus and by evaluating broadband ultrasound attenuation (BUA. Twenty-seven patients were treated with intravenous iban- dronate during the observation period. 18 were female. The mean age of all patients was 23.9 years ± 19.6 (range 4-63. Seventeen patients were categorized to have OI Type I, 5 patients to have OI Type III and 5 patients to have OI Type IV. There was a statistically significant decrease in total alkaline phosphatase (P<0.0001. We detected also a statistically significant decrease in the ratio urinary deoxypyridinoline/urinary creatinine (P=0.0048 and the ratio urinary pyridinoline/urinary creatinine (P<0.0001 respectively. There was also a statistically significant increase in serum magnesium (P=0.034 and BUA (P=0.0071. No statistically significant changes were seen for total serum calcium (P=0.16, the ratio of urine calcium/urine creatinine (P=0.29, alkaline phosphatase (isoform bone (P=0.3, procollagen-I-peptide (P=0.5, osteocalcin (P=0

  15. A method for the estimation of femoral bone mineral density from variables of ultrasound transmission through the human femur.

    Science.gov (United States)

    Barkmann, R; Laugier, P; Moser, U; Dencks, S; Padilla, F; Haiat, G; Heller, M; Glüer, C-C

    2007-01-01

    Quantitative ultrasound (QUS) measurements at peripheral sites can be used to estimate osteoporotic fracture risk. However, measurements at these sites are less suitable to predict bone mineral density (BMD) or fracture risk at the central skeleton. We investigated whether direct QUS measurements at the femur would allow to estimate dual X-ray absorptiometry (DXA) BMD of the total proximal femur with errors comparable to established DXA accuracy errors. Two independent sets of femora were measured in Kiel (6 f, 4 m, age: 55-90) and Paris (19 f, 20 m age: 45-95) using different benchtop systems in the two laboratories. The femora were scanned in transverse transmission mode using focused US transducers of 500 kHz center frequency. The QUS values were averaged over a region similar to the total hip region of dual X-ray absorptiometry (DXA) measurements. BMD was measured using DXA. SOS and BMD correlated significantly (p<0.0001) in both data sets (R2=0.81-0.93). Correlations between BUA and BMD were also significant at p<0.001, but correlation coefficients were lower (R2=0.61-0.75). Residual errors for the estimation of BMD were 8%-10% for SOS as predictor, and 14%-16% for BUA as predictor. The residual error of 8 to 10% for the estimation of BMD from SOS is comparable to variabilities among different DXA femur subregions and accuracy errors of femoral DXA measurements caused by the impact of soft tissue. It is substantially smaller than the errors of 13% for the estimation of total femur BMD from spine BMD, 14% for the estimation of total femur BMD from calcaneus SOS or 16% for the estimation of ash weight from DXA. The results of the study show that SOS is able to predict total BMD with adequate accuracy. If femoral BMD could be obtained in vivo with comparable accuracy, femoral QUS would be suited for the assessment of bone status at one of the main osteoporotic fracture sites.

  16. Differences in joint-position sense and vibratory threshold in runners with and without a history of overuse injury.

    Science.gov (United States)

    Switlick, Tiffany; Kernozek, Thomas W; Meardon, Stacey

    2015-02-01

    A relationship between altered postural control and injury has been reported in sports. Sensorimotor function serves a fundamental role in postural control and is not often studied in runners. Persons who sustain running injury may have altered sensorimotor function contributing to risk of injury or reinjury. To determine if differences in knee and ankle proprioception or plantar sensation exist between injured and noninjured runners. Retrospective case-control study. University campus. Twenty runners with a history of lower-extremity overuse injury and 20 noninjured runners were examined. Injured runners were subcategorized into 2 groups based on site of injury: foot/ankle and knee/hip. Active absolute joint-repositioning error of the ankle at 20° inversion and 10° eversion and the knee at 15° and 40° flexion was assessed using an isokinetic dynamometer. Vibratory threshold at the calcaneus, arch, and great toe was determined for each subject using a handheld electric sensory threshold instrument. Runners in the injured-foot/ankle group had increased absolute error during ankle-eversion repositioning (6.55° ± 3.58°) compared with those in the noninjured (4.04° ± 1.78°, P = .01) and the hip/knee (3.63° ± 2.2°, P = .01) groups. Runners in the injured group, as a whole, had greater sensitivity in the arch of the plantar surface (2.94 ± 0.52 V) than noninjured runners (2.38 ± 0.53 V, P = .02). Differences in ankle-eversion proprioception between runners with a history of ankle and foot injuries and noninjured runners were observed. Runners with a history of injury also displayed an increased vibratory threshold in the arch region compared with noninjured runners. Poor ankle-joint-position sense and increased plantar sensitivity suggest altered sensorimotor function after injury. These factors may influence underlying postural control and contribute to altered loading responses commonly observed in injured runners.

  17. Laws' masks descriptors applied to bone texture analysis: an innovative and discriminant tool in osteoporosis

    Energy Technology Data Exchange (ETDEWEB)

    Rachidi, M. [Orleans Hospital, INSERM Unit U658, Orleans (France); INSERM-U658. IPROS Hopital Porte Madeleine, Orleans (France); Marchadier, A. [Orleans Hospital, IPROS, Orleans (France); Gadois, C. [D3A Medical Systems, Orleans (France); Lespessailles, E. [Ipros-service de Rhumatologie CHR d' Orleans, Orleans (France); Chappard, C.; Benhamou, C.L. [Orleans Hospital, INSERM Unit U658, Orleans (France)

    2008-06-15

    The objective of this study was to explore Laws' masks analysis to describe structural variations of trabecular bone due to osteoporosis on high-resolution digital radiographs and to check its dependence on the spatial resolution. Laws' masks are well established as one of the best methods for texture analysis in image processing and are used in various applications, but not in bone tissue characterisation. This method is based on masks that aim to filter the images. From each mask, five classical statistical parameters can be calculated. The study was performed on 182 healthy postmenopausal women with no fractures and 114 age-matched women with fractures [26 hip fractures (HFs), 29 vertebrae fractures (VFs), 29 wrist fractures (WFs) and 30 other fractures (OFs)]. For all subjects radiographs were obtained of the calcaneus with a new high-resolution X-ray device with direct digitisation (BMA, D3A, France). The lumbar spine, femoral neck, and total hip bone mineral density (BMD) were assessed by dual-energy X-ray absorptiometry. In terms of reproducibility, the best results were obtained with the TR{sub E5E5} mask, especially for three parameters: 'mean', 'standard deviation' and 'entropy' with, respectively, in vivo mid-term root mean square average coefficient of variation (RMSCV)%=1.79, 4.24 and 2.05. The 'mean' and 'entropy' parameters had a better reproducibility but 'standard deviation' showed a better discriminant power. Thus, for univariate analysis, the difference between subjects with fractures and controls was significant (P<10{sup -3}) and significant for each fracture group independently (P<10{sup -4} for HF, P=0.025 for VF and P < 10{sup -3} for OF). After multivariate analysis with adjustment for age and total hip BMD, the difference concerning the 'standard deviation' parameter remained statistically significant between the control group and the HF and VF groups (P<5 x 10

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

    Directory of Open Access Journals (Sweden)

    Jain Saurabh

    2013-12-01

    internal fixation with locking calcaneal plate gives sound functional outcome, i.e. restoring anatomically reconstruction of height, width, Bohler’s and Gissiane’s angles of the calcaneum, and allow- ing early mobilization. Key words: Calcaneus; Fractures, bone; Bone plates; Fracture fixation, internal

  19. Association between bone stiffness and nutritional biomarkers combined with weight-bearing exercise, physical activity, and sedentary time in preadolescent children. A case-control study.

    Science.gov (United States)

    Herrmann, Diana; Pohlabeln, Hermann; Gianfagna, Francesco; Konstabel, Kenn; Lissner, Lauren; Mårild, Staffan; Molnar, Dénes; Moreno, Luis A; Siani, Alfonso; Sioen, Isabelle; Veidebaum, Toomas; Ahrens, Wolfgang

    2015-09-01

    Physical activity (PA) and micronutrients such as calcium (Ca), vitamin D (25OHD), and phosphate (PO) are important determinants of skeletal development. This case-control study examined the association of these nutritional biomarkers and different PA behaviours, such as habitual PA, weight-bearing exercise (WBE) and sedentary time (SED) with bone stiffness (SI) in 1819 2-9-year-old children from the IDEFICS study (2007-2008). SI was measured on the calcaneus using quantitative ultrasound. Serum and urine Ca and PO and serum 25OHD were determined. Children's sports activities were reported by parents using a standardised questionnaire. A subsample of 1089 children had accelerometer-based PA data (counts per minute, cpm). Moderate-to-vigorous PA (MVPA) and SED were estimated. Children with poor SI (below the 15th age-/sex-/height-specific percentile) were defined as cases (N=603). Randomly selected controls (N=1216) were matched by age, sex, and country. Odds ratios (OR) for poor SI were calculated by conditional logistic regression for all biomarkers and PA behaviour variables separately and combined (expressed as tertiles and dichotomised variables, respectively). ORs were adjusted for fat-free mass, dairy product consumption, and daylight duration. We observed increased ORs for no sports (OR=1.39, p<0.05), PA levels below 524 cpm (OR=1.85, p<0.05) and MVPA below 4.2% a day (OR=1.69, p<0.05) compared to WBE, high PA levels (<688 cpm) and high MVPA (6.7%), respectively. SED was not associated with SI. ORs were moderately elevated for low serum Ca and 25OHD. However, biomarkers were not statistically significantly associated with SI and did not modify the association between PA behaviours and SI. Although nutritional biomarkers appear to play a minor role compared to the osteogenic effect of PA and WBE, it is noteworthy that the highest risk for poor SI was observed for no sports or low MVPA combined with lower serum Ca (<2.5 mmol/l) or lower 25OHD (<43.0 nmol

  20. 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.

  1. Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China

    Science.gov (United States)

    Jiang, Nan; Ma, Yun-fei; Jiang, Yi; Zhao, Xing-qi; Xie, Guo-ping; Hu, Yan-jun; Qin, Cheng-he; Yu, Bin

    2015-01-01

    Abstract Although extremity chronic osteomyelitis is common in China, updated data were still limited regarding its characterizations. The present study aimed to review clinical features of extremity chronic osteomyelitis in Southern China. A retrospective analysis was conducted in the patients who had sought medical attention from January 2010 to April 2015 for extremity chronic osteomyelitis in Nanfang Hospital in Southern China. Clinical data were collected and analyzed. A total of 394 patients (307 males and 87 females) were included, giving a gender ratio of 3.53. The median age at first diagnosis was 42 years for all. The most frequent type was traumatic osteomyelitis (262 cases, 66.50%), which was mainly caused by open injury (166 cases, 63.36%) and during a road accident (91 cases, 34.73%). Single-site infection accounted for 81.98% (323 cases), with tibia (126 cases), femur (79 cases), calcaneus (37 cases), and toes (37 cases) as the top sites. The positive rate of intraoperative culture was 70.63% (214/303), 78.97% (169/214) of which was monomicrobial infection. Staphylococcus aureus (59 cases) was the most frequent bacteria for monomicrobial infection, followed by Pseudomonas aeruginosa (29 cases) and Escherichia coli (11 cases). The positive ratios of preoperative serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were 21.63%, 64.92%, 53.27%, 42.25%, 72.82%, and 66.67%, respectively. The most frequently used intravenous antibiotic was cephalosporins. The overall cure rate was 77.74%, with a total amputation rate of 16.75%. In this representative Chinese cohort, extremity chronic osteomyelitis was mostly caused by open injury and during a road accident, predominated in males and favored the tibia. S. aureus was the most frequent pathogenic organism. Preoperative elevated levels of serum IL-6, TNF-α, and ESR may be helpful

  2. Charcot arthropathy of the foot and ankle associated with rheumatoid arthritis.

    Science.gov (United States)

    Grear, Benjamin J; Rabinovich, Alexander; Brodsky, James W

    2013-11-01

    Diabetic peripheral neuropathy is now well recognized as the most common cause of Charcot arthropathy of the foot and ankle, but it may be associated with other peripheral neuropathies. While not well known, it is well documented that rheumatoid arthritis is correlated with peripheral neuropathy. However, despite rheumatoid neuropathy, Charcot arthropathy has never been associated with rheumatoid arthritis. We report a series of Charcot arthropathy patients with concomitant rheumatoid arthritis. The medical records of patients treated between 1986 and 2009 with Charcot arthropathy and rheumatoid arthritis were reviewed. Recorded data included neuropathy risk factors, medications, history of ulcerations, ambulatory status, shoe wear, and treatment course. Radiographs of Charcot joints were categorized according to the Brodsky anatomic classification. Patient care was based on published treatment algorithms, emphasizing accommodative, nonoperative treatment with selective surgical interventions. Surgery was indicated for recalcitrant, nonhealing lesions of the soft tissue and/or unbraceable, nonplantigrade feet. A successful outcome was considered an ambulatory patient without amputation and a closed skin envelope at last follow-up. Four men and 16 women met the diagnostic criteria, resulting in 33 feet in the series. Average age was 61 years, and average follow-up was 4.3 years. In addition to rheumatoid arthritis, 4 patients (7 feet) had hypothyroidism, 4 patients (6 feet) had diabetes, 1 patient (2 feet) had megaloblastic anemia and diabetes, and 1 patient (1 foot) had hypothyroidism and diabetes; however, 17 feet (52%) had no known sources for neuropathy. Charcot involvement was type 1-midfoot in 21 feet (64%), type 2-hindfoot in 7 (21%), type 3a-ankle in 4 (12%), and type 3b-calcaneus in 1 (3%). Twenty-three feet (70%) were treated with conservative modalities. Ten feet (30%) required 15 surgeries, of which an exostectomy was the most common procedure. Of the 33

  3. Lactose intolerance among Malay and Orang Asli female children in selected rural Selangor and its effect on bone mineral density

    Science.gov (United States)

    Makbul, Ika Aida Aprilini; Daud, Norlida Mat; Aziz, Nurul Azrianti Abdul; Yahya, Noor Fairuzi Suhana

    2016-11-01

    Sufficient intake of calcium during childhood is very important to ensure an optimal growth and strong bones development. However, lactose intolerance (LI) may limit the intake of milk and dairy products due to the inability of the body to digest lactose to its constituents, glucose and galactose. Children in rural area were a major concern as they are commonly associated with an inadequate intake of nutrients. Hence, the objectives of this study are to determine the prevalence of LI among Malay and Orang Asli female children in rural Selangor and its association with bone mineral density (BMD). A total of 65 (39 Malay, 26 Orang Asli) female primary school students with a mean age of 10.4 ± 0.6 years old underwent hydrogen breath test and lactose tolerance test (LTT) during fasting and after ingestion of 25g lactose solution. A Wong Baker Face Pain Rating Scale (WBFPRS) was used to assess the presence of gastrointestinal (GI) symptoms during the study. LI symptoms are defined when breath H2 levels exceed 20 ppm above baseline values, an increase of postprandial blood glucose (PBG) levels of less than 1.1 mmol/L and GI symptom score is more or equal than score 2. BMD was measured in the calcaneus using QUS-2 Ultrasonometer. The result showed that 35 subjects (15 Malay, 20 Orang Asli) had a positive breath test (>20ppm). A total of 74.4% Malay and 88.5% Orang Asli children had an increase of PBG of less than 1.1 mmol/L. Both groups have low percentage (35.9 % Malay, 34.6 % Orang Asli) of GI symptoms. A total of 20.0% children (n=13, Malay=4, Orang Asli=9) was found to experience LI. Orang Asli children showed a significantly higher (p<0.001) BMD (95.7 ± 11.0 dB/MHz) compared to Malay children (71.7 ± 8.6 dB/MHz). The result shown there is an association between LI with BMD (p=0.031). Hence, LI does affect in decreasing an individual BMD. In conclusion, the prevalence of LI among female children in rural Selangor is low. However, the relationship between LI and BMD

  4. [Clinical application of peroneal muscles tendon transposition in repair of Achilles tendon rupture].

    Science.gov (United States)

    Jin, Rihao; Jin, Yu; Fang, Xiulin

    2006-07-01

    To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3 females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture (8 cases of complete rupture and 2 cases of incomplete rupture). The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5 +/- 2.5 cm. The width of origin tendon was 0.9 +/- 0.2 cm and the thickness was 0.3 +/- 0.1 cm; the width on apex of lateral malleolus was 0.7 +/- 0.1 cm and the thickness was 0.4 +/- 0.1 cm, the width on head of cuboid was 0.7 +/- 0.1 cm and the thickness was 0.3 +/- 0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2,292.4 +/- 617.3 N on tendon calcaneus, 1,020.4 +/- 175.4 N on long peroneal muscles tendon, 752.0 +/- 165.4 N on peroneus brevis tendon and 938.2 +/- 216.7 N on tibialis posterior tendon. Ten cases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 18-24 months. No Achilles tendon re-rupture, necrosis of skin or other complications occurred

  5. Differential Motion and Compression Between the Plantaris and Achilles Tendons: A Contributing Factor to Midportion Achilles Tendinopathy?

    Science.gov (United States)

    Stephen, Joanna M; Marsland, Daniel; Masci, Lorenzo; Calder, James D F; Daou, Hadi El

    2017-12-01

    The plantaris tendon (PT) has been thought to contribute to symptoms in a proportion of patients with Achilles midportion tendinopathy, with symptoms improving after PT excision. There is compression and differential movement between the PT and Achilles tendon (AT) during ankle plantarflexion and dorsiflexion. Descriptive laboratory study. Eighteen fresh-frozen cadaveric ankles (mean ± SD age: 35 ± 7 years, range = 27-48 years; men, n = 9) were mounted in a customized testing rig, where the tibia was fixed but the forefoot could be moved freely. A Steinmann pin was drilled through the calcaneus, enabling a valgus torque to be applied. The soleus, gastrocnemius, and plantaris muscles were loaded with 63 N with a weighted pulley system. The test area was 40 to 80 mm above the os calcis, corresponding to where the injury is observed clinically. Medially, the AT and PT were exposed, and a calibrated flexible pressure sensor was inserted between the tendons. Pressure readings were recorded with the ankle in full dorsiflexion, full plantarflexion, and plantargrade and repeated in these positions with a 5 N·m torque, simulating increased hindfoot valgus. The pressure sensor was removed and the PT and AT marked with ink at the same level, with the foot held in neutral rotation and plantargrade. Videos and photographs were taken to assess differential motion between the tendons. After testing, specimens were dissected to identify the PT insertion. One-way analysis of variance and paired t tests were performed to make comparisons. The PT tendons with an insertion separate from the AT demonstrated greater differential motion through range (14 ± 4 mm) when compared with those directly adherent to the AT (2 ± 2 mm) ( P plantarflexion for all specimens ( P plantarflexion, suggesting that adapting rehabilitation tendon-loading programs to avoid this position may be beneficial. The insertion pattern of the PT may be a factor in plantaris-related midportion Achilles

  6. Bone mineral content (bmc and bone mineral density (bmd in postmenopausal women formerly practising kayaking and fencing

    Directory of Open Access Journals (Sweden)

    B Raczyńska

    2003-06-01

    Full Text Available The investigation was aimed at answering the following questions: 1 Can a prolonged career in sports associated with considerable training loads, in conjunction with other osteoporosis risk factors (both past and present, affect the bone mineral content (BMC and bone mineral density (BMD of the former female athletes in their postmenopausal period of life?, and 2 How does the present lifestyle of the tested women, including physical activity and diet (calcium intake, influence the preservation of the optimal bone mass in these subjects? The postmenopausal subjects recruited to the present study included 15 former athletes (ten kayakers and five fencers and 11 women who never actively engaged in sports (control group. BMC (g and BMD (g/cm2 were densitometrically determined in the lumbar segment (L2-L4 of the spine, and the bone stiffness coefficient was ultrasonically determined in calcaneus. The effects of the osteoporosis risk factors (both past and present were estimated from individual replies to the questionnaire inquiries about the past career in sports, present physical activity, gonadal dysfunctions (dysmenorrhoea during the career and the present need for hormonal supplementary treatment, and the current dietary patterns. The results indicate that mean BMC and BMD values detected in the former athletes did not differ significant from those obtained in the non-athlete, control women: the BMC values equalled to 54.5±10.5, 52.6±14.6, and 46.5±3.2 g in the kayakers, the fencers, and the control women, respectively, while the respective BMD values were 1.05±0.45, 0.96±0.66, and 1.08±0.58 g/cm2. The questionnaire-based studies showed that neither the former female athletes nor the non-athlete controls exhibited in the past longer (i.e., lasting more than three months periods of hormonal disorders (amenorrhoea. As assessed from the dietary intake, only in the former fencers the diet covered the demand for calcium in 100%. In conclusion

  7. Tratamento cirúrgico do pé eqüino na paralisia cerebral: uma revisão sistemática e quantitativa da literatura Surgical treatment of equinus varus deformity of the foot in cerebral palsy: a systematic and quantitative review of the literature

    Directory of Open Access Journals (Sweden)

    Rodrigo Montezuma César de Assumpção

    2008-09-01

    -up. The studies in which the mean age of patients at the time of surgery was older than seven years show a smaller sum total of relative risks when compared to the group with mean ager younger than seven years, showing a significant reduction of the absolute risk. The comparative analysis of studies that mention performance of lengthening of the calcaneus tendon shows a lower sum total of risks when compared to studies that mention lengthening in the muscle-tendon junction, but with a small reduction in absolute risk. CONCLUSIONS: Zetaplasty for the lengthening of the calcaneus tendon tends to be safer. Patients should operated on after seven years of age. In the long term, the risk of recurrence increases significantly, which reinforces the need for a follow-up of these patients at least till they reach skeletal maturity.

  8. The Digital Astronaut Project Computational Bone Remodeling Model (Beta Version) Bone Summit Summary Report

    Science.gov (United States)

    Pennline, James; Mulugeta, Lealem

    2013-01-01

    Under the conditions of microgravity, astronauts lose bone mass at a rate of 1% to 2% a month, particularly in the lower extremities such as the proximal femur [1-3]. The most commonly used countermeasure against bone loss in microgravity has been prescribed exercise [4]. However, data has shown that existing exercise countermeasures are not as effective as desired for preventing bone loss in long duration, 4 to 6 months, spaceflight [1,3,5,6]. This spaceflight related bone loss may cause early onset of osteoporosis to place the astronauts at greater risk of fracture later in their lives. Consequently, NASA seeks to have improved understanding of the mechanisms of bone demineralization in microgravity in order to appropriately quantify this risk, and to establish appropriate countermeasures [7]. In this light, NASA's Digital Astronaut Project (DAP) is working with the NASA Bone Discipline Lead to implement well-validated computational models to help predict and assess bone loss during spaceflight, and enhance exercise countermeasure development. More specifically, computational modeling is proposed as a way to augment bone research and exercise countermeasure development to target weight-bearing skeletal sites that are most susceptible to bone loss in microgravity, and thus at higher risk for fracture. Given that hip fractures can be debilitating, the initial model development focused on the femoral neck. Future efforts will focus on including other key load bearing bone sites such as the greater trochanter, lower lumbar, proximal femur and calcaneus. The DAP has currently established an initial model (Beta Version) of bone loss due to skeletal unloading in femoral neck region. The model calculates changes in mineralized volume fraction of bone in this segment and relates it to changes in bone mineral density (vBMD) measured by Quantitative Computed Tomography (QCT). The model is governed by equations describing changes in bone volume fraction (BVF), and rates of

  9. Bursite peritrocantérica: descrição de nova manobra semiológica para auxílio diagnóstico Peritrochanteric bursits: a description of a new semiologic maneuver for diagnostic assistance

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    Edson Noburo Fujiki

    2008-01-01

    Full Text Available O estudo tem como objetivo testar a validade de nova manobra semiológica no diagnóstico de bursite peritrocantérica. Foram avaliados 30 pacientes, com diagnóstico clínico de bursite do grande trocanter. Todos os pacientes foram submetidos à radiografia de bacia AP e Perfil. Quando necessário, outros exames de imagem foram realizados, com a finalidade de descartar doenças associadas; os pacientes foram submetidos a duas manobras semiológicas no quadril são e afetado. TESTE 1: paciente em decúbito dorsal, o membro examinado é aduzido em extensão cruzando sobre o membro contralateral, com o calcâneo em contato com a maca, faz-se a flexão do quadril até aproximadamente 90º, o quadril ao final da manobra estará em flexão, adução e leve rotação externa, durante a manobra poderá ser referida dor na região do trocanter maior. TESTE 2: a posição final do TESTE 1, é a posição inicial desta, faz-se a adução forçada do quadril, pode haver referencia de dor ou exacerbação. Os resultados das manobras foram submetidos ao estudo estatístico, que demonstrou serem os exames diferentes entre si, porém complementares. O teste 2 mostrou ser positivo em 96,6%. As manobras semiológicas denominadas de TESTE 1 e 2, podem ser utilizadas como auxiliares nos diagnósticos clínicos das bursites peritrocanterianas.The objective of the present study was to test the validity of a semiologic maneuver on the diagnosis of peritrochanteric bursitis. Thirty patients with a clinical diagnosis of great trochanter bursitis were assessed. All patients were submitted to X-ray studies at AP and LP. Whenever necessary, other imaging tests were performed, intending to rule out any associated diseases; the patients were submitted to two semiologic maneuvers on both hips, the affected and the normal one. TEST 1: with patient at supine position, the examined limb is adduced in extension and crossing it over the contralateral limb, with the calcaneus

  10. Intraosseous lipoma: radiological findings Lipoma intra-ósseo: achados radiológicos

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    Özgür Öztekin

    2008-04-01

    Full Text Available OBJECTIVE: Intraosseous lipomas may be less rare lesions than previously suggested in the literature. They have frequently been misdiagnosed as other benign bone lesions. A combination of computed tomography, magnetic resonance imaging and radiography is essential for decreasing misdiagnosis rates. MATERIALS AND METHODS: This retrospective study presents ten cases of intraosseous lipoma. The patients' ages ranged from 25 to 80 years, and six of them were female. Six patients presented with bone pain, whereas four patients were asymptomatic with incidentally discovered lesions. The involved bones were: femur (four patients, tibia (two patients, calcaneus (one patient, sacrum (one patient, iliac bone (one patient, navicular bone (one patient. All of the patients were assessed by means of conventional radiography, computed tomography and magnetic resonance imaging of the affected region. RESULTS: In all of the cases, plain films revealed well-defined lytic lesions. Both computed tomography and magnetic resonance imaging were quite useful in demonstrating fat within the femur. The histologic pattern of all tumors was that of mature adipose tissue. CONCLUSION: Intraosseous lipoma is a well-defined entity that may develop with varying presentations. Plain radiographs alone cannot establish the diagnosis of this lesion. However, both computed tomography and magnetic resonance imaging are quite useful methods in these cases.OBJETIVO: Lipomas intra-ósseos podem ser lesões menos raras do que anteriormente sugerido na literatura. Freqüentemente têm sido erroneamente diagnosticados como outras lesões ósseas benignas. A combinação de tomografia computadorizada, ressonância magnética e radiografia é essencial para reduzir as taxas de erro diagnóstico. MATERIAIS E MÉTODOS: Este estudo retrospectivo apresenta dez casos de lipoma intra-ósseo. As idades dos pacientes variavam entre 25 e 80 anos, e seis deles eram do sexo feminino. Seis pacientes

  11. Radiography and sonography of clubfoot: A comparative study

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    Satish Kumar Bhargava

    2012-01-01

    Full Text Available Background: Congenital talipes equinovarus is a common foot deformity afflicting children with reported incidence varying from 0.9/1000 to 7/1000 in various populations. The success reported with Ponseti method when started at an early age requires an imaging modality to quantitate the deformity. Sonography being a radiation free, easily available non-invasive imaging has been investigated for this purpose. Various studies have described the sonographic anatomy of normal neonatal foot and clubfoot and correlated the degree of severity with trends in sonographic measurements. However, none of these studies have correlated clinical, radiographic and sonographic parameters of all the component deformities in clubfoot. The present study aims to compare the radiographic and sonographic parameters in various grades of clubfoot. Materials and Methods: Thirty-one children with unilateral clubfoot were examined clinically and graded according to the Demeglio system of classification of clubfoot severity. Antero-posterior (AP and lateral radiographs of both normal and affected feet were obtained in maximum correction and AP talo-calcaneal (T-C, AP talo-first metatarsal (TMT and lateral T-C angles were measured. Sonographic examination was done in medial, lateral, dorsal and posterior projections of both feet in static neutral position and after Ponseti manouever in the position of maximum correctability in dynamic sonography. Normal foot was taken as control in all cases. The sonographic parameters measured were as follows : Medial malleolar- navicular distance (MMN and medial soft tissue thickness (STT on medial projection, calcaneo-cuboid (C-C distance, calcaneo-cuboid (C-C angle and maximum length of calcaneus on lateral projection, length of talus on dorsal projection; and tibiocalcaneal (T-C distance, posterior soft tissue thickness and length of tendoachilles on posterior projection. Also, medial displacement of navicular relative to talus, mobility

  12. Lower Leg Injury Reference Values and Risk Curves from Survival Analysis for Male and Female Dummies: Meta-analysis of Postmortem Human Subject Tests.

    Science.gov (United States)

    Yoganandan, Narayan; Arun, Mike W J; Pintar, Frank A; Banerjee, Anjishnu

    2015-01-01

    Derive lower leg injury risk functions using survival analysis and determine injury reference values (IRV) applicable to human mid-size male and small-size female anthropometries by conducting a meta-analysis of experimental data from different studies under axial impact loading to the foot-ankle-leg complex. Specimen-specific dynamic peak force, age, total body mass, and injury data were obtained from tests conducted by applying the external load to the dorsal surface of the foot of postmortem human subject (PMHS) foot-ankle-leg preparations. Calcaneus and/or tibia injuries, alone or in combination and with/without involvement of adjacent articular complexes, were included in the injury group. Injury and noninjury tests were included. Maximum axial loads recorded by a load cell attached to the proximal end of the preparation were used. Data were analyzed by treating force as the primary variable. Age was considered as the covariate. Data were censored based on the number of tests conducted on each specimen and whether it remained intact or sustained injury; that is, right, left, and interval censoring. The best fits from different distributions were based on the Akaike information criterion; mean and plus and minus 95% confidence intervals were obtained; and normalized confidence interval sizes (quality indices) were determined at 5, 10, 25, and 50% risk levels. The normalization was based on the mean curve. Using human-equivalent age as 45 years, data were normalized and risk curves were developed for the 50th and 5th percentile human size of the dummies. Out of the available 114 tests (76 fracture and 38 no injury) from 5 groups of experiments, survival analysis was carried out using 3 groups consisting of 62 tests (35 fracture and 27 no injury). Peak forces associated with 4 specific risk levels at 25, 45, and 65 years of age are given along with probability curves (mean and plus and minus 95% confidence intervals) for PMHS and normalized data applicable to

  13. Caracterização dos portadores de diabetes submetidos à amputação de membros inferiores em Londrina, Estado do Paraná - doi: 10.4025/actascihealthsci.v32i2.7754 Characterization of diabetic patients submitted to lower limb amputation in Londrina, Paraná State - doi: 10.4025/actascihealthsci.v32i2.7754

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    Maria do Carmo Lourenço Haddad

    2010-09-01

    % of patients had diabetic neuropathy, 93% had lower limb ulcers, 52% had gangrene. They remained hospitalized an average of 14 days, and the length of hospital stay varied from 3 to 50 days. Of the amputations performed, 30% involved the thigh, 30% toes, 27.50% upper third of the leg, 5% transmetatarsal region, 5% knee disarticulation and 2.5% calcaneus bone. The increase in amputations is cause for concern for the quality of life of these patients, considering the physical and psychological impact that amputation has on the individual. Furthermore, higher government and institutional costs will be required to assist the health needs of these patients. It was concluded that prevention is the best alternative to reduce this amputation rate and improve the quality of life of diabetics.

  14. Caracterização dos portadores de diabetes submetidos à amputação de membros inferiores em Londrina, Estado do Paraná = Characterization of diabetic patients submitted to lower limb amputation in Londrina, Paraná State

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    Maira Sayuri Sakay Bortoletto

    2010-07-01

    patients had diabetic neuropathy, 93% had lower limb ulcers, 52% had gangrene. They remained hospitalized an average of 14 days, and the length of hospital stay varied from 3 to 50 days. Of the amputations performed, 30% involved the thigh, 30% toes, 27.50% upper third of the leg, 5% transmetatarsal region, 5% knee disarticulation and 2.5% calcaneus bone. The increase in amputations is cause for concern for the quality of life of these patients, considering the physical and psychological impact that amputation has on the individual. Furthermore, higher government and institutional costs will be required to assist the health needs of these patients. It was concluded that prevention is the best alternative to reduce this amputation rate and improve the quality of life of diabetics.

  15. Fluid Shifts

    Science.gov (United States)

    Stenger, M. B.; Hargens, A. R.; Dulchavsky, S. A.; Arbeille, P.; Danielson, R. W.; Ebert, D. J.; Garcia, K. M.; Johnston, S. L.; Laurie, S. S.; Lee, S. M. C.; hide

    2017-01-01

    Introduction. NASA's Human Research Program is focused on addressing health risks associated with long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed after short-duration missions were largely transient, but now more than 50 percent of ISS astronauts have experienced more profound, chronic changes with objective structural findings such as optic disc edema, globe flattening and choroidal folds. These structural and functional changes are referred to as the visual impairment and intracranial pressure (VIIP) syndrome. Development of VIIP symptoms may be related to elevated intracranial pressure (ICP) secondary to spaceflight-induced cephalad fluid shifts, but this hypothesis has not been tested. The purpose of this study is to characterize fluid distribution and compartmentalization associated with long-duration spaceflight and to determine if a relation exists with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during spaceflight, as well as any VIIP-related effects of those shifts, are predicted by the crewmember's pre-flight status and responses to acute hemodynamic manipulations, specifically posture changes and lower body negative pressure. Methods. We will examine a variety of physiologic variables in 10 long-duration ISS crewmembers using the test conditions and timeline presented in the figure below. Measures include: (1) fluid compartmentalization (total body water by D2O, extracellular fluid by NaBr, intracellular fluid by calculation, plasma volume by CO rebreathe, interstitial fluid by calculation); (2) forehead/eyelids, tibia, and calcaneus tissue thickness (by ultrasound); (3) vascular dimensions by ultrasound (jugular veins, cerebral and carotid arteries, vertebral arteries and veins, portal vein); (4) vascular dynamics by MRI (head/neck blood flow, cerebrospinal fluid

  16. Insertional Achilles tendinitis and Haglund's deformity.

    Science.gov (United States)

    Kang, Steve; Thordarson, David B; Charlton, Timothy P

    2012-06-01

    Haglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus, which is frequently associated with insertional Achilles tendinitis. To our knowledge, no study has been done successfully correlating the characteristics of a Haglund's deformity with insertional Achilles tendinitis. The purpose of our study was to analyze the characteristics of a Haglund's deformity in patients with and without insertional Achilles tendinitis to see if there was a correlation. The study was a retrospective radiographic review of a single surgeon's patients with insertional Achilles tendinitis from 2005 to 2008. Our study population consisted of 44 patients, 48 heels (22 male, 22 female) with insertional Achilles tendinitis, with a mean age of 52 (range, 23 to 79) years. Our control population consisted of 50 patients (25 males, 25 females) and 50 heels without insertional Achilles tendinitis with a mean age of 55.6 (range, 18 to 89) years. We introduced two new measurements of the Haglund's deformity in this study: the Haglund's deformity height and peak angle. A standing lateral foot or ankle radiograph was analyzed for each patient and the following measurements were made: Haglund deformity height and peak angle; Bohler's angle; Fowler-Philip angle; and parallel pitch sign. We also looked for the presence of calcification in the study group and the length and width of the calcification. Unpaired t-test was used to analyze the measurements between the groups. Ten patients' radiographs were re-measured and correlation coefficients were obtained to assess the reliability of the measuring techniques. For the insertional Achilles tendinitis group, the mean Haglund's deformity height was 9.6 (range, 5.3 to 15.3) mm and the mean Haglund's deformity peak angle was 105 (range, 87 to 123) degrees. Calcification was present in 35 of 48 or (73%) of patients with a mean length of 13.3 (range, 3.2 to 41.9) mm and mean width of 4.5 (range, 1.0 to 10.4) mm. In the control

  17. New method for evaluation of cutaneous sensibility in diabetic feet: preliminary report Novo método para avaliação da sensibilidade cutânea do pé diabético: relato preliminar

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    Marcus Castro Ferreira

    2004-01-01

    Full Text Available Diabetic neuropathy is an important complication of the disease, responsible for ulceration and amputation of the foot. Prevention of these problems is difficult mainly because there is no method to correctly access sensibility on the skin of the foot. The introduction of the Pressure-Specified Sensory Device (PSSD TM in the last decade made possible the measurement of pressure thresholds sensed by the patient, such as touch, both static and in movement, on a continuous scale. This paper is the first in Brazil to report the use of this device to measure cutaneous sensibility in 3 areas of the foot: the hallux pulp, the calcaneus, and the dorsum, which are territories of the tibial and fibular nerves. METHOD: Non-diabetic patients were measured as controls, and 2 groups of diabetic patients - with and without ulcers - were compared. The PSSD TM was used to test the 3 areas described above. The following were evaluated: 1 PS (1-point static, 1 PD (1-point dynamic, 2 PS (2-points static, 2 PD (2-points dynamic. RESULTS: The diabetic group had poorer sensibility compared to controls and diabetics with ulcers had poorer sensibility when compared to diabetics without ulcers. The differences were statistically significant (P A neuropatia diabética é uma complicação importante do Diabetes melitus, responsável por ulcerações e amputações de membros inferiores. A prevenção desses problemas é difícil principalmente pela ausência de métodos que avaliem de forma precisa a sensibilidade cutânea dos pés. A introdução do PSSD TM (Pressure-Specified Sensory Device na década passada tornou possível a medição dos limiares cutâneos de pressão. Estes são sentidos como estímulos táteis tanto estáticos como dinâmicos. Este artigo é o primeiro no Brasil a relatar o uso do PSSD TM para avaliar 3 áreas dos pés: polpa do hallux, calcâneo e dorso do pé, territórios de inervação dos nervos tibial e fibular. MÉTODO: Pacientes não diab

  18. Terapia hormonal y calidad del hueso Hormone therapy and bone quality

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    2005-08-01

    multidisciplinary office of climacteric of “Ramón Gonzales Coro” Gynecoobstetric Hospital from January 1997 to December 2003, it was determined the bone quality by dual X-ray absorptiometry in the lumbar region (L2-L4 or by calcaneus ultrasound (CALUS. They receive continuing treatment with estrogenic therapy (E or with progestogenous estrogens (PE for no less than a year (n = 30. Women who were not able to receive RHT were grouped and evaluated as a control group (n = 12. During an average observation time of 2 years, the females that receieved RHT improved their bone quality in 16.8 %, whereas those of the control group got worse in 8 % of the cases. The initial results, although modest, showed the usefulness of RHT for improving the bone quality and the need to continue carrying out studies that allow to define in our setting the persistance of bone improvement, as well as the magnitude of postmenopausic osteoporosis.

  19. Prevalence of lactose intolerance and its relation with bone mineral density among Malay students of Universiti Kebangsaan Malaysia, Malaysia

    Science.gov (United States)

    Yahya, Noor Fairuzi Suhana; Daud, Norlida Mat; Makbul, Ika Aida Aprilini; Aziz, Qurratul Aini Salma Abdul

    2016-11-01

    Lactose intolerance (LI), a risk factor for low bone mineral density (BMD), is the most common type of carbohydrate intolerance, which predominantly affects Southeast Asian populations. However, data on the prevalence of LI and its association with BMD among Malaysian adults are still lacking as not much research has been done on this matter. Thus, the aims of this study are to determine the prevalence of LI and to evaluate its association with BMD among students of Universiti Kebangsaan Malaysia. A total of 100 Malay students (50 males and 50 females) with mean age of 23.9 ± 4.7 years old and body mass index of 24.5 ± 5.8 kg/m2 were selected to involve in this preliminary study. After an overnight fast, subjects were asked to perform hydrogen breath test (HBT) and lactose tolerance test (LTT) after an intake of 300 ml lactose drink (50g lactose). HBT measurements were recorded at every 30 minutes intervals while LTT results were recorded at fasting and 30 minutes after lactose consumption. Visual analogue scales were used to measure gastrointestinal symptoms. BMD was measured at calcaneus bone using quantitative ultrasound and expressed as T-score. A consistent rise by >20 ppm for HBT and failure of blood sugar to rise by >1.10 mmol/L above basal level were considered as abnormal HBT and LTT. Lactose malabsorption (LM) is defined by abnormal HBT and LTT whilst LI is characterized by having abnormal HBT, LTT and gastrointestinal symptoms. The result showed that 86% male and 90% female subjects exhaled breath hydrogen >20 ppm but there was no significant difference (p>0.05) between them. LTT results showed that 86% male subjects failed to rise their blood sugar level >1.10 mmol/L compared to 60% in female subjects. Both male and female subjects had high percentage occurrence of gastrointestinal symptom (82 % and 80% respectively) although no significant difference (p>0.05) was demonstrated. The prevalence of LI and LM among all subjects was 77% and 18

  20. Lower extremity overuse bone injury risk factors in collegiate athletes: a pilot study.

    Science.gov (United States)

    Reinking, Mark F; Austin, Tricia M; Bennett, Jason; Hayes, Ann M; Mitchell, William A

    2015-04-01

    . Sport (cross-country/track) had a significant relative risk value of 2.26 (95% CI = 1.18-4.32) for LEOBI. There was no association between LEOBI occurrence and sex, hip abductor strength, body mass index, foot type, and menstrual function. There was no difference in bone mineral density at initial or follow-up measures between LEOBI and non-LEOBI groups (p>.05) when analyzing all athletes. When analyzing ground-based athletes only at follow-up (n=44), athletes with LEOBI had lower bone mineral density of right (p = .05) and left (p =.07) calcaneus. The relative risk for developing LEOBI based on calcaneal bone mineral density below the mean of the study participants was 2.1 (95%CI = 1.09-3.35) on the left and 1.53 (95% CI=.80- 3.06) on the right. The incidence of LEOBI in this population of athletes was approximately 10%. Risk factors were sport (cross-country/track) and decreased left calcaneal bone mineral density. This study supports the use of calcaneal bone mineral density as a screening measurement for LEOBI risk and suggests the need for further investigation into additional LEOBI risk factors. 2.

  1. Influência de diferentes comprimentos de onda da laserterapia de baixa intensidade na regeneração tendínea do rato após tenotomia Influence of different low-intensity laser therapy wavelengths for rat tendon regeneration following tenotomy

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    ERB Arruda

    2007-08-01

    wavelengths (670nm and 904nm and in the combination of both on the tissue repair of the calcaneus tendon. METHODS: We used 37 female Wistar rats divided in 5 groups which had been submitted to the total tenotomy. Group GA (n= 8 was submitted to the laser irradiation in lambda= 904nm, GaAS diode, pulsated emission, peak power 15W and dose of 3J/cm², group GB (n= 8 was submitted to laser irradiation lambda= 670nm AlGaInP diode, continuous emission, power 30 mW and dose 3J/cm², group GAB (n= 8 was submitted to association of both of lasers and group GCL (n= 7 which the calcaneum tendon was submitted to placebo treatment. The group GP (n= 6 was a standard group without lesion and treatment. The animals received 12 sessions of lasertherapy and submitted to euthanasia on 14th day after surgery. The tendons were submitted to histological procedure and were analyzed to evaluate the optic retardation (in nm for the birefringence measurement. RESULTS: The statistic analysis showed that the irradiated groups have higher values of optic retardation statistically significant than placebo group (p= 0,00001. It indicates that all the treated groups show better organization of collagen fibers in the longitudinal axis of the tendon, evidencing better quality in the tissue repair. The group GAB was that shown best results (p= 0,00001 when compared to another groups.

  2. Resultado do acompanhamento clínico-radiológico pós-cirúrgico do condroblastoma Results from clinical and radiological follow-up, after surgical treatment of chondroblastoma

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    Valter Penna

    2011-10-01

    technique. METHODS: A retrospective study was conducted on 12 patients with histological diagnoses of chondroblastoma, who were attended between 2003 and 2009 at the Pius XII Foundation (Barretos Cancer Hospital, Barretos, State of São Paulo. These patients underwent surgical treatment with intralesional resection of the tumor, adjuvant electrocauterization and replacement with methyl methacrylate (11 cases or an autologous graft from the iliac crest (one case. The preoperative evaluation included physical examination, plain radiographs of the site, magnetic resonance imaging, computed axial tomography and bone scintigraphy. The patients were assessed clinically and radiologically according to a predefined protocol, with a series of plain radiographs, and a functional assessment in accordance with the Enneking functional score. RESULTS: The average age at the time of diagnosis was 14 years and 4 months. The most frequent location affected was the distal femoral epiphysis (75%, followed by the proximal tibial epiphysis (16.6% and the calcaneus (8.4%. There was higher prevalence among the female patients than among the male patients (3:1. In three cases, preoperative biopsy was necessary. During the follow-up, there was no evidence of local tumor recurrence, and all the patients presented an excellent functional result from the surgical technique used, with Enneking scores ranging from 20 to 30. CONCLUSION: Surgical treatment of chondroblastoma, using intralesional resection, adjuvant electrocauterization and replacement with methyl methacrylate or bone graft produced good results.

  3. How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

    Science.gov (United States)

    Benedetti, Maria Grazia; Okita, Yusuke; Recubini, Elena; Mariani, Elisabetta; Leardini, Alberto; Manfrini, Marco

    2016-04-01

    %) were survivors at the time the study was done, 29 of whom were continuously disease free (64%) and two had no evidence of disease after a pulmonary metastasectomy (5%). These 31 patients were invited to participate in the study, and 25 of the 31 agreed to participate. There were 15 males and 10 females with a mean age of 23.8 years (SD, 7.5 years) and mean followup of 15 years (SD, 5.8 years). Clinical assessment included the MSTS score (total score ranges between 0 and 30 with 0 indicating poor results and 30 indicating good results), obtained by clinical assessment and patient interview, measurements of the residual thigh-shank length and of the contralateral thigh, of the lengths of the surgically treated and contralateral feet, and of active ROM of the rotated and contralateral ankles. Of the 25 patients, 22 (88%) agreed to have lower limb radiographs and 16 (64%) agreed to perform gait analysis. The residual thigh-shank was, on average, 5.8% longer than the contralateral thigh. Differences in the length of the residual thigh-shank relative to the contralateral thigh resulted in altered gait patterns. Patients with longer residual thigh-shank length had greater pseudoknee flexion during stance and swing. Patients with shorter residual thigh-shank length walked with a gait similar to that of controls. The mean MSTS score was 25 (SD, 2). With respect to the contralateral foot, the surgically treated foot was 10% shorter, the talus 11% shorter in the long axis and 7.6% in the short axis and the calcaneus was 2.7% shorter in the long axis and 8.6% in the short axis. Radiologic arthritis was present in most patients at the tibiotalar, subtalar, and talonavicular joints. As adults, our patients showed improved gait parameters compared with previously reported findings for children undergoing rotationplasty. Vertical ground reaction force during midstance was reduced by 6% and knee ROM during the gait cycle was increased by 24.6°. The residual thigh-shank length

  4. [Treatment of 568 patients with frostbite in northeastern China with an analysis of rate of amputation].

    Science.gov (United States)

    Su, Haitao; Li, Zongyu; Li, Yishu; Zhu, Yinglai; Zhao, Hongwei; Kan, Kan; Lyu, Zhuo

    2015-12-01

    To study the key points of treatment and amputation in patients with frostbite, so as to increase the successful rate of the treatment. Five hundred and sixty-eight patients with frostbite admitted to our department from January 2005 to December 2014. (1) For the patients admitted to our department within one week after injury, the frostbite wounds were soaked in 42 °C herbal fluid (twice per day, 30 min for each time) and irradiated with infrared or red light (three times per day, 40 min for each time) from the day of admission to the 7th day after injury. Meanwhile, treatment for improvement of microcirculation, vasodilation, and anti-infection were also given. Then they received infrared or red light irradiation to the wound sites. For the patients admitted to our department longer than one week after frostbite, the frostbite wounds were irradiated with infrared or red light, and treated with antibiotics if inflammation was found around the wound. Among all the patients, 5 cases suffered from frozen stiff, and they were given fluid resuscitation as well as above-mentioned treatments after admission. (2) All patients were given wound treatment immediately after admission. The superficial partial-thickness wounds and deep partial-thickness wounds of 264 patients were given routine dressing change. The full-thickness wounds in 79 patients were treated with exposure therapy after routine dressing change first, and then granulation tissue of these wounds were grafted with autologous thigh split-thickness skin grafts. After debridement and exposure therapy, amputation was done in 225 patients 3 to 4 weeks after injury when the underlying bone was exposed. In 4 patients with exposure of calcaneus, the wounds were covered with reverse sural nerve nutrient vessels island flap. Mean healing time of superficial partial-thickness wound and deep partial-thickness wound, survival rate of skin graft in full-thickness wound, and survival rate of flap covering wound deep to

  5. Status Sistematico del Género Geobatrachus Ruthven 1915 (amphibia: Anura Status Sistematico del Género Geobatrachus Ruthven 1915 (amphibia: Anura

    Directory of Open Access Journals (Sweden)

    Ardila Robayo María Cristina

    1979-06-01

    on in the region showed that its distribution cover the area of humid forest, with frequent mists, at. 1.750-3.000 m., and pointed also that the species tolerates paraclimacic situations (in plantations of Cupressus sp., and Pinus sp. , and their habits are exclusively terrestrial and semifossorial.  Among the external characters it can be emphasized the high degree of chromatic individual variation, the absence of xeromorphic adaptations and specialized glandular complexes in the skin, which point towards an adaptation towards a hygrophilic habitat, added to the extreme reduction of the first pedial digit. The skeleton characters, studied through dissection and differential staining, show a generalized type without pronounced reduction in the cranial elements, the occurrence of non-pedicellated teeth in the maxillary arch, the absence of either phragmotic or fossorial adaptations, or epicraneal ornamentation exostosis; a generalized hyoid apparatus; 8 presacral vertebrae without fusion or imbrication, and with specialized transverse processes; no expanded sacral diapophyses, fused talus and calcaneus and only two tarsalia. The T-shaped terminal phalanges might suggest a preadaptation towards an arboreal way of life (or, conversely, an arboreal ancestor; also the full firmisternal condition of the pectoral girdle and the striking clavicular reduction which would show an apparent relationship with the Microhylids. The following muscular characters are noteworthy: M. intermandibularis with medial raphe, the type "s" insertion of the M. adductor mandibularis subexternus, the distal tendon of M. semitendinosus passing ventral to the Mm. graciles, the insertion over the knee of the M. adductor longus, and the absence of an accessory head (or tendon in the M. glutaeus magnus (an unique condition among the Neobatrachia, presumably due to secondary loss.  In contrast with previous wrong assertions, a direct development (without free larval stages was confirmed, a condition