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Sample records for intraarticular calcaneal fractures

  1. Clinical Outcome Scoring of Intra-articular Calcaneal Fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); M.J. Heetveld (Martin); P.G.H. Mulder (Paul); P. Patka (Peter)

    2008-01-01

    textabstractOutcome reporting of intra-articular calcaneal fractures is inconsistent. This study aimed to identify the most cited outcome scores in the literature and to analyze their reliability and validity. A systematic literature search identified 34 different outcome scores. The most cited outc

  2. Percutaneous treatment of displaced intra-articular calcaneal fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); I.B. Schipper (Inger); L.M.M. Vogels (Lucas); A.Z. Ginai (Abida); P.G.H. Mulder (Paul); M.J. Heetveld (Martin); P. Patka (Peter)

    2007-01-01

    textabstractBackground. The outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues. To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and fixation have been

  3. Clinical Outcome Scoring of Intra-articular Calcaneal Fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); M.J. Heetveld (Martin); P.G.H. Mulder (Paul); P. Patka (Peter)

    2008-01-01

    textabstractOutcome reporting of intra-articular calcaneal fractures is inconsistent. This study aimed to identify the most cited outcome scores in the literature and to analyze their reliability and validity. A systematic literature search identified 34 different outcome scores. The most cited

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2010-08-01

    Depending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients with 37 secondary arthrodeses (17 subtalar and 20 triple) with a median follow-up of 116 months were asked to complete questionnaires regarding disease-specific functional outcome (Maryland Foot Score, MFS), quality of life (SF-36) and overall satisfaction with the treatment (Visual Analogue Scale, VAS). Patient groups were comparable considering median age at fracture, initial treatment (conservative or operative), time to arthrodesis, median follow-up, and post-arthrodesis radiographic angles. The MFS score was similar after subtalar versus triple arthrodesis (59 vs. 56 points; P = 0.79). No statistically significant difference was found for the SF-36 (84 vs. 83 points; P = 0.67) and the VAS (5 vs. 6; P = 0.21). Smoking was statistically significantly associated with a non-union (χ(2) = 6.60, P = 0.017). The current study suggests that there is no significant difference in functional outcome between an in situ subtalar or triple arthrodesis as a salvage technique for symptomatic arthrosis after an intra-articular calcaneal fracture. Smoking is a risk factor for non-union.

  6. Clinical Analysis of Internal Fixation Treatment of Intra-articular Calcaneal Fractures with Titanium Plate.

    Science.gov (United States)

    Chen, Xiao-Dong; Zhang, Chang-Chun; Li, Zhao-Cheng; Zhang, Heng; Zhou, Xin-She; Deng, Min

    2015-05-01

    To explore the clinical effect of internal fixation treatment of intra-articular calcaneal fractures with titanium plate, we used open reduction and internal fixation with titanium plate to 48 treated feet from 42 patients with intra-articular calcaneal fractures. The efficacy of surgical treatment was evaluated based on assessment of pain, function, and line of force aspects according to the American Orthopedic Foot and Ankle Society scoring system. Our data show that internal fixation with titanium plate is an effective treatment for calcaneal fractures. It provides satisfactory reduction, reliable fixation, and early rehabilitation.

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  8. Protective Effect of Surgery Against Early Subtalar Arthrodesis in Displaced Intra-articular Calcaneal Fractures

    Science.gov (United States)

    Liu, Yueju; Li, Zhi; Li, Heng; Zhang, Yingze; Wang, Pengcheng

    2015-01-01

    Abstract The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment. The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67–7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001). Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures. PMID:26559281

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

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2011-01-01

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

  10. Open Reduction and Internal Fixation of Displaced Calcaneum, Intra-Articular Fractures by Locking Calcaneal Plate

    Science.gov (United States)

    Santosha; Singh, Arambam Mahendra; Waikhom, Sanjib; Pakhrin, Vishal; Mukherjee, Sagnik; Debbarma, Rajkumar; Prashant, Prabhu Shrinivas

    2016-01-01

    Introduction Calcaneal fractures constitute the most common fractures in hindfoot. Lots of controversies exist in the management of calcaneal fractures but now-a-days, it is preferable to perform open reduction and internal fixation and early mobilizatation. Aim To evaluate the functional outcome after open reduction and internal fixation of displaced intra-articular fractures of the calcaneum by locking calcaneal plate. Materials and Methods The study was conducted in the Department of Orthopaedic Surgery from September 2013 to April 2016. Thirty intra-articular fractures of the calcaneum were treated by locking calcaneal plate. Patients were followed up for a period of 24 months. Bohler’s angle was measured in preoperative, immediate Post-operative period and after 2 years, follow-up was compared. Results were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results After 24 months of follow-up, all 24 patients were available for evaluation. Radiological union was achieved in a mean time of 12.5 weeks. Mean duration of hospital stay was 21 days. Bohler’s angle was significantly higher after 2 years of follow-up when compared with preoperative x-ray. According to the AOFAS, Ankle–Hind foot Scale outcome score results were excellent in 43.3% of the patients, good in 33.3%, fair in 10%, and poor in 13.3% of patients. The mean AOFAS score was 79.9 (Range 49-96). Conclusion Open reduction and internal fixation of intra-articular fractures of the calcaneum with locking calcaneal plate gives good results. Maintenance of calcaneal height and Bohler’s angle helps to decrease the incidence of subtalar arthritis. PMID:28208957

  11. [Reconstruction of calcaneal thalamus and subtalar arthrodesis to treat old antiquated intra-articular calcaneal fractures of Sanders type III].

    Science.gov (United States)

    Sun, Qing-Peng

    2013-11-01

    To observe the outcome of treatment for serious old intra-articular calcaneal fracture by reconstruction of calcaneal thalamus and subtalar arthrodesis and to summarize the operative indications and its attention points. From March 2006 to July 2011,26 patients with Sanders type III old intra-articular calcaneal fracture were treated including 15 males and 11 females with an average age of 34 years old ranging from 27 to 45 years old. The clinical courses ranged from 7 to 24 months with an average of 18 months. Before the operation,X-ray and CT showed that Gissane angle increased while Böhler angle decreased,and calcaneus broadened,bulging on both sides. After the operations,all patients tested by imaging examination, and the width of calcaneus, the height of calcaneal thalamus, the Böhler angle and Gissane angle were measured to compare with the preoperative data. Besides, for identification of improvement of the operation,the functions of patient's feet after the operation were graded according to AOFAS Ankle-Hindfoot Scale to compare with preoperative data. Among them, 24 patients were followed-up from 5 to 26 months with an average of 19 months. X-rays confirmed that all cases healed successfully. There were no serious infection, and only one skin necrosis case. Sural neurocutaneous island flap was used to repair the skin with success. According to AOFAS Ankle-Hindfoot Scale, the total score increased from preoperative (41.00 +/- 8.22) to postoperative (79.04 +/- 7.46). There were 3 cases of excellent result, 15 cases of good result,and 6 cases of fair result. Postoperative width of calcaneus, the height of thalamus, Böhler angle and Gissane angle were better than that of preoperative data, and had statistical significance between two groups. Subtalar arthrodesis with the reconstruction of calcaneal thalamus is an effective way to treat old intra-articular calcaneal fractures. It can correct the calcaneal deformity, restore the shape of foot and improve the

  12. 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

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

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

    Institute of Scientific and Technical Information of China (English)

    Saurabh Jain; Anil Kumar Jain; Ish Kumar

    2013-01-01

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

  14. The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    WANG Hong; ZHANG Qingsong; DUAN Deyu; YAN Lijun

    2006-01-01

    To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months (range 12-30 months). The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation (P<0.01), the total excellent and fine rate was 91.86 %. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

  15. Percutaneous reduction and fixation of intraarticular calcaneal fractures

    NARCIS (Netherlands)

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

    2008-01-01

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

  16. A Three-Dimensional Finite Element Analysis of Displaced Intra-Articular Calcaneal Fractures.

    Science.gov (United States)

    Xu, Can; Liu, Hua; Li, Mingqing; Wang, Chenggong; Li, Kanghua

    A better understanding of displaced intra-articular calcaneal fractures, their effect on joint mechanics, and the relationship between altered mechanics and osteoarthritis could aid in the development or refinement of treatment methods. Finite element modeling is accepted as the reference standard for evaluating joint contact stresses. The objective of the present study was to analyze the in vivo joint mechanical data from finite element modeling for normal and injured subtalar joints. A 3-dimensional model of the ankle-hindfoot was developed and validated. Both height loss and width increases in the calcaneus were simulated. Next, they were used to investigate the relationship between calcaneal height or width and the contact mechanics of the posterior facet of the subtalar joint. The contact area/joint area ratio increased in the subtalar joint with injury when the calcaneal width increased. Moreover, the peak contact pressure and the proportion of the area under high contact pressure (>6 MPa) increased. The contact area/joint area ratio decreased with reduced calcaneal height, but the peak contact pressure remained almost constant. The width increases of the calcaneus somewhat limited the subtalar joint motion, especially for eversion; however, the height loss mostly resulted in subtalar rotatory instability. The height loss diminished the subtalar joint's stability in eversion, internal rotation, and external rotation. The results of the present study support the advisability of surgery for these complex injuries. Reestablishing the calcaneal height and width could restore the normal kinematics and contact stress distribution in the subtalar joint, improve the tibiotalar position, and diminish long-term degeneration in the ankle.

  17. Protective Effect of Surgery Against Early Subtalar Arthrodesis in Displaced Intra-articular Calcaneal Fractures: A Meta-Analysis.

    Science.gov (United States)

    Liu, Yueju; Li, Zhi; Li, Heng; Zhang, Yingze; Wang, Pengcheng

    2015-11-01

    The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment. The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67-7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001).Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures.

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

    LENUS (Irish Health Repository)

    Kennedy, J G

    2012-02-03

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

  19. Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.

    Science.gov (United States)

    Potenza, V; Caterini, R; Farsetti, P; Bisicchia, S; Ippolito, E

    2010-07-01

    We report the short- and mid-term results in six patients (seven feet) affected by markedly comminuted intra-articular calcaneal fractures (Sanders type IV), treated by primary subtalar arthrodesis. The average age at surgery was 40 years. In all patients, arthrodesis of the subtalar joint was performed using a limited lateral approach to the calcaneus; it was stabilised with two or three cannulated screws. No patient had a preliminary reduction and internal fixation of the fracture. The time from injury to surgery averaged 20 days because all of the patients had associated visceral and/or other skeletal injuries. All of the patients were followed up clinically and radiographically 2 times, at an average of 12 months and 53 months after surgery. At the short-term follow-up, the mean AOFAS score was 70 points; the X-rays showed a complete fusion of the subtalar joint in all seven feet, without any sign of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints. In all cases, an altered shape of the calcaneus was present. At the mid-term follow-up, the mean AOFAS score increased to 85 points; in one patient, radiographic signs of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints were present and, in another patient, only talo-navicular joint was present, although both patients were free from pain. The difference between the two AOFAS scores was statistically significant. We believe that primary subtalar arthrodesis performed for markedly comminuted Sanders type IV calcaneal fractures yielded good mid-term results, and it is especially indicated when surgical treatment is delayed for whatever reason. A preliminary open reduction and internal fixation to restore the normal height of the calcaneus before performing the subtalar arthrodesis, as suggested by several authors, does not seem indispensable to obtain good clinical results. 2009 Elsevier Ltd. All rights reserved.

  20. 跟骨关节内骨折--手术治疗%Intraarticular calcaneal fractures Operative management

    Institute of Scientific and Technical Information of China (English)

    Tim Pohlemann; David Ring; Hartmut R.Siebert

    2004-01-01

    Evidence is lacking from these trials concerning the optimal procedure for treatment of displaced intraarticular calcaneal fractures. Clinical trials comparing different treatment , especially as they relate to potential risk fractors such as fracture classification, should be explored.%这些研究没有证明何种方法是治疗跟骨关节内移位骨折的最佳手术方法.应该对比较性临床研究进行探讨,尤其是不同治疗方法与潜在的风险因素如骨折类型的相关性.

  1. 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

  2. Effectiveness of MIS technique as a treatment modality for open intra-articular calcaneal fractures: A prospective evaluation with matched closed fractures treated by conventional technique.

    Science.gov (United States)

    Dhillon, Mandeep Singh; Gahlot, Nitesh; Satyaprakash, Sambit; Kanojia, Rajendra Kumar

    2015-09-01

    Twenty-five displaced intra-articular calcaneal fractures in 21 patients, aged 15-55 years were included in this study. Sanders' type I fractures, severe crushing or partial amputation, were excluded from the study. Patients were divided into group 1 (open fractures treated by MIS), and group 2 (closed fractures treated by ORIF). Group 1 had 16 and group 2 had 9 cases. Seven of 25 fractures (28%) developed wound related issues postoperatively. One patient (11.1%) in group 2 had wound margin necrosis, while 6 patients (37.5%) in group 1 developed pin tract and/or wound infection. At 1-year follow-up, the mean MFS for group 1 was 79 and mean MFS for group 2 was 84.4 (66.67% were good). The AOFAS score for group 1 was 77.37 and for group 2 was 86.1. The Bohlers' angle was restored in 81.16% cases in group 1 and 88.8% in group 2, while Gissane angle was restored in 68.75% of group 1 cases and 77.79% of group 2 cases. This study shows that acceptable fracture reduction can be obtained and maintained by MIS technique and it can be used as the primary definitive treatment option in open calcaneal fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.

    Science.gov (United States)

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

    2013-09-24

    Controversy exits over the role of Böhler's angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler's angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler's angle and functional outcome. Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler's angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler's angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler's angle by ratio was calculated by dividing the difference value of Böhler's angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler's angle, difference value of Böhler's angle between bilateral calcaneus, and change in Böhler's angle by ratio each has a significant correlation with Sanders classification (rs=-0.178, P=0.003; rs=-0.174, P=0.004; rs=-0.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements

  4. Experimental intra-articular calcaneal fractures: anatomic basis for a new classification.

    Science.gov (United States)

    Carr, J B; Hamilton, J J; Bear, L S

    1989-10-01

    Experimental calcaneus fractures were produce by axially loading 18 specimens. Anatomic dissections were performed and documented. Two constant primary fracture lines were identified, dividing the calcaneus in the coronal and sagittal planes. A constant anterolateral fragment was identified, as were three patterns of calcaneocuboid joint fracture involvement. Based on the pathoanatomy and surgical anatomy of the calcaneus, a medial and lateral column classification is proposed. The medial column includes the superomedial fragment. The lateral column includes the calcaneocuboid joint, lateral wall and posterior facet. This concept can help identify fracture displacements and correlate them with a treatment plan.

  5. 开放性跟骨关节内骨折的手术治疗%Surgical treatment of open intraarticular calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    孙洋; 曲家富; 曹利海; 闫荣亮

    2013-01-01

    Objective To investigate effect of surgical treatment for open intraarticular calcaneal fracture.Methods A total of 128 patients (141 feet) with open intraarticular calcaneal fracture combined with severe soft tissue injury were treated,in the early stage of treatment,the primary purposes were to achieve soft tissue coverage for wound healing,and to reduce calcaneal fracture for avoiding increase of skin tension and contracture of Achilles tendon.In the first stage operation,the fractures were reduced by drawing,prying or manual reduction to restore the width,height and length of calcaneus,and then fixed with screws or Kirschner wires.Finally vacuum sealing drainage(VSD) was used to cover wound according to degree of injury.In the second stage operation,open reduction and internal fixation or reconstruction of calcaneal thalamus combined with subtalar arthrodesis were used according to Sanders classification.Results All patients werefollowed up for 18 months to 6 years (average,40 months).The average wound healing time was 16 days,and the first rate healing rate was 90.8%.The total infection rate was 9.2%,including superficial infection rate of 7.8% and deep infection rate of 1.4%.According to AOFAS classification,functional recovery was excellent in 58 feet,good in 70 feet,fair in 10 feet and poor in 3 feet,the excellent and good rate was 90.8%.Conclusion For open intraarticular calcaneal fracture combined with severe soft tissue injury,different methods should be used according to degree of injury and fracture style.Usually,the VSD should be used for patients with severe soft tissue injury,which can significantly reduce infection rate and improve effect.%目的 探讨开放性跟骨关节内骨折手术治疗的有效方法.方法 对Gustilo Ⅱ型以上128例(141足)跟骨关节内骨折,早期解决软组织覆盖及伤口愈合问题,尽量恢复跟骨正常骨性结构,用螺钉或克氏针临时固定骨折,均采用VSD技术治疗为后期处理

  6. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review.

    Science.gov (United States)

    Sharr, P J; Mangupli, M M; Winson, I G; Buckley, R E

    2016-03-01

    Management of Displaced Intra-articular Calcaneal Fractures (DIACFs) continues to be technically demanding. The literature has not been definitive in its guidance for surgeons dealing with these injuries. Recent publications have further added to the lack of clarity. This review is intended to summarise the present state of knowledge, and provide some genuine guidance for clinicians. To review previous research, focussing on articles published within the last fifteen years, and summarise the findings to aid surgeons in managing DIACFs with choosing best management for patients. We reviewed the best evidence and literature, focussing on articles published within the last fifteen years, and summarised findings into workable recommendations. Variables of (1) patient, (2) the associated soft tissue injury and (3) the fracture characteristics were used to aid surgeons in choosing the best of the available options for each patient that presents with a DIACF. Management of DIACFs can best be divided into four broad categories: (i) non-operative management, (ii) open reduction and internal fixation, (iii) minimally invasive reduction and fixation, and (iv) primary subtalar arthrodesis. The evolution of the literature would suggest orthopaedic surgeons managing calcaneus fractures should have an expert's knowledge, surgical expertise and the latest techniques to cover these four options, to tailor the treatment of DIACFs to the individual patient. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2009-01-01

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

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

    Science.gov (United States)

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

    2016-07-15

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

  10. 改良外侧“L”形切口治疗跟骨关节内移位骨折%The effect of surgical treatment of displaced intra-articular calcaneal fracture via modified lateral Lshaped incision

    Institute of Scientific and Technical Information of China (English)

    梁军; 辛景义; 曹红彬

    2012-01-01

    目的 探讨改良外侧“L”形切口治疗跟骨关节内移位骨折的临床疗效.方法 自2005年1月至2011年10月收治跟骨关节内移位骨折患者133例143足,男125例,女8例;年龄19~65岁,平均43.2岁.左侧56例,右侧67例,双侧10例,均为闭合骨折.其中3例合并脊柱损伤.根据Sanders分型:Ⅱ型15足、Ⅲ型107足、Ⅳ型21足.均采用外侧改良“L”型切口,切开复位异型钢板内固定.术后均未给予石膏外固定,早期行踝关节功能练习,术后6周部分负重,12周完全负重.采用美国足与踝关节外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统评价术后足踝功能.结果 125例135足获得随访(8例8足术后12周后失访),随访时间12~28个月,平均18.5个月.骨折均愈合,愈合时间8~16周,平均13周.无神经损伤,骨髓炎.4足切口裂开,骨折愈合内固定钢板取出后皮肤愈合.17足发生距下关节创伤性关节炎,行走时疼痛.5足负重后关节面出现塌陷.根据AOFAS踝与后足功能评分系统,优94例、良29例、可14例、差6例,优良率为92.9%.结论 应用改良外侧切口切开复位异型钢板内固定治疗跟骨关节内移位骨折可以获得满意疗效,但在临床应用中需要掌握熟练手术技术.%Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type

  11. Effect of sustentaculum tali screw placement after open reduction and internal fixation of intraarticular calcaneal fractures%切开复位内固定跟骨关节内骨折后载距突固定效果

    Institute of Scientific and Technical Information of China (English)

    强敏菲; 陈雁西; 张坤; 李浩博; 戴号

    2014-01-01

    Objective To investigate the effect of sustentaculum tali screw placement on outcomes following open reduction and internal fixation (ORIF) of intraarticular calcaneal fractures.Methods A retrospective analysis was made on 139 patients with intraarticular calcaneal fractures treated by ORIF from April 2008 to January 2012.According to Sanders classification,there were 9 patients with type Ⅱ fractures,87 with type Ⅲ fractures and 43 with type Ⅳ fractures.Fracture reduction followed by placement of calcaneal anatomic plate or anatomic locking plate was performed via calcaneal lateral L-shape incision.All the patients received X-rays and CT scans within postoperative 2 weeks.Placement of screws in sustentaculum tail was detected by CT volume rendering to visualize implants combined with multiplanar reconstruction imaging (MPR).Patients were divided into accurate fixation group (Group A,n =28),marginal fixation group (Group B,n =58),and non-fixation group (Group C,n =53) based on radiological results.Intra-and peri-operative parameters,time to partial weight-bearing,time to full weight-bearing,fracture healing time,and clinical outcome were compared among groups.Functional outcome was assessed using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale.Results Postoperative X-rays indicated accurate fixation of sustentaculum tail in 64 patients,marginal fixation in 22,and non-fixation in 53,but CT images manifested accurate fixation in 28 patients,marginal fixation in 58,and non-fixation in 53.Group A had operation duration of (93 ±11) min and intraoperative blood loss of (252 ± 27) ml,longer or higher than those in Group B [(85 ±8) min,(194±16) ml] and Group C [(57±6) min,(136 ±13) ml] (P<O.05).There was no significant difference in mean hospital stay among the three groups (P > 0.05).Ninety-two patients were followed-up for 12-38 months (mean 18.5 months) and 85 patients completed foot and ankle exercise as planned

  12. 切开复位内固定治疗移位的跟骨关节内骨折的疗效分析%Open reduction and internal fixation for displaced intra-articular calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    李喜功; 孙俊英; 殷浩; 宋兵华; 朱若夫; 唐祖林

    2008-01-01

    Objective To evaluate open reduction and internal fixation for displaced intra-articular calcaneal fractures and analyze factors affecting its clinical results. Methods From March 2004 to July 2006,46 displaced intra-arficular calcaneal fractures in 40 patients were surgically treated by open reduction and internal fixation.According to Sanders classification,there were 16 cases of type Ⅱ,19 cases of type Ⅲ and 11 cases of type Ⅳ. Results All the patients were followed up for anaverage of 18(13 to 28)months.The effects of treatment were evaluated according to Maryland Foot Score:excellent in 21 feet,good in 16 feet,fair in 6 feet,poor in 3 feet. The total good to excellent ratewas 82.6%.The respective good to excellent rates were 93.8%for type Ⅱ fractures,84.2%for type Ⅲ,and 54.5%for type Ⅳ;87.2%for the group with time interval from injury to surgery ≤14d,and 42.9%for the group with time interval>14d;37.5%for thegroup with B(o)hler angle<15°,and 89.5% for the group with B(o)hler angle≥15 °.91.2%for the group with reduction of intra-articular calcaneal fractures ≤2 mm,and 45.5% for the group with the reduction>2mm.The differences within each factor group were statistically significant(P<0.05). Conclusions Open reduction and internal fixation fordisplaced intra-articularcalcaneal fractures is a good method.Fracture type,time interval from injury to surgery,B(o)hler angle reduction,reduction of intra-articular calcaneal fractures are important factors affecting outcome of operation.%目的 评定切开复位内固定治疗移位的跟骨关节内骨折的疗效,并分析其影响因素.方法 回顾性分析2004年3月至2006年7月收治的采用切开复位内固定治疗的移位跟骨关节内骨折40例(46足).按照Sanders分型:Ⅱ型16足,Ⅲ型19足,Ⅳ型11足,总结评定其临床疗效并分析影响疗效的相关因素. 结果 所有患者均得到随访,平均随访18个月(13~28个月).根据Maryland足部评

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

    NARCIS (Netherlands)

    T. Schepers (Tim)

    2013-01-01

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

  14. 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 c

  15. 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

  16. Surgical treatment of displaced intraarticular calcaneal fractures in children%应用跗骨窦有限切口克氏针内固定加植骨治疗儿童跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    李凡; 勘武生; 刘郁东; 徐剑; 李明静

    2015-01-01

    Objective To retrospectively evaluate the surgical outcomes of displaced intraarticular calcaneal fractures in children after open reduction,internal fixation with Kirschner wire and bone grafting via limited tarsal sinus incision.Methods The clinical data of 26 boys (77 sides) with displaced intraarticular calcaneal fractures from June 2010 to February 2014 were collected for respective analyses.Limited open reduction,internal fixation and bone grafting via limited tarsal sinus incision with k-wire were performed.Their average age was 9.6 (2-15) years.Preoperative radiographs and computed tomographic scans were used to classify the fractures.According to the Sanders classification,there were 6 feet of type Ⅱ (4 type Ⅱa,2 type Ⅱb),14 feet of type Ⅲ (6 type Ⅲab,5 type Ⅲac & 3 type Ⅲbc) and 7 feet of type Ⅳ.The functional outcomes were assessed by the modified American Orthopedic Foot & Ankle Society (AOFAS) ankle and hindfoot score.Results The mean follow-up period was 21 (8-30) months.All fractures healed clinically after 4 weeks postoperation.In patients with type Ⅱ fractures,B hler angle was restored from 16.8 ± 12.9 to 36.8 ±7.5 (P<0.05)and Gissane angle from 104.8°± 12.8° to 124.3°± 9.6°(P<0.05); In type Ⅲ fractures,B? hler angle improved from 15.4°± 14.1° to 34.4°± 9.1°(P<0.000 1) and Gissane angle from 100.6° ± 10.1° to 119.8° ± 11.7°(P<0.05) ; In type Ⅳ fractures,B? hler angle was restored from 8.6° ± 10.5° to 34.7° ± 5.3°(P<0.05) and Gissane angle from 105.4° ± 4.0° to 121.4° ± 8.9°(P<0.05).The mean modified AOFAS scores were 65.2 ± 2.5,67.0 ± 1.6 and 65.0 ± 2.8 in patients with type Ⅱ,type Ⅲ and type Ⅳ respectively.The differences of AOFAS scores were not statistically significant among three groups (P<0.05).Pin hole infection occurred in one foot.There was on onset of wound infection,tissue necrosis,osteomyelitis or traumatic arthritis.Conclusions Limited open reduction

  17. Minimally invasive plate internal fixation for calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    SHAN Shu-lan; XU Jun-ling; YAO Shu-zhang; YU Guo-sheng; LIU Yu-qin

    2010-01-01

    Objective: To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures.Methods: Manual reduction, rectification of deformity,and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union.Results: All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%.Conclusion: Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation,good recovery, and rare complications in the treatment of intraarticular fractures.

  18. Factors influencing the operative results of displaced intra-articular calcaneal fracture%影响移位关节内跟骨骨折手术疗效的因素

    Institute of Scientific and Technical Information of China (English)

    宋兵华; 孙俊英; 倪增良; 何斌; 成文; 童舜谊

    2015-01-01

    Objective To determine the factors influencing the results of open reduction and internal fixation for displaced intra-articular calcaneal fracture (DIACF).Methods From May 2009 to June 2013, 80 patients with DIACF involving in 91 feet were treated by open reduction and internal fixation.Mean age was 38.7 years (range, 18-72 years).Patients were grouped according to the possible factors related to the operative results, including the Sanders classification of fracture, quality of fracture reduction, postoperative B(o)hler angle, width of postoperative calcaneus, and time to surgery after injury.Clinical result was evaluated and compared within each group.Results Mean duration of follow-up was 18.3 months (range, 14-26 months).The clinical results were excellent for 67 feet (74%), good for 12 feet (13%), fair for 7 feet (8%) and poor for 5 feet (5%), which yielded 87% good to excellent results.Good to excellent results in Sanders Ⅱ , Ⅲ and Ⅳ groups reached 94%, 85% and 53% respectively, in quality of fracture reduction ≤ 2 mm and > 2 mm groups reached 93% and 30% respectively, in postoperative B(o)hler angle < 15° and ≥15° groups reached 33% and 90% respectively;in broadening of postoperative calcaneus < 1 cm and ≥ 1 cm groups reached 92% and 17% respectively, in time to surgery after injury ≤14 days and > 14 days groups reached 91% and 43% respectively, in age ≤60 years old and > 60 years old groups reached 85% and 88% respectively.Except for the age group, the clinical result differed significantly within group (P < 0.05).Conclusions Fracture type, reduction quality, postoperative B(o)hler angle, width of postoperative calcaneus, time to surgery after injury are the factors influencing on the operative results of patients with displaced intra-articular calcaneal fracture.Thereupon the unfavorable influences should be avoided to improve the operative results.%目的 探讨影响移位关节内跟

  19. Primary subtalar joint arthrodesis with internal and external fixation for the repair of a diabetic comminuted calcaneal fracture.

    Science.gov (United States)

    Facaros, Zacharia; Ramanujam, Crystal L; Zgonis, Thomas

    2011-01-01

    Comminuted, intra-articular calcaneal fractures can cause severe lower extremity impairment and have devastating effects on a patient's well being. Diabetes is a multisystem process that may cause neuropathy and loss of protective sensation further complicating the prognosis. Not all calcaneal fractures are created equal and when considering the patient's overall presentation and extent of injury, the combined approach of internal and external fixation for fracture reduction may be beneficial for restoration of anatomic alignment and function. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Schepers, T

    2013-03-01

    The late complications following a displaced intra-articular calcaneal fractures includes painful arthrosis for which a subtalar fusion might be considered. In case of malalignment due to loss of height and varus deformity a reconstructive arthrodesis is necessary. The primary aim of the current review study was to assess the functional outcome of the subtalar distraction bone block arthrodesis in the management of late complications of displaced intra-articular calcaneal fractures. The literature was searched for studies in which a subtalar distraction bone block arthrodesis was used in the management of persistent complaints following a displaced intra-articular calcaneal fractures, after its first description in 1988 up to November 1st 2011. The methodological quality of the included studies was assessed using the Coleman Methodology Score. Twenty-one studies reporting on 456 patients were identified. In 93 percent the procedure was a salvage procedures following the late complications of a calcaneal fracture (372 cases). Duration of follow-up ranged from 21 to 108 months (average 40 months). Union rates were reported with an overall average of 96% (range 83-100%). The average modified AOFAS score (maximum 94 points) was 73 points at final follow-up (range 64-83 points). Six studies reported pre- and post-reconstruction AOFAS outcome scores with an average increase of 44.2 points. Wound complications occurred in approximately 6%. With the exception of one study all were level 4 retrospective case series, with an average Coleman Methodology Score of 55 (range 41-79) points. The subtalar distraction bone block arthrodesis is a technically demanding procedure which, in the right hands, provides an overall good result. This is reflected in a significant increase in outcome scores post-operatively. Although most complications are considered minor, there are several pitfalls which should be recognized and avoided. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. LATERAL APPROACH UNDER FLUROSCOPIC GUIDANCE WITH NONLOCKING CALCANEAL PLATE IS AN EFFECTIVE TECHNIQUE FOR CLOSED CALCANEAL FRACTURE

    Directory of Open Access Journals (Sweden)

    Alok Sobhan

    2014-06-01

    Full Text Available Intra-articular calcaneal fractures which accounts for about 75% of calcaneal fractures is usually associated with poor functional outcome. The present was under taken to evaluate the efficacy of open reduction and internal fixation of displaced articular fractures of calcaneum in adults through lateral approach under fluroscopic guidance with non-locking calcaneal plate and ipsilateral iliac crest bone graft. 30 adult patients (25 males and 5 females with closed displaced intra articular fractures of calcaneum of less than 15 days constituted the study group. All cases were operated by lateral approach as described by Seligson, a modification of Gould’s technique under spinal anaesthesia. All machers Arthrosis Rating Scale were used for the evaluation of posttraumatic posterior facet degenerative changes. Primarily27 of all 35 wounds (77% healed without any form of wound complications. Excellent to good results noted in 3 (100% patients with preoperative Bohler´s angle larger or equal to 20° (n = 3 whereas patients with preoperative Bohler´s angle smaller than 20° (n=32 achieved excellent to good results in 16 cases (50% Clinically significant subtalararthrosis (Allmacher grade 2-4 noted in 7 cases (20% cases with Bohler´s angle smaller than 20° (n=32. In 5 cases, clinically significant complaints (Allmachers Arthrosis Rating Scale grades II to V noted. Therapeutic success of such fracture depends on timely open reduction and internal fixation with proper fracture reduction and early rehabilitation. Thus management of these injuries as well as complications should be performed in a specialized orthopaedics or traumatology center.

  2. Comparison of clinical effects between external fixator combined with limited internal fixation and plates for treatment of intraarticular calcaneal fractures%外固定架结合有限内固定与钢板内固定治疗跟骨关节内骨折比较

    Institute of Scientific and Technical Information of China (English)

    柴雷子; 薛锋; 丁亮; 沈玉春; 赵勇

    2013-01-01

    Objective To investigate the clinical effects of the external fixator combined with the limited internal fixation for the treatment of intrarticular calcaneal fractures.Methods According to different ways of treatment of intraarticular calcaneal fractures,78 patients(86 feet) were divided into two groups:42 patients(48 feet) were treated with the external fixator combined with the limited internal fixation as group A; 36 patients (38 feet) were treated with plates as group B.Fracture healing time,recovery of the calcaneal,clinical outcomes and the rate of incision complications were compared.Results A total of 78 cases were followed up for 8~34 months (average 16.8 months).Both group A and B all had acceptable reduction in calcaneal length,height,width,Bohler angle,and Gissane angle,there was significant difference between preoperative and postoperative results(P <0.05),and there was no signicant difference in postoperative results between group A and group B(P >0.05).Based on the Maryland grading system,excellent rate was 89.6% in the group A,excellent rate was 86.8% in the group B,there were no significant difference between them(P >0.05).The rate of incision complications in the group A was lower than in the group B,there was significant difference between them (4.2% vs 21.1%,P <0.05).Conclusion External fixator combined with limited internal fixation for intraarticular calcaneal fractures is satisfactory and minimally invasive.%目的 探讨外固定架结合有限内固定治疗跟骨关节内骨折的临床疗效.方法 78例(86足)跟骨关节内骨折分为2组:A组42例(48足)采用外固定架结合有限内固定治疗;B组36例(38足)采用钢板内固定治疗.对两组骨折愈合时间、跟骨恢复情况、临床疗效、切口并发症发生率等指标进行比较.结果 78例均获得平均16.8(8~34)个月随访.两组术后跟骨的长度、宽度、高度、Bohler角及Gissane角均得到了良好的恢复,与术前比较

  3. Calcaneal chondroblastoma with pathologic fracture and recurrence.

    Science.gov (United States)

    Dutt, Laksha; Schade, Valerie L; Manoso, Mark W

    2015-01-01

    Chondroblastomas account for 80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point.

  4. Curative effect of anatomical Ti-plate fixation combining with bone graft in the treatment of intra-articular calcaneal fractures%解剖型跟骨钛板并植骨治疗跟骨关节内骨折的临床疗效

    Institute of Scientific and Technical Information of China (English)

    王怀斌; 袁志; 裴国献; 刘建; 毕龙; 王连军; 孙克理; 隋天棋

    2014-01-01

    Objective To investigate the curative effect of anatomical Ti-plate combined with bone graft in treatment of intra-articular calcaneal fractures .Methods Retrospective analysis was conducted in 25 patients with 33 feet from Mar.2009 to May 2012,who were diagnosed as Sanders typeⅡ-Ⅳintra-articular calcaneal fractures .There were 20 males(26 feet) and 5 females (7 feet) with average age of (36.16 ±14.63)years(ranged from 15 to 65 years old) .There were 17 cases of single foot injury and 8 cases of double feet injury .All the patients were treated with Ti-plate fixation combined with bone graft and their calcaneal anatomic forms were recovered during operation .Mary-land foot score was used to evaluate the postoperative function .Results All the 25 cases (33 feet) were followed up for 12-36 months,with a mean time of 19.3 months.According to Maryland foot score ,17 feet were rated as excellent , 12 feet as good,4 feet as moderate.The excellent and good rate was 87.88 %.Conclusion Anatomical Ti-plate combined with bone graft for treatment of intra-articular calcaneal fractures can restore the smoothness of subtalar joint surface,help patients take earlier functional exercise and obtain a reliable curative effect .%目的:探讨解剖型跟骨钛板并植骨治疗跟骨关节内骨折的临床疗效。方法选择2009年3月~2012年5月期间收治的25例(33足)SanderslⅡ~Ⅳ型跟骨关节内骨折患者,男性20例(26足),女性5例(7足);年龄15~65岁,平均(36.16±14.63)岁。单足17例,双足8例,采用切开复位解剖型跟骨钛板内固定并植骨进行治疗,术中恢复跟骨解剖形态,按Maryland足部评分系统进行术后功能评分,评价手术效果,进行系统的回顾性总结分析。结果本组25例(33足)术后均获12~36个月随访(平均19.3个月),按Maryland足部评分标准:优17足、良12足、可4足,差0足;优良率为87.88%。

  5. [Gait analysis after intra-articular calcaneus fractures].

    Science.gov (United States)

    Siegmeth, A; Petje, G; Mittlmeier, T; Vécsei, V

    1996-01-01

    We retrospectively compared 20 patients with displaced intra-articular calcaneal fractures by clinical assessment and dynamic pedography. Eleven were treated operatively, 9 conservatively. The purpose was to identify differences in post-traumatic gait performance and to correlate the pedographic data to a clinical score to show its reliability. Twenty individuals without a history of foot injuries were used as a control group. Both groups had restricted motion in the subtalar joint, increased hindfoot and midfoot loading and decreased forefoot loading. Furthermore, they showed prolonged contact phases and an impaired ability to speed up gait during the toe-off phase. Load transfer from the hindfoot to the forefoot showed typical distribution patterns. The operatively treated group showed better functional results with fewer subjective complaints.

  6. Combination of plate screw and Steinmann pin in repair of comminuted calcaneal intra-articular and posterosuperior fractures%钢板螺钉结合斯氏针内固定修复粉碎性跟骨关节内伴后上方骨折

    Institute of Scientific and Technical Information of China (English)

    李广峰; 张鑫; 彭勇; 吴献民; 王思成; 杨国庆; 张友忠; 曹中华; 何国云; 尹志峰; 杨笑宇

    2014-01-01

    背景:目前跟骨关节内粉碎性骨折的治疗方案一般选择钢板螺钉内固定,但对于伴有跟骨后上方骨折的病例,往往因为跟腱牵拉及钢板螺钉内固定的薄弱导致骨折复位困难或者复位难以保持。目的:探讨切开复位钢板螺钉结合斯氏针置入内固定在粉碎性跟骨关节内移位骨折伴后上方骨折中的疗效。方法:选取2009年12月至2013年12月上海中冶医院骨科收治的粉碎性跟骨关节内骨折伴跟骨后上方骨折患者40例,随机分为2组。对照组予切开复位钢板螺钉内固定,试验组予切开复位钢板螺钉结合斯氏针内固定。分别于术前、术后4周测量患者GISSANE角、BOHLER角,末次随访时进行MARYLAND足部评分,并进行组内及组间比较。结果与结论:所有患者均获随访,时间9-23个月。两组患者术后4周BOHLER角、GISSANE角均显著大于术前(P <0.05);术后4周试验组BOHLER角、GISSANE角均显著大于对照组(P <0.05)。末次随访时MARYLAND足部评分试验组平均78分,优良率为80%;对照组平均67分,优良率为73%,试验组优良率显著高于对照组(P<0.05)。提示钢板螺钉内固定辅助斯氏针置入固定修复粉碎性跟骨骨折伴有跟骨后上方骨折,可较单纯钢板螺钉置入内固定取得更为满意的关节内骨折及后上方骨折复位,固定牢靠,可早期功能锻炼,术后患肢功能恢复较单纯钢板螺钉内固定较好。%BACKGROUND:The therapeutic regimen of intraarticular calcaneal comminuted fractures commonly selects plate and screw fixation. However, for case of posterosuperior calcaneal fracture, the weakness of achil es tendon stretch and plate screw fixation results in difficulty or maintenance of reduction. OBJECTIVE:To investigate the therapeutic effects of open reduction and internal fixation with steel screw and Steinmann pins for comminuted calcaneal intra-articular and posterosuperior

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

    Directory of Open Access Journals (Sweden)

    Pendse Aniruddha

    2006-01-01

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

  8. 微创锁定板内固定和切开复位内固定治疗跟骨关节内骨折效果分析%Analysis Efficacy of Minimally Invasive Locking Plate Fixation and Open Reduction Internal Fixation in the Treatment of Intra-articular Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    张番; 郑淑媛

    2014-01-01

    Objective:To investigate the clinical treatment efficacy of minimally invasive locking plate fixation and open reduction internal fixation in the treatment of intra-articular calcaneal fractures.Method:76 patients with calcaneal fracture in orthopedic department for elective surgery in our hospital from June 2012 to July 2013 were selected.All cases were randomly divided into the minimally invasive fixation group and the open reduction internal fixation group according to the admission number parity,38 cases in each group.The surgical time,intraoperative and postoperative bleeding, hospitalization time,healing time of the two groups were compared.The postoperative treatment efficacies of the two groups were evaluated by AOFAS ankle and hindfoot scoring system,visual analog scale(VAS method)and condensed Health Status Scale(SF-36).Postoperative complications of the two groups were recorded.Result:The surgical time and intraoperative and postoperative bleeding volume of the minimally invasive fixation group were significantly less than the open reduction internal fixation group,the differences were statistically significant(P0.05).The total complication rate of the minimally invasive fixation group was 7.9%,it was significantly lower than 36.8% of the open reduction internal fixation group,the difference was statistically significant(P0.05);微创内固定组总并发症发生率7.9%明显低于切口内固定组的36.8%,差异有统计学意义(P<0.05)。结论:微创锁定板内固定治疗跟骨关节内骨折临床效果优于切开复位内固定,有助于减少术后并发症的发生,促进跟骨术后功能恢复,提高患者生活质量,值得在临床推广使用。

  9. 普通接骨板与锁定接骨板治疗成人闭合性跟骨关节内骨折疗效对比%Clinical analysis of open reduction and internal fixation with unlocking plate or locking plate for treatment of adult in-tra-articular calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    曲绍东; 杨占辉; 史宏伟; 石明国; 张立军; 贾文杰; 苏庆军

    2015-01-01

    Objective To analyze the effect of open reduction and internal fixation (ORIF) with unlocking plate or locking plate for treatment of adult intra-articular calcaneal fracture. Methods 68 cases of calcaneal fracture,including 72 feet in 56 males (4 males were bilateral) and 12 females,with the average age of 35 years (ranging from 18 to 71), were en-rolled. According to Sanders' classification,15 feet were classified as type Ⅱ,46 feet were classified as type Ⅲ, and 11 feet were classified as type Ⅳ. 44 feet were treated with unlocking plate for calcaneal fracture in group A , 28 feet were treated with locking plate for calcaneal fracture in group B. The cases of existing ipsilateral lower limb fracture, ipsilateral vascular injury, and ipsilateral lower limb open injury were excluded. Results The wounds of 64 feet healed piemarily,5 feet were delayed healing. The soft tissue coloboma of 3 feet delayed until pedicle flap transfered. The B(o)hler angle of two groups were significantly different between preoperation and postoperation, but there were no significant differences in B(o)hler angle between two groups. 64 feet in 63 cases were followed up for 12~26 months. According to the AOFAS Ankle-Hindfoot Scale ,49 feet scored 90~100 points,13 feet scored 75~89 points and 2 feet scored 50~74 points. The excellent and good rate was 96.9%. Conclusion ORIF with unlocking plate or locking plate are all effective methods to treat the calcaneal fracture , there are no significant dif-ferences in curative effect between the two methods.%目的 分析普通接骨板与锁定接骨板治疗成人闭合性跟骨骨折的临床疗效. 方法 本组跟骨骨折68例(72足),男56例,女12例,4例男性为双侧. 年龄18~71岁,平均35岁. 应用Sanders分型,其中Ⅱ型15足,Ⅲ型46足,Ⅳ型11足.其中应用非锁定跟骨接骨板治疗44足(A组),应用锁定跟骨接骨板治疗28足(B组).排除术前合并同侧下肢骨折、同侧血管损伤及同

  10. 自制双边三角形万向可伸缩外固定支架治疗开放性关节内粉碎性跟骨骨折%Treatment of open comminuted intra-articular calcaneal fractures with extensible gimbaled bilateral triangle external fixators

    Institute of Scientific and Technical Information of China (English)

    梁伟; 邹光翼; 王济纬; 苗旭东

    2016-01-01

    目的 观察自制的双边三角形万向可伸缩外固定支架治疗开放性关节内粉碎性跟骨骨折的效果. 方法 对2011年1月至2014年6月收治并获得随访的12例开放性关节内粉碎性跟骨骨折患者资料进行回顾性分析,男8例,女4例;年龄23 ~ 58岁,平均36.8岁;骨折按照Sanders分型:Ⅱ型4例,Ⅲ型7例,Ⅳ型1例;软组织损伤按照Gustilo分型:Ⅱ型2例,ⅢA型7例,ⅢB型3例.所有患者急诊行伤口清创,根据伤口软组织损伤情况一期行闭合伤口或负压封闭引流覆盖,根据病情7例急诊、5例在伤后3~5d行自制的双边三角形万向可伸缩外固定支架撑开克氏针撬拨,克氏针或空心钉固定.待确定创口无明显感染后,6例择期行外侧切口切开复位内固定,6例一直使用外固定支架及辅助克氏针固定8 ~10周(平均9.1周).结果 12例患者术后获6~36个月(平均18.5个月)随访,美国足踝外科协会的踝-后足评分平均为84.6分(74 ~ 94分),有1例患者后期行游离植皮覆盖伤口,有3例患者发生伤口浅表感染,无深部感染及需要截肢治疗患者,6例患者二期行切开复位内固定者无一例发生切口感染及坏死. 结论 开放性跟骨骨折应用自制的双边三角形万向可伸缩外固定支架支撑辅助固定,把握内固定的时机和手术指征、选择恰当的固定方法可以有效降低术后深部感染和骨髓炎的发生率.%Objective To report the clinical outcomes of the patients with open comminuted intra-articular calcaneal fracture who were treated with our self-designed bilateral triangle external fixators which are extensible and gimbaled.Methods Between January 2011 and June 2014,12 patients with open comminuted intra-articular calcaneal fracture were treated and followed up.They were 8 men and 4 women,aged from 23 to 58 years (average,36.8 years).According to the Sanders classification,the fractures were type Ⅱ in 4 cases,type Ⅲ in 7,and type Ⅳ in

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  12. [Arthroscopical subtalar arthrodesis for malunion of calcaneal fractures].

    Science.gov (United States)

    Mi, Kun; Liu, Pengfei; Liu, Wu; Feng, Zhibin

    2010-07-01

    To evaluate the clinical results of arthroscopical subtalar arthrodesis for malunion of calcaneal fractures. Between July 2006 and December 2008, 12 cases of malunion of calcaneal fractures were treated with arthroscopical subtalar arthrodesis, including 10 males and 2 females with an age range of 38-54 years (44.8 years on average). The location was left side in 5 cases and right side in 7 cases. The injury was caused by falling from height in 8 cases, by traffic accident in 3 cases, and other in 1 case. It was 3-7 months from injury to operation. All cases were classified as Stephens type II. The total score was 35.68 +/- 10.35 and the pain score was 8.14 +/- 1.83 before operation according to Hindfoot scores system of American Orthopaedic Foot & Ankle Society (AOFAS). All incisions achieved primary healing and the patients were all followed up 14-32 months (18 months on average). The X-ray films showed bony fusion after 10-14 weeks (11.5 weeks on average). The total score was 76.45 +/- 9.83 and the pain score was 1.52 +/- 1.48 after operation according to Hindfoot scores system of AOFAS, showing significant difference when compared with those before operation (P < 0.01). Arthroscopical subtalar arthrodesis can get satisfactory fusion rate with few complications for malunion of calcaneal fractures.

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

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2004-06-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  15. Up-regulation of the chemo-attractive receptor ChemR23 and occurrence of apoptosis in human chondrocytes isolated from fractured calcaneal osteochondral fragments.

    Science.gov (United States)

    Sena, Paola; Manfredini, Giuseppe; Benincasa, Marta; Mariani, Francesco; Smargiassi, Alberto; Catani, Fabio; Palumbo, Carla

    2014-06-01

    To study the expression level of a panel of pro/anti-apoptotic factors and inflammation-related receptors in chondral fragments from patients undergoing surgical treatment for intra-articular calcaneal fractures, cartilage fragments were retrieved from calcaneal fractures of 20 patients subjected to surgical treatment. Primary cultures were performed using chondral fragments from fractured and control patients. Chondrocyte cultures from each patient of the fractured and control groups were subjected to immunofluorescence staining and quantitatively analyzed under confocal microscopy. Proteins extracted from the cultured chondrocytes taken from the fractured and control groups were processed for Western blot experiments and densitometric analysis. The percentage of apoptotic cells was determined using the cleaved PARP-1 antibody. The proportion of labelled cells was 35% for fractured specimens, compared with 7% for control samples. Quantification of caspase-3 active and Bcl-2 proteins in chondrocyte cultures showed a significant increase of the apoptotic process in fractured specimens compared with control ones. Fractured chondrocytes were positively stained for ChemR23 with statistically significant differences with respect to control samples. Densitometric evaluation of the immunoreactive bands confirmed these observations. Human articular chondrocytes obtained from patients with intra-articular calcaneal fractures express higher levels of pivotal pro-apoptotic factors, and of the chemo-attractive receptor ChemR23, compared with control cultures. On the basis of these observations, the authors hypothesize that consistent prolonged chondrocyte death, associated with the persistence of high levels of pro-inflammatory factors, could enhance the deterioration of cartilage tissue with consequent development of post-traumatic arthritis following intra-articular bone fracture.

  16. TREATMENT OPTIONS FOR DISPLACED FRACTURE OF THE CALCANEAL TUBEROSITY

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    Siva G. Prasad

    2016-12-01

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

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

    NARCIS (Netherlands)

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

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

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

    Science.gov (United States)

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

    2017-01-01

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

  19. Early Intra-Articular Complement Activation in Ankle Fractures

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    Hagen Schmal

    2014-01-01

    Full Text Available Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P<0.001. Furthermore, synovial expressions of both proteins correlated with each other (P<0.001. Although IL-1β expression was relatively low, intra-articular levels correlated with C5a (P<0.01 and serological C-reactive protein concentrations 2 days after surgery (P<0.05. Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P<0.02. Whereas aggrecan and IL-1β concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P<0.01. Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures.

  20. Treatment of Calcaneal Fracture With Severe Soft Tissue Injury and Osteomyelitis: A Case Report.

    Science.gov (United States)

    Karns, Michael; Dailey, Steven K; Archdeacon, Michael T

    2015-01-01

    Advancements in surgical technique have resulted in the ability to reconstruct lower extremity injuries that would have previously been treated by amputation. Currently, a paucity of data is available specifically addressing limb amputation versus reconstruction for calcaneal fractures with severe soft tissue compromise. Reconstruction leaves the patient with their native limb; however, multiple surgeries, infections, chronic pain, and a poor functional outcome are very real possibilities. We present the case of a complex calcaneal fracture complicated by soft tissue injury and osteomyelitis that highlights the importance of shared decision-making between patient and surgeon when considering reconstruction versus amputation. This case exemplifies the need for open communication concerning the risks and benefits of treatment modalities while simultaneously considering the patient's expectations and desired outcomes.

  1. Operative treatment of calcaneal fractures%跟骨骨折的手术治疗策略及疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈滨; 黎润光; 王钢

    2010-01-01

    目的 探讨跟骨骨折的受伤机制、临床分型、手术治疗方法及其疗效.方法 2005年6月至2009年5月共收治70例(83足)闭合性新鲜跟骨骨折患者,男45例,女25例;年龄18~62岁,平均38.3岁.骨折根据Essex-Lopresti分类:关节外骨折20足(前突骨折5足,体部骨折9足,结节部骨折3足,内外侧突骨折3足),关节内骨折63足(舌状骨折25足,关节压缩型骨折38足).63足关节内骨折根据Sanders分型:Ⅱ型30足,Ⅲ型21足,Ⅳ型12足.采用常规足外侧"L"形切开复位普通钢板或锁定钢板内固定50足,微创切开复位螺钉固定20足,撬拨复位克氏针(或加螺钉)固定13足.20足骨缺损>2 cm3,行骨移植治疗.术后采用美国足踝外科协会(AOFAS)踝与后足评分评价患者足部功能恢复情况. 结果 70例患者术后获12~30个月(平均18个月)随访.末次随访时70例患者83足AOFAS踝与后足评分平均为(90.3±11.0)分(48~100分).20足关节外骨折患者AOFAS踝与后足评分平均为(98.1±2.6)分(90~100分),无并发症发生.63足关节内骨折患者AOFAS踝与后足评分平均为(87.8±11.4)分(48~100分).并发症包括:切口皮缘坏死2足,经换药后创面闭合;腓肠神经损伤4足;距下关节创伤性关节炎10足. 结论 对于不同类型的跟骨骨折,术前慎重评估软组织损伤和骨折类型、程度,采用适当的治疗方法,可以获得较好疗效.关节外骨折的疗效明显优于关节内骨折.%Objective To investigate the injury mechanism, clinical classification, treatment methods and clinical results of calcaneal fractures. Methods From June 2005 to May 2009, 83 feet in 70 patients with calcaneal fractures were treated. According to Sanders and Essex-Lopresti classifications, 63 feet had intra-articular fractures (30 feet of type Ⅱ, 21 type Ⅲ, and 12 type Ⅳ ) and 20 feet had extra-articular fractures (3 feet of lateral condylar fracture, 5 anterior process fracture, 9 calcaneal body fracture

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

    Directory of Open Access Journals (Sweden)

    Licheng Zhang

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

  3. 跟骨骨折术后并发症的分析及预防策略%Analysis of postoperative complications of calcaneal fractures and prevention strategies

    Institute of Scientific and Technical Information of China (English)

    刘彦

    2012-01-01

    Objective To investigate the intra-articular calcaneal fracture fixation complications, causes, prevention and policy. Methods For intra-articular calcaneal fractures in 82 feet for an open reduction and internal fixation and treatment, routine use of perioperative antibiotics to prevent infection, follow-up time of 5 to 35 months, an average of 10 months. Results In accordance with Marryland Foot Score were evaluated, the affected foot function fine 27 feet, good 42 feet, 13 feet. Early complications occurred in this group of 16 feet, the rate was 19. 5% , of which 9 feet cut edge of skin necrosis, wound infection in 4 foot, 2 foot wound rejection, sural nerve injury in 1 foot. Later stage of the subtalar joint chronic pain, significantly affect walking 6 feet, the rate was 7%. Conclusion Intra-articular calcaneal fracture fixation complications and anatomical characteristics of the calcaneus and calcaneal fracture mechanisms, but through effective measures to reduce the incidence of complications, complications after the treatment according to the situation accordingly.%目的 探讨跟骨关节内骨折内固定手术并发症的原因、预防和策略.方法 对77例82足跟骨关节内骨折进行了切开复位内固定治疗,围手术期常规应用抗生素预防感染,随访时间5 ~35个月,平均10个月.结果 按照Marryland足部评分系统(Marrryland Foot Score)评价术后功能,患足功能优27足,良42足,可13足.本组发生早期并发症16足,发生率为19.5%,其中切口边缘皮肤坏死9足,伤口感染4足,伤口排异反应2足,腓肠神经损伤1足.晚期出现距下关节慢性疼痛、明显影响行走6足,发生率为7%.结论 跟骨关节内骨折内固定手术并发症与跟骨解剖特点、跟骨骨折机制、手术方式、手术切口的选择、复位效果以及固定方式有关,但可以通过有效的措施减少并发症的发生,出现并发症后可根据情况作出相应的处理.

  4. Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures

    Directory of Open Access Journals (Sweden)

    Ata C. Atalar

    2017-01-01

    Conclusion: Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models.

  5. 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.

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

    Science.gov (United States)

    Labronici, Pedro José; Reder, Vitor Rodrigues; de Araujo Marins Filho, Guilherme Ferreira; Pires, Robinson Esteves Santos; Fernandes, Hélio Jorge Alvachian; Mercadante, Marcelo Tomanik

    2016-01-01

    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. PMID:27069891

  7. Does joint architecture influence the nature of intra-articular fractures?

    Science.gov (United States)

    Steer, R A; Smith, S D; Lang, A; Hohmann, E; Tetsworth, K D

    2015-07-01

    The architecture of joints has potentially the greatest influence on the nature of intra-articular fractures. We analysed a large number of intra-articular fractures with two aims: (1) to determine if the pattern of injuries observed supports our conjecture that the local skeletal architecture is an important factor and (2) to investigate whether associated dislocations further affect the fracture pattern. A retrospective study of intra-articular fractures over a 3.5-year period; 1003 joints met inclusion criteria and were analysed. Three independent investigators determined if fractures affected the convex dome, the concave socket, or if both joint surfaces were involved. Further review determined if a joint dislocation occurred with the initial injury. Statistical analysis was performed using a one-way frequency table, and the χ(2) test was used to compare the frequencies of concave and convex surface fractures. The odds ratios (ORs) were calculated to establish the association between the frequencies of concave and convex surface fractures, as well as between dislocation and either fracture surface involvement. Of the 1003 fractures analysed, 956 (95.3%) involved only the concavity of the joint; in 21 fractures (2.1%) both joint surfaces were involved; and in 26 fractures (2.6%) only the convexity was involved (χ(2)=1654.9, df=2, parchitecture of joints clearly plays a highly significant role in determining the nature of intra-articular fractures. Intra-articular fractures involving the convexity are much more likely to be associated with a concurrent joint dislocation. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  8. Enhancement of fracture healing by electrical stimulation in the comminuted intraarticular fracture of distal radius.

    Science.gov (United States)

    Kohata, Kazuhiro; Itoh, Soichiro; Takeda, Shu; Kanai, Misa; Yoshioka, Taro; Suzuki, Hiroyuki; Yamashita, Kimihiro

    2013-01-01

    Effectiveness of an alternating electric current (AC) stimulation in prevention of bone deformity for comminuted intraarticular fracture of distal radius were verified by comparing postoperative results treated with a wrist-bridging external fixator combined with or without an AC stimulator (EF and NEF, respectively), and a palmar locking plate (LP). This study evaluated 92 cases (mean age 67.9 ± 11.4 years) of type C2 and 60 cases (mean age 69.7 ± 9.5 years) of type C3 distal radius fractures, as classified by the Association for Osteosynthesis. In total, 55 and 24 cases were treated with EF and NEF, respectively; and 73 cases were treated with LP. Callus appeared 27.5 ± 4.6 days postoperatively and the external skeletal fixation period was significantly shorter in the EF group than in the NEF group. The decrease in radial length was significantly lower in the EF group when compared to the LP group. There were no significant differences among the groups for the other radiographic and functional parameters. AC stimulation combined to the external fixation may be a promising method to prevent postoperative deformity in the severely comminuted intraarticular fractures by accelerating callus maturation and facilitating new bone bridging across the gap of fracture site.

  9. [Underfoot pressure distribution of a patient after fracture of the calcaneal bone and bilateral hallux amputation--case report].

    Science.gov (United States)

    Lorkowski, Jacek; Trybus, Marek; Hładki, Waldemar; Brongel, Leszek

    2006-01-01

    The aim of our study was to estimate underfoot pressure distribution of a patient after bilateral hallux amputation and the unilateral calcaneal bone fracture on the left side at the end of orthopaedic end rehabilitation treatment. The pedobarographic examination during bipedal standing revealed localisation of maximal pressure at H region on the side of fracture and on MT1 and H foot regions on the other side. After the and of orthopaedic treatment underfoot pressure distribution changes persists in spite of pain regression.

  10. Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture.

    Science.gov (United States)

    Gabl, M; Arora, R; Klauser, A S; Schmidle, Gernot

    2016-08-01

    The purpose of this study was to assess characteristics of radiocarpal arthrofibrosis after intra-articular distal radius fractures (DRF). In this study 20 patients who underwent wrist arthroscopy at the time of implant removal after volar plating for intra-articular DRF were included retrospectively. The direction of fibrous tissue formation (FTF) and its rigidity were investigated. The findings were correlated to the course of intraarticular fracture lines seen in the preoperative CT, patient age and AO fracture types. In all patients FTF spanned the radiocarpal joint. Fibrous tissue formations extended from previous fracture gaps to the scapholunate interosseous ligament and/or capsule. Four basic types of FTF (Type 1-4) and two combination types (Type 1a, 2a) were found. Fibrotic fans with dorsal capsular attachment (Type 1, 30 %) and its combination with dorsal capsule obliteration (Type 1a, 40 %) were the most common findings. Mild rigidity was present in 3 (15 %), moderate in 7 (35 %), and severe rigidity in 10 cases (50 %). Fracture lines crossing the radius extensor compartments or interfacet ridge, cartilage defects and C3 fractures showed the highest risk to develop severely rigid fibrous tissue formations. In older patients and in more comminuted fractures the number of rigid fibrous tissue formations was higher. Fracture severity correlates with the development of rigid intra-articular FTF. In case of rigid FTF with restricted wrist motion arthroscopic debridement may be considered at the time of hardware removal.

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

    Science.gov (United States)

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

    2017-09-19

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

  12. En bloc joystick reduction of a comminuted intra-articular distal radius fracture: a technical trick.

    Science.gov (United States)

    Siegall, Evan; Ziran, Bruce

    2014-08-01

    A patient with a 1-month-old intra-articular distal radius fracture (treated closed in a splint) presented with an unacceptable degree of pain and stiffness caused by shortening and dorsal angulation of the distal radius. The fracture was comminuted with 4 or 5 distinct fragments, several involving the articular surface. Surgical correction was attempted. During the procedure, it was noted that, though the distal radius was shortened and angulated, there was actually acceptable congruity of the articular surface itself, despite the intra-articular nature of the fracture. Bone quality was poor and healing incomplete. Thus, we were concerned the currently congruous articular surface would fall apart with manipulation. Given this situation, we used a unique scaffolding technique with Kirschner wires placed in perpendicular fashion to both hold the articular surface intact and manipulate it en bloc. This technique is a simple way to turn a complex fracture into an easily reduced 2-part fracture.

  13. Condylar orientation plating in comminuted intraarticular fractures of adult distal humerus

    Directory of Open Access Journals (Sweden)

    Sukhendu Sarkhel

    2015-01-01

    Conclusion: Excellent pain free range of motion with a high rate of union can be achieved in comminuted intraarticular distal humerus fractures in adults with the use of condylar orientation precontoured plating technique. Condylar orientation is very important with perfect articular congruity in elbow motion.

  14. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistic...

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

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Marianne

    2015-01-01

    articular displacement was 0 mm in 69% of the Sanders type 2 fractures and 57% of the Sanders type 3 fractures. Operation duration averaged 118 minutes, and there were no reoperations due to misplaced screws or plates. The average absorbed radiation dose per patient was 288 mGy·cm. CONCLUSION......BACKGROUND: Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures......, resulting in improved articular congruence and implant positioning. METHOD: Sixty-two displaced calcaneal fractures were operated on using standard fluoroscopic views. When the surgeon had achieved a satisfactory reduction, an intraoperative 3D scan was conducted, malreductions or implant imperfections were...

  16. Functional Outcomes to Surgical Treatment of the Distal Humerus Intra-Articular Fractures in Adults

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    Abdulkadir Yýðman

    2013-11-01

    Full Text Available Aim: Displaced and intraarticular humerus distal fractures require surgical treatment.  In this study we  evaluated to functional results of the surgical treatment of distal humerus intraarticular fractures in adults. Additionally, we evaluated the factors affecting surgical outcomes. Material and Method: Between 2005 to 2010, 22 elbows of 21 patients who were operated for distal humerus intraarticular fractures were evaluated retrospectively. 11(52.4% patiens were male and 10(47.6% were female, mean age 46.2 (range 17 to 71.  Fractures were classified as type B3 for 10, type C1 for 6 and type C2 for 6 subjects according to AO classifications. We performed paralel double locking plate for 9(41%, perpendicular double plate for 2(9%, K wires and screw combination for 7(32%, and single plate for 4(18% patients. Functional assesment were performed with the MEPS and q-DASH scoring systems. Results: Mean follow-up  was 30.4(5-68 months. Fracture healing was observed in all of the patients. Mean elbow flexion of 117 (90-145 degrees and extension loss of 24.3 (0-60 were noted. 10 (47.6% patients were excellent, 6 (28.6% were good, 3 (14.3% were fair and 2(9.5% were poor according to MEPS. Mean q-DASH scores were 15 (0-69.8 in 21 patients. Good results were obtained in fractures treated with stable fixation, in early performed surgeries, and in early  started rehabilitation. Discussion: Treatment of distal humerus intraarticular fractures with anatomical reduction, stable osteosynthesis, and early rehabilitation are very important in obtaining successful outcomes. Additionally, age and fracture type are important factors to conclude good results..

  17. An Innovative Intra-articular Osteotomy in the Treatment of Posterolateral Tibial Plateau Fracture Malunion.

    Science.gov (United States)

    Wang, Yukai; Luo, Congfeng; Hu, Chengfang; Sun, Hui; Zhan, Yu

    2016-07-13

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration.

  18. The Role of Computed Tomography in Evaluating Intra-Articular Distal Humerus Fractures.

    Science.gov (United States)

    Nolan, Betsy M; Sweet, Stephan J; Ferkel, Eric; Udofia, Aniebet-Abasi; Itamura, John

    2015-09-01

    Computed tomography (CT) is often used to evaluate intra-articular distal humerus fracture patterns, but it increases radiation exposure and cost. We conducted a study to determine the effect of adding CT evaluation to plain radiographic evaluation on the classification of, and treatment plans for, intra-articular distal humerus fractures. Nine blinded orthopedic surgeons evaluated 30 consecutive fractures for classification and surgical approach. Evaluations were performed first using plain radiographs and then again using the same radiographs plus CT images. Statistical analysis was performed using the κ correlation coefficient and Cramer V testing. We hypothesized that adding CT images to plain radiographs would change the classification and treatment of these fractures and would improve interobserver agreement on classification and treatment. Intraobserver reliability (Cramer V) was fair (.393) for classification and moderate (.426) for treatment. Interobserver reliability (Cohen κ) did not improve with CT: For classification, κ was .21 without CT and .20 with CT; for treatment, κ was .28 without CT and .27 with CT. When classifying the fractures, attending surgeons chose the multiplanar fracture pattern 25.6% of the time without CT, and remained consistent at 23.3% with CT. Trainees chose this fracture pattern much less often without CT than with CT. Use of CT changed the treatment for multiplanar fractures (73.7% lateral approach vs 51.9% posterior approach with olecranon osteotomy). When added to plain radiographic evaluation, CT evaluation changes classification and treatment plans. Interobserver reliability did not improve. Less experienced surgeons were more likely to identify multiplanar fracture patterns with use of CT. We recommend performing CT for all intra-articular distal humerus fractures.

  19. OPERATIVE MANAGEMENT OF INTRA-ARTICULAR DISTAL HUMERAL FRACTURES WITH LOCKING PLATES

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    Abhilekh

    2015-11-01

    Full Text Available BACKGROUND: Intra-articular distal humeral fractures are common, but complex elbow injuries. To obtain good results, anatomical reduction with rigid fixation and early range of mobilization is required. Treatment of these fractures with conventional plates is associated with many complications such as non-anatomic reduction of articular surfaces, malunion, non-union, loosening of implant, residual stiffness of the elbow and post-traumatic osteoarthrosis. In this situation the application of locking plates having a fixed angle plate screw construct can minimise most of the above complications. OBJECTIVE: To evaluate radiological and functional outcome of locking plate application for the management of intra-articular distal humeral fractures. MATERIAL AND METHODS: This prospective study was conducted from January 2013 to December 2014. We operated 20 patients of AO type-C intra-articular distal humeral fractures. Fracture was exposed using modified Campbell’s posterior approach in less comminuted fractures and a V-shaped Olecranon osteotomy was done to get better exposure of the articular surface in cases with severe articular comminution. The fracture was stabilized using an intercondylar screw, pre-contoured locking compression plates and/or locking reconstruction plates as per preoperative planning. Patients were reviewed at monthly interval for clinical-radiological evaluation. Final outcome measures included radiological assessment, range of motion and Mayo elbow performance score (MEPS. RESULTS: All the fractures were united at an average 12 weeks. Two patients developed numbness in the distribution of ulnar nerve and one patient developed superficial infection in immediate postoperative period. None of the patients had malunion and loosening of implant. The average arc of flexion-extension was 105`, although no patient had loss of supination/pronation. Mayo Elbow Performance Score was excellent in 15 (75%, good in 3 (15%, fair in 1 (5

  20. Mitochondrial Based Treatments that Prevent Post Traumatic Osteoarthritis in a Translational Large Animal Intraarticular Fracture Survival Model

    Science.gov (United States)

    2015-09-01

    Animal Intraarticular Fracture Survival Model” PRINCIPAL INVESTIGATOR: James A. Martin, PhD CONTRACTING ORGANIZATION: University of Iowa Iowa City...for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302. Respondents should be aware...Osteoarthritis in a Translational Large Animal Intraarticular Fracture Survival Model” 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-11-1-0583 5c. PROGRAM

  1. Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

    Directory of Open Access Journals (Sweden)

    Erhan Yılmaz

    2009-01-01

    Full Text Available Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with in-traarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up pe-riod was 25.3 months. All fractures were type C accord-ing to the AO/ASIF fracture classification system. Chev-ron type olecranon osteotomy was performed within 12-24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appro-priate range checks were made.Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in pa-tients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complica-tions were seen as 2 (9.6% transient neuropraxia of the ulnar nerve, 2 (9.6% failure of fixation, 1 (4.8% het-erotopic ossification and 1 (4.8% olecranon non-union. Fracture type (C1 and time from occurrence of injury to surgery (<12 hours are the main prognostic factors for achieving the excellent/ good functional results.Conclusions: The critical factors for a successful out-come of intraarticular fractures of the distal humerus in-cluded meticulous surgical technique, stable internal fix-ation, surgical experimentation and early controlled postoperative mobilization.

  2. Early intra-articular complement activation in ankle fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Salzmann, Gian M; Niemeyer, Philipp;

    2014-01-01

    osteochondritis dissecans (OCD) of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1 β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture...... and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures....

  3. Discriminative ability of calcaneal quantitative ultrasound compared with dual-energy X-ray absorptiometry in men with hip or distal forearm fractures.

    Science.gov (United States)

    Cesme, Fatih; Esmaeilzadeh, Sina; Oral, Aydan

    2016-10-01

    The aim of this case-control study was to compare the discriminatory ability of bone mineral density (BMD) measurements and calcaneal quantitative ultrasound (QUS) parameters for fractures and to determine fracture thresholds for each variable in men with hip or distal forearm fractures. A total of 20 men with hip and 18 men with distal forearm fractures and 38 age-matched controls were included in this study. Dual-energy X-ray absorptiometry (DXA) BMD (spine and hip) and calcaneal QUS measurements were made. Area under the curves (AUCs) were calculated to assess fracture discriminatory power of DXA and QUS variables. Quantitative Ultrasound Index (QUI) T-score and Speed of Sound (SOS) were found to be the best parameters for the identification of hip and distal forearm fractures, respectively, with AUCs greater than those of DXA BMD and other QUS parameters. While a QUI T-score of ≤-1.18 could identify and rule out hip fracture cases with approximately 80% sensitivity and specificity, a SOS value of ≤1529.75 reached to almost 90% for ruling in and out distal forearm fractures. The discriminatory performance of calcaneal QUS variables between fractured and non-fractured men was as good as those of the DXA BMD and even better. Since men appear to sustain fractures at closer QUS variable levels than those of the DXA BMD regardless of the fracture type, it may be speculated that calcaneal QUS may be more helpful in predicting the risk of fractures when BMD alone does not demonstrate impaired bones. Level III, Study of Diagnostic Test. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  4. Postoperative monitoring of distal intraarticular radial fractures treated with osteosynthesis by means of multislice CT

    Energy Technology Data Exchange (ETDEWEB)

    Lorenzen, M.; Wedegaertner, U.; Weber, C.; Adam, G.; Lorenzen, J. [Universitaetsklinik Hamburg-Eppendorf (Germany). Abt. fuer Radiologie

    2011-02-15

    Purpose: This study evaluates multislice CT (MSCT) for the postsurgical control of intraarticular fractures of the distal radius. Materials and Methods: In 131 patients conventional X-rays in two planes and MSCT were performed. In a consensus process two experienced radiologists judged conventional X-ray and computed tomography images in a random view. The correct position of the osteosynthetic material was assessed and it was ascertained whether an articular surface incongruity, a gap between two fracture fragments, or an intraarticular bone element was detectable. For each point of evaluation a confidence level of the evaluation was assessed on a five-point scale. Results: Ninety patients were classified as having correct alignment and osteosynthesis according to conventional X-ray, while when using the findings from axial CT scans only, 82 patients, and after the addition of multiplanar re-constructions (MPR) only 73 patients were found to have almost proper alignment and osteosynthesis. In 42 patients dehiscence of the fragments was diagnosed with MSCT, but was not visualized by X-ray, leading to surgical revision in eight patients, confirming the diagnosis. In five patients an intraarticular position of intraarticular material was confirmed with MSCT and surgical revision. A significant advantage for the evaluation confidence level was achieved for MPRs in comparison with axial CT scans and X-ray. Conclusion: The marked diagnostic advantage with a high evaluation confidence level in comparison with conventional X-ray methods justify the use of MSCT during postoperative monitoring of articular radial fractures treated with osteosynthesis. (orig.)

  5. 外侧切口治疗跟骨骨折%Treatment of calcaneal fracture with the lateral incision

    Institute of Scientific and Technical Information of China (English)

    王树金; 孔丹辉; 张华俊; 陈建红; 蒋波逸

    2013-01-01

    Objective To explore the effects of lateral incision surgical in treatment of calcaneal fractures. Methods From September of 2009 to December of 2011 using the lateral incision surgical treatment of calcaneal fractures in 21 patients:15 males and 6 females;ages 31~65 years old, with an average of 48. 3 years old. Unilateral calcaneus in 19 cases, bilateral in 2 cases, fall injury in 17 feet, crush injury in 4 feet. According to Sanders type: type II 9 feet, type III 11 feet, type IV 3 feet. The surgery time was 5~12 days after injury. Results Follow-up of 10~24 months, with an average of 16 months. 3 feet with superficial necrosis of skin flap, scar healing after changing dressing;2 feet with lateral edge of the skin is numb. 17 feet postoperative X-ray films showed that the articular surface reset good, calcaneal height and width satisfactory recovery;6 feet postoperative Bohler angle and Gissane angle than before surgery significantly improved, but not completely back to normal. Conclusion The efficacy by Maryland scoring criteria:excellent in 13 feet, good in 6 feet, general in 4 feet, good rate of 82.6%. Lateral incision treat calcaneal fractures have such advantages:fracture lines revealed clear, subtalar articular surface and formation calcaneocuboid articular surface can recoverable to normal arch form and calcaneal width, and have enough space to place plates and screws, which will properly protected Soft tissue. Sanders II fractures and articular surface crushed Sanders III fractures is applicable.%目的:探讨外侧切口手术治疗跟骨骨折的效果。方法2009年9月~2011年12月采用外侧切口治疗跟骨骨折21例,男15例,女6例;年龄31~65岁,平均48.3岁。单侧足19例,双侧足2例。坠落伤17例,压砸伤4例。按Sanders分型:Ⅱ型9足、Ⅲ型11足、Ⅳ型3足。手术时间为伤后5~12 d。结果随访10~24个月,平均16个月。术后3足出现皮缘浅表坏死,经换药后瘢痕愈合;2足出

  6. Operative management of closed intra-articular fractures of distal end of humerus in adults.

    Science.gov (United States)

    Bhattacharyya, Arunangsu; Jha, Amrish Kumar; Chatterjee, Debdutta; Ghosh, Bappaditya; Roy, Sandip Kumar; Banerjee, Debabrata

    2011-06-01

    This is a study of 60 patients with mean age of 30 years having intra-articular fracture of distal humerus of type C (AO classification). We treated these fractures by open reduction and internal fixation through transolecranon approach. Mean duration of operative time with that of injury was 10 days. In all the cases 1st the intracondylar fracture was fixed followed by reconstruction and stabilisation of medial and lateral pillar by 1/3 tubular plate and 3.5 mm dynamic compressent plate (DCP) or recon plate respectively. Minimum follow-up was of 1 year duration with average follow-up of 3 years. We could achieve 100% union with mean range of movement at the and of 1 year was 20 degree to 110 degree. Two fractures had delayed union, 5 patients had skin complications for which extended dressing was required. None of these patients required SSG or secondary suture.

  7. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

    LENUS (Irish Health Repository)

    Leonard, M

    2012-02-01

    The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20\\/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.

  8. Modified Dwyer osteotomy with rotation and reinsertion of autograft bone wedge for residual heel deformity despite previous delayed subtalar joint arthrodesis after calcaneal fracture.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2014-01-01

    Calcaneal fracture patterns vary widely, and many factors determine the type and timing of the treatment rendered. Severe calcaneus fractures involving joint damage, loss of heel height, and varus deformity of the tuberosity are ideally treated with open reduction and internal fixation to repair the joint surface and re-establish anatomic structure. This is not always possible owing to delayed presentation, soft tissue compromise, unrelated injuries, unstable medical condition, or lack of expertise by the treating physician. We present the case of a patient who had residual forefoot and rearfoot deformity despite undergoing delayed subtalar joint arthrodesis at an outside hospital 10 years before for a calcaneal fracture that was initially treated nonoperatively. At 4 years of follow-up after modified Dwyer calcaneal osteotomy with rotation and reinsertion of the autograft bone wedge and Cotton midfoot osteotomy, the postoperative gait was relatively normal, other than the expected lack of hindfoot mobility. The lateral column pain was resolved. The patient remained highly satisfied with the outcome at long-term follow-up of 48 months, with improved heel alignment, lack of a wide stance gait, a functional medial column, and a relatively normal gait. This case demonstrates the value of periarticular calcaneal osteotomies without the need to revise the subtalar joint arthrodesis for this challenging clinical situation. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Controversies in the management of intra-articular fractures of distal humerus in adults

    Directory of Open Access Journals (Sweden)

    Sudhir Babhulkar

    2011-01-01

    Full Text Available Background: The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3 in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3 were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108 was performed out of which 94 have been published in another publication. In later second part (1993 onward, extra-articular olecranon osteotomy (n=76 was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174 however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94, there was delayed union in 4% (n=4, with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3 and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of

  10. Outcomes of pin and plaster versus locking plate in distal radius intraarticular fractures.

    Science.gov (United States)

    Bahari-Kashani, Mahmoud; Taraz-Jamshidy, Mohammad Hosein; Rahimi, Hassan; Ashraf, Hami; Mirkazemy, Masoud; Fatehi, Amirreza; Asadian, Mariam; Rezazade, Jafar

    2013-01-01

    Distal radius fractures are among the most prevalent fractures predictive of probable occurrence of other osteoporotic fractures. They are treated via a variety of methods, but the best treatment has not been defined yet. This study was performed to compare the results of open reduction and internal fixation with locking plates versus the pin and plaster method. In this prospective study, 114 patients aged 40 to 60 years with Fernandez type III fracture referring to Imam-Reza and Mehr hospitals of Mashhad from 2009 to 2011, were selected randomly; after obtaining informed consent, they were treated with pin and plaster fixation (n = 57) or internal fixation with the volar locking plate (n = 57). They were compared at the one year follow up. Demographic features and standard radiographic indices were recorded and MAYO, DASH and SF - 36 tests were performed. Data was analyzed by SPSS software version 13, with descriptive indices, Mann-Whitney and Chi-square tests. SF-36 test demonstrated a better general health (P plaster group. Also, in the LCP group mean MAYO score (P plaster group. Mean DASH score was not different between the groups (P = 0.218). The rate of acceptable results of radiographic indices (P plaster method. In treatment of intra-articular distal radius fractures in middle-aged patients internal fixation with locking plates may be prefered to pin and plaster as the treatment of choice.

  11. 钢板内固定与外固定架治疗跟骨骨折效果比较%PLATE INTERNAL FIXATION VERSUS EXTERNAL FIXATOR IN THE TREATMENT OF CALCANEAL FRACTURES

    Institute of Scientific and Technical Information of China (English)

    李玉椿; 杨斌; 王振宇

    2012-01-01

    目的 分析比较切开复位钢板内固定和闭合复位外固定架治疗跟骨骨折的效果.方法 钢板内固定组43侧,采用切开复位钢板内固定治疗;外固定架组19侧,采用闭合复位外固定治疗,术后测量Bohler角,按Marry Land评分系统进行效果评定.结果 钢板内固定组优34侧,良6侧,可3侧,优良率93%;外固定架组优14侧,良5侧,优良率100%.两种治疗方法疗效比较差异无显著性(P>0.05).钢板内固定组术后2例出现切口拐角处感染不愈合,1例深部感染.结论 两种方法治疗跟骨关节内骨折均取得满意的疗效,但外固定架治疗跟骨骨折简单易行,降低了手术切口不愈合及神经肌腱损伤的风险,是一种可靠的治疗办法.%Objective To compare the effectiveness between open reduction plus plate internal fixation and closed reduction plus external fixator in the treatment of calcaneal fractures. Methods Forty-three patients with calcaneal fractures were treated with open reduction and internal plate fixation, and 19 received closed reduction plus external fixation. Postoperatively, the Bohler Angle was measured, and the efficacy was assessed according to Marry Land scoring system. Results In plate fixation group: 34 were excellent, six were good, and three were improved, the excellent and good rate being 93%. In external fixation group, 14 were excellent and five were good, the excellent and good rate being 100%. The difference between the two groups was no significant in regard to the two methods of therapy (P>0. 05). In plate fixation group, postoperative infection occurred in two cases and did not heal, one with deep-part infection. Conclusion Both therapies can obtain satisfactory for intra-articular fracture of calcis, but external fixation is simple and easy to perform, being a reliable therapy, which decreases the risk of wound disunion, and injury of nerve and tendon.

  12. Intraarticular fractures of the distal radius in young adults--a review of the outcome of treatment.

    Science.gov (United States)

    Pan, K L; Masbah, O; Ali, M

    2001-06-01

    A retrospective review of 30 intraarticular fractures of the distal radius in 27 patients was done. Only young adults aged between 18 and 40 were included. Road traffic accidents accounted for 25 of the cases (23 motorcyclists). Fourteen fractures were treated by closed reduction and a plaster cast. Sixteen fractures were treated by open reduction with internal fixation using a buttress plate or multiple Kirschner wires. At a mean follow-up of 17 months, 63% of the wrists had a satisfactory result and 37% unsatisfactory result. The main adverse factor was intraarticular congruity. The grip strength on the injured side averaged 56% of that of the uninjured side and the pinch strength averaged 73%. Most of the patients were able to return to their former occupation in an average of four months.

  13. Patient-specific finite element analysis of chronic contact stress exposure after intraarticular fracture of the tibial plafond.

    Science.gov (United States)

    Li, Wendy; Anderson, Donald D; Goldsworthy, Jane K; Marsh, J Lawrence; Brown, Thomas D

    2008-08-01

    The role of altered contact mechanics in the pathogenesis of posttraumatic osteoarthritis (PTOA) following intraarticular fracture remains poorly understood. One proposed etiology is that residual incongruities lead to altered joint contact stresses that, over time, predispose to PTOA. Prevailing joint contact stresses following surgical fracture reduction were quantified in this study using patient-specific contact finite element (FE) analysis. FE models were created for 11 ankle pairs from tibial plafond fracture patients. Both (reduced) fractured ankles and their intact contralaterals were modeled. A sequence of 13 loading instances was used to simulate the stance phase of gait. Contact stresses were summed across loadings in the simulation, weighted by resident time in the gait cycle. This chronic exposure measure, a metric of degeneration propensity, was then compared between intact and fractured ankle pairs. Intact ankles had lower peak contact stress exposures that were more uniform and centrally located. The series-average peak contact stress elevation for fractured ankles was 38% (p = 0.0015; peak elevation was 82%). Fractured ankles had less area with low contact stress exposure than intact ankles and a greater area with high exposure. Chronic contact stress overexposures (stresses exceeding a damage threshold) ranged from near zero to a high of 18 times the matched intact value. The patient-specific FE models represent substantial progress toward elucidating the relationship between altered contact stresses and the outcome of patients treated for intraarticular fractures.

  14. Causes and strategies of skin necrosis after open reduction and internal fixation of calcaneal fracture%跟骨骨折内固定术后皮肤坏死原因及对策

    Institute of Scientific and Technical Information of China (English)

    邓志成; 朱小华; 王小平; 许国泰; 郭胜

    2013-01-01

    目的 探讨跟骨骨折行外侧L型切口钢板内固定术后伤口皮肤延迟愈合、皮肤坏死的原因及对策.方法 回顾分析我院骨科2006-2010年行外侧L型切口钢板内固定术的72例跟骨骨折患者术后伤口情况.结果 本组72例均获平均4.5个月的随访,术后发生创口边缘皮肤坏死、创口感染导致创口不愈合7例,5例经换药后愈合.2例行腓肠神经营养皮瓣转移修复创面治疗痊愈.结论 采取跟骨外侧L型切口行切开复位钢板内固定治疗跟骨关节内骨折时,熟练掌握跟骨周围解剖结构,把握手术时机、规范操作、充分引流、按皮瓣技术操作是避免后皮肤坏死的关键.%Objective To explore the causes and strategies of skin necrosis and incision delayed union after open reduction and internal fixation (ORIF) by lateral L-shaped incision. Methods Seventy two patients of calcaneal fractures in our department from 2006 to 2010 with lateral incision were observed and discussed after open reduction and internal fixation (ORIF). Results The patients were followed up for an average of 4.5 months. Skin incision edge partially necrosis or faulty union postoperation occurred in seven patients, of which five were cured by dressing and two were cured by skin island flap supplied by the nervus suralis. Conclusion For treating calcaneal intraarticu-lar fractures with ORIF through lateral L-shaped incision, the surgeons should know the regional anatomy around the calcaneos very well, choose the best operation timing, drain the wound properly and perform according to skin flap technique. These are the key points to avoid the skin flap necrosis.

  15. Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation

    Institute of Scientific and Technical Information of China (English)

    LI Wen-jun; TIAN Wen; TIAN Guang-lei; CHEN Shan-lin; ZHANG Chang-qing; XUE Yun-hao; LI Zhong-zhe; ZHU Yin

    2009-01-01

    Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons.Inappropriate management of these injuries may result in chronic pain,stiffness,deformity,or post traumatic arthritis.Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization.The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation.Methods From May 2005 to May 2007,a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation.Of the 26 cases,11 involved in metacarpophalangeal joint,and 15 interphalangeal joint in proximal interphalangeal.Kirschner wire,mini wire and absorbable suture were used for limited internal fixation.All patients were followed up and patients were accomplished with total active motion(TAM)of fingers.Results All patients were reviewed by an independent observer.The mean follow up was 13 months(range 9 to 24 months).Subjective,objective and radiographic results were evaluated.X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases,joint incongruity(less than 1 mm)and joint space narrowing in 3 cases respectively.Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases.An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery.Based on TAM the overall good-excellent rate of joint motion function was 80.8%.Conclusion Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.

  16. Benefits and harms of locking plate osteosynthesis in intraarticular (OTA Type C) fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Rasmussen, Jeppe Vejlgaard; Frich, Lars Henrik

    2012-01-01

    INTRODUCTION: Locking plate osteosynthesis of proximal humeral fractures are widely recommended and used, even in complex intraarticular fracture patterns such as AO/OTA Type C fractures. We systematically reviewed clinical studies assessing the benefits and harms of osteosynthesis with angle...... stable plates in AO/OTA Type C fractures of the proximal humerus. METHODS: We conducted an iterative search in PubMed, Embase, Cochrane Library, Web of Science, Cinahl, and PEDro in all languages from 1999 to November 2010. Eligible studies should study the outcome for Type C fractures after primary...... osteosynthesis with locking plate within two weeks of injury, and a follow-up period of six months or more. Patients should be evaluated with the Constant-Murley Score (CS). Two observers extracted data independently. RESULTS: Twelve studies and 282 Type C fractures were included. Results were categorised...

  17. Corrective osteotomy assisted by computer simulation for a malunited intra-articular fracture of the distal humerus: two case reports.

    Science.gov (United States)

    Oura, Keiichiro; Kunihiro, Oka; Okada, Kiyoshi; Tanaka, Hiroyuki; Murase, Tsuyoshi

    2016-11-01

    Intra-articular malunion after fractures of the distal humerus can cause pain, stiffness and, consequently, osteoarthritis in the long run. Although corrective osteotomy for intra-articular malunion has been reported, it is still technically challenging and needs careful preoperative evaluation and planning. Here, we present two cases of corrective osteotomy assisted by preoperative three-dimensional (3-D) computer simulation. We present two cases of malunited intra-articular fracture of the distal humerus, which was treated by corrective osteotomy with the aid of 3-D computer simulation. One case was initially treated with closed reduction and pinning, and the other was initially treated with open reduction and internal fixation. Both of them had pain and severely limited range of motion in the elbow due to intra-articular malunion. 3-D models of the bilateral humeri were created on a computer using computed tomography (CT) data. The deformity was analyzed by superimposing the model of the affected humerus on the mirrored model of the contralateral normal humerus. Osteotomy, reduction and fixation were simulated preoperatively on the computer. The actual surgery was performed exactly according to the preoperative 3-D computer simulation. The operative procedures were performed successfully according to the computer simulation. Range-of-motion exercises started 3 days and immediately after the surgery in cases 1 and 2, respectively. Two years after surgery, there were no complaints of pain or instability. The range of elbow motion was 5°-140° and 15°-125° in cases 1 and 2, respectively. Plain radiographs and CT scans showed good reconstruction of the articular surface. 3-D computer simulations can be useful in preoperative planning for intra-articular corrective osteotomy for complex malunion of the distal humerus.

  18. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome.

    Science.gov (United States)

    Pan, M; Chai, L; Xue, F; Ding, L; Tang, G; Lv, B

    2017-07-01

    The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared. The relative displacement of the EFLIF was less than that of the plate (0.1363 mm to 0.1808 mm). The highest von Mises stress value on the plate was 33% higher than that on the EFLIF. A normal restoration of the Böhler angle was achieved in both groups. No significant difference was found in the clinical outcome on the American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale, or on the Visual Analogue Scale between the two groups (p > 0.05). Wound complications were more common in those who were treated with ORIF (p = 0.028). Both EFLIF and ORIF systems were tested to 160 N without failure, showing the new construct to be mechanically safe to use. Both EFLIF and ORIF could be effective in treating Sanders type 2 calcaneal fractures. The EFLIF may be superior to ORIF in achieving biomechanical stability and less blood loss, shorter surgical time and hospital stay, and fewer wound complications.Cite this article: M. Pan, L. Chai, F. Xue, L. Ding, G. Tang, B. Lv. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome. Bone Joint Res 2017

  19. 跟骨关节内骨折内固定手术临床报告%The Clinical Report of Inter-articular Calcaneal Fracture Fixation Surgery

    Institute of Scientific and Technical Information of China (English)

    陈家麟

    2011-01-01

    Objective Through inter-articular calcaneal fracture fixation surgery and complications study to evaluated the results of surgical technique with open reduction and internal fixation of the inter-articular calcaneal fractures,and controlled complications. Methods From February 2004 to October 2010,45 sides of calcaneal in 42 patients were treated with open reduction and plastic calcaneus titanium plate fixation Sanders Ⅰ~Ⅳ type fractures through lateral approach with lateral “L” shaped incision,part of cases supplemented by autogenous bone grafting when necessary. According to Sanders classification,3 sides were accounted for type Ⅰ ,20 for type Ⅱ , 17 for type Ⅲ ,5 for type Ⅳ. During operation,intraoperative lateral X-ray observation Bohlers and Gissanes angle,Broden view was made to evaluate the recovery of articular surface. Results Incision necrosis infection in 3 cases,sural nerve injury in one foot. X-axis and lateral radiography ,and patients were Maryland foot score standard evaluation results of operations,45 sides of calcaneal fractures in 42 patients were followed up for 2~36 months,average of 18 months. Excellent in 27,good in12 feet,fair in 4 feet,poor in 2,excellent and good rate was 86.7%. Conclusion Lateral “L” shaped incision,open reduction and internal fixation of calcaneal fractures,can be more satisfactory anatomical reduction and rigid fixation of calcaneal fractures. It is an effective way. Intraoperative flap incision must be carefully protected to prevent postoperative wound necrosis or infection.%目的 通过对跟骨关节内骨折内固定手术和并发症研究,探讨跟骨关节内骨折内固定手术方法和治疗效果,防治并发症.方法 2004年2月至2010年10月我科采用外侧"L"型切口、可塑形跟骨解剖钢板进行开放复位内固定,手术治疗Sanders分型Ⅰ~Ⅳ型跟骨骨折42 例45足,必要时行植骨.根据Sanders分型,Ⅰ型3足,Ⅱ型20足,Ⅲ型17足,Ⅳ型5足.术中

  20. A new building block: costo-osteochondral graft for intra-articular incongruity after distal radius fracture.

    Science.gov (United States)

    Tang, Chris Yuk Kwan; Fung, Boris; Poon, T L; Fok, Margaret

    2014-01-01

    Even with the invention of locking plates, intra-articular fractures of distal radius with extreme comminution remain a challenge for orthopaedic surgeons. Osteochondral graft is a potential choice to reconstruct the articular defect. We report a patient who had a fracture of distal radius with costo-osteochondral graft for articular reconstruction which has not yet been described in the English literature. At nine-year follow-up, he was pain free and had full range of movement of the wrist. The authors suggest that costo-osteochondral graft could be an option with satisfactory result.

  1. TACTICS OF TREATMENT IN CHILDREN WITH INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS

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    Y. N. Proshchenko

    2012-01-01

    Full Text Available Material and methods. The authors studied 121 patients with intra-articular fractures of the distal humerus in age from 3 to 18 years. In the study group (consisted of 81 patients the displacement of the distal fragment retained after a single unsuccessful reduction. In these children open reduction and fixation were performed. In cases of damaged neurovascular bundle the authors carried out revision and reconstruction of damaged nerve and vascular trunks. The control group consisted of 40 children who were treated conservatively (closed reposition. Follow-up was at least 6 months after discharge. Results. Evaluation of the functional results showed improvement in 67,0% of patients in the study group and 33,0% - in the control group. In study group a good anatomic result was achieved in 73 (90% patients, satisfactory - in 6 (7,5% and poor - in 2 (2,5%. In the control group a good anatomical results were obtained in 7 (17,5% patients, satisfactory - in 14 (35%, poor -in 19 (47,5%. Conclusion. Indications for surgical treatment: secondary displacement of bone fragments after a single failure or closed reduction. Elimination of fragment displacement prevents posttraumatic contractures and deformities of the upper extremity, and contribute to the full restoration of elbow joint function.

  2. Sustentaculum Lunatum: Appreciation of the Palmar Lunate Facet in Management of Complex Intra-Articular Fractures of the Distal Radius.

    Science.gov (United States)

    Paryavi, Ebrahim; Christian, Matthew W; Eglseder, W Andrew; Pensy, Raymond A

    2015-09-01

    Fracture of the distal radius is the most common wrist injury. Treatment of complex intra-articular fractures of the distal radius requires an accurate diagnosis of the fracture pattern and a thoughtful approach to fixation. We propose a new term, sustentaculum lunatum, for the palmar lunate facet. The sustentaculum lunatum deserves specific attention because of its importance in load transmission across the radiocarpal joint. It is also key to restoring the anatomy of the palmar distal radial metaphysis during internal fixation. We provide a review of the structure and function of the sustentaculum lunatum and describe fixation techniques. This article is intended to promote awareness of this fragment in the treatment of fractures of the distal radius.

  3. Operative treatment of displaced intra-calcaneal fractures%跟骨移位关节内骨折的手术治疗

    Institute of Scientific and Technical Information of China (English)

    梁军; 辛景义; 曹红彬

    2012-01-01

    Objective To explore the clinical efficacies of displaced intra-calcaneal fractures with operative treatment.Methods From January 2005 to December 2010,103 calcaneal patients (92 males,11 females) were recruited.The mean age was 45.8 years old ( range:23 - 65 ).All received operative treatment.They included left calcaneal fractures (n =51 ),right calcaneal fractures (n =40) and bilateral calcaneal fractures (n =12 ).All patients were of closed fractures.According to the Sanders classification,there were type Ⅱ ( n =15 ),type Ⅲ ( n =75 ) and type Ⅳ ( n =13 ).A modified lateral approach with profiled plate fixation was adopted for all.Partial weight-bearing occurred at 6 weeks and full weight-bearing at 12 weeks.Function assessment was made with the American Orthopedic Foot and Ankle Society anklehindfoot scale (AOFAS).Results The mean follow-up period was 18 months ( range:6 -30) and the mean healing duration 12 weeks (range:8 - 15 ).Two cases had incision dehiscence.After the removal of plate,the skin healed.Eight cases were associated with subtalus arthritis and painful walking.Three cases of caved calcaneal surface appeared after weight-bearing.According to the AOFAS foot score,the outcomes were excellent ( n =83 ),good ( n =13 ),fair ( n =5 ) and poor ( n =2 ).And the excellent and good rate was 93.2%.Conclusion With a modified lateral approach,displaced intra-calcaneal fracture may be treated with a satisfactory clinical efficacy.But an orthopedic surgeon should master skillful surgical techniques.%目的 探讨跟骨移位关节内骨折切开复位异型钢板手术治疗的临床疗效.方法 自2005年1月至2010年12月天津医院创伤骨科收治并获得随访的跟骨移位关节内骨折患者103例,男92例,女11例,年龄23 ~65岁,平均45.8岁.左跟骨51例,右跟骨40例,双跟骨骨折12例,均为闭合骨折,2例并发脊柱损伤.骨折根据Sander分型,SanderⅡ型15例,SanderⅢ型75例,SanderⅣ型13例.所有患者均应用改

  4. Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series.

    Science.gov (United States)

    Rubin, Guy; Chezar, Avi; Rinott, Micha; Bor, Noam; Rozen, Nimrod

    2013-06-01

    At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the "volar Kapandji technique" completed follow-up of at least 12 (12 to 54) months. The mean age was 43 (23 to 53) years. The mean Disability of the Arm, Shoulder, and Hand score was 21.7 (0 to 41) and the mean Patient-Rated Wrist Evaluation score was 12.9 (0 to 25.8). The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.

  5. 空心钉治疗跟骨骨折疗效分析%Effective analysis of calcaneal fractures treated with the hollow screw

    Institute of Scientific and Technical Information of China (English)

    赵航; 薛锋; 单连成; 徐雪荣; 张东

    2012-01-01

    目的 探讨空心钉治疗跟骨骨折的临床疗效.方法 对75例跟骨骨折患者中38例(45足)用空心钉治疗,37例(45足)用钢板内固定治疗.记录两组患者的手术时间、术中出血量、骨折愈合时间及术后功能,对两种疗效进行对比.结果 75例患者均获得随访,时间6~18(10.32±2.18)个月.空心钉组优良率为93.33%,钢板组优良率为91.11%,两组疗效差异无统计学意义(P>0.05).与钢板组比较,空心钉组的手术时间和术中出血量明显缩短或者减少,差异有统计学意义(P0.05);两组并发症发生率差异无统计学意义(P>0.05).结论 空心钉治疗跟骨骨折能有效防止关节面复位后再塌陷及骨折端再移位,手术简便、手术创伤小,是治疗跟骨骨折较理想的一种方法.%Objective To explore the curative effect of calcaneal fractures treated with the hollow screw. Methods 75 patients with calcaneal fractures in our hospital were studied, 38 patients ( 45 feet ) were treated with the hollow screw, 37 patients ( 45 feet ) were treated with plate fixation. The operation time, blood loss, fracture healing time, and postoperative functional scores were recorded in two groups, and the therapeutic effect in two groups was compared. Results 75 cases were followed up from 6 to 18 months( average 10. 32 ±2. 18 months ). The excellent and good rate was 93. 33% in hollow screw group, and 91. 11% in plate group. There was no significant difference between two groups ( P >0. 05 ). The operative time and volume of blood loss in hollow screw group were significantly shorter or reduced than those in plate group, the difference was statistically significant ( P 0. 05 ). The incidence of complications was no significant difference in two groups( P > 0. 05 ). Conclusions The hollow screw in treatment of calcaneal fractures can effectively prevent the collapse of the articular surface and re-displacement again. It is very simple with less surgical trauma. It is a way

  6. Individualized reconstruction plate for treatment of calcaneal fractures via tarsal sinus incision%个体化重建钢板在经跗骨窦切口治疗跟骨骨折中的临床应用

    Institute of Scientific and Technical Information of China (English)

    吴勐; 郭永明; 张朝; 刘重; 石宇; 杨亚龙; 郑文; 魏媛媛

    2015-01-01

    Objective To investigate the clinical efficacy of individualized reconstruction plate in the treatment of calcaneal fractures through the tarsal sinus incision.Methods From May 2010 to September 2012,we treated 46 cases of calcaneal fracture (51 feet) involving talocalcaneal joint.They were 35 males and 11 females,17 to 65 years of age (average,35 years).The injury affected the left foot in 24 cases,the right foot in 17,and both feet in 5.By the Sander's classification,30 feet were type Ⅱ and 21 type 11Ⅲ.The fractures were reduced through the tarsal sinus incision before internal fixation with individualized reconstruction according to the morphology of fracture.When necessary,fixation with hollow screws was added.The B(o)hler and Gissane angles were compared between preoperation and postoperation.The clinical efficacy was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) system.Results The patients were followed up for 8 to 14 months (average,12 months).No such complications as incision infection,skin necrosis,plate loosening or exposure occurred in this group.There were significant differences in the B(o)hler and Gissane angles between preoperation and postoperation [(31.70° ± 5.50° and 122.10° ± 6.79° at 3 days postoperation) and (30.95° ± 3.47° and 122.49° ± 4.83° at 6 months postoperation) versus (6.14° ± 1.58° and 91.63° ± 4.76° at preoperation)] (P < 0.05),but no significant difference in the B(o)hler and Gissane angles between 3 days postoperation and 6 months postoperation (P > 0.05).All the patients obtained bony union at 6 months postoperation.According to the AOFAS scores,38 feet were excellent,9 feet good and 4 feet fair,giving an excellent to good rate of 92.2%.Conclusion In the treatment of intra-articular calcaneal fractures through the tarsal sinus incision,application of individualized reconstruction plate can lead to fine fracture reduction,rigid internal fixation,early exercise

  7. Treatment of plastic Titanium plate on fixation of calcaneal fractures%可塑钛板内固定治疗跟骨骨折

    Institute of Scientific and Technical Information of China (English)

    崔庆元

    2011-01-01

    Objective To investigate the plastic plate fixation of calcaneal fractures. Methods Totally 22 patients, 18 males, 10 cases of left foot, right foot 7 cases in which both feet 1 female 4 cases , 3 cases of left foot right foot in 1 case. The average age of 22 -44 years old 33 years old. Are fall injuries. Are blunt trauma, the use of L - shaped lateral calcaneal incision subperiosteal dissection to expose the subtalar and calcaneocuboid joints, so Bohler recovery to 30° angle or so, with a plastic titanium plate. Results After 2 feet skin flap with partial necrosis of subcutaneous infection in which a foot, some exposed steel, dressing healed. Patients were followed up using Maryland foot score excellent joint function rate of 88%. Conclusions Plastic plate fixation of calcaneal fractures, if done correctly, results are quite satisfactory.%目的 探讨可塑钛板内固定治疗跟骨骨折.方法 本组22例,男性18例,左足10例,右足7例,其中双足1例,女性4例,左足3例,右足1例.年龄22 ~44岁,平均33岁.均为坠落伤.均为闭合性损伤,采用跟骨外侧L型切口骨膜下剥离,显露距下关节及跟骰关节,使B(o)hler角恢复至30°左右,用可塑钛合金钢板固定.结果 术后两足切口皮缘有部分坏死其中1足出现皮下感染,钢板部分外露,换药愈合.术后随访采用Maryland足部评分法关节功能优良率达88%.结论 可塑钛板内固定治疗跟骨骨折,只要方法得当,效果十分理想.

  8. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images

    Energy Technology Data Exchange (ETDEWEB)

    Suojaervi, Nora; Lindfors, N. [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Sillat, T.; Koskinen, S.K. [HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Department of Radiology, Helsinki (Finland)

    2015-12-15

    Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities. (orig.)

  9. Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

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    Panigrahi

    2016-08-01

    Full Text Available Background Scapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint. Objectives This study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate. Methods Between 2012 and 2015, at 2 centers (HMCH & SHCE of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side. Results The median score was 88% (mean 65%, range 30 to 100. The median score for strength was 21/25 (mean 19, range 0 to 25 and that for pain 11/15 (mean 11, range 5 to 15. The median functional score was 16/20 (mean 15, range 0 to 20. The mean range of active abduction of the shoulder was 135° (20 to 180, the mean range of flexion 138° (20 to 180 and the mean range of external rotation 38° (0 to 100. Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%. Conclusions Various fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.

  10. 开放性跟骨骨折的早期规范化治疗%Early and standard treatment of open calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    龚晓峰; 武勇; 王岩; 王满宜; 贺良

    2008-01-01

    目的 探讨开放性跟骨骨折的早期规范化治疗,以期降低骨髓炎、下肢截肢的发生率.方法 2005年10月-2006年10月收治开放性跟骨骨折16例17处,其男12例13处,女4例4处;平均年龄31岁.应用规范化治疗:伤后急诊手术清创,大量等渗盐水、过氧化氢、碘伏冲洗.根据全身情况及骨折类型分别进行Ⅰ期手法整复石膏托外固定和Ⅰ期多克氏针经皮固定.待软组织消肿后,经外侧切口行切开复位内固定.术后平均随访6个月,采用美国足踝外科协会(AOFAS)踝-后足功能评分评估并发症发生率.结果 本组患者未截肢;伤口浅表感染、深部感染及骨髓炎各1例;伤口延迟愈合及足底皮肤坏死各1例.结论 早期规范化治疗能够显著降低伤口感染率,从而预防骨髓炎的发生,并为Ⅱ期手术处理骨折提供良好的软组织条件.%Objective To discuss early and standard treatment of open calcaneal fractures so as to lower incidence of amputation and osteomyelitis. Methods From October 2005 to October 2006,16 cases of 17 open calcaneal fractures were treated in our department.There were 12 males(13 fractures)and 4 females at a mean age of 31 years.All cases were treated with the sanle early treatment protocol,including emergent debridement,and lavaging with normal saline,H2O2 and iodide solutions.All cases were immobilized with plaster or multiple K-wires according to systemic condition and fracture type.With detumescence of the soft tissues.open reduction and internal fixation was done via lateral incision.The patients were followed up for mean six months and the incidence rate of complications evaluated bv American Orthopaedic Foot and Ankle Society(AOFAS)scale. Resuits No amputation was found.but there was one case with osteomyelitis.one with superficial infection and one with deep infection.Delayed skin union was found in one case and plantar skin necrosis in one. Conclusion Early and standard treatment of open

  11. Arthroscopic removal of intraarticular fragments following fracture dislocation of the hip

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    Bagaria Vaibhav

    2008-01-01

    Full Text Available We report here a case of posterior dislocation of hip with fracture of posterior lip of acetabulum, with retained fracture fragments after a successful closed reduction. The fractured fragments were removed by arthroscopy of the hip. The technique of hip arthroscopy used in removing the fragments is discussed.

  12. THE FUNCTIONAL OUTCOME OF LOCKING VS NON-LOCKING DUAL PLATE FIXATION IN INTRAARTICULAR FRACTURE DISTAL END HUMERUS: A RETROSPECTIVE COMPARATIVE STUDY

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    Manish Bairagi

    2016-07-01

    Full Text Available BACKGROUND Despite all advances in treatment, it is a challenge to most of the orthopaedic surgeons to give better result in the management of distal end humerus intra-articular fractures, because it has complex anatomy. This study has been done to evaluate the functional outcome of double plate fixation with right angle to each other for intra-articular fracture of distal end humerus and compared with locking vs non-locking plate fixation. AIM This study has been done to evaluate the functional outcome of double plate fixation with right angle to each other for intraarticular fracture of distal end humerus with comparison of locking and non-locking plate fixation. METHODS This is retrospective comparative study done between 2006 and 2014 in the Department of Orthopaedics, G.R. Medical College and J.A. Group of Hospital, Gwalior (M.P., India. All patients who were presented to Department of Orthopaedics with intra-articular fracture, distal end humerus fracture, medically fit patient who were of age group between 18-80 years of age with close or type 1 GA (Gustilo Anderson compound fracture and fracture type AO type C were included. Other patients who sustained GA type 2 and 3, severely comminuted and severe osteoporotic bone were excluded. RESULT A total no. of 60 patients. The age of patients ranged from 22 to 65 years. To classifying according to AO classification, 15 cases were of type C1, 39 were of type C2 and 06 were of type C3. The results were rated using Jupiter’s criteria as excellent in 26 (43.3% cases, good in 16 (26.7%, fair in 11 (18.3% cases and poor in 07 (11.7%. CONCLUSION Double plate fixation is standard and effective method of treating intra-articular fracture of distal humerus, the method gives a stable fixation and allow early mobilization of elbow joint without risk of implant failure. In the study, there is no much advantage from the locking plate fixation in comparison with the non-locking plates.

  13. 锁定加压钛板内固定治疗跟骨骨折%Application of locking compression plate in treatment of calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    董玉金; 童致虹; 张铁慧; 曾伟峰; 李靖年

    2013-01-01

    Objective To evaluate the clinical effect of the treatment for calcaneal fractures by locking compression plate.Methods From January 2008 to December 2011,30 patients with 40 calcaneal fractures were operated with locking compression plate.There were 25 males (33 feet) and 5 females (7 feet) with an average age of 44.8 years (range,22-60 years).Fifteen feet were on the left side,and 25 feet were on the right side.All patients had closed fractures,with complicated spinal injury in 2 patients.According to Sanders classification,20 feet were type Ⅱ[fractures,15 feet were type Ⅲ,and 5 feet were type Ⅳ.The lateral approach was adopted for all the patients in the treatment in which locking compression plate fixation was used but no external fixation.Early and suitable rehabilitation was carried out postoperatively.The patients could bear part of the loading six weeks after the operation and all the loading twelve weeks after the operation.The results were validated using the Anerican Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results The patients were followed up for 8-20 months (average,12 months).Bone union occurred in all cases with roentgenographic evidence during 8-12 weeks postoperation (average,10 weeks).None of the patients had such complications as nerve injury or osteomyelitis.Incision dehiscence occurred in one case in which a little part of titanium plate and screw was exposed,but the incision was healed by dressing 1 month later.Two patients had subtalar arthritis and suffered from the pain while walking.Of the two patients,the pain was relieved for one after the operation of subtalar joint fusion,and the other was lost to the follow-up after he or she refused further treatment for economic reasons.According to AOFAS foot score standard,the effects of 20 cases were excellent,17 were good,and 3 were fair.The excellent and good rate was 92.5%.Conclusion The application of locking compression plate is an effective and satisfied

  14. 足跟部软组织剥脱伤合并跟骨骨折的手术治疗%Surgery treatment of heel soft tissue denudation injury associated with calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    黄恩铭

    2015-01-01

    Objective To investigate the treatment methods and clinical efficacy of heel soft tissue denudation injury associated with calcaneal fractures.Methods 16 cases of heel soft tissue denudation injury associated with calcaneal fractures were undergone surgery.Firstly,a thorough debridement were applied,secondly calcaneal fractures were treated with open reduction,plate fixation and bone graft complex with antibiotics.Results All soft tissue denudation injury flap survived,while skin necrosis occurred in two cases,but wounds healed by short-term of changing dress-ing.All patients were followed up from 6 months to 24 months,no chronic soft tissue infections and osteomyelitis. Fracture healing time was 15 ~22 weeks.The last follow-up for AOFAS ankle-hind foot functional scores:excellent in 6 cases,good in 8,fair in 1.Conclusions For the heel soft tissue denudation injury associated with calcaneal frac-tures,thorough firstly debridement can provide good soft tissue conditions for the second phase fracture fixation, which can achieve satisfactory effect.%目的:探讨足跟部软组织剥脱伤合并跟骨骨折的临床治疗方法及疗效。方法对16例足跟软组织剥脱伤合并跟骨骨折患者行一期清创、二期跟骨骨折切复钢板内固定加带抗生素人工骨植骨术。结果患者足跟部剥脱伤皮瓣均一期成活(其中有2例术后初期出现表皮部分坏死,经短期换药创面顺利愈合)。患者均获得随访,时间6~24个月。未并发慢性软组织感染、骨髓炎。骨折愈合时间为15~22周。末次随访 AOFAS踝-后足功能评分:优6例,良8例,中2例。结论足跟软组织剥脱伤合并跟骨骨折,一期清创为二期骨折内固定提供良好的软组织条件,可取得满意疗效。

  15. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

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    Fakoor

    2015-08-01

    Full Text Available Background Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives In this study we compared two surgical approaches, open reduction and internal fixation (ORIF and closed reduction with external fixation (CR + EF, for treatment of intra-articular distal radius fractures. Patients and Methods Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification were treated with two surgical methods (ORIF and CR + EF; 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ. We compared radiological parameters of distal radius, range of motion (ROM of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results In our study, radiological findings for the ORIF group were radial inclination (RI: 19.35, radial length (RL: 10.35, radial tilt (RT: 8.92, and ulnar variance (UV: 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E: 137, Radial/Ulnar deviation (R/U: 52, and Supination/Pronation (S/P: 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  16. Efficacy of radial styloid targeting screws in volar plate fixation of intra-articular distal radial fractures: a biomechanical study in a cadaver fracture model

    Directory of Open Access Journals (Sweden)

    Yamashita Toshihiko

    2010-12-01

    Full Text Available Abstract Background The locking screws target the radial styloid, theoretically provide greater stability against radial styloid fragment. However, it is unknown whether the radial styloid locking screws increased the stability of the volar plating system fixation along the entire distal radius or not. In this study, we evaluated the stability of the volar plating system fixation with or without the radial styloid screws using a biomechanical study in a cadaver fracture model. Methods Six matched pairs of fresh-frozen human cadaver wrists complete from the proximal forearm to the metacarpal bones were prepared to simulate standardized 3-part intra-articular and severe comminuted fractures. Specimens were fixed using the volar plating system with or without 2 radial styloid screws. Each specimen was loaded at a constant rate of 20 mm/min to failure. Load data was recorded and, ultimate strength and change in gap between distal and proximal fragments were measured. Data for ultimate strength and screw failure after failure loading were compared between the 2 groups. Results The average ultimate strength at failure of the volar plate fixation with radial styloid screws (913.5 ± 157.1 N was significantly higher than that without them (682.2 ± 118.6 N. After failure loading, the average change in gap between the ulnar and proximal fragment was greater than that between the radial and proximal fragment. The number of bent or broken screws in ulnar fragment was higher than that in radial fragment. The number of specimens with bent or broken screws in cases with radial styloid screws was fewer than that in the fixation without radial styloid screws group. Conclusion The ulnar fragment is more intensively stressed than the radial fragment under axial loading of distal radius at full wrist extension. The radial styloid screws were effective in stable volar plate fixation of distal radial fractures.

  17. Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation

    Directory of Open Access Journals (Sweden)

    Roland Biber

    2016-01-01

    Full Text Available MAGNEZIX® (Syntellix AG, Hanover, Germany is a biodegradable magnesium-based alloy (MgYREZr which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up.

  18. Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management.

    Science.gov (United States)

    Toon, Dong Hao; Premchand, Rex Antony Xavier; Sim, Jane; Vaikunthan, Rajaratnam

    2017-02-02

    To evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation. A total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients' treatment costs, median salaries and lengths of medical leave were obtained. DASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52). Our study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option. Level 3.

  19. Effect of different hemostasis methods on operative incision healing of calcaneal fracture%不同止血方法对跟骨骨折手术切口愈合的影响

    Institute of Scientific and Technical Information of China (English)

    代灿; 苟景跃; 邓子龙; 张晓星

    2016-01-01

    目的:观察和对比分析电凝止血、钳夹止血及压迫止血对跟骨骨折手术切口愈合的影响。方法收集2012年12月~2015年12月收治的60例66足跟骨骨折患者临床资料,其中男性48例,女性12例;年龄18~59岁,平均36.6岁。均经跟骨外侧L形切口行切开复位钛板内固定术,术中止血方法分别采用电凝止血、钳夹止血及压迫止血。记录三组患者年龄、骨折分型、伤后至手术时间、手术时间、切口干燥时间、切口愈合时间、切口并发症发生率及足部功能Maryland评分等,并进行统计学分析。结果在切口干燥时间、切口愈合时间及切口并发症等方面钳夹止血组显著优于电凝止血组和压迫止血组(P<0.05),而电凝止血组和压迫止血组之间无显著性差异(P>0.05),三组足部功能Maryland评分无显著性差异(P>0.05)。结论跟骨骨折术中行钳夹止血可明显降低切口并发症的发生率。%Objective To observe and compare the effects of electrocoagulation hemostasis, forceps hemo-stasis and compression hemostasis on the operative incision healing in calcaneal fracture patients.Methods From Dec.2012 to Dec.2015,60 patients with calcaneal fracture were treated.Among them 48 were male and 12 were fe-male ranged from 18 to 59 years(average,36.6 years).All cases (66 calcaneal fractures) were treated by open re-duction and internal fixation through L-type calcaneal lateral incision.Intra-operative hemostasis methods included the electrocoagulation hemostasis, forceps hemostasis and compression hemostasis. Indexes such as age, fracture classification,time from injury to operation,operation time,drying time and healing time of the incision,incidence of incision-related complications and Maryland foot function score among the 3 groups were recorded and statistically analyzed.Results The forceps hemostasis group was significantly better than the electrocoagulation

  20. 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)

  1. Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years.

    Science.gov (United States)

    Board, T; Kocialkowski, A; Andrew, G

    1999-12-01

    Forty-six patients aged 55-90 with intra-articular displaced fractures of the distal radius were reviewed retrospectively. All patients were treated with either manipulation and plaster of Paris or Kapandji wiring. Radiographic and functional review was performed by an independent observer a mean of 17 months after the fracture. The results showed superior anatomical and functional results in the group treated with Kapandji wiring. The mean dorsal angle was significantly better in the wired group, and the improvement in dorsal angle, radial angle and radial length from presentation to final result was also significantly better. Functional results were excellent or good in 19/23 of the wired group, compared with 12/23 of the plaster group. There was a strong correlation between functional outcome and both dorsal angle and radial length at union. These results support the use of this method of wire fixation in older patients, as the technique is simple and complications were few.

  2. Anatomy Titanium Plate and Bone Graft for Treatment of Calcaneal Fractures Rating%解剖钛钢板加植骨术对跟骨骨折的治疗效果评价

    Institute of Scientific and Technical Information of China (English)

    杨国涛

    2015-01-01

    Objective To evaluate the anatomy of the titanium plate and bone graft for the treatment of calcaneal fractures. Methods 30 patients in our hospital 33 patients with fractures of the heel joint for the study were given anatomical titanium plate and bone graft treatment, analyze its therapeutic effect. Results Al patients were fol owed up foot in 1-2 years after treatment, postoperative complication rate 6.1%; Maryland Foot Score draw its excel ent rate was 90.9%. Conclusion he Anatomy of titanium plate and bone graft treatment of calcaneal fracture treatment significantly, the prognosis is good, worthy of promotion in clinical practice.%目的:评价解剖钛钢板加植骨术对跟骨骨折的治疗效果。方法选取我院收治的30例33足跟关节内骨折患者为研究对象,均给予解剖钛钢板加植骨术治疗,分析其治疗效果。结果所有患足在治疗后均随访1~2年,术后并发症发生率为6.1%;Maryland 足部评分标准得出其优良率为90.9%。结论解剖钛钢板加植骨术治疗跟骨骨折的治疗效果显著,预后效果好,值得在临床上推广。

  3. Calcaneal reconstructive plate plus bone graft in treatment of intra-articular calcaneal fractures%跟骨重建钢板加植骨治疗跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    袁瑞斌

    2010-01-01

    @@ 跟骨骨折是足部的常见损伤,伤者以青壮年居多.跟骨骨折占所有骨折的1%~2%, 严重损伤易遗留伤残.2005年至2008年我科采用跟骨重建钢板加植骨治疗跟骨关节内骨折16例,疗效满意.现报告如下.

  4. 跟骨关节内骨折钢板内固定与克氏针内固定的比较%TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES USING KIRSCHNER'S WIRE OR CALCANEAL PLATE

    Institute of Scientific and Technical Information of China (English)

    李学金; 李群; 张知博; 温晓燕; 严宏践

    2008-01-01

    目的 比较采用克氏针内固定和钢板内固定治疗跟骨关节内骨折的效果.方法 回顾性分析2003年3月-2006年3月收治的71例86足跟骨关节内骨折手术治疗的患者资料,均为闭合性骨折.其中39例48足使用克氏针内固定,男34例,女5例;年龄15~64岁,平均36岁;病程4 h~10 d.双侧骨折9例,单侧骨折30例;根据Sanders分型,Ⅱ型40足,Ⅲ型7足,Ⅳ型1足.32例38足使用标准AO跟骨钢板内固定,男30例,女2例;年龄18~55岁,平均33岁;病程4 h~10 d.双侧骨折6例,单侧骨折26例:Sanders Ⅱ型31足,Ⅲ型5足,Ⅳ型2足.对术后随访超过12个月的患者进行评估,评估项目包括:术前和术后Bohler角、Gissane角;对单侧跟骨骨折评估跟骨高度和宽度(与健侧对比):通过手术前后的CT扫描和Borden位判断复位情况;功能评估采用美国足踝骨科协会(American Orthopedic Foot & Ankle Society,AOFAS)的评分系统.结果 克氏针内固定组获随访12~48个月,AOFAS评分75~100分,平均90.6分;优良率为87.8%.Bohler角术前0~10°,平均7.8°;随访时30~40°,平均33.2°;Gissane角术前75~95°,平均84°;术后115~135°,平均125°;手术前后差异有统计学意义(P<0.05).术后并发症:切口皮缘表浅坏死1足,针道感染1足.钢板内固定组获随访12~48个月,AOFAS评分49~100分,平均87.5分;优良率81.6%,与克氏针内固定组比较差异无统计学意义(P>0.05).Bohler角术前0~15°,平均6.5°;随访时25~40°,平均30.2°;Gissane角术前72~92°,平均80°;术后115~130°,平均120°;手术前后差异有统计学意义(P<0.05).术后并发症:切口皮缘坏死5足,腓肠神经损伤1足,腓骨肌腱鞘炎1足.结论 跟骨关节内骨折切开复位钢板内固定与克氏针内固定可获得相似的治疗效果,但克氏针内固定操作更加简便、经济、创伤小,软组织风险更低.

  5. 促进跟骨骨折内固定术后切口愈合的护理对策%Nursing Strategy of Promoting Incision Healing After Internal Fixation of Calcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    吴惠冰; 杜雪莲

    2014-01-01

    Objective To investigate nursing strategy of promoting incision healing after internal fixation of calcaneal fractures. Methods 121 patients with internal fixation of calcaneal fractures were divided into two groups. 60 cases of control group received routine nursing, while 61 cases of observation group received swelling care, pain care and wound care on the basis of routine nursing. The clinical outcomes were compared. Results Among 61 cases of observation group, there were 56 cases of incision healing within 14 days, 4 cases of poor partial involution (healing after one month of treatment) and one case of unhealed incision (caused by allograft rejection). Among 60 cases of control group, there were 39 cases of incision healing within 14 days, 15 cases of poor partial involution (healed after one month of treatment) and 6 cases of necrosis of local skin of incision (healing at 2 months after treatment). Conclusions Nursing intervention can promote the incision healing of calcaneal fractures surgery.%目的:探讨促进跟骨骨折内固定术后切口愈合的护理对策。方法将121例跟骨骨折内固定手术患者分为观察组及对照组,观察组在常规护理基础上,加强肿胀护理、疼痛护理、伤口护理,对照组予常规护理,比较两组的临床效果。结果观察组61例患者有56例切口14天愈合,4例切口局部对合差,经治疗1月内愈合,1例伤口不愈,为异体骨排斥引起;对照组60例患者有39例切口14天愈合,15例患者切口局部对合差,经治疗1月内愈合,6例患者伤口局部皮肤坏死,术后2个月愈合。结论护理干预可以促进跟骨骨折术后切口的愈合。

  6. Open reduction and internal fixation of Ideberg IV and V glenoid intra-articular fractures through a Judet approach: a retrospective analysis of 11 cases.

    Science.gov (United States)

    Hu, Chuanzhen; Zhang, Weibin; Qin, Hui; Shen, Yuhui; Xue, Zichao; Ding, Haoliang; An, Zhiquan

    2015-02-01

    To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations. The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively. 11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points. Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach.

  7. Effects of irrigation plus drainage on postoperative wound complications in calcaneal fractures QU%冲洗引流对预防跟骨骨折术后切口并发症的作用

    Institute of Scientific and Technical Information of China (English)

    曲文庆; 王丹; 陈明齐; 周智勇; 孙涛; 赵孟臣; 于敏; 夏江

    2008-01-01

    Objective To compare the effects of irrigation plus drainage versus sole drainage on wound complications after open reduction and internal fixation (ORIF) of calcaneal fractures. Methods From June 2003 to Decemher 2006,107 calcaneal fractures (92 cases)were treated by open reduction and internal fixation using a lateral approach. Of them.63 fractures (group A) were managed with irrigation plus drainage, and 44 fractures (group B) received drainage without irrigation. Postoperative wound complications, including incision infection, ecchymoma, blistering, sloughing, dehiscence, necrosis and exposure of implants. Were compared between the 2 groups by t-test. Results Postoperative wound complications occurred in 4 fractures (4 times)in group A and in 11 fractures (15 times)in group B. The difference in postoperative wound complication rate between group A (6.3%) and group B (25.0%) was statistically significant (χ2=7.476,P<0.05). Conclusion Drainage plus irrigation plays a positive role in the prevention of wound complications after ORIF of calcaneal fractures.%目的 通过比较冲洗引流与单纯引流在跟骨骨折内固定术后预防切口并发症方面的价值,探讨切口冲洗引流在跟骨骨折钢板内固定围手术期的意义.方法 对2003年6月至2006年12月间采用外侧入路切开复位钢板内固定治疗的92例107侧跟骨骨折患者进行回顾性分析,其中术后冲洗引流(A组)63侧,术后单纯引流(B组)44侧,A、B两组经两独立样本t检验排除年龄、坠落高度、开放伤、术前时间、止血带及抗生素使用时间等干扰冈素.从切口感染、皮下血肿形成、表皮水疱、切口裂开、皮缘坏死、钢板外露等方面比较两组的结果,并对两组切口并发症发生率进行χ2检验.结果 A组63侧跟骨手术后4侧(4次)发生切口相关并发症,发牛率为6.3%;其中1侧为可疑伤口感染,3侧发生表皮水疱.B组44侧跟骨手术后11侧(15次)发牛切口

  8. Medial displacement calcaneal osteotomy using minimally invasive technique.

    Science.gov (United States)

    Kheir, Ehab; Borse, Vishal; Sharpe, Jon; Lavalette, David; Farndon, Mark

    2015-03-01

    Medial displacement calcaneal osteotomy is a common procedure often used as part of pes planovalgus deformity correction. Traditionally the osteotomy is performed using a direct lateral or extended lateral approach, which may carry the risk of wound problems, infection and neurovascular injury. The authors describe a minimally invasive technique to perform the osteotomy and achieve the desired correction. The article illustrates our experience and learning curve with the use of this technique as an option for calcaneal osteotomy. We retrospectively reviewed the records of a sequential series of patients since 2011 whose calcaneal osteotomies were performed by 2 surgeons, after cadaveric training using a minimally invasive operative approach. Prior to 2011, similar surgeries, performed by the senior authors, were undertaken using a direct lateral approach. Thirty cases were identified; 29 had tibialis posterior reconstruction coupled with calcaneal osteotomy for acquired flexible planovalgus deformity and 1 patient had surgery for a malunited calcaneal fracture. Radiological and clinical union occurred in all 30 cases (100%). The radiographs of all cases were reviewed by a specialist musculoskeletal radiologist. There were no neurovascular or wound complications. All patients had restoration of neutral hindfoot alignment. One patient required screw removal after union, resolving all symptoms. This series suggests that minimally invasive calcaneal osteotomy surgery can achieve excellent union rates aiding correction of deformity with no observed neurovascular or soft tissue complications. For surgeons experienced in open surgery, there is a short learning curve after appropriate training. © The Author(s) 2014.

  9. Staging rehabilitative management of functional disorder of intraarticular fracture of knee joint following lower limbs trauma%膝关节内骨折后功能障碍的分期康复治疗

    Institute of Scientific and Technical Information of China (English)

    梁春祥; 王楚怀

    2002-01-01

    Objective To investigate staging rehabilitative management of intraarticular fracture of knee joint following lower limbs trauma.Method According to pathological changes during repair process,rehabilitation prescription was determined for 479 patients with intraarticular fracture of knee joint following lower limbs trauma.Knee joint scale was used to evaluate the patients before and after treatment.Result Mean range of motion of knee joint was increased by (45.73± 8.79) degree(t=8.79;P<0.01),mean total score of 6 indexes was increased by (41.16± 7.55) (t=9.28,P<0.01).Conclusion Rehabilitation treatment determined according to pathological process of fracture repair is necessary

  10. 关节镜诊治关节内桡骨远端粉碎性骨折的软组织损伤%Arthroscopic assessment of soft tissue injuries in comminuted intra-articular fractures of the distal radius

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To diagnose and evaluate soft tissue injuries in intra-articular fractures of the distal radius using arthroscopy. Methods Twenty young patients with displaced intra-articular fractures of distal radius were recruited in this prospective study. Three AO C2 and 17 C3 fractures were included. After arthroscopic examination fractures of distal radius were treated by external fixation with limited internal fixation or open plate fixation.Results Triangular fibrocartilage complex (TFCC) injury was found in 18 patients (90%) . Most were isolated Palmer type 1D injuries (67 %). Scapho-lunate ligament injury was found in two patients: one partial tear (grade Ⅱ) and one complete tear (grade Ⅲ). Follow-ups ranged from 6 to 18 months. At the last follow-up, wrist function was excellent in one patient (6%), good in eight(44%) and fair in 11 (50%). Conclusion TFCC injuries are common in intra-articular fractures of the distal radius while injuries to scapho-luuate ligament are uncommon.

  11. 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.

  12. Arthroscopic subtalar arthrodesis after a calcaneus fracture covered with a forearm flap.

    Science.gov (United States)

    Michels, Frederick; Stockmans, Filip; Guillo, Stéphane; Van Der Bauwhede, Jan; Oosterlinck, Dirk

    2011-01-01

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

  13. 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.

  14. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    Science.gov (United States)

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p notch step-off, diastasis or DRUJ

  15. Effect of SKy bone expander system by percutaneous osteoplasty in treatment calcaneal fracture%采用Sky骨扩张器经皮跟骨成形术治疗跟骨骨折

    Institute of Scientific and Technical Information of China (English)

    陈海涛; 杨朝华; 梁群英; 李启中; 郭海欧; 杜国聪; 区杰雄

    2013-01-01

    Objective To explore the clinical effect of percutaneous osteoplasty with SKy bone expander system in the treatment of calcaneal fracture.Methods 63 feet of 55 patients with calcaneal fractures were involved in this study.According to Sanders fracture classification including 38 feet of Sanders Ⅱ,18 feet of Sanders Ⅲ,7 feet of Sanders Ⅳ.There were 6 to 16 days interval between the injuries and the surgeries.The patients were treated by percutaneous osteoplasty with the SKy bone expander system.The standard of operation was the satisfaction of reduction and Bohler's and Gissane's angles under X-ray.Results All of 63 feet of 55 patients were followed up for average 22 months.According to the criterion of therapeutic effect,the results were as follows:excellent in 30 cases,good in 26 cases,fair in 7cases,and no poor case.The excellent and good rate was 88.9%.Conclusion Percutaneous osteoplasty with SKy bone expander system in the treatment of calcaneal fracture,especially in reduction and fixation of Sanders type Ⅱ and Sanders type Ⅲ,can recover Bohler's and Gissane's angles,significantly shorten the duration of illness,and has fast recovery and can possess satisfactory curative effect,and it is worth popularizing.%目的 探讨采用Sky骨扩张器经皮跟骨成形术治疗跟骨骨折的临床疗效.方法 该组55例63足跟骨骨折,受伤至手术时间6~16d.骨折按Sanders分类:Ⅱ型38足,Ⅲ型18足,Ⅳ型7足.采用Sky骨扩张器经皮跟骨成形术治疗跟骨骨折,手术标准是X线透视下应用Sky骨扩张器骨折复位满意与Bohler角和Gissane角满意.结果 该组55例63足均得到随访,随访时间平均22个月.按疗效标准评定,优30足,良26足,可7足,无差病例,优良率88.9%.结论 Sky骨扩张器经皮跟骨成形术治疗跟骨骨折,尤其适用于SandersⅡ型及SandersⅢ型跟骨骨折复位固定,并能恢复Bohler角和Gissane角,病程明显缩短,恢复快,疗效满意值得推广.

  16. Comparison of curative effects of two kinds internal fixation in treating calcaneal fractures%跟骨骨折两种内固定手术疗效比较

    Institute of Scientific and Technical Information of China (English)

    徐海栋; 赵建宁; 陈勇

    2013-01-01

    目的 对比分析可塑钛板及空心钉内固定治疗跟骨骨折的临床疗效.方法 对40例(52足)跟骨骨折根据自愿原则分别进入可塑钛板内固定组及空心钉内固定组进行手术治疗,各20例(26足),对比分析两组患者手术时间、术中出血量、骨折愈合时间及术后足踝功能.结果 40例均获得随访6~18个月,平均(10.42±1.33)个月.空心钉内固定组与可塑钛板内固定组比较,手术时间较短、出血量较多,差异有统计学意义(P<0.05);骨折愈合时间、Bohler角、Gissane角、踝关节活动范围两组差异无统计学意义(P>0.05);两组并发症发生率差异无统计学意义(P>0.05).结论 空心钉内固定治疗跟骨骨折能有效防止关节面复位后再塌陷及骨折移位,手术方式简单、创伤小,具有较大的徼创手术优势.%Objective To explore the curative effect of plastic titanic plates and hollow screws in the treatment of calcaneal fractures. Methods Forty patients (52 feet) with calcaneal fractures were studied. They were divided into two groups,20 patients (26 feet) were treated with plastic titanic plates and 20 patients(26 feet) were treated with hollow screws. The operative times,blood loss,fractures healing time,and postoperative function scores were recorded in two groups. And the therapeutic effect in two groups was compared. Results All of 40 cases were followed up for 6~18 months, with an average of (10.42± 1.33) months. The operative time and volume of blood loss in hollow screws group were significantly shorter or reduced than those in plastic titanic plates group. The difference was statistically significant(P0.05). The incidence of complications was not significantly different in two groups(P >0.05). Conclusion The hollow screws in treatment of calcaneal fractures can effectively prevent the collapse of articular surface and re-displacement again. The surgery is simple with less trauma,strong advantages of minimally

  17. Three-dimensional finite element analysis of calcaneal fractures%跟骨三维有限元模型的建立及其骨折发生机制

    Institute of Scientific and Technical Information of China (English)

    黄诸侯; 李俊; 陈日齐; 杜景文; 张建新

    2012-01-01

    目的:建立跟骨三维有限元模型,探讨跟骨骨折发生机制.方法:通过扫描正常人跟骨螺旋CT,精确模拟边界条件,并运用Sap 93计算软件运算建立跟骨有限元模型,模型由1 959个节点,1 496个单元组成.在跟骨有限元模型上模拟踝关节在中立位和背伸20°时的状况后对模型施以500N的垂直轴向载荷,观察模型应力分布和位移情况.结果:跟骨在踝关节中立位时通过跟距外侧的关节面,并且由内后斜向前外方向的跟骨处遭受应力最大.背伸20°受力时除上述位置遭受应力最大外,从跟骨体部走向后距关节面与跟腱之间的部位遭受应力也比较大.结论:高处坠落踝关节中立位时跟骨骨折的发生将从跟距关节面的外侧向内后方向走行;当坠落时踝关节处于背伸位时除产生上述骨折线外,跟骨体部走向后距关节面方向也将发生骨折,同时跟腱附着点附近也会形成撕脱性骨折.%Objective :To establish the three-dimensional finite element model of calcaneus,and to discuss mechanism of calcaneal fracture. Methods:The calcaneus of normal person was scanned with spinal CT.and the finite element model was established with the Sap 93 software. The node and element number of this model was 1 959 and 1 496 respectively. After establishing the finite element model of the calcaneus, the axial load of 500 N was applied on the model in neutral position and back stretches 20° position. The stress distribution and the displacement of the models were observed. Results:The fracture line passed through the lateral articular facet of talocalcaneal joint when the ankle joint was in neutral position,and the stress distribution was maximal at calcaneus from posteromedial to anterolateral aspect. In addition, the stress distribution was maximal from calcaneus to position between posterior talar articular surface and calcaneal tendon when the ankle joint was in back stretch position of 20 degree

  18. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Klempka, A.; Wagner, M.; Fodor, S.; Schmitt, R. [Cardiovascular Center Bad Neustadt an der Saale, Department of Diagnostic and Interventional Radiology, Bad Neustadt an der Saale (Germany); Prommersberger, K.J. [Clinic for Hand Surgery, Bad Neustadt an der Saale (Germany); Uder, M. [Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Department of Diagnostic Radiology, Erlangen (Germany)

    2016-03-15

    To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF). Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification). In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions. In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography. (orig.)

  19. 切开复位内固定治疗SandersⅢ型及Ⅳ型跟骨骨折%Treatment of Sanders type Ⅲ and Ⅳ calcaneal fractures with open reduction and internal fixation

    Institute of Scientific and Technical Information of China (English)

    陈志伟; 杨乐忠; 吴文特; 刘春磊

    2011-01-01

    目的:探讨切开复位内固定治疗Sanders Ⅲ、Ⅳ型跟骨骨折的手术方法和治疗效果.方法:2004年1月至2010年1月,采用切开复位内固定术治疗51例58足SandersⅢ、Ⅳ型跟骨骨折,男29例,女22例;年龄17~58岁,平均29.5岁;伤后至手术时间7~14d,平均10d.术前均行CT扫描及三维重建,按Sanders分类:Ⅲ型26足,Ⅳ型32足.均经可延长的外侧"L"形入路切开复位钢板内固定治疗.术后通过X线测量Bohler角、Gissane角并与术前进行比较,按照Maryland足部评分系统从疼痛、功能方面对疗效评定.结果:51例58足全部获随访,时间6~24个月,平均13个月.术后皮缘表皮坏死2足,慢性疼痛4足,晚期发生距下关节炎2足,并发症发生率13.8%(8/58).按照Maryland足部评分系统:优23足,良27足,可5足,差3足.结论:切开复位钢板内固定治疗SandersⅢ、Ⅳ型跟骨骨折,能够获得较满意的解剖复位,且固定可靠,是治疗SandersⅢ、Ⅳ型跟骨骨折的有效方法.%Objective:To investigate the surgical techniques and results of open reduction and internal fixation for the treatment of Sanders type Ⅲ, Ⅳ calcaneal fractures. Methods:From January 2004 to January 2010,58 feet of Sanders type Ⅲ, Ⅳ in 51 patients were treated with open reduction and plate fixation through L incision. There were 29 males and 22 females,the age ranged from 17 to 58 years with an average of 29.5 years old. The time between injury and operation ranged from 7 to 14 days(mean, 10 days). All the patients underwent systematic CT scan with coronal and horizontal images and sagittal reconstruction. The classification of the fractures by the Sanders scale showed that there were 26 feet of type Ⅲ, 32 feet of type Ⅳ. The B(o)hler angle and Gissane angle were compared before and after operation. The clinical results were evaluated with the Maryland foot score: pain ( 45 scores), function (55 scores: distance walked 10 scores, stability 4, support 4, limp 4

  20. 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.

  1. External fixation and gradual limb lengthening for complicated delayed calcaneal fractures: report of 12 cases%距下关节截骨缓慢延长治疗陈旧性跟骨骨折

    Institute of Scientific and Technical Information of China (English)

    范伟力; 王子明; 赵玉峰; 吴思宇; 王雨; 孙红振; 王爱民

    2011-01-01

    目的 伴有距下关节损伤的陈旧性跟骨骨折,目前主要是采用距下关节原位融合术和距下关节牵伸骨块植入融合术治疗,在此介绍一种新手术方式,距下关节截骨外固定支架缓慢延长手术,并评估其疗效.方法 12例15足(单足9例,双足3例)陈旧性跟距关节骨折脱位,年龄16~53岁,平均33.6岁.闭合性7例(10足),开放型性5例(5足).开放性损伤中3例严重多发伤病人手术时伤口已愈合2个月以上,2例伤口仍未愈合.均采用距下关节截骨牵伸融合新方法治疗,术中行内、外侧骨突切除、距下关节截骨与植骨、Orthofix外固定支架固定,术后7~10天延长,至距下关节间隙牵开1~2cm、跟骨高度和Bohler角基本恢复正常时结束延长,2~3个月后距下关节骨性融合后取出外固定支架开始负重行走.结果 12例(15足)得到了6~50个月的随访,伤口均愈合,无皮肤坏死.距下关节在3~6个月(平均3.7个月)得到骨性融合.采用美国骨科足踝外科学会(AOFAS)评分标准,平均由术前的24.2分提高到术后随访时的76.8分.结论 距下关节截骨缓慢延长治疗陈旧性跟骨骨折是一种新的有效治疗方法;无皮肤坏死、无需植骨和内固定;用于开放性陈旧性跟骨骨折的治疗可明显缩短疗程.%Objective For delayed calcaneal fractures accompanied by subtalar joint injury, the most common treatment is the use of in situ subtalar arthrodesis and subtalar distraction bone-hlock arthrodesis. In this study,we introduced a novel surgical treatment, subtalar osteotomy with external fixation and limb lengthening, and assessed its efficacy. Methods Totally 12 cases ( 15 feet) of delayed calcaneal fractures accompanied by severe subtalar joint injury were treated with this method. The patients ranged in age from 16 to 54 years, with an average age of 33. 6 years. And seven cases were closed injury, others were opened injury. The protruding lateral calcaneus was

  2. Primary subtalar joint arthrodesis for comminuted fractures of the calcaneus.

    Science.gov (United States)

    Holm, Janson L; Laxson, Steven E; Schuberth, John M

    2015-01-01

    Severely comminuted intra-articular calcaneal fractures often culminate in subtalar arthrosis and stiffness even after operative reduction. In some instances, subtalar arthrodesis is necessary to reduce the symptoms. Primary subtalar arthrodesis for these fractures has gained acceptance in recent years. However, few definite predictors of functional outcome after primary fusion have been found. A series of 17 patients with highly comminuted fractures were studied to determine which radiographic parameters were predictive of functional outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was obtained at an average of 34 (range 12 to 157) months after arthrodesis. Radiographic measurements included the talocalcaneal, calcaneal inclination, talo-first metatarsal, and Böhler's angles, and the height of the tibial plafond, width of the calcaneus, and the presence of a medial step-off on the injured and uninjured foot. The mean Ankle-Hindfoot scale score was 78 (range 56 to 92), and the mean visual analog score was 1.9 (0 to 4). Statistically significant associations were noted between greater postoperative function and increasing age (p = .028), the quality of restoration of Böhler's angle (p = .038), and the talocalcaneal angle (p = .049). No patient had nonunion. The results of the present study suggest that the outcomes after primary arthrodesis of the subtalar joint are favorable, in particular, when the radiographic relationships of the hindfoot have been restored. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. 外固定架或石膏固定对桡骨远端不稳定性关节内骨折康复的影响%Rehabilitative effect on external fixator or cast immobilization for unstable intra-articular fracture of distal radius

    Institute of Scientific and Technical Information of China (English)

    蔡靖宇; 郭涛; 朱庆生

    2002-01-01

    Objective To investigate the advantage of external fixator in treatment of unstable intra-articular fracture of distal radius and important of rehabilitation treatment. Methods Fifty-two consecutive patients with unstable intra-articular fractures of distal radius (Frykman type VII, VIII) were randomly divided into 2 groups.A group treated by external fixator and B group treated by closed reduction and cast immobilization. Using the scoring system of Stewart and Dinest assessed all patients. Wrist joint rang motion (ROM) was measured by using gonimeter pre and post rehabilitation treatment.Results Both the anatomical and functional results were significantly better in the external fixator group than in the cast immobilization group (P< 0.05), there was significantly difference of wrist joint ROM between pre and post rehabilitation treatment. Conclusion It is recommended the use of external fixator for unstable intra-articular fractures of distal radius and rehabilitation treatment have an important role.

  4. 软组织损伤评估处理对跟骨骨折术后感染的意义%Classified Treatments of Soft-tissue Injury in Preventing Postoperative Infection in Patients with Calca-neal Fracture

    Institute of Scientific and Technical Information of China (English)

    徐生根; 肖坚; 吴维剑

    2016-01-01

    Objective To study the clinical significance of soft tissue assessment and classification treat⁃ment for the prevention of postoperative infection in the patients with calcaneal fractures. Methods We re⁃cruited 91 patients who underwent open reduction and reconstruction plate internal fixation operation for closed calcaneal fractures (103 feet). All patients were randomly divided into a control group and an evaluation group. In the control group, there were 36 men (40 feet) and 7 women (8 feet). They aged from 18 to 72 years (average 38.5 years). By Sanders classification, 11 feet were of type Ⅱ, 21 feet of type Ⅲ and 8 feet of type IV. All con⁃trol patients with preoperative soft tissue injury underwent the conventional preparation processing, and preopera⁃tive assessment of soft tissue and classification treatment was not carried out. In the evaluation group, there were 39 men (44 feet) and 9 women (11 feet). They aged from 19 to 71 years(average 39.6 years). By Sanders classifi⁃cation,12 feet were of type Ⅱ, 23 feet of type Ⅲ, and 9 feet of type IV. They underwent soft tissue assessment using criteria for preoperative assessment and also underwent classification treatment. Results The control group of 43 patients were followed up for 13~17 months (average 14.5 months). There were 5 cases of postopera⁃tive wound infection, and the infection rate was 16.3%. In the evaluation group, 48 cases were followed up for 14-22 months (average 16.1 months), and only 2 cases had wound infection after surgery, and the infection rate was 4.17%. The infection rates in the two groups were different significantly (P<0.05). Conclusion It is im⁃portant to conduct preoperative skin and soft tissue assessments and classification treatment, as an intervention strategy for calcaneal fractures. It can significantly reduce the rate of wound infection after fracture of calcaneus.%目的:探讨皮肤软组织损伤评估及分级处理对预防跟骨骨折术后切

  5. GustiloⅡ、ⅢA型开放性跟骨骨折的手术治疗%Operative treatment of open calcaneal fractures of Gustilo type Ⅱ and type Ⅲ A

    Institute of Scientific and Technical Information of China (English)

    王庆贤; 孟庆汀; 张英泽; 王鹏程; 彭阿钦; 吴希瑞

    2014-01-01

    Objective To assess the operative treatment of open calcaneal fractures of Gustilo types Ⅱ and Ⅲ A by urgent debridement,reduction through the open wound,immediate fixation by percutaneous transarticular k-wire and delayed wound closure.Methods From May 2009 to October 2012,19 cases of open calcaneal fractures were treated according to the same operative protocol.They were 17 men and 2 women,aged from 31 to 60 years (average,39.6 years).By Gustilo classification,8 cases were of type Ⅱ and 11 of type ⅢA.By Sanders classification,there were 3 cases of type Ⅱ,12 ones of type Ⅲ and 4 ones of type Ⅳ.After intravenous administration of antibiotics,urgent debridement and reduction through the open wound under the C-arm inspection,the sinus tarsi approach was used when necessary.Percutaneous K-wire fixation was conducted through the posterior facet,and the wound was left open or covered with VSD.The soft tissue coverage was delayed until application of a split-thickness skin graft or pedicle flap transfer.Before and after operation,axial and lateral X-ray radiography and axial,semi-coronal and sagittal CT of the heel were performed.The width,height,B(o)hler's angle and Gissane's angle were compared between preoperation and postoperation.Clinical results were graded according to the AOFAS (American Orthopaedic Foot and Ankle Society) scoring one year postoperation.Results All the 19 patients were available for an average follow-up of 16.8 months (from 14 to 26 months).Superficial infection occurred in 5 patients but was cured after dressing change.No skin necrosis,deep infection,bone nonunion,osteomyelitis or amputation occurred.Reduction of the posterior facet was graded as anatomical in 12 cases and as nearly anatomical in 7 cases.The width,height,B(o)hler's and Gissane's angles were improved significantly in all patients (P < 0.05).By the AOFAS ankle-hindfoot scores,9 cases were excellent,7 good,2 moderate and one poor.Conclusion The surgical protocol of

  6. 自固化磷酸钙人工骨植骨联合可塑形钛板内固定治疗 Sanders Ⅲ,Ⅳ型跟骨骨折%Autosetting Calcium Phosphate Cement Bone-Grafting and Internal Fixation with Shaping Titanium Plate for Treatment of SandersⅢ,ⅣCalcaneal Fractures

    Institute of Scientific and Technical Information of China (English)

    韩振学; 李志仙

    2014-01-01

    [ ABSTRACT] Objective To investigate the curative effect of Sanders Ⅲ,Ⅳ calcaneal fractures by autosetting calcium phosphate cement bone-grafting and internal fixation with shaping titanium plate.Methods Twenty-eight cases(28 feet) SandersⅢ,Ⅳcalcaneal frac-tures adopted open reduction with shaping titanium plate internal fixation combined with autosetting calcium phosphate cement bone-grafting, the shaping titanium plate were placed at the outward of calcaneus,reset evaluation of calcaneal fractures by measuring Bohler's Angle,Gis-sane's Angle in postoperation.Results All patients were followed up,postoperative skin necrosis in 2 cases and sural nerve injury in 1 case. After 6 months,Bohler's Angle in 20 foot≥35°,in 8 foot≥30°,Gissane Angle fully recovered to normal range and calcaneal varus deformity on axial were not seen.Fracture healing time was 2~3 months,according to Maryland foot scoring system,treatment effects of all patients were as follows:excellent in 15 feet,good in 5 feet,normal in 3 feet and poor in 2 feet,the total excellent and good rate was 83.7%,the excel-lent and good rate ofⅣtype was 56.2%.Conclusion The treatment of SandersⅢ,Ⅳcalcaneal fractures by autosetting calcium phosphate cement bone-grafting and internal fixation with shaping titanium plate is simple and its curative effect is satisfied.%目的:探讨自固化磷酸钙人工骨植骨联合可塑形钛板内固定治疗Sanders Ⅲ,Ⅳ型跟骨骨折的疗效。方法对28例(28足) SandersⅢ,Ⅳ型跟骨骨折均采用切开复位可塑形钛板固定联合自固化磷酸钙人工骨治疗,跟骨外侧放置可塑形钛板,术后测量Bohler's 角、Gissane's角,评价跟骨骨折的复位情况。结果所有患者均得到随访,术后皮缘坏死2例,腓肠神经损伤1例。术后6个月Bohler's 角20足≥35°,8足≥30°,Gissane角全部恢复至正常范围,轴位片上未见跟骨内翻畸形。骨折愈合时间2~3个月,

  7. Time and dose-effect relationship of lateral pressure of Calcaneal tension band splint fixation%跟骨张力带夹板固定侧方压力的时效、量效关系研究

    Institute of Scientific and Technical Information of China (English)

    李引刚; 孟祥东; 刘艳平; 杨锋; 陈明光

    2012-01-01

    Objective;To investigate time and dose-effect relationship of lateral pressure at different intensities on the injury of skin after the calcaneal fracture with percutaneous poking postoperative tension band splint fixation and obtain a suitable pressure range. Methods:20 patients with 20 feet in healthy subjects and 20 patients with 20 feet with intra-articular fractures of the calcaneus prying postoperative patients were included , we used self-made balloon tension band fixation, and observed and recorded the local pain, numbness, skin color changes at different pressure and time. Results: Evaluating pressure ulcers by Shea staging standard, according to skin color, pain, numbness and other autonomic manifestations, healthy subjects pressure should be<40 kPa, patients should be< 35kPa. Conclusion:Calcaneal lateral pressure pad can effectively prevent calcaneal diameter width and calcaneal ever-sion, but needed regulating pressure and action time according to the swelling degree, to avoid the formation of pressure ulcers.%目的:探讨跟骨骨折经皮撬拨术后张力带夹板固定法中侧方压力在不同强度下对皮肤损伤时效、量效之间的关系.方法:20例20足健康受试者及20例20足符合跟骨关节内骨折撬拨术后的患者纳入试验,采用自制带气囊的张力带夹板固定,观察并记录跟骨内外侧皮肤在不同压强、时间下局部疼痛、麻木、皮肤颜色的改变.结果:压疮以shea分期作为标准,根据皮肤颜色、疼痛、麻木等自主表现,健康受试者压强应<40kPa,患者应<35kPa.结论:跟骨内外侧压力垫有效防止跟骨横径变宽及跟骨外翻,但要根据肿胀的程度注意调节压强大小及作用时间,避免压疮形成.

  8. 锁定加压钢板在治疗桡骨远端不稳定骨折中的应用%Locking Compression Plate Fixation for Intraarticular and Unstable Distal Radial Fractures

    Institute of Scientific and Technical Information of China (English)

    张珂; 刘其明; 赵庆华; 李峰; 王予治; 孙羽

    2012-01-01

      目的:探讨锁定加压钢板(locking compression plate,LCP)治疗不稳定型桡骨远端骨折(distal radial fractures,DRF)的效果.方法:分析自2006年1月~2012年5月我院采用锁定加压钢板治疗桡骨远端不稳定骨折20例患者临床资料,其中男12例,女8例;年龄18~66岁,平均年龄44.6岁.按AO桡尺骨远端骨折分型,B2、3型(部分关节面骨折,掌背侧骨块)6例;Cl型(完全关节内骨折,干骺端骨折)7例;C2型(完全关节内骨折,干骺端粉碎骨折)5例;C3型2例.部分患者初期手法复位固定治疗失败.掌侧入路切开复位,LCP内固定治疗.结果:术后门诊随访2~36个月.桡骨远端骨折均完全愈合,按改良的Mcbirde评分和纽约骨科医院腕关节功能评估标准,优良率为85℅(17/20).结论:对桡骨远端不稳定性骨折,掌侧LCP是一种安全有效的治疗方法.%  Objective:To investigate the locking compression plate (locking compression plate,LCP) the effect of the treatment of unstable distal radial fracture (distal radial fractures,DRF). Methods: Analysis from January 2006 to May 2012 using locking compression plate for treatment of distal radius unstable fracture of the clinical data of 20 patients,including 12 males and 8 females; age 18-66 years,mean age 44.6 years old. Radius and ulna in remote according to the AO fracture classification,B2,3 (partial articular fractures,palm dorsal bone) six cases: Cl (complete articular fractures of the metaphyseal fracture) 7 cases; C2,type (full intra-articular fracture,metaphyseal comminuted fracture) 5 cases; C3 type 2 patients. Fixed treatment failure in some patients early manipulative reduction. Volar open reduction and internal fixation in the LCP.Results: Folowed-up from 2 to 36 months,Distal radius fractures are completely healed,the improved Mcbirde score and the New York Orthopaedic Hospital,wrist function evaluation criteria, excellent rate of 85 ℅ (17/20). Conclusion:Volar LCP

  9. QUANTITATIVE EVALUATION OF POSTOPERATIVE EFFECT OF CALCANEAL FRACTURES USING FOOTSCAN SYSTEM%Footscan足底压力分析系统对跟骨骨折术后疗效的定量评价

    Institute of Scientific and Technical Information of China (English)

    陈占法; 张英泽; 郑占乐; 郭明珂

    2009-01-01

    Objective To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures. Methods From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwent minimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type Ⅱ, 11 of type Ⅲ, and 2 of type Ⅳaccording to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type Ⅱ, 11 of type Ⅲ and 23 of type Ⅳ according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P > 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed. Results All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P 0.05).Significant differences

  10. Effect observation on treating malnutrition bone atrophy after calcaneal fracture surgery by Qianggu capsule plus salmon calcitonin%强骨胶囊配合鲑降钙素治疗跟骨骨折术后营养不良性骨萎缩疗效观察

    Institute of Scientific and Technical Information of China (English)

    郭鹏飞; 赵洪涛; 韩玉范

    2013-01-01

    Objective:To observe clinical effects of Qianggu capsule plus salmon calcitonin on treating malnutrition bone atrophy after calcaneal fracture surgery. Methods: 44 patients were given the Qianggu capsule plus salmon calcitonin. Results: Compared with before treatment, the total efficiency was over 72.8%. Conclusion:The Qianggu capsule plus salmon calcitonin was effective in treating malnutrition bone atrophy after calcaneal fracture surgery.%  目的:观察强骨胶囊配合鲑降钙素治疗跟骨骨折术后营养不良性骨萎缩的临床疗效。方法:对44例跟骨骨折术后出现营养不良性骨萎缩的患者,使用鲑鱼降钙素皮下注射,同时口服强骨胶囊进行治疗。结果:采用强骨胶囊配合鲑降钙素治疗44例跟骨骨折术后营养不良性骨萎缩患者,各种主要症状治疗前后对比,总有效率在72.8%以上。结论:用强骨胶囊配合鲑降钙素治疗跟骨骨折术后营养不良性骨萎缩是一种有效的治疗方法。

  11. CT classification of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B.; Porcellini, B.; Robotti, G.

    1984-05-01

    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  12. 柱螺钉结合牵开器治疗 Sanders 型与Ⅲ型跟骨骨折疗效分析%Clinical effects of treatment with screws combining retractor on Sanders typeⅡand Ⅲ calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    陈志军; 杨国涛

    2016-01-01

    Objective To investigate the clinical effects of the treatment for calcaneal fracture of Sanders type Ⅱ and type Ⅲ by screws combining the retractor .Methods From January 2014 to December 2015, 30 cases (30 feet) of Sanders typeⅡand typeⅢcalcaneal fractures were treated by screw fixations.All the cases were given X-ray examination, and the preoperative images were compared with the postoperative images .During the follow-up, postoperative functional outcomes were evaluated by Maryland foot score , and t test was performed for statistical analysis .Results The patients were followed up for six to 11 months (mean, 8 ±0.7 months).The fracture healing time ranged from three to seven months (mean, 4.5 ±0.6 months).No skin necrosis at the incision site, nor hematoma, obvious fracture re-displacement , peroneal tendonitis , neuritis or other complications occured .The overall satisfactory results rate( excellent and good ) were 90%.Significant difference was found in the Bohler ’ s and the Gissane ’ s angles compared with the preoperative ones (t =2.13,3.14,P<0.05).Conclusion Screw combined retractor fixation in treating calcaneal fractures ( Sanders typeⅡ、Ⅲ) presents the advantages of less trauma, fewer wound complications , accurate reduction and stable fixation; the clinical curative effect is satisfactory.%目的:探讨柱螺钉结合牵开器手术治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法2014年1月至2015年12月南通大学附属丹阳市人民医院骨科采用柱螺钉结合牵开器技术治疗SandersⅡ、Ⅲ型跟骨骨折患者30例(30足),根据术前、术后及随访的X线片分析比较手术前后跟骨Bohler角、Gissane角改变,并于随访时按照Maryland 足部评分系统对功能进行评价,统计学分析采用t检验。结果本组病例随访时间6~11个月,平均(8.0±0.7)个月。骨折愈合时间3~7个月,平均(4.5±0.6)个月。所有患者术后

  13. 跟骨骨折切开复位内固定不同手术时机与术后软组织并发症的关系%Relationship between different surgery time and postoperative soft tissue complications in calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    韩俊

    2015-01-01

    Objective To investigate the relationship between different surgery time and postoperative soft tissue complications in calcaneal fractures treated by open reduction and internal fixation. Methods The clinical data of 70 patients with calcaneal fractures (78 feet) was analyzed retrospectively, and the data was compared between pa-tients complicated with postoperative soft tissue complications (complication group) and those not (without complica-tion group). Depending on the timing of surgery, the patients were divided into 8 h after injury group, 8 h~7 d group and 7~14 d after injury group. The incidence of postoperative soft tissue complications were compared between differ-ent groups. Results In this study, the rate of postoperative soft tissue complications was 9.23%(15/78), and the rate of smoking and diabetes in complication group was significantly higher than those without complication group, with statistically significant difference (P<0.05). The complication rate of surgery in 8 h after injury group and 7~14 d after injury group was significantly lower than that 8 h~7d after injury group, and the difference was statistically significant (P<0.05). Conclusion Preoperative no smoking, controlling blood glucose, selecting the optimal timing of surgery in 8 h and 7~14 d after injury can reduce postoperative soft tissue complications of calcaneal fractures.%目的:探讨跟骨骨折切开复位内固定不同手术时机与术后软组织并发症的关系。方法回顾性分析接受切开复位内固定治疗的70例78足跟骨骨折患者的临床资料,比较合并术后软组织并发症患者与未合并并发症患者一般资料的差异,并根据不同的手术时机将患者分为伤后8h内组、伤后8h~7d组及伤后7~14d组,比较不同组别患者术后软组织并发症发生率。结果本组患者术后软组织并发症发生率为19.23%(15/78),其中并发症组吸烟及糖尿病的比例明显高于无并发症组,

  14. [Intra-articular injections].

    Science.gov (United States)

    Chapelle, Ch

    2015-09-01

    It is not unusual for a specialist or general practitioner to be presented with a pathology which necessitates the use of an intra-articular injection of corticosteroids, hyaluronic acid or a local anaesthetic. It would seem to be interesting to update and to precise the techniques and methods of intraarticular injections which have appeared in recent international publications, when we know that 30 % of the injections given into the knee and so called "dry" are incorrect and, therefore, inefficient. The indication of an articular injection depends, firstly, on the diagnosis which should be done with great care; after which should be an objective analysis complete with secondary effects linked to both the injection and the product used. The conditions of asepsis, the choice of needles and quantities of the injection and even the ways of the injections should be reviewed in detail. The last studies clearly question the secondary effects of the cartilage degradations of the cortisone given as an intra-articular injection and shows its efficiency on the pain and inflammatory phenomonen in osteoarthritis. Studies on hyaluronic acid are often contradictory going from a modest result to an important pain relief but it is necessary to be aware that the objective criteria are difficult to interpret. The use of local anaesthetics in intra-articular is limited by the few indications in view of the major risk of aggravating the pre-existing lesions by the disappearing signs of pain.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-12-01

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

  16. Soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures%软组织评估及干预策略对预防跟骨骨折术后伤口并发症的临床意义

    Institute of Scientific and Technical Information of China (English)

    王焱; 李公; 潘恒; 何矫; 路玉峰

    2012-01-01

    Objective To evaluate the clinical significance of soft tissue assessment and intervention strategies to prevent postoperative wound complications in closed calcaneal fractures. Methods A prospeclive study over a 6-year period was conducted on 207 closed calcaneal fractures in 168 patients who had sought medical treatment in our department from February 2005 through July 2011 for closed calcaneal fractures.There were 152 men with 190 feet involved and 16 women with 17 feet involved.They were aged from 17 to 68 years (average,38.1 years).By Sanders classification,58 feet were of type Ⅱ,124 feet of type Ⅲ and 25 feet of type Ⅳ.A self-developed system of soft tissue assessment was adopted to evaluate the patients.including initial assessment and preoperative assessment, before clinical interventions were adopted accordingly. All patients were randomized into 3 groups who were taken care of by doctors with similar competence according to the same specified protocol.The associations were analyzed between initial soft tissue assessment and time interval from injury to operation, and between initial and preoperative soft tissue assessments and wound complications as well.The postoperative wound complications were compared between groups. Results The incidence of wound complications was 9.2% in this series.The initial soft tissue assessment was positively correlated with the time interval from injury to operation ( r =2.474,P =0.000),closely associated with the severity of the fracture (x2 =109.829,P =0.000),and significantly associated with the wound prognosis ( P < 0.05).Preoperative soft tissue assessment (including wrinkle test,capillary reaction test and percutaneous partial pressure of oxygen) had significant effects on the incidence of wound complications (x2 =440.961,P =0.000).There was no significant difference between the 3 groups in incidence of wound complications ( P > 0.05). Conclusion It is important to conduct perioperative soft tissue

  17. The Pathomechanics Of Calcaneal Gait

    Science.gov (United States)

    Sutherland, David H.; Cooper, Les

    1980-07-01

    The data acquisition system employed in our laboratory includes optical, electronic and computer subsystems. Three movie camera freeze the motion for analysis. The film is displayed on a motion analyzer, and the body segment positions are recorded in a three dimensional coordinate system with Graf/pen sonic digitizer. The angular rotations are calculated by computer and automatically plotted. The force plate provides measurements of vertical force, foreaft shear, medial-lateral shear, torque, and center of pressure. Electromyograms are superimposed upon gait movies to permit measurement of muscle phasic activity. The Hycam movie camera si-multaneously films (through separate lens) the subject and oscilloscope. Movement measurements, electromyograms, and floor reaction forces provide the data base for analysis. From a study of the gait changes in five normal subjects following tibial nerve block, and from additional studies of patients with paralysis of the ankle plantar flexors, the pathomechanics of calcaneal gait can be described. Inability to transfer weight to the forward part of the foot produces ankle instability and reduction of contralateral step length. Excessive drop of the center of mass necessitates com-pensatory increased lift energy output through the sound limb to restore the height of the center of mass. Excessive stance phase ankle dorsiflexion produces knee instability requiring prolonged quadriceps muscle phasic activity.

  18. Surgical Treatment of Calcaneal Spur.

    Directory of Open Access Journals (Sweden)

    Eduardo Sarmiento Sánchez

    2007-12-01

    Full Text Available Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level, antibiotic prophylaxis, final outcomes, and patient's satisfaction with the treatment were the set of variables selected. Results: High morbidity of the heel pain syndrome was evidenced in this studied. The most frequent cause was the calcaneal spur. There is predominance in female Indian race. The high influenced of the socio-cultural factor in the genesis of this disease is proved as well as the impossibility of carrying out the conservative treatment due to high cost of medications. Conclusions: The efficacy achieved with combined treatment technique allowed the results obtained. All this contributed to achieve high satisfaction levels.

  19. Intra-Articular Osteotomy for Distal Humerus Malunion

    Directory of Open Access Journals (Sweden)

    René K. Marti

    2009-01-01

    Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

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

    Science.gov (United States)

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

    2015-01-01

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

  1. 经皮撬拨复位轴向结合横向多枚中空钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效%An analysis of the clinical effects of percutaneous fracture reduction followed by internal fixation with multiple axial and horizontal cannulated screws in the treatment of Sanders type II and III calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    林文琛; 许耀明; 颜峻; 李超颖; 郑烽礼

    2014-01-01

    ObjectiveTo explore and compare the curative effects of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of Sanders typeⅡ andⅢ calcaneal fracture at early stage.Methods 60 patients with calcaneal fracture from February 2010 to September 2013 were selected. They all belonged to Sanders typeⅡ andⅢ fracture, in which 34 patients were typeⅡ and 26 typeⅢ. All patients were randomly assigned to two groups and received surgeries of percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate. They were observed in the follow-ups, and functional evaluation was carried out via Marryland evaluation system. Excellent and good rate of the two methods was calculated, and differences between the two groups were analyzed through statistics. Results Follow-ups were carried out for 60 patients, and the follow-up time was 4-38 months (average 18 months). Clinical effects: among 31 patients who received percutaneous fracture reduction followed by internal fixation with cannulated screws, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 83.8%; among 29 patients who received open reduction followed by internal fixation with titanium plate, 18 patients showed excellent foot functions, 6 good, 3 average and 2 unsatisfactory. The excellent and good rate was 82.8%. The differences of the excellent and good rate between the two methods were not statistically significant (x2=0.617,P =0.971>0.05).Conclusion Percutaneous fracture reduction followed by internal fixation with cannulated screws and open reduction followed by internal fixation with titanium plate in the treatment of calcaneal fracture can both achieve favorable effects. Percutaneous fracture reduction followed by internal fixation with

  2. Comparison of therapeutic effects between open reduction and internal fixation with conventional plate via L-shaped lateral approach and internal fixation with percutaneous plate using a sinus tarsi approach in treatment of calcaneal fractures%经跗骨窦切口插入钢板与经外侧L形切口钢板内固定治疗跟骨骨折临床疗效的比较

    Institute of Scientific and Technical Information of China (English)

    夏胜利; 王秀会; 陆耀刚; 王惠中; 王子平

    2012-01-01

    Objective To compare therapeutic effects between open reduction and internal fixation with conventional plate via L-shaped lateral approach and internal fixation with percutaneous plate using a sinus tarsi approach in the treatment of calcaneal fractures. Methods All of 108 patients (117 feet) of displaced intra—articular calcaneal fractures were randomly divided into two groups: minimally invasive treatment group with 59 cases (64 feet) and conventional treatment group with 49 cases (53 feet).Results All patients were followed up for 8 to 28 months (mean 19 months).Lateral roentgenograms showed satisfactory restoration of the calcaneal height,width,length,Bohlers angle and Gissanes angle after operation in all patients.Early wound complications occurred postoperatively in 8 feet in conventional treatment group, while no feet developed wound complication in invasive treatment group. Maryland foot score demonstrated excellent results achieved in 49 feet, good in 11, fair in 4 in minimally invasive treatment group with the excellent and good rates of 93.8%, and excellent results in 31 feet, good in 15 feet, fair in 7 feet in conventional treatment group with the excellent and good rates of 86.8%, with significant difference found between two groups (P <0.01). Conclusion Compared with conventional surgical methods of treatment of displaced intra—articular calcaneal fractures, sinus tarsi approach for the reduction and internal fixation with percutaneous plate not only significantly reduces operative time and achieves satisfactory clinical therapeutic effects, but also effectively avoids postoperative complications.%目的 比较经跗骨窦切口插入钢板内固定与经外侧L形切口复位钢板内固定治疗跟骨骨折的临床疗效.方法 108例(117足)跟骨关节内骨折被随机分为微创及常规治疗组,微创治疗组59例(64足)采用经跗骨窦切口插入钢板内固定,常规治疗组49例(53足)采用外侧L

  3. 切开内固定联合外固定架治疗桡骨远端关节内骨折疗效观察%Observation of curative effect of open reduction internal fixation combined with external fixation of intra-articular fractures of the distal radius

    Institute of Scientific and Technical Information of China (English)

    王传文; 黄久勤; 王红旗

    2014-01-01

    Objective To investigate the clinical effect internal fixation combined with external fixator incision in the treatment of intra-articular fractures of the distal radius.Methods 80 cases of intra-articular distal radius fracture patients underwent cut internal fixation combined with external fixator in the treatment of orthopedic were chosen,postoperative rehabilitation exercises,fracture healing after the removal of the external fixator.All patients were followed up for 8 months to 12 months,an average of 9.2 months.Results 80 patients were intraarticular fractures healed,the time required was 4 to 10 months,an average of 6.3 months.In accordance with the assessment of functional systems Dienst wrist,51 cases wrist function were excellent,21 cases were good,the good rate was 90% (72/80).There were no clinical fractures common complication after surgery.Conclusion Open internal fixation combined with external fixator treatment of intra-articular fractures of the distal radius fractures not only makes reduction of fracture and immobilization satisfaction,but also conducive to the wrist of early postoperative functional rehabilitation exercise.%目的 观察采用切开内固定联合外固定架法治疗桡骨远端关节内骨折的临床效果.方法 80例采用切开内固定联合外固定架法治疗的桡骨远端关节内骨折患者,术后进行康复锻炼,骨折愈合后拆除外固定架.对所有患者进行随访,时间为8~12个月,平均9.2个月,按照Dienst腕关节功能系统评定治疗效果.结果 80例患者关节内骨折全部愈合,所需时间为4 ~ 10个月,平均6.3个月.腕关节功能优51例,良21例,可8例,优良率为90%(72/80).临床上骨折手术后常见的并发症均未出现.结论 切开内固定联合外固定架法治疗桡骨远端关节内骨折既能使骨折复位、固定满意,又有利于术后早期手腕部的功能康复锻炼.

  4. Case-control study on therapeutic effects between Kirschner wire fixation after early bebridement and staged plate fixation in the treatment of open calcaneal fractures%早期清创复位克氏针内固定与Ⅱ期钢板内固定治疗开放性跟骨骨折的病例对照研究

    Institute of Scientific and Technical Information of China (English)

    朱永展; 李逸群; 吴峰; 张宏宁; 温建强; 包杭生

    2012-01-01

    Objective:To compare therapeutic effects between Kirschner wire fixation after early debridement(Kirschner wire group) and staged plate fixation (plate group) in the treatment of open calcaneal fractures. Methods: From January 2001 to May 2008,55 patients (58 feel) with open calcaneal fractures were reviewed,the mean age was 36.8 years(ranged, 19 to 65 years) and the average visit time was 3 hours (ranged,30 min to 7 h). All the patients were divided into two groups:Kirschner wire group and plate group. There were 20 males(20 feet) and 9 females(9 feet) in Kirschner wire group,in which 15 feet were type 1,13 feet were type Ⅱ , 1 foot was type Ⅲ A according to Gustilo classification and 9 feet were type Ⅱ ,18 feet were type Ⅲ ,2 feet were type Ⅳ according to Sanders classification. The patients in Kirschner wire group were treated with early de-bridement,fracture reduction and Kirschner wire fixation,and the soft tissue defects were covered with VSD temporarily,and then were enveloped by skin or flap grafts at the second stage. There were 18 males (19 feet) and 8 females (10 feet) in the plate group, in which 13 feet were type 1,14 feet were type Ⅱ , 2 feet were type Ⅲ A according to Gustilo classification and 11 feet were type Ⅱ , 15 feet were type Ⅲ , 3 feet were type Ⅳ according to Sanders classification. The patients in the plate group were treated with early debridement, and plate internal fixation with were performed when the wound became stabilization. Results : Twenty-three feet (15 patients) in the Kirschner wire group and 22 feet (13 patients) in the plate group were followed, the duration ranged from 10 to 36 months,with an average of 24 months. Compared with preoperative ones,the heel height, width, Bohler angle and Gissane angle of calcaneal got improvements. According to AOFAS ankle- foot evaluation system, 11 feet got an excellent result,8 good in the Kirschner wire group;2 feet had wound local skin necrosis and cured by dressing

  5. Results of fixation of dorsally displaced intra-articular distal radius fractures with non angular stable implants%非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果

    Institute of Scientific and Technical Information of China (English)

    Wong Merng Koon

    2006-01-01

    Objective Intra-articular fractures of the distal radius in young adults comprise a distinct fracture pattern that is difficult to manage and associated with a high frequency of post-traumatic arthritis. Restoration of articular congruency and alignment should improve the outcome. Methods In this study we prospectively reviewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction. Results 3 patients were lost to follow-up. For the rest of 18 patients, follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results. The final volar tilt averaged 4.9°; radial inclination 23.9°; radial length 14mm; and articular incongruity, 0. 1 mm. Wrist motion at final follow-up examination averaged flexion 62°, extension 60°, radial deviation 16°, ulnar deviation 27°, pronation 77°and supination 74°. Grip strength averaged 83% of the uninjured side. The overall outcome of 18 patients (94.4%) had a good or excellent result according to the system of Gartland and Werley and 18 patients (72. 2% ) had a good result according to the modified system of Green and O'Brien at the most recent evaluation. The only complication in this series was a superficial pin tract infection, which was rapidly resolved with removal of pins at 5th week of external fixation.Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.

  6. 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.)

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

    Directory of Open Access Journals (Sweden)

    Torkel B. Brismar

    2010-01-01

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

  8. 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.

  9. Calcaneal "Z" osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model.

    Science.gov (United States)

    Zanolli, Diego H; Glisson, Richard R; Utturkar, Gangadhar M; Eckel, Tobin T; DeOrio, James K

    2014-12-01

    Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal "Z" osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot. Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after "Z" osteotomy. The calcaneal "Z" osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal "Z" osteotomy did not differ from those measured after varus triple fusion. In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal "Z" osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions. The results provide additional information on which to base treatment after triple arthrodesis with varus malunion. © The Author(s) 2014.

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

    Directory of Open Access Journals (Sweden)

    Gulseren Kayalar

    2009-01-01

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

  11. [Arthroscopic treatment for calcaneal spur syndrome].

    Science.gov (United States)

    Stropek, S; Dvorák, M

    2008-10-01

    PURPOSE OF THE STUDY Arthroscopic treatment of calcaneal spur syndrome is a tissue-sparing and effective approach when conservative therapy has failed. This method, its results and our experience with the treatment of this syndrome are presented here. MATERIAL Between January 2003 and November 2007, 26 patients underwent an arthroscopic procedure for calcaneal spur syndrome; of these, 20 were women with an average age of 49 years, and six were men with an average age of 45 years. Four, three women and one man, were lost to follow-up, therefore 22 patients with 24 heels were eventually evaluated. All had conservative therapy for 3 to 6 monts. METHODS The arthroscopic method used was developed by the arthroscopic group of the Orthopaedic Service of Hospital Hermanos Ameijeiras in Havana, Cuba. The surgical technique insolves treatment of the spur and plantar fasciitis commonly found in calcaneal spur syndrome, but it also addresses adjacent calcaneal periostitis. RESULTS The results were evaluated on the scale that is part of the foot function index developed by Budiman-Mak for measuring rheumatoid arthritis pain. The patients were asked mine questions on pain intensity during various activities before and after surgery. Pain was evaluated on a scale with grades from 0 to 9. The average value was 5.9 before surgery and 1.4 after surgery. A 0-1 pain range was reported by 25 %, 1-2 by 26 % and 2-4 by 22 % of the patients. All patients reported improvement. DISCUSSION The orthopaedic group in Havana led by Carlos achieved 85 % excellent outcomes (pain range, 0-2) at one-year followup; this was 79 % in our study, in which no problems with foot arches or wound infection were recorded. CONCLUSIONS The heel spur syndrome is a result of an inflamed ligament (plantar fascia) due to repeated microtrauma. It is not a traction osteophyte,but a reaction of the tissue where it attaches to the calcaneus. Adjacent calcaneal periostitis is usually present as well. Therefore, this

  12. 桡骨远端复杂关节内骨折两种治疗策略疗效分析%Comparison of efficacies of two fixation methods in treatment of complex intra-articular fracture of the distal radius

    Institute of Scientific and Technical Information of China (English)

    卓乃强; 葛建华; 税巍; 李正疆; 鲁晓波

    2009-01-01

    目的 比较研究锁定加压钢板(LCP)与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的疗效及适应证. 方法 分别以LCP和克氏针结合外固定支架治疗复杂的桡骨远端关节内骨折共98例,对术后手的握持力、腕关节各方向活动度等方面进行回顾性评估和比较,初步评价其临床疗效. 结果 随访4~20个月,平均12.4个月,均获得骨折愈合.参照1990年纽约骨科医院腕关节评估标准,对于AO/ASIF分型C1、C2型骨折,LCP组与克氏针结合外固定支架组疗效比较,差异无统计学意义(P>0.05),C3型骨折克氏针结合外固定支架疗效优越(P 0.05), while the efficacy of external fixator plus Kirschner wires was significantly superior to that of LCP in treating type C3 fracture (P < 0.05). Conclusions For types C1 or C2 intra-articu-lar fractures of the distal radius, the efficacies of LCP and external fixator plus Kirschner wires are simi-lar, while the efficacy of external fixator plus Kirschner wires is superior to that of LCP in treating type C3 intra-articular fracture of the distal radius.

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

    Directory of Open Access Journals (Sweden)

    Lorena Aguirre Zambrano Velho

    2007-06-01

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

  14. Relationship between full weight-bearing exercise and joint function in postoperative SandersⅡ-Ⅲcalcaneal fractures%SandersⅡ~Ⅲ型跟骨骨折术后完全负重练习开始时间与足部功能关系

    Institute of Scientific and Technical Information of China (English)

    付尧; 王金成; 贾云龙; 张汉阳; 钟专; 陈高扬; 刘贺; 常非

    2015-01-01

    背景:SandersⅡ~Ⅲ型跟骨骨折切开复位内固定术后患肢完全负重功能练习的开始时间尚存争议。  目的:探讨SandersⅡ~Ⅲ型跟骨骨折切开复位内固定术后患肢完全负重功能练习的开始时间与足部功能的关系。  方法:选取2010年1月至2013年10月收治的SandersⅡ~Ⅲ型跟骨骨折患者29例36足,按完全负重练习的开始时间分为:A组16例17足,术后6~8周开始部分负重功能锻炼,3个月内开始完全负重锻炼,平均完全负重时间2.8个月;B组13例19足,因个人因素(复合伤、工伤、心理因素等),术后开始完全负重时间大于3个月,平均完全负重时间5.5个月。  结果:随访根据Maryland足部评分标准,A组平均为(91.4±3.4)分,B组平均为(86.3±4.5)分,相比较有统计学差异(P<0.05)。A组切口愈合不良3足,经换药2周愈合;B组切口愈合不良1足,经换药2周愈合,骨髓炎1足,经抗生素骨水泥填充治疗后治愈,两组无明显差别(P>0.05)。A组平均Böhler角29.5°±3.3°,平均Gissan角130.1°±5.4°,骨折均已愈合;B组平均Böhler角31.1°±2.1°,平均Gissan角131.5°±3.9°,骨折均已愈合。两组统计学无明显差异(P>0.05)。  结论:SandersⅡ~Ⅲ型跟骨骨折术后3个月内开始完全负重锻炼患者的足部功能明显优于开始完全负重时间大于3个月的患者。%Background:When to begin full weight-bearing exercise after open reduction and internal fixation for SandersⅡ-Ⅲcalca-neal fractures is still in dispute. Objective:To investigate the relationship between joint function recovery and postoperative full weight-bearing exercise af-ter open reduction and internal fixation for treatment of SandersⅡ-Ⅲcalcaneal fractures. Methods:A total of 29 patients (36 feet) with SandersⅡ-Ⅲcalcaneal fractures treated between January 2010 and October 2013 were enrolled in the

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

    Directory of Open Access Journals (Sweden)

    Gautham Prabhakar

    2017-01-01

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

  16. Medial talo-calcaneal coalition. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Daly, B.D.; Towers, M.J.; Hamilton, S.

    1988-11-01

    Medial talo-calcaneal coalition is an uncommon developmental anomaly consisting of a bony projection arising from the postero-medial aspect of the sustentaculum tali, which may articulate with another bony projection from the medial aspect of the talus. Fibrous, cartilaginous or bony ankylosis may occur. It usually presents in adolescents, and causes pain following exercise. It may cause a lump, and can predispose to flat foot and early osteoarthrosis. This condition is easily overlooked on routine views of the ankle, and may require oblique views and tomography for its detection and clarification.

  17. 郑氏正骨手法治疗桡骨远端关节内粉碎性骨折36例%Zhengshi Bone-setting manipulation treatment of intra-articular distal radius comminuted fracture in 36 cases

    Institute of Scientific and Technical Information of China (English)

    董霞; 陈天洪

    2012-01-01

    目的 探讨通过郑氏正骨手法、小夹板及中立板外固定治疗桡骨远端关节内粉碎性骨折的临床效果.方法 2009年1月-2010年6月采用郑氏正骨手法治疗桡骨远端关节内粉碎性骨折36例,骨折分型为AO C型,采用臂丛神经麻醉下郑氏正骨手法复位,小夹板、中立板外固定.骨折临床愈合时间6~8周,平均7周.治疗期问辅以活血化瘀、续筋接骨中药口服及指导功能锻炼.结果 36例患者均获得随访,随访时间3~6个月,平均4个月,末次随访时,腕关节功能评分(Gartland-Werley功能评分):优18例,良12例,可6例.结论 郑氏正骨手法整复并小夹板、中立板外固定是治疗桡骨远端关节内粉碎性骨折的有效方法,能尽可能避免手术治疗及其二次手术取除内固定所带来的痛苦,在达到较好疗效的同时又减少了医疗费用投入.%Objective To investigate the bone-setting techniques by Zhengshi, splint and neutral plate fixation of in-tra-articular distal radius fractures of the clinical effects. Methods 2009. 1 ~ 2010. 6 Zhengshi bone-setting techniques used on the treatment of intra-articular distal radius fractures in 36 cases, fracture classification for the AO C-type, the use of brachial plexus anesthesia in orthopedic manual reduction Cheng, splints, neutral plate fixation. Fracture healing time of 6 ~ 8 weeks, an average of 7 weeks. Supplemented by blood circulation during treatment, continued reinforcement of oral medicine and bone functional exercise guidance. Results 36 patients were followed up for 3 ~ 6 months, an average of 4 months and last follow-up, wrist function score ( Gartland-Werley functional score) ; excellent in 18 cases, good in 12 cases, 6 cases. Conclusion Zhengshi orthopedic manipulative and splints, external fixation is the treatment of neutral plate distal radial intra-articular fractures of the effective ways as possible to avoid surgery and second surgery to take in addition to the pain

  18. Percutaneous surgery for plantar fasciitis due to a calcaneal spur

    National Research Council Canada - National Science Library

    Apóstol-González, Saúl; Herrera, Jesús

    2009-01-01

    .... This is an observational, descriptive, clinical series analyzing the outcomes of 10 patients with a diagnosis of talalgia due to plantar fasciitis with a calcaneal spur treated with percutaneous foot surgery...

  19. 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.

  20. Relationship between ankle-hind foot function and calcaneal three-dimensional morphological parameters%跟骨三维形态学参数与踝后足功能的关系

    Institute of Scientific and Technical Information of China (English)

    许灿; 李明清; 李康华; 刘华

    2016-01-01

    背景:跟骨整体形态与后距下关节面解剖对位都是跟骨关节内骨折手术治疗的重要预后因素,但当前仍缺少系统的生物力学实验证实跟骨三维形态学参数对于踝-后足功能的重要性。目的:综合利用实体实验与数值分析方法,明确跟骨三维形态学参数与踝后足功能的相关性。方法:首先使用人体踝足尸体标本构建跟骨高度、宽度和长度异常模型,通过生物力学加载支架对各组模型进行加载,分析跟骨高度丢失、宽度增加和长度短缩模型的动力学数据。进而构建正常人体踝后足有限元模型,在其基础上建立跟骨高度丢失、宽度增加和长度短缩数值模型,计算后距下关节面的接触特征。结果与结论:①跟骨宽度增加和长度短缩会部分限制踝后足的活动度,跟骨高度丢失则会引起距下关节活动度增加;②跟骨宽度增加会增加距下关节的接触面积,高度丢失会减少距下关节的接触面积,并使关节应力中心向关节面前下方移动;③跟骨三维形态学参数的改变会导致踝后足生物力学异常,因此跟骨骨折修复治疗中应当细致恢复跟骨的整体形态。%BACKGROUND:Both the overal appearance of the calcaneus and anatomical reduction of posterior subtalar joint are important prognostic factors of calcaneal intra-articular fracture repair. However, there is a lack of biomechanical data supporting the clinical importance of calcaneus height, length and heel width for the ankle-hind foot function. OBJECTIVE:To determine the correlation of the three-dimensional morphological parameters with the ankle-hind foot biomechanics as determined by the entity experiment and numerical analysis. METHODS:Models of abnormal calcaneus height, length and width were constructed in the human cadaveric feet and underwent a biomechanical load. The kinematics of the ankle-hind foot were compared between normal and

  1. The operative treatment of chronic calcaneal paratenonitis.

    Science.gov (United States)

    Kvist, H; Kvist, M

    1980-08-01

    The conservative management of chronic calcaneal paratenonitis is time-consuming and often unsatisfactory. A new, safe and simple technique is described. The crural fascia on both sides of the tendon is incised and left open, adhesions around the tendon are trimmed away, the strongly hypertrophied portions of the paratenon are removed and mobilisation is begun immediately after operation. Between 1961 and 1978 201 such operations were performed on 182 patients 62 of whom were top-ranking Finnish athletes. Only five patients were not athletes. The results, including early return to full activity, were excellent in 169, good in 25 and poor in seven cases. After operation one of the patients gained an Olympic gold medal; others have attained international prominence.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-04-15

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

  3. Intra-Articular Lubricin Gene Therapy for Post-Traumatic Arthritis

    Science.gov (United States)

    2015-09-01

    regeneration factors, and lubricants for OA cure and treatment . Nowadays, physical therapy and joint splinting and joint replacement surgery are also...negotiated: Joint Distraction Treatments of Intra-articular Fracture Induced Post-traumatic Ostearthritis in a Large Animal Model W81XWH-15-1-0642... fracture (IAF). As part of that work, the model was used to demonstrate short term effects of a promising biological treatment , and it is currently being

  4. Complications of minimally invasive calcaneal osteotomy versus open osteotomy.

    Science.gov (United States)

    Kendal, Adrian R; Khalid, Ali; Ball, Tom; Rogers, Mark; Cooke, Paul; Sharp, Robert

    2015-06-01

    Calcaneal osteotomy is an established technique for correcting hindfoot deformity. Patients traditionally receive an osteotomy through the open lateral approach to the calcaneus. To reduce the rate of wound complications associated with a direct open lateral approach, a minimally invasive surgical (MIS) technique has been adopted. This uses a low-speed, high-torque burr to perform the same osteotomy under radiographic guidance. We hypothesized that the new MIS calcaneal osteotomy would be a safe alternative to open calcaneal osteotomy while obtaining the same displacement. The safety of the new MIS technique was investigated with a case controlled study on all patients who underwent displacement calcaneal osteotomy at the Nuffield Orthopaedic Centre from 2008 to 2014. The primary outcome measure was 30 day postoperative complication rate. Secondary outcome measures included operating time, duration of stay, fusion rates, and calcaneal displacement. Eighty-one patients underwent calcaneal osteotomy as part of their corrective surgery, 50 in the Open approach group and 31 in MIS group. The average age was 47.7 years (range 16-77) for the Open group and 50.1 (range 21-77) in the MIS group. A mean calcaneal displacement of 9.4 mm (SD = 1.16, 8 to 11 mm) and 10.2 mm (SD = 1.06, 8 to 13 mm) was achieved through the MIS and Open approaches, respectively. There were significantly fewer wound complications in the MIS group (6.45%) compared to the Open group (28%, P = .022). The MIS group was associated with significantly lower rate of wound infection (3% versus 20%, P = .044). Three patients in the Open group experienced sural peripheral neuropathy. The average length of stay was 3.8 days following MIS and 4.3 days following open calcaneal osteotomy. Nonunion occurred in only 1 patient in the MIS group and none in the open group. MIS calcaneal osteotomy was found to be a safe technique. It was technically as effective as calcaneal osteotomy performed through an open lateral

  5. [Intra-articular injection of cortisone].

    Science.gov (United States)

    Hammer, M; Schwarz, T; Ganser, G

    2015-11-01

    Intra-articular injections with glucocorticoids are standard procedures according to therapy guidelines in many rheumatic conditions. There is increasing evidence from clinical trials on the treatment of rheumatoid arthritis that more patients will attain the target of remission using a combination of systemic medication and intra-articular injections with glucocorticoids compared to systemic medication alone. Intra-articular injections with glucocorticoids play an important role in the therapeutic management of pediatric rheumatic diseases. In many countries competency in performing intra-articular injections is among the important skills necessary for certification as a specialist in rheumatology.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-10-15

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

  7. Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet

    Science.gov (United States)

    Martinkevich, P.; Rahbek, O.; Møller-Madsen, B.; Søballe, K.; Stilling, M.

    2015-01-01

    Objectives Lengthening osteotomies of the calcaneus in children are in general grafted with bone from the iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and precise method for measurements of rigid body movements including the evaluation of joint implant and fracture stability, however, RSA has not previously been used in clinical studies of calcaneal osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal lengthening osteotomy (LCLO). Methods LCLO was performed in six fixed adult cadaver feet. Tantalum markers were inserted on each side of the osteotomy and in the cuboideum. Lengthening was done with a plexiglas wedge. A total of 24 radiological double examinations were obtained. Two feet were excluded due to loose and poorly dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits. Results Systematic bias was generally below 0.10 mm for translations. Precision of migration measurements was below 0.2 mm for translations in the osteotomy. Conclusion RSA is a precise tool for the evaluation of stability in LCLO. Cite this article: Bone Joint Res 2015;4:78–83. PMID:25957380

  8. 跟骨距下关节内移位骨折的手术治疗与术后康复%Operative treatment and postoperative rehabilitation of displaced intra-articular fractures of calcaneus

    Institute of Scientific and Technical Information of China (English)

    金晨; 胡小鹏; 杨裕红; 张德常; 陈学桂; 吴揭地

    2002-01-01

    @@ Background:Fracture of calcaneus often leads to pain,deformity,function of foot is impaired and even permanent function impairments are left.Many divergence existed in treatment of severe intra articular fracture existed,but with the development of pedal surgery and deep study of biomechanics anatomy,especially building of BO theory,the therapeutic programs have become clearer.

  9. The risk of intraarticular injections are overestimated

    DEFF Research Database (Denmark)

    Asmussen, Rikke; Just, Søren Andreas; Jensen Hansen, Inger Marie

    The risk of intraarticular injections are overestimated. Volume 73, Annals of the Rheumatic Diseases, the EULAR Journal,, June 2014 volume 73, supplement 2, p. 286-87......The risk of intraarticular injections are overestimated. Volume 73, Annals of the Rheumatic Diseases, the EULAR Journal,, June 2014 volume 73, supplement 2, p. 286-87...

  10. Plate fixation and small splint for intraarticular fracture of distal radius:comparison of curative effects%钢板内固定与小夹板治疗桡骨远端关节内骨折的效果比较

    Institute of Scientific and Technical Information of China (English)

    黄海晶; 温建民

    2014-01-01

    背景:目前,国内外有不少有关钢板内固定与小夹板治疗桡骨远端骨折的临床试验,但尚缺乏相关的系统评价。  目的:评价钢板内固定与小夹板治疗桡骨远端关节内骨折疗效。  方法:电子检索中国生物医学文献数据库(1979年至2008年)、中国知网(1979年至2008年)、维普数据库(1989年至2008年)和万方数字化期刊群(1998年至2008年),其中中国知网包括中国期刊文献数据库、重要会议全文数据库、硕博学位论文数据库;国外数据库PubMed(1966年至2008年)、EMbase(1980年至2008年)和Cochrane Library(2008年第4期)。不能获取的全文,则辅以手工检索天津中医药大学图书馆过刊资料库。收集钢板内固定与小夹板治疗桡骨远端关节内骨折的临床随机对照试验,由两名评价者独立提取资料并进行方法学质量评估。按检索策略和资料收集方法,查到英文文献363篇,中文文献488篇,其中期刊文献401篇,会议论文集79篇,学位论文8篇。经阅读标题、、全文后,最终12项研究符合纳入标准。统计学采用Cochrane 协作网提供的RevMan 5.0.20软件进行Meta分析。  结果与结论:文章系统评价涉及锁定加压钢板、普通钢板内固定、小夹板及石膏外固定等方法。Meta分析结果显示,锁定加压钢板治疗桡骨远端关节内骨折的疗效优于普通钢板、小夹板或石膏外固定,且并发症少。而普通钢板内固定治疗桡骨远端关节内骨折的疗效与石膏外固定或小夹板比较疗效差异尚无显著性意义。%BACKGROUND:At present, there are many clinical trials concerning plate fixation and smal splint for distal radius fracture, but there is lack of systemic evaluation. OBJECTIVE:To evaluate the curative effect of the plate fixation and smal splint in the treatment of intraarticular fractures of the distal radius. METHODS:We retrieved the Chinese

  11. Open reduction and internal fixation of OTA type C2-C4 fractures of the calcaneus with a triple-plate technique.

    Science.gov (United States)

    Brunner, Alexander; Müller, Jochen; Regazzoni, Pietro; Babst, Reto

    2012-01-01

    The purpose of this study was to present a surgical technique of open reduction and internal fixation of displaced intra-articular calcaneal fractures with 3 AO mini-fragment plates and to evaluate the clinical and radiological outcome of a consecutive group of patients after a mean follow-up of 41.7 months. A series of 54 patients (16 women and 38 men) with 62 calcaneal fractures were treated over a period of 6.5 years. Forty-five patients with 50 calcaneal fractures were completely clinically and radiologically followed up. Clinical follow-up included assessment of range of motion, pain according to a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score, and the short-form 36 health survey. Radiological follow-up included plain axial and lateral radiographs and measurement of the Böhler's angle and Gissane's angle. Independent Student's t test and paired Student's t test were used alongside the chi-square test to compare clinical and radiological data and score values between different groups of patients. Eleven patients showed breakage of the osteosynthesis material during the healing process and 2 patients sustained deep wound infection requiring revision surgery. At the final follow-up all fractures had healed. The average range of motion was supination 26.4° (range 0° to 50°; SD 11.6°), pronation 15.4° (range 0° to 30°; SD 6.4°), dorsal extension 14.3° (range -10° to 30°; SD 8.0°), and plantarflexion 39.6° (range 20° to 65°; SD 11.7°). Patients with OTA type C4 fractures achieved significantly lower supination (p fracture types. The mean visual analog scale pain score was 3.6 (range 0 to 8; SD 2.3) points, average American Orthopaedic Foot and Ankle Society hindfoot score was 70.8 (range 33 to 100; SD 17.1) points, and the mean short-form 36 score was 60.98 (range 22.9 to 93.0; SD 18.4) points. The mean postoperative Böhler's angle was 28.9° (range 8° to 38°; SD 7.1°), which decreased to 23.6° (range 4

  12. Endoscopic treatment of calcaneal spur syndrome: A comprehensive technique.

    Science.gov (United States)

    Blanco, C E; Leon, H O; Guthrie, T B

    2001-05-01

    We describe a comprehensive approach to the endoscopic treatment of calcaneal spur syndrome developed by the Arthroscopic Group of the Orthopedic Service of Hospital Hermanos Ameijeiras in Havana, Cuba. The surgical technique involves treatment of the heel spur and plantar fasciitis commonly found in calcaneal spur syndrome, but it also addresses adjacent calcaneal periostitis and allows decompression of the nerve to the abductor digiti quinti. Medial endoscopy and lateral instrumentation are used in a sequential approach with exposure and debridement of the posterior roof of the calcaneal arch, followed by removal of the calcaneal spur, lateral to medial release of the medial 75% of the plantar fascia, and if necessary, debridement of the calcaneal tuberosity periosteum. This technique was used in a prospective case series from June 1997 to May 1998 to treat a select group of 38 feet in 30 patients who reported unacceptable levels of pain despite 5 months of conservative treatment, which included an aggressive 8-week physical therapy program prescribed by the treating physician. Good to excellent results were obtained at 3 months postoperatively in all patients with regard to pain relief and return to normal activity, although 5 patients required a short course of physical therapy to resolve symptoms brought on by sports, trauma, or impact loading before 1-year follow-up, at which time all patients reported good to excellent results. Complications included 3 superficial wound infections cured by oral antibiotics and 2 transient lateral paresthesias that resolved with rest and nonsteroidal inflammatory medications. The described technique may provide a useful method for treating refractory heel spur syndrome and warrants further study.

  13. Imaging of intra-articular osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Allen, S.D.; Saifuddin, A. E-mail: asaifuddin@aol.com

    2003-11-01

    Intra-articular osteoid osteoma accounts for approximately 13% of all osteoid osteomas and presents as a monoarthropathy. Radiographs commonly do not identify the nidus, and in this event, MRI is likely to be the next imaging investigation. MRI may show a variety of appearances depending upon the age of the lesion. This article illustrates the imaging features of intra-articular osteoid osteoma, with emphasis on MRI. CT remains the investigation of choice for identifying the nidus.

  14. Magnetic resonance tomography in the diagnosis of intraarticular tibial plateau fractures: value for fracture classification and spectrum of fracture-associated soft tissue injuries; Die Magnetresonanztomographie in der Diagnostik der intraartikulaeren Tibiakopffraktur: Stellenwert bei der Frakturklassifikation und Spektrum der frakturbegleitenden Weichteilverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Fischbach, R.; Maintz, D.; Zaehringer, M.; Landwehr, P. [Koeln Univ. (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Prokop, A. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Unfall-, Hand- und Wiederherstellungschirurgie

    2000-07-01

    Purpose: To compare magnetic resonance imaging (MRI) and X-ray tomography in assessing the type of fracture, degree of comminution and amount of articular surface depression in acute tibial condylar fractures and to describe the associated soft tissue injuries diagnosed with MRI. Method: 27 patients with acute tibial plateau fractures were investigated usig linear X-ray tomography and MRI employing T{sub 1}-weighted and proton density turbo spin echo, STIR, and T{sub 2}-weighted gradient echo images. Fractures were classified according to the AO classification system. The degrees of depression and comminution were measured and soft tissue injuries were recorded. Results: Fractures were classified as type B1 in 7, as B2 in 6, and as B3 in 6 cases by MRI. More complex C-type fractures were diagnosed in 8 cases. MR and X-ray grading were consistent with the exception of two B3 fractures, which were graded as B1 by X-ray tomography. X-ray tomography under-estimated the degree of comminution. 63% of the patients had either meniscal tears or complete ruptures of their cruciate or collateral ligaments. Ten meniscal tears were diagnosed in 9 of 27 patients. Complete tears of the anterior cruciate ligament were seen in 4, and avulsions of the posterior cruciate ligament in 2 patients. Conclusion: MRI allows a detailed assessment of acute tibial plateau fractures and can replace conventional X-ray tomography. The high rate of fracture-associated soft tissue lesions makes MRI an especially valuable tool. (orig.) [German] Ziel: Vergleich der Magnetoresonanztomographie (MRT) und der konventionellen Verwischungstomographie in der Beurteilung von Frakturtyp, Fragmentierung und der Gelenkflaechenimpression sowie Beschreibung der MR-tomographisch diagnostizierten Weichteilverletzungen bei Patienten mit Tibiakopffraktur. Methode: 27 Patienten mit akuten Tibiakopffrakturen wurden mittels linearer Verwischungstomographie und MRT unter Verwendung einer T{sub 1}-gewichteten sowie einer

  15. Arthroscopic Treatment of Medial Femoral Condylar Coronal Fractures and Nonunions

    Science.gov (United States)

    Ercin, Ersin; Bilgili, M. Gokhan; Basaran, S. Hakan; Baca, Emre; Kural, Cemal; Avkan, M. Cevdet

    2013-01-01

    Nonunion of medial femoral condylar coronal fractures are uncommon. In neglected Hoffa fractures despite nonunion, there is a risk of missing accompanying ligamentous and intra-articular injuries. Neither preoperative clinical examination nor magnetic resonance imaging showed these injuries before arthroscopy. Arthroscopy before internal fixation gives additional information and changes the surgical protocol for these fractures and nonunions. PMID:24400191

  16. Treatment method study for unstable Intra-articular fractures of distal radius%桡骨远端不稳定性关节内骨折治疗方法的比较

    Institute of Scientific and Technical Information of China (English)

    蔡靖宇; 郭涛; 吴富章; 张勇; 刘畅

    2012-01-01

    目的 比较外固定支架与T型钢板内固定治疗桡骨远端不稳定性关节内骨折的临床效果.方法 将2007年8月~2010年1月连续48例桡骨远端不稳定性关节内骨折(FrykmanⅦ型、Ⅷ型)随机分成2组,其中外固定架组23例,男性9例,女性14例,平均年龄48.7岁(21~72岁),右侧12例,左侧11例,按Frykman分类Ⅶ型12例,Ⅷ型11例.钢板内固定组25例,男性11例,女性14例,平均年龄50.2岁(20~74岁),右侧12例,左侧13例,按Frykman分类Ⅶ型11例,Ⅷ型14例.分别采用闭合复位外固定架固定和切开复位T型钢板内固定治疗,Dinest标准行疗效评估.结果 所有患者获得随访,随访时间12~23个月,平均16个月,X线片示所有骨折均已愈合,术后1年后复位质量和疗效2组无显著性差异(P>0.05 ).结论 闭合复位外固定支架固定和切开复位T型钢板内固定2种方法治疗桡骨远端不稳定性关节内骨折,均可获得较满意的疗效,应根据患者具体情况选择最佳的治疗方法.%Objective To Compare the clinic therapeutic outcomes of T plate osteosynthesis and external fixation devise for unstable distal radius joint bone fracture s. Method From August 2007 to January 2010 continuously in 48 patients unstable distal radius joint bone fracture 0.05). Conclusion Indirect reduction and external fixation or open reduction and T plate internal fixation 2 method treatment unstable distal radius joint bone fracture, may obtain the satisfactory curative effect, because acts according to the patient special details choice best method of treatment

  17. Intra-articular angiolipoma of the knee: a case report

    Directory of Open Access Journals (Sweden)

    Nishimori Makoto

    2010-04-01

    Full Text Available Abstract We report a case of intra-articular angiolipoma of the knee. This case report describes our experience in excising an intra-articular angiolipoma of the knee joint. Complete resection under arthroscopy was performed in a 30-year-old man. Two years after the surgery, no evidence of recurrence was seen. Intra-articular angiolipomas should be considered in the differential diagnosis of intra-articular masses in adolescents with recurrent hemarthrosis without trauma.

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

    Science.gov (United States)

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

    2010-05-01

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

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    Demet Ofluoğlu

    2005-06-01

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

  1. [Excessively long calcaneal spur. A rudimentary form of calcaneo-navicular synostosis].

    Science.gov (United States)

    Hardy, J; Pouliquen, J C

    1983-01-01

    The authors have seen 5 children aged between 12 and 16 years suffering from a painful foot described as a recurrent sprain. Movements of the subtalar joint were limited and radiographs showed a hypertrophic calcaneal spur projecting towards the navicular but without fusion between the calcaneus and navicular. The calcaneal spurs were resected with good results and with an immediate symptomatic improvement.

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

    Directory of Open Access Journals (Sweden)

    Doug M Boyer

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

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

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2008-08-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Fantauzzi A

    2016-05-01

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

  6. Bicolumnar 90–90 plating of AO 13C type fractures

    National Research Council Canada - National Science Library

    Cemal Kural; Ersin Ercin; Mehmet Erkilinc; Evren Karaali; Mustafa Gokhan Bilgili; Suleyman Altun

    2017-01-01

    Objective: The aim of this study was to evaluate functional results and complication rate of patients who underwent medial-dorsolateral plating for intra-articular distal humeral fracture (Müller AO type 13C). Methods...

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

    LENUS (Irish Health Repository)

    Moroney, Paul J

    2013-12-30

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

  8. Calcaneal osteomyelitis due to Achromobacter xylosoxidans: a case report.

    Science.gov (United States)

    Ozer, Kadri; Kankaya, Yuksel; Baris, Ruser; Bektas, Cem Inan; Kocer, Ugur

    2012-12-01

    Achromobacter xylosoxidans (A. xylosoxidans) has been described as an opportunistic pathogen causing infection. The case we describe is that of an elderly man who had osteomyelitis of calcaneal bone caused by A. xylosoxidans. As far as we are aware there are only 5 cases of osteomyelitis with A. xylosoxidans in the literature. Impaired defensive mechanism of the foot in direct contact with this waterborne bacterium can cause this disease. Because of the high level of antibiotic resistance of this bacterium, clinically more attention should be paid to patients who have impaired defensive mechanisms in their extremities, for example free flaps.

  9. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  10. 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.

  11. Intra-articular chondroma of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Talwalkar, S.C.; Kambhampati, S.B.S.; Lang Stevenson, A.I. [Oldchurch Hospital, Romford, Essex (United Kingdom); Whitehouse, R. [Manchester University, Department of Radiology, Manchester (United Kingdom); Freemont, A. [University of Manchester, Department of Osteoarticular Pathology, Manchester (United Kingdom)

    2005-06-01

    Chondromas are tumours that develop in relation to the periosteum and, although they are common around the knee, most reports deal with soft tissue chondromas in para-articular locations or intracortical tumours in extra-articular regions. We report a rare case of an intra-articular chondroma in a 16-year-old boy of Asian origin developing in the region of the medial femoral condyle of the femur and extending into the femoral sulcus and the patellofemoral joint. (orig.)

  12. Intra-Articular Osteoid Osteoma Mimicking Juvenile Arthritis

    Directory of Open Access Journals (Sweden)

    Sidi Yaya Traore

    2014-01-01

    Full Text Available In case of intra-articular osteoid osteoma, misdiagnosis as juvenile arthritis may occur, delaying adequate treatment. We report cases of intra-articular osteoid osteomas in children that were misdiagnosed and initially inappropriately treated with intra-articular corticoid injection. Diagnosis of osteoid osteoma was finally given by CT-scan and appropriate treatment by radiofrequency ablation or surgical ablation was performed. Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma.

  13. Internal fixation and bone grafting for intraarticular nonunion of tibial plateau: a report of four cases

    Institute of Scientific and Technical Information of China (English)

    Ramesh K Sen; Ashwani Soni; Uttam Chand Saini; Daljit Singh

    2011-01-01

    Intraarticular nonunion of tibial plateau is rare.In the literature,only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results.Internal fixation along with bone grafting was done as a standard treatment in all cases.We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods.We treated these cases with plaster of paris cast,internal fixation along with bone graft,arthrodesis with K-nail and total knee replacement.Case 1 was treated with plaster of paris (POP)cast as the patient refused surgery.The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment.Case 2 was managed with open reduction internal fixation along with bone grafting.The patient had a good union and got full range of motion at the knee joint.Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result.Case 4 was an infected nonunion.Arthrodesis was done and the patient could walk with full weight bearing independently.We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau.Causes of nonunion,present condition and range of motion of the knee joint,as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.

  14. Computed tomography of the acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Ho Young; Suh, Jin Suck; Park, Chang Yun; Lee, Kil Woo [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initial radiographs, we compared and analysed the computed tomographic findings and plain radiographic findings. The results were as follow: 1. In patients with multiple trauma, no further change in position was required during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plain radiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, and femoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments. 5. CT was helpful in detecting the associated fractures and soft tissue injuries. 6. CT also demonstrated the adequacy of reduction, the position of metallic fixation devices, and the presence or absence of remaining intraarticular osseous fragments after surgery.

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

    Science.gov (United States)

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

    2016-06-01

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

  16. Increased mast cell numbers in a calcaneal tendon overuse model.

    Science.gov (United States)

    Pingel, J; Wienecke, J; Kongsgaard, M; Behzad, H; Abraham, T; Langberg, H; Scott, A

    2013-12-01

    Tendinopathy is often discovered late because the initial development of tendon pathology is asymptomatic. The aim of this study was to examine the potential role of mast cell involvement in early tendinopathy using a high-intensity uphill running (HIUR) exercise model. Twenty-four male Wistar rats were divided in two groups: running group (n = 12); sedentary control group (n = 12). The running-group was exposed to the HIUR exercise protocol for 7 weeks. The calcaneal tendons of both hind limbs were dissected. The right tendon was used for histologic analysis using Bonar score, immunohistochemistry, and second harmonic generation microscopy (SHGM). The left tendon was used for quantitative polymerase chain reaction (qPCR) analysis. An increased tendon cell density in the runners were observed compared to the controls (P = 0.05). Further, the intensity of immunostaining of protein kinase B, P = 0.03; 2.75 ± 0.54 vs 1.17 ± 0.53, was increased in the runners. The Bonar score (P = 0.05), and the number of mast cells (P = 0.02) were significantly higher in the runners compared to the controls. Furthermore, SHGM showed focal collagen disorganization in the runners, and reduced collagen density (P = 0.03). IL-3 mRNA levels were correlated with mast cell number in sedentary animals. The qPCR analysis showed no significant differences between the groups in the other analyzed targets. The current study demonstrates that 7-week HIUR causes structural changes in the calcaneal tendon, and further that these changes are associated with an increased mast cell density.

  17. Suprapatellar nailing of tibial fractures: surgical hints.

    Science.gov (United States)

    Brink, Ole

    2016-01-01

    Intramedullary nailing of the tibia with suprapatellar entry and semi-extended positioning makes it technically easier to nail the proximal and distal fractures. The purpose of this article was to describe a simple method for suprapatellar nailing (SPN). A step-by-step run through of the surgical technique is described, including positioning of the patient. There are as yet only a few clinical studies that illustrate the complications with this method, and there has been no increased frequency of intraarticular damage. Within the body of the manuscript, information is included about intraarticular damage and comments with references about anterior knee pain.

  18. 外固定支架结合关节镜治疗跟骨 Sanders II~IV 型骨折41例%Treatment of Sanders II~IV calcaneal fracture with external fixation bracket combined with arthroscopic (41 cases)

    Institute of Scientific and Technical Information of China (English)

    杜中兴; 岳发翔; 朱贤久; 唐方科; 朱怡; 陈勇

    2013-01-01

    Objective To estimate the clinical efficacy of prying reduction and external fixation support+joint surface with mandibular reconstruction under arthroscopy (or bone graft) simple gram needle fixation on calcaneus comminuted fracture, and to explore the treatment's advantages and disadvantages. Methods 41 cases (46 feet) with bone comminuted fracture patients were treated by prying reduction and external fixation support+joint surface with mandibular reconstruc-tion under arthroscopy (or bone graft) simple gram needle fixation. Results According to the Maryland foot rating Score, excellent in 31 feet, good in 11, fair in 4, and the excellent and good rate was 90.1%. Conclusion The treatment on calcaneus comminuted fracture has the advantages of curative effect with small surgical trauma, fewer complications, does not destroy the blood supply, joint surface reduct well, and it is more suitable choice for the calcaneus fracture patients accompanying with soft tissue injuries needing several operations.%  目的观察撬拨复位外固定支架+关节镜下跟骨关节面撬拨整复(植骨)克氏针简单内固定治疗跟骨粉碎性骨折的临床疗效,探讨该方法治疗跟骨粉碎性骨折的优点和不足.方法对41例(46足)跟骨粉碎性骨折病人接受撬拨复位外固定支架+关节镜下跟骨关节面撬拨整复(或植骨)克氏针简单内固定治疗跟骨粉碎性骨折.结果术后其疗效按Maryland足部评分标准,优31足,良11足,可4足,优良率90.1%.结论利撬拨复位外固定支架+关节镜下跟骨关节面撬拨整复(植骨)克氏针简单内固定治疗跟骨粉碎性骨折疗效满意,有手术创伤小、并发症少,不破坏骨折血运,对骨折愈合影响小,跟骨关节面复位理想等优点,且对伴有软组织损伤需多次手术治疗的患者更适合该方法.

  19. Proximal Humeral Fractures: A Biomechanical Comparison of Locking Plate Constructs in a Cadaveric 3-Part Fracture Model

    OpenAIRE

    2010-01-01

    The purpose of our study was to biomechanically compare, under cyclic loading conditions, fracture site motion, humeral head collapse, and intra-articular hardware penetration in simulated 3-part osteoporotic proximal humeral fractures stabilized with 1 of 2 locking-plate constructs. We performed fixation on simulated 3-part proximal humeral fractures in 10 pairs of cadaveric osteoporotic humeri with a Hand Innovations S3 Proximal Humerus Plate (S3 plate) or an LCP Proximal Humerus Plate (LCP...

  20. Are intraarticular steroids effective for knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Jorge Faúndez

    2016-12-01

    Full Text Available Resumen La artrosis de rodilla es una enfermedad crónica, invalidante, de evolución progresiva e irreversible. Los corticoides intraarticulares han sido comúnmente utilizados con el fin de disminuir sus síntomas y retrasar la resolución quirúrgica. Sin embargo, hasta el día de hoy, existe debate sobre su eficacia y seguridad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, se identificaron 12 revisiones sistemáticas que en conjunto incluyen 41 estudios que contestan la pregunta de interés, entre los cuales se cuentan 40 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que los corticoides intraarticulares probablemente llevan a una leve disminución del dolor a corto plazo, hacen poca o ninguna diferencia a mediano plazo y podrían no tener ningún efecto a largo plazo.

  1. 股骨干骨折和膝部损伤术后的康复%Postoperational rehabilitation of patients with fracture of femoral stem and knee injury

    Institute of Scientific and Technical Information of China (English)

    张晓霞; 王建民

    2002-01-01

    Background:Joint activity directly affect limbs function.Early continual passive motion(CPM) can improve fracture healing and regeneration and repair of intraarticular cartilage,effectively prevent joint adhesion and recover limbs function.

  2. Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term?

    National Research Council Canada - National Science Library

    Jakubietz, Michael G; Gruenert, Joerg G; Jakubietz, Rafael G

    2012-01-01

    .... This paper reports the result of a randomised clinical study comparing dorsal Pi plates and palmar, angle-stable plates for treatment of comminuted, intraarticular fractures of the distal radius over...

  3. An Anatomic Study of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy Technique to Correct Hindfoot Malalignment.

    Science.gov (United States)

    Veljkovic, Andrea; Tennant, Joshua; Rungprai, Chamnanni; Abbas, Kaniza Zahra; Phisitkul, Phinit

    2017-02-01

    Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach. Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery. Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery. Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.

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

    Science.gov (United States)

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

    2017-01-01

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

  5. Low-trauma fractures indicate increased risk of hip fracture in frail older people.

    Science.gov (United States)

    Chen, Jian Sheng; Cameron, Ian D; Simpson, Judy M; Seibel, Markus J; March, Lyn M; Cumming, Robert G; Lord, Stephen R; Sambrook, Philip N

    2011-02-01

    This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n = 953), the nonhip fracture group (n = 194), and the hip fracture group (n = 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59; p < .001] for the nonhip fracture group and 1.48 (95% CI 0.63-3.49, p = .37) for the hip fracture group after adjusting for age, sex, residence type, calcaneal broadband ultrasound attenuation, fracture history, weight, lower leg length, immobility, cognitive function, and medications. Frail institutionalized older people with newly acquired fractures are at increased risk of subsequent hip fracture for the next few years. Accordingly, despite their advanced age, they are a high-priority target group to investigate interventions that might reduce the risk of hip fracture.

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

    Directory of Open Access Journals (Sweden)

    Thulesius Hans

    2010-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-06-15

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

  8. Minimally Invasive Calcaneal Displacement Osteotomy Site Using a Reference Kirschner Wire: A Technique Tip.

    Science.gov (United States)

    Lee, Moses; Guyton, Gregory P; Zahoor, Talal; Schon, Lew C

    2016-01-01

    As a standard open approach, the lateral oblique incision has been widely used for calcaneal displacement osteotomy. However, just as with other orthopedic procedures that use an open approach, complications, including wound healing problems and neurovascular injury in the heel, have been reported. To help avoid these limitations, a percutaneous technique using a Shannon burr for calcaneal displacement osteotomy was introduced. However, relying on a free-hand technique without direct visualization at the osteotomy site has been a major obstacle for this technique. To address this problem, we developed a technical tip using a reference Kirschner wire. A reference Kirschner wire technique provides a reliable and accurate guide for minimally invasive calcaneal displacement osteotomy. Also, the technique should be easy to learn for surgeons new to the procedure. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation.

    Science.gov (United States)

    Talusan, Paul G; Cata, Ezequiel; Tan, Eric W; Parks, Brent G; Guyton, Gregory P

    2015-12-01

    We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the "landmark line." A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk. © The Author(s) 2015.

  10. Calcaneal osteosarcoma: a rare cause of heel pain in the paediatric population.

    Science.gov (United States)

    Taslakian, Bedros; Issa, Ghada; Saab, Raya; Jabbour, Mark N; Khoury, Nabil J

    2013-02-04

    Osteosarcoma is the most common primary non-haemopoietic malignant bone tumour in children and adolescents. However, it rarely occurs in the calcaneus with only a few case reports in the literature. We report a case of a 14-year-old boy with calcaneal osteosarcoma, who presented with heel pain followed by swelling. The pain was initially thought to be related to a benign process and treated with analgesics, delaying the diagnosis. We discuss the clinical presentation, the differential diagnosis, multi-imaging and pathological findings of a calcaneal osteosarcoma, its clinical outcome and the importance of early diagnosis to improve outcome.

  11. Fatigue Fracture of the Calcaneus: From Early Diagnosis to Treatment: A Case Report of a Triathlon Athlete.

    Science.gov (United States)

    Serrano, Simão; Figueiredo, Pedro; Páscoa Pinheiro, João

    2016-06-01

    Stress fractures are frequently underdiagnosed and undertreated despite being common in sports. Early diagnosis is crucial; therefore, a high index of clinical suspicion is required. Complementary examinations are essential for diagnosis and follow-up. The authors report a clinical case of a young adult triathlon athlete referring mechanical pain in the rear left foot, with 2 weeks' progression. An earlier increase in daily training intensity was recorded. Complementary examinations confirmed a calcaneal fatigue fracture. Immobilization and no weight bearing were introduced for an initial period of 4 weeks, and the rehabilitation process was started. Progressive weight bearing was introduced between fourth and eighth weeks. Sports activity started at the 12th week. Boundaries to sports activity were eliminated by the 24th week, without pain or functional limitation. Repetitive overload to the heel and intense axial weight bearing in association to repetitive concentric/eccentric gastrocnemius contraction are related to calcaneal stress fracture, the second most common stress fracture in the foot. Calcaneal stress fractures can be adequately treated with activity modification, without casting or surgical intervention. When in the presence of bilateral stress fractures, metabolic and nutritional issues must be considered. The case report highlights the importance of sports medicine examination for detecting intrinsic and extrinsic fatigue fracture risk factors.

  12. Neglected isolated fracture of the trochlea humeri

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Ish Kumar Dhammi; Anil Kumar Jain; Saurabh Jain

    2010-01-01

    A 15 years old girl was found to have isolated trochlea fracture 10 weeks after an injury caused by a fall on her left elbow. Movement of the elbow was severely restricted. Radiographs showed a half moon-shaped and anterosuperiorly displaced osteochondral fragment. Medial approach capsulotomy of the elbow and excision of the intraarticular adhesions were done to expose the isolated trochlea fracture. Headless screws were used for fixation,combined with bone grafting. The follow-up showed union and excellent functional recovery of the elbow. Isolated trochlea fracture in adults is rare and usually associated with capitellar fractures and/or elbow dislocations. A neglected trochlea fracture is rarely reported in the English language literature to the best of our knowledge. Recognition of isolated trochlea fracture is vital to apprehend the pathomechanics of the injury and to devise a suitable treatment approach.

  13. Clinical benefits of intra-articular anakinra for arthrofibrosis.

    Science.gov (United States)

    Brown, Christopher A; Toth, Alison P; Magnussen, Bob

    2010-12-01

    Postoperative inflammation and stiffness, as well as the struggle to achieve full range of motion (ROM), following knee surgery is a significant clinical challenge. Interleukin-1 is a crucial mediator of the inflammatory response and development of pathological conditions leading to chronic inflammation. We hypothesized that intra-articular injection of intra-articular anakinra, an IL-1 antagonist, would result in sustained improvements of chronic refractory arthrofibrosis and limited arthrofibrosis of the knee joint. We retrospectively reviewed 8 patients who underwent injection of intra-articular anakinra, 200 mg. Four patients (3 women, 1 man) had intra-articular anakinra for treatment of chronic refractory arthrofibrosis, and 4 patients (4 women) had intra-articular anakinra for limited arthrofibrosis. All 4 of the refractory arthrofibrosis patients had failed conservative treatment with intensive physical therapy, corticosteroid injections, and anti-inflammatory medication. Three of the 4 patients had failed a prior manipulation under anesthesia with lysis of adhesions. All 4 reported improvement in ROM (10°-45°) and swelling, with 75% reporting improvement in pain. Seventy-five percent of these patients returned to prior activity level. All 4 of the limited arthrofibrosis also failed similar attempts at conservative treatment, and 2 of the 4 had failed a prior manipulation under anesthesia with lysis of adhesions. After intra-articular anakinra, all 4 reported improvement in ROM (20°-45°) and swelling, with 80% reporting improvement in pain. Seventy-five percent of these patients were able to return to prior activity level. We found intra-articular anakinra to be effective in this small cohort of patients with refractory arthrofibrosis and limited arthrofibrosis. Copyright 2010, SLACK Incorporated.

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

    Directory of Open Access Journals (Sweden)

    Twarowska Natalia

    2016-06-01

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

  15. Diagnostic value of CT in pelvic fracture by trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Kyung Sook; Kang, Hyun Il; Suh, Myung Ok; Lee, Yul; Chung, Soo Young; Bae, Sang Hoon; Yoon, Jong Sup [College of Medicine Hallym University, Choonchun (Korea, Republic of)

    1987-06-15

    In order to determine the diagnostic value of CT in pelvic trauma, esp. acetabular fracture, we analysed 32 cases of pelvic trauma with conventional radiographic and computed tomographic findings. The results were as follows : 1. There were 26 males and 6 female and peak age span was 4th decade. 2. In 32 cases of acetabular fractures, single column fracture were diagnosed in 20 cases and two column fracture in 12 cases by CT. Among single column fractures, anterior column fractures were 12 cases and posterior column fractures were 8 cases. Complex fracture was most common type in two column fractures. 3. In 32 cases of acetabular fractures diagnosed by CT, 18 cases could be detected by plain X-ray. 4. Intraarticular bony fragments were detected on CT in 11 cases and on plain X-ray in 2 cases. 5. Combined soft issue injuries were 13 cases of pelvic hematoma, 1 case of retroperitoneal hematoma and 2 cases of hemarthrosis. 6. CT was useful in acetabular injury to delineated the extent and type of fracture, localized intraarticular bony fragments, characterize joint dislocation and detect the combined soft tissue injury.

  16. The effect of age, weight, and lifestyle factors on calcaneal quantitative ultrasound: the ESOPO study.

    Science.gov (United States)

    Adami, Silvano; Giannini, Sandro; Giorgino, Ruben; Isaia, GianCarlo; Maggi, Stefania; Sinigaglia, Luigi; Filipponi, Paolo; Crepaldi, Gaetano; Di Munno, Ombretta

    2003-05-01

    Quantitative ultrasound (QUS) techniques have been shown to be as good as bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA), in predicting fracture risk: QUS technique could increase substantially the accessibility to a reliable bone osteoporosis risk evaluation, but little is know regarding the relationship of QUS to risk factors that have been found to predict DXA-BMD values and this is even more true in men. We studied 6,811 postmenopausal women 40 to 80 years of age and 4,981 men 60-80 years of age representative of the general population of all regions of Italy. All participants were questioned on lifestyle habits and on their medical history. After a physical examination "bone stiffness" (called here for simplicity, stiffness), which is derived from the values of broadband ultrasound attenuation (BUA) and speed of sounds (SoS) was measured by a heel QUS device (Achilles apparatus, Lunar, Madison, USA). The most common recognized determinants of bone mass (either categorical or continuous variables) were modeled with stiffness by multiple regression analysis or ANOVA. Stiffness was strongly related to age and weight. After adjusting for these variables, the women who had taken hormone replacement therapy for more than a year had significantly higher stiffness values. The difference versus nonusers remained significant for up to 20 years-since-menopause (YSM). This effect was so strong that for further analysis these women were excluded. By multivariate analysis, stiffness was then found to be significantly related to recalled body weight at 25 years of age, actual and past cigarettes smoked per day, and dairy calcium intake. Stiffness was also associated with a number of categorial factors adjusted for age, weight, and YSM: prior ovariectomy, history of more than 2 months confined to bed, outdoor physical activity, smoking, chronic use of any drug, and past corticosteroid use. All these categorial and continuous variables predicted

  17. Intra-articular capacity of the elbow joint.

    Science.gov (United States)

    Van Den Broek, Mathias; Van Riet, Roger

    2017-09-01

    The intra-articular capacity of the elbow joint is reported to be 23 ± 4 ml on cadaveric elbows. During years, this value was the standard. The aim of this observational study was to reanalyze the volume of the elbow joint on live patients. Measurement of the intra-articular capacity and pressure of the elbow joint was performed on 30 patients (mean age: 43.8 years) undergoing elbow arthroscopy. Intra-articular capacity was recorded when the elbow moved to the maximum lose packed position and/or when there was a sudden drop in pressure, indicating a capsular rupture (maximum capacity). Indications for arthroscopy were loose bodies, osteoarthritis, synovitis, radial head resection, and lateral collateral ligament repair. Mean intra-articular capacity and pressure were 35.8 ml and 557.5 mm Hg, respectively. Mean maximal capacity was 40.5 ml. We conclude that the intra-articular capacity of the elbow joint is substantially greater than reported in previous studies. Clin. Anat. 30:795-798, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. Arthroscopy-Assisted Reduction and Fixation of a Transversal Glenoid Fracture: About a Case

    Directory of Open Access Journals (Sweden)

    David Zbili

    2017-01-01

    Full Text Available An articular glenoid fracture is an uncommon injury. Usually significantly displaced intra-articular glenoid fractures are treated with open reduction surgery. Conventional open surgery techniques involve high morbidity. Here we describe an arthroscopy-assisted reduction and fixation method of an Ideberg type III glenoid fracture. This method provides good articular reduction without extensive exposure or soft tissue dissection and without nerve and/or vascular lesion.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-04-15

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

  20. Recreational Sports Activities After Calcaneal Fractures and Subsequent Subtalar Joint Arthrodesis.

    Science.gov (United States)

    Romeo, Giovanni; Martinelli, Nicolò; Bonifacini, Carlo; Bianchi, Alberto; Sartorelli, Elena; Malerba, Francesco

    2015-01-01

    Subtalar joint arthrodesis is a common treatment for the management of hindfoot pathologic entities. Despite pain reduction, hindfoot stiffness is a common concern of active patients, who wish to continue or start exercising for fitness. The purpose of the present retrospective observational clinical study was to assess the rate and type of recreational sports activities in patients before and after subtalar joint arthrodesis and to correlate the clinical outcome and the level of sports activities. In 33 patients (22 males, 11 females) treated with subtalar joint arthrodesis, the pre- and postoperative participation in sports and recreational activities was evaluated. The American Orthopaedic Foot and Ankle Society hindfoot scale score, 36-item Short Form Health Survey, and a visual analog scale for pain were used as clinical outcome measures. The weekly session number, session time, and interval to activity recovery after surgery were registered. Patients with a subtalar joint arthrodesis returned to a satisfactory level of activity postoperatively. The sports participation almost reached levels similar to those preoperatively but with a shift from high- to low-impact activities. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Intraarticular morphine analgesia in chronic pain patients with osteoarthritis.

    Science.gov (United States)

    Likar, R; Schäfer, M; Paulak, F; Sittl, R; Pipam, W; Schalk, H; Geissler, D; Bernatzky, G

    1997-06-01

    Controlled clinical studies have shown that local administration of morphine can significantly relieve acute postoperative pain. This analgesic effect is long-lasting (up to 48 h) and is mediated by peripheral opioid receptors. Experimental evidence shows that analgesic effects of peripheral opioids and the density of opioid receptors on peripheral sensory nerves increase with the duration of painful inflammatory processes. This study examines the analgesic effects of 1 mg of morphine injected into the arthritic knee joints of two groups of chronic pain patients (n = 23) suffering from osteoarthritis. Using a randomized, double-blind cross-over design, patients received either an intraarticular injection of morphine and intravenous saline (Group A, n = 13) or an intraarticular injection of saline and intravenous morphine (Group B, n = 10) during Phase I. Seven days later, patients crossed over to the opposite treatment (Phase II). During Phase I, intraarticular morphine resulted in significantly greater pain relief than intraarticular saline, and this effect was present at rest as well as during movement. The analgesic effect was surprisingly long-lasting and extended into Phase II, a carry-over effect that prevented the analysis of Phase II. No side effects were reported. The treatment of arthritic pain by peripherally acting opioids may be a promising alternative to currently available medications that have serious side effects.

  2. A Study of Incidence of calcaneal spurs in North Indian population: A dry bone study

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    G. S. Ghindha

    2015-07-01

    Full Text Available The calcaneal spurs are the most common cause of pain in heel. The pain appears when patient stands on the foot for walking and pain disappears when patient walks some distance. The most common causes of spur formation is chronic fasciitis, wears and tears of ligaments and fascia present in the sole of foot. When the fasciitis heals, during the healing process the calcification of fascia or ligaments takes place, which results into the spur formation. The present study has been conducted on 325 dry human calcanei, irrespective of their sex, in the Department of Anatomy of M. M. Medical College and Hospital, Kumarhatti, District Solan (Himachal Pradesh. The objective of this study is to assess the rate of incidence of the presence of spurs in the calcanei and their types present in these calcanei. The photographs of all types of calcaneal spurs are taken and recorded and the study is compared with the standard literature and previous studies done by other authors. Out of 325 calcanei, 150 (35.38 % cases are having inferior, posterior calcaneal spurs. In 28 (8.62 % cases both types of spurs have been found. Other calcanei are having either inferior or posterior calcaneal spurs. The inferior spurs are more common on right and left side i.e out of 325 cases 75 (23.08 % cases, and posterior spurs found in 40 (12,31 % cases, respectively. In 2 (0.61 % cases a scale type of spurs was present which was attached in the middle of the inferior surface of the calcanei and their anterior ends are free, sharp and pointing forwards. These observations are definitely helpful to the orthopedician, traumatologist and surgeons in their diagnosis and treatment.

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

    Science.gov (United States)

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

    2014-09-01

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

  4. Clinical effect of two operation methods in treatment of Sanders II type calcaneus fractures

    Institute of Scientific and Technical Information of China (English)

    Dong Liu; Jun Hua; Yong-Ming Sun; Lu-Min Cao

    2015-01-01

    Objective:To explore the differences between percutaneous reduction hollow screw internal fixation and open reduction plate internal fixation in the treatment of Sanders II type calcaneal fracture.Method:68 patients with Sanders II type calcaneal fracture from January, 2012 to February, 2013 were divided into poking group and open reduction group, 34 cases in each group. They were treated with poking reduction and internal fixation, as well as open reduction and internal fixation, and then followed up for one year successfully. The operation time, hospitalization time, wound healing time and the amount of bleeding were compared. The Maryland foot score system was employed to assess the function recovery of two groups and the related complications were recorded.Result:The operation time, hospitalization time, incision healing time and the amount of bleeding in operation of poking group were significantly less than the open reduction group; The excellent rate of functional recovery of poking group and open reduction group were 79.41% and 82.35%. The difference between two groups had no statistical significance; the complication rate of poking group and open reduction group were 2.94% and 17.65%. The difference between two groups had statistical significance.Conclusion:Poking reduction combined with internal fixation for the treatment of Sanders II type calcaneal fracture can not only reduce the wound and intraoperative bleeding, shorten operation and hospitalization time, but also prevent the occurrence of complications.

  5. Comparative study of subtalar arthrodesis after calcaneal frature malunion with autologous bone graft or freeze-dried xenograft.

    Science.gov (United States)

    Henning, Carlo; Poglia, Gabriel; Leie, Murilo Anderson; Galia, Carlos Roberto

    2015-12-01

    Calcaneal fracture malunion may evolve into arthrosis and severe foot deformities. The aim of this study was to identify differences in bony union following corrective subtalar arthrodesis with interposition of autologous tricortical bone graft or freeze-dried bovine xenograft. We prospectively evaluated 12 patients who underwent subtalar arthrodesis, six patients received autografts and 6 received freeze-dried bovine xenografts. After a mean followup of 58 weeks, the patients were clinical assessed using AOFAS scale and the visual analog scale (VAS) for pain and for final radiographic parameters measurement. Two blind raters evaluated the length of time required for solid union of the arthrodesis and graft integration by retrospective radiographic examination. In the autograft group, AOFAS score improved from a preoperative average of 37 to 64 points postoperatively (p = 0.02) and mean VAS score improved from 4.7 to 1.9 (p = 0.028). In the xenograft group, AOFAS score improved from 38 to 74 points (p = 0.02) and VAS from 5.5 to 2.7 (p = 0.046). Solid union was achieved in all cases in the autograft group at an average of 5.3 weeks and in five cases in the xenograft group at 8.8 weeks (p = 0.077). Graft integration occurred after an average of 10.7 weeks in the autograft group and 28.8 weeks in the xenograft group (p = 0.016). With the numbers available, no significant difference could be detected in the length of time required for solid union of subtalar arthrodesis between groups, although time to integration of freeze-dried bovine xenografts was statistically higher. Clinical and functional improvement was observed in both groups.

  6. Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report

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    Shariff Sajid

    2010-02-01

    Full Text Available Abstract Introduction Cases of acute tarsal tunnel syndrome are rare. To the best of our knowledge, we describe the only reported case of acute posterior tibial nerve compression resulting from adjacent haemotogenous pyogenic calcaneal osteomyelitis. Case presentation A previously healthy 38-year-old Caucasian woman developed symptoms of acute tarsal tunnel syndrome in her right foot over a six-day period. No antecedent trauma or systemic symptoms were noted. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of Staphylococcus aureus calcaneal osteomyelitis. Her pain and paraesthesia disappeared after the operation, while her inflammatory markers normalised during a 12-week course of antibiotics. After four years she has remained asymptomatic without any indication of recurrence. Conclusion This case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, because haemotogenous calcaneal osteomyelitis is in itself a rare pathology. We recommend considering infection as a differential diagnosis in patients presenting with acute tarsal tunnel syndrome.

  7. Partial calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers

    Science.gov (United States)

    Akkurt, Mehmet Orçun; Demirkale, Ismail; Öznur, Ali

    2017-01-01

    ABSTRACT Objective: The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon’s armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers. Methods: The study included 23 patients with diabetic hindfoot ulcers who were treated with radical excision of the necrotic tissue and application of circular external fixation. The treatment protocol was a combination of magnetic resonance imaging (MRI)-guided debridement of the necrotic tissues and application of an Ilizarov external fixator in plantarflexion to decrease the soft-tissue defect. Primary outcome measures were total cure of infection and obvious healing of the osteomyelitis at 12 weeks determined by MRI, and clinical cure through objective assessment of the appearance of the wound. Results: The wounds healed in 18 of the 23 patients (78%), partial recovery occurred and subsequent flap operation was performed in three patients (13%), and below-the-knee amputation was performed in two patients (9%). Conclusions: This surgical protocol is effective in ameliorating diabetic hindfoot ulcers with concomitant calcaneal osteomyelitis, and satisfactorily reduces the need for amputation.

  8. Mechanical and morphological aspects of the calcaneal tendon of mdx mice at 21 days of age.

    Science.gov (United States)

    Nakagaki, Wilson Romero; Tomiosso, Tatiana Carla; Pimentel, Edson Rosa; Camilli, José Angelo

    2013-10-01

    A relationship between compromised muscles and other tissues has been demonstrated in mdx mouse, an animal model studied for understanding of Duchenne muscular dystrophy. The hypothesis is that changes in the calcaneal tendon of mdx mice occur previous to the onset of rigorous and most marked episodes of muscle degeneration, which start suddenly after 21 days of life. Thus, this study aimed to identify possible alterations in the calcaneal tendon of mdx mouse at 21 days of age. Control and mdx tendons were submitted to mechanical tensile testing, quantification of hydroxyproline, and staining with toluidine blue and picrosirius red. Hydroxyproline content was similar between mdx and control groups. The control tendon presented higher mechanical strength (load, stress, and elastic modulus) and its morphological analysis showed a larger number of round fibroblasts, nuclei with well-decondensed chromatin, and slightly metachromatic well-stained cytoplasmic material, different from that observed in mdx tendons. The results suggest that the absence of dystrophin in mdx mouse can provoke directly or indirectly alterations in the mechanical properties and morphology of the calcaneal tendon. Copyright © 2013 Wiley Periodicals, Inc.

  9. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report

    Science.gov (United States)

    Yi, Tae-Im; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-01-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

  10. Intra-articular osteoid osteoma at the femoral trochlea treated with osteochondral autograft transplantation

    Science.gov (United States)

    Leeman, Joshua J; Motamedi, Daria; Wildman-Tobriner, Ben; O’Donnell, Richard J; Link, Thomas M

    2016-01-01

    We present the case of an intra-articular osteoid osteoma at the femoral trochlea. Intra-articular osteoid osteoma can present a diagnostic challenge both clinically and with imaging because it presents differently from the classic cortical osteoid osteoma. Given the lesion’s proximity to overlying cartilage, the patient underwent resection of the lesion with osteochondral autograft transplantation at the surgical defect. A comprehensive literature review and discussion of intra-articular osteoma will be provided. PMID:27761182

  11. Serum testosterone, sex hormone-binding globulin and total calcium levels predict the calcaneal speed of sound in men

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    Kok-Yong Chin

    2012-08-01

    Full Text Available OBJECTIVES: Variations in sex hormones and the calcium balance can influence bone health in men. The present study aimed to examine the relationship between the calcaneal speed of sound and biochemical determinants of bone mass, such as sex hormones, parathyroid hormones and serum calcium. METHODS: Data from 549 subjects from the Malaysian Aging Male Study, which included Malay and Chinese men aged 20 years and older residing in the Klang Valley, were used for analysis. The subjects' calcaneal speed of sound was measured, and their blood was collected for biochemical analysis. Two sets of multiple regression models were generated for the total/bioavailable testosterone and estradiol to avoid multicollinearity. RESULTS: The multiple regression results revealed that bioavailable testosterone and serum total calcium were significant predictors of the calcaneal speed of sound in the adjusted model. After adjustment for ethnicity and body mass index, only bioavailable testosterone remained significant; the total serum calcium was marginally insignificant. In a separate model, the total testosterone and sex hormone-binding globulin were significant predictors, whereas the total serum calcium was marginally insignificant. After adjustment for ethnicity and body mass index (BMI, the significance persisted for total testosterone and SHBG. After further adjustment for age, none of the serum biochemical determinants was a significant predictor of the calcaneal speed of sound. CONCLUSION: There is a significant age-dependent relationship between the calcaneal speed of sound and total testosterone, bioavailable testosterone and sex hormone-binding globulin in Chinese and Malay men in Malaysia. The relationship between total serum calcium and calcaneal speed of sound is ethnicity-dependent.

  12. TIBIAL PLATEAU FRACTURES – SURGICAL MANAGEMENT BY MIPPO

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    Bharath Raju

    2014-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: Tibial plateau fractures are one of the most common intra-articular fractures. They are the outcome of indirect coronal or direct compressive forces. The incidence of tibial plateau fractures is 1.3% of all fractures. These fractures have varied degree of fracture configuration involving medial, lateral or both tibial plateaus with varied degree of intra-articular depressions and displacements. Due to speedy vehicles and mechanization there has been increase in the number of tibial plateau fractures. Knee joints being one of the major weight bearing joints of human body, these fractures are of big importance. METHODS: We studied 30 cases of tibial plateau fractures treated by MIPPO at kempegowda institute of medical sciences from June 2012 to April 2014 with minimum follow up of up to 6months. RESULTS: All the selected patients were evaluated both clinically as well as radiologically. The lab investigations were done and then they were taken up for the surgery. The fractures were classified as per schatzker’s classification and treated accordingly. In the post-op period early range of movements were started and the patients were non weight bearing till 6 weeks. Till 12 weeks partial weight bearing was allowed and full weight bearing was allowed after radiological union of the fracture. CONCLUSION: Tibial plateau fractures when treated with MIPPO give articular anatomical reduction, rigid fixation and early mobolisation of the knee joint. This prevents development of osteoarthritis and includes all the advantages of minimally invasive procedure and so better patient compliance.

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

    Directory of Open Access Journals (Sweden)

    Georgios D. Georgakopoulos

    2010-10-01

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

  14. Neurologic Deficit Associated With Lateralizing Calcaneal Osteotomy for Cavovarus Foot Correction.

    Science.gov (United States)

    VanValkenburg, Scott; Hsu, Raymond Y; Palmer, Daniel S; Blankenhorn, Brad; Den Hartog, Bryan D; DiGiovanni, Christopher W

    2016-10-01

    Lateralizing calcaneal osteotomy (LCO) is a frequently used technique to correct hindfoot varus deformity. Tibial nerve palsy following this osteotomy has been described in case reports but the incidence has not been quantified. Eighty feet in 72 patients with cavovarus foot deformity were treated over a 6-year span by 2 surgeons at their respective institutions. Variations of the LCO were employed for correction per surgeon choice. A retrospective chart review analyzed osteotomy type, osteotomy location, amount of translation, and addition of a tarsal tunnel release in relation to the presence of any postoperative tibial nerve palsy. Tibial nerve branches affected and the time to resolution of any deficits was also noted. The incidence of neurologic deficit following LCO was 34%. With an average follow-up of 19 months, a majority (59%) resolved fully at an average of 3 months. There was a correlation between the development of neurologic deficit and the location of the osteotomy in the middle third as compared to the posterior third of the calcaneal tuber. We found no relationship between the osteotomy type, amount of correction, or addition of a tarsal tunnel release and the incidence of neurologic injury. Tibial nerve palsy was not uncommon following LCO. Despite the fact that deficits were found to be transient, physicians should be more aware of this potential problem and counsel patients accordingly. To decrease the risk of this complication, we advocate extra caution when performing the osteotomy in the middle one-third of the calcaneal tuberosity. Although intuitively the addition of a tarsal tunnel release may protect against injury, no protective effect was demonstrated in this retrospective study. Level III, retrospective cohort study. © The Author(s) 2016.

  15. Ulnocarpal stabilization in the management of comminuted fractures distal end radius

    OpenAIRE

    Gupta Dinesh; Kumar Gaurav

    2009-01-01

    Background : Malunion due to progressive radial collapse during healing is a common complication following comminuted fracture distal radius treated by conventional methods. Many treatment modalities have been described with their own merits and demerits. Stabilization of ulnocarpal articulation is an effective method to prevent radial collapse during healing, and hence this study. Materials and Methods : A prospective study of 200 patients of comminuted intraarticular fracture lower end rad...

  16. Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

    DEFF Research Database (Denmark)

    Rasmussen, S; Kehlet, H

    2000-01-01

    In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone...

  17. Medial column stabilization improves the early result of calcaneal lengthening in children with cerebral palsy.

    Science.gov (United States)

    Huang, Che-Nan; Wu, Kuan-Wen; Huang, Shier-Chieg; Kuo, Ken N; Wang, Ting-Ming

    2013-05-01

    Calcaneal lengthening is a popular surgical treatment for pronated foot deformity. The aim of this study is to assess the effectiveness of medial column stabilization in improving the results of calcaneal lengthening for pronated foot deformity in ambulatory children with cerebral palsy. Twenty-one consecutive (37 feet) children with cerebral palsy with pronated foot deformity who received calcaneal lengthening from 2004 to 2009 were reviewed. Talonavicular stabilizations were performed by either stapling alone or fusion depending on the children's age and correctability of midfoot deformity. Satisfaction rates were assessed using Mosca's radiographic, Mosca's clinical, and Yoo's clinical criteria. Talonavicular coverage angle was also measured. Results between groups with and without stabilization of the talonavicular joint were compared. Group 1 included 11 children (19 feet) who had no talonavicular stabilization. Group 2 included 10 children (18 feet) who had talonavicular fixation. Groups were further divided into subgroups A [Gross Motor Function Classification System (GMFCS)≤II] and B (GMFCS≥III). Factors including demography, geographical classification, functional status, and preoperative degree of deformity were similar between the two groups. After the operation, all four radiographic parameters improved significantly. The talonavicular coverage angle was better in group 2 than in group 1. Mosca's radiographic results were satisfactory in 73.68% of cases in group 1 and 100% in group 2; the difference was statistically significant (P=0.027). As for Mosca's clinical results, 63.16% in group 1 and 83.33% in group 2 achieved satisfactory results (P=0.156). On the basis of Yoo's criteria, the results were satisfactory in 57.89% of cases in group 1 and in 94.44% of cases in group 2 (P=0.012). Further analysis on the satisfaction rates between the subgroups showed similar results between the patients in subgroup 1A and 2A, and significantly better results

  18. Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial.

    Science.gov (United States)

    Mulders, Marjolein A M; Walenkamp, Monique M J; Goslings, J Carel; Schep, Niels W L

    2016-02-09

    Of all distal radius fractures, 25 % are complete articular fractures (AO/OTA type C fractures). Two thirds of those fractures are displaced and require reduction. According to several International Guidelines, adequately reduced intra-articular distal radius fractures are best treated non-operatively with plaster immobilisation, while surgical fixation is suggested only when the articular step exceeds 2 mm after reduction. However, these recommendations are based on studies that did not differentiate between intra- and extra-articular distal radius fractures. Thus, no clear consensus about the best treatment for patients with displaced intra-articular distal radius fractures can be reached. Despite the lack of evidence, an increase in internal fixation of intra-articular distal radius fractures has been observed over the last decade. The aim of this study is to determine the difference in functional outcome following open reduction and plate fixation compared with non-operative treatment with closed reduction and plaster immobilisation in patients with a displaced intra articular distal radius fracture. This multicentre randomised controlled trial will randomise between open reduction and internal plate fixation (intervention group) and closed reduction and plaster immobilisation (control group). All consecutive adult patients from 18 to 65 years with a displaced intra-articular distal radius fracture (AO/OTA type C), which has been adequately reduced at the Emergency Department according to the Dutch National Guidelines, are eligible for inclusion in this study. The primary outcome is function and pain of the wrist assessed with the Patient-Rated Wrist Evaluation score (PRWE). Secondary outcomes are the Disability of the Arm, Shoulder and Hand score (DASH), pain, quality of life (SF-36), range of motion, grip strength, radiological parameters, complications, crossovers and cost-effectiveness of both treatments. A total of 90 patients will be included in this

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

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2015-01-01

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

  20. JUSTIFICATION OF THE CHOICE OF THE METHOD OF TREATMENT AT INJURY OF THE CALCANEAL BONE ON THE BASIS OF ANALYTICAL MODEL OF RISK OF DEVELOPMENT OF COMPLICATIONS

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    Vitaly Vladimirovich Savgachev

    2015-12-01

    Full Text Available Research objective. Decrease in risk of emergence of complications of treatment at patients with injury of a calcaneal bone.Scientific novelty. The assessment of attributive and relative risks of emergence of complications at injuries of a calcaneal bone is made. Complex studying of structure of the help at injury of a calcaneal bone in the conditions of a profile traumatology hospital is offered. Need of development mathematically of the verified algorithm of prevention of emergence of complications after treatment concerning an injury of a calcaneal bone locates.Conclusions:1. The retrospective analysis with an assessment of attributive and relative risks of emergence of complications at injuries of a calcaneal bone will lead to decrease in frequency of complications at treatment of injuries of a calcaneal bone with improvement of quality of life of patients.2. Introduction in practice of maintaining patients with injuries of a calcaneal bone ma-thematically of the verified algorithm of prevention of emergence of complications after treatment, will allow to reduce risk of developing of this pathology significantly.

  1. An analysis of suboptimal outcomes of medial malleolus fractures in skeletally immature children.

    Science.gov (United States)

    Luhmann, Scott J; Oda, Jon E; O'Donnell, June; Keeler, Kathryn A; Schoenecker, Perry L; Dobbs, Matthew B; Gordon, J Eric

    2012-03-01

    We retrospectively analyzed cases of intra-articular medial malleolar fractures in skeletally-immature patients (Salter-Harris III and IV) with suboptimal outcomes at St. Louis Children's Hospital and Shriner's Hospital for Children. Common causes of poor outcome were frac­ture malunion or malreduction and physeal damage. Malreductions of only 2 mm does not appear to be toler­ated and the concept of "remodeling" does not apply to these fracture patterns. Based on this study, we "recom­mend" fracture reduction and fixation if there is greater than 1 mm of fracture step-off..

  2. Preliminary experience with biodegradable implants for fracture fixation

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    Dhillon Mandeep

    2008-01-01

    Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

  3. Pseudomonas aeruginosa septic arthritis of knee after intra-articular ozone injection.

    Science.gov (United States)

    Seyman, Derya; Ozen, Nevgun Sepin; Inan, Dilara; Ongut, Gozde; Ogunc, Dilara

    2012-07-01

    We describe a case of septic arthritis caused by Pseudomonas aeruginosa in an immunocompetent patient following intra-articular ozone injection into the knee. To the best of our knowledge, and after considering the current literature,we believe this case is unique as no other reports of septic arthritis caused by P. aeruginosa following intra-articular ozone injection has been made.

  4. Simultaneous bilateral septic arthritis of the knee after intraarticular steroid injection: A clinical report.

    Science.gov (United States)

    Munigangaiah, Sudarshan; O'Sullivan, Theresa A; Lenehan, Brian

    2014-07-01

    Osteoarthritis of knee is one of the common problems in elderly population. Intraarticular corticosteroid injection is a conservative management modality in osteoarthritis of knee. Septic arthritis is an infective complication of intraarticular corticosteroid injection. Septic arthritis in rheumatoid arthritis patients have worse prognosis because of delay in diagnosis. A higher rate of infectious complications following intraarticular injection is expected in immunocompromised and rheumatoid patients. We would like to report an extremely rare case of simultaneous bilateral knee septic arthritis after bilateral knee intraarticular steroid injection in a rheumatoid arthritis patient. Patient was treated successfully with multiple bilateral knee arthroscopic washouts and long-term intravenous antibiotics. This case report emphasizes the increased risk of infection in rheumatoid arthritis patients and a risk benefit assessment on individual basis before carrying out intraarticular steroid injection. Patient should be aware of this increased risk of infection.

  5. Is structural hydroxyapatite tricalcium-phosphate graft or tricortical iliac crest autograft better for calcaneal lengthening osteotomy in childhood?

    DEFF Research Database (Denmark)

    Martinkevich, P; Rahbek, Ole; Stilling, M

    2016-01-01

    AIMS: To compare the structural durability of hydroxyapatite-tricalcium phosphate (HATCP) to autologous iliac crest bone graft in calcaneal lengthening osteotomy (CLO) for pes planovalgus in childhood. PATIENTS AND METHODS: We present the interim results of ten patients (HATCP, n = 6 and autograft...

  6. The influence of foot geometry on the calcaneal osteotomy angle based on two-dimensional static force analyses

    NARCIS (Netherlands)

    Reilingh, M.L.; Tuijthof, G.J.M.; Van Dijk, C.N.; Blankevoort, L.

    2011-01-01

    Background: Malalignment of the hindfoot can be corrected with a calcaneal osteotomy (CO). A well-selected osteotomy angle in the sagittal plane will reduce the shear force in the osteotomy plane while walking. The purpose was to determine the presence of a relationship between the foot geometry and

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

    Science.gov (United States)

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

    2012-01-01

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

  8. Preliminary screening of osteoporosis and osteopenia in middle aged urban women from Hyderabad (INDIA using calcaneal QUS

    Directory of Open Access Journals (Sweden)

    Ashwin Kasturi

    2015-08-01

    Conclusions: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis. [Int J Res Med Sci 2015; 3(8.000: 2029-2033

  9. Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial

    OpenAIRE

    Sun, Shu-Fen; Hsu, Chien-Wei; Lin, Huey-Shyan; Chou, Yi-Jiun; Chen, Jun-Yang; Wang, Jue-Long

    2014-01-01

    Background There was an increasing requirement for novel treatments of osteoarthritis (OA). The aim was to compare the efficacy of intraarticular Botulinum toxin type A (BoNT-A) and intraarticular hyaluronate plus rehabilitation exercise in patients with ankle OA. Methods This was a prospective, randomized, assessor-blinded study with a 6-month follow-up period, conducted in the outpatient rehabilitation department at a university-affiliated tertiary care medical center. Seventy-five patients...

  10. [Retrograde nailing in a tibial fracture].

    Science.gov (United States)

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

    2014-01-01

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

  11. Hip Fracture

    Science.gov (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  12. Luxación intra-articular de rótula Intra-articular dislocation of patella

    OpenAIRE

    2006-01-01

    Presentamos el caso de una paciente de 73 años de edad que, tras una caída accidental en las escaleras, sufrió una luxación intra-articular aguda de rótula de la rodilla izquierda. Esta luxación excepcional presentaba incarceración del polo proximal rotuliano en el surco intercondíleo femoral. Se realizó reducción bajo anestesia general debido al dolor y contractura muscular en los intentos de reducción sin anestesia. Realizamos revision quirúrgica que descartó lesiones asociadas del aparato ...

  13. A PROSPECTIVE STUDY OF CLINICAL OUTCOME AFTER USING LIGAMENTOTAXIS IN MANAGEMENT OF DISTAL RADIUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Chandrashekhar V. Mudgal

    2017-04-01

    Full Text Available BACKGROUND A study was done to evaluate the effect of the ligamentotaxis in the management of intraarticular fractures of the distal radius. MATERIALS AND METHODS 34 patients were studied prospectively between March 2014 and February 2016. All patients had intraarticular fracture of distal end of radius and all were treated with ligamentotaxis after closed reduction with fluoroscopic guidance. The follow-up period was 12 months. At the time of surgery, the mean age was 45.29 years. RESULTS In all fracture cases, the mean of fracture union was 5.8 weeks. During the final follow-up, the mean range of motion was 55.30 in flexion, 56.60 in extension, 21.0 in ulnar deviation, 9.00 in radial deviation, 70.30 in pronation and 67.10 in supination. According to the scoring system of Gartland and Werley, the clinical and functional outcomes showed that 15 patients (44.1% had excellent results, 14 (41.1% had good results, 3 (8.8% had fair results and 2 (5.8% had poor results. CONCLUSION Closed reduction under fluoroscopic image guidance and the ligamentotaxis is useful and effective in the treatment of intraarticular fractures of the distal radius.

  14. Intra-articular Implantation of Mesenchymal Stem Cells, Part 2

    Science.gov (United States)

    Kraeutler, Matthew J.; Mitchell, Justin J.; Chahla, Jorge; McCarty, Eric C.; Pascual-Garrido, Cecilia

    2017-01-01

    Knee osteoarthritis (OA) after partial or total meniscectomy is a prevalent issue that patients must face. Various methods of replacing meniscal tissue have been studied to avoid this progression, including meniscal allograft transplantation, meniscal scaffolds, and synthetic meniscus replacement. Studies have shown that meniscal scaffolds may improve symptoms but have not been shown to prevent progression of OA. Recently, mesenchymal stem cells (MSCs) have been proposed as a possible biological therapy for meniscal regeneration. Several animal studies and 1 human study have evaluated the effect of transplanting MSCs into the knee joint after partial meniscectomy. The purpose of this review was to assess the outcomes of intra-articular transplantation of MSCs on meniscal regeneration in animals and humans after partial meniscectomy. Limited results from animal studies suggest that there is some potential for intra-articular injection of MSCs for the regeneration of meniscal tissue. However, further studies are necessary to determine the quality of regenerated meniscal tissue through histological and biomechanical testing. PMID:28203596

  15. Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy.

    Science.gov (United States)

    Meinig, R P; Holtgrewe, J L; Wiedel, J D; Christie, D B; Kestin, K J

    1988-01-01

    Arthroscopy of the knee was performed using 30 ml single dose intraarticular instillations of 0.5% or 0.25% solutions of bupivacaine (Marcaine). A total of 18 patients (mean age, 34 years), divided into two groups, participated in this study. Venous plasma levels were measured at 0, 10, 20, 30, 45, 60, 90, 120, and 240 minute intervals following a single instillation into the knee joint. All patients had suspected traumatic internal derangement of the knee. Electrocardiogram tracings, blood pressure, and neurologic assessment were monitored at each venous sampling interval or more often if clinically indicated. The type and amount of supplemental anesthesia were also recorded. None of our 18 patients required a general anesthetic because of pain although the following procedures were performed: meniscectomy, plica release, abrasion chondroplasty, loose body retrieval, and limited meniscal repair. A new methodology for the measurement of plasma bupivacaine using the gas chromatograph mass spectrometer is described. Monitoring specific molecular mass fragments allows the measurement of picogram per milliliter levels of bupivacaine. The highest peak plasma concentration occurred 20 minutes after instillation of 30 ml of 0.5% bupivacaine. The 625 +/- 225 ng/ml level was well below the 2,500 to 4,000 ng/ml reported to elicit early subjective CNS symptoms of bupivacaine toxicity. Thus, a single dose intraarticular instillation of 30 ml 0.5% or 0.25% bupivacaine is convenient, efficacious, and pharmacologically safe for routine clinical arthroscopy.

  16. Intra-articular analgesia and steroid reduce pain sensitivity in knee OA patients

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Graven-Nielsen, Thomas; Ellegaard, Karen

    2014-01-01

    Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded...... before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus...... muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee (P 

  17. Arthroscopic Excision of an Intraarticular Osteoid Osteoma in the Distal Femur

    Science.gov (United States)

    Kang, Suk; Kim, Young Sung; Lee, Ho Min; Lee, Min Young

    2016-01-01

    An intraarticular osteoid osteoma of the knee is uncommon, and its treatment is challenging. The authors present a case of arthroscopic excision of an intraarticular osteoid osteoma in the distal femur, which was accessible through the knee joint. After confirming the nidus of the osteoid osteoma by computed tomography, the lesion was completely removed arthroscopically. The patient reported complete pain relief immediately after surgery. This case demonstrates that intraarticular osteoid osteomas in the knee joint can be treated by arthroscopic excision and that good results can be obtained. PMID:27904732

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

    DEFF Research Database (Denmark)

    Barkmann, R; Dencks, S; Laugier, P

    2010-01-01

    A quantitative ultrasound (QUS) device for measurements at the proximal femur was developed and tested in vivo (Femur Ultrasound Scanner, FemUS). Hip fracture discrimination was as good as for DXA, and a high correlation with hip BMD was achieved. Our results show promise for enhanced QUS......-based assessment of osteoporosis. INTRODUCTION: Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement...... has been introduced yet. We developed a QUS scanner for measurements at the femur (Femur Ultrasound Scanner, FemUS) and tested its in vivo performance. METHODS: Using the FemUS device, we obtained femoral QUS and DXA on 32 women with recent hip fractures and 30 controls. Fracture discrimination...

  19. Exercise increases interleukin-10 levels both intraarticularly and peri-synovially in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Helmark, Ida C; Mikkelsen, Ulla R; Børglum, Jens

    2010-01-01

    The microdialysis method was applied to the human knee joint with osteoarthritis (OA) in order to reveal changes in biochemical markers of cartilage and inflammation, intraarticularly and in the synovium, in response to a single bout of mechanical joint loading....

  20. Safety of Intra-Articular Use of Atelocollagen for Enhanced Tissue Repair

    OpenAIRE

    Magarian, Elise M; Vavken, Patrick; Connolly, Susan A; Mastrangelo, Ashley N.; Murray, Martha M.

    2012-01-01

    Collagen is an important biomaterial in intra-articular tissue engineering, but there are unanswered questions about its safety. We hypothesize that the addition of type-I-collagen for primary repair of the Anterior Cruciate Ligament (ACL) might result in a local and systemic reaction in a porcine model after 15 weeks as demonstrated by joint effusion, synovial thickening, elevated intraarticular and systemic leukocyte counts. Further, this reaction might be aggravated by the addition of a pl...

  1. Diagnosis and management of an intra-articular foreign body in the foot.

    LENUS (Irish Health Repository)

    Mulhall, K J

    2002-10-01

    We describe a case of a small intra-articular foreign body in the foot presenting 48 hours following injury, which at operation showed early evidence of septic arthritis. It is essential to accurately localise periarticular foreign bodies in the foot and proceed to arthrotomy and debridement in all cases where there is radiological or clinical evidence to suggest intra-articular retention of a foreign body.

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

    OpenAIRE

    Ioannis A. Ignatiadis; Tsiampa, Vassiliki A.; Arapoglou, Dimitrios K.; Gerostathopoulos, Nicolaos E.; Polyzois, Vasilios D.; Georgakopoulos, Georgios D.

    2010-01-01

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

  3. Effects on the Tarsal Tunnel Following Malerba Z-type Osteotomy Compared to Standard Lateralizing Calcaneal Osteotomy.

    Science.gov (United States)

    Cody, Elizabeth A; Greditzer, Harry G; MacMahon, Aoife; Burket, Jayme C; Sofka, Carolyn M; Ellis, Scott J

    2016-09-01

    Tarsal tunnel syndrome is a known complication of lateralizing calcaneal osteotomy. A Malerba Z-type osteotomy may preserve more tarsal tunnel volume (TTV) and decrease risk of neurovascular injury. We investigated 2 effects on the tarsal tunnel of the Malerba osteotomy compared to a standard lateralizing osteotomy using a cadaveric model: (1) the effect on TTV as measured by magnetic resonance imaging (MRI) and (2) the proximity of the osteotomy saw cuts to the tibial nerve. Ten above-knee paired cadaveric specimens underwent MRI of the ankle to obtain a baseline measurement of TTV. One foot in each pair received a standard lateralizing calcaneal osteotomy, with the other foot receiving a Malerba osteotomy. MRIs were performed after each of 3 increasing amounts of lateral displacement, which were accompanied by increasing amounts of wedge resection in the Malerba osteotomy group. TTV was measured on MRI using previously described and validated parameters. Differences in TTV with osteotomy type, displacement, and their interaction were assessed with generalized estimating equations. After all MRIs were completed, each specimen was dissected and the nearest distance of tibial nerve branches to the osteotomy site was measured. Baseline TTV averaged 13 229 ± 2354 mm(3) and did not differ between groups (P = .386). TTV decreased on average by 7% after the first translation, 14% after the second, and 27% after the third (P osteotomies versus those with Malerba osteotomies (P = .578). At least one of the major branches of the tibial nerve crossed the osteotomy site in 5 of 5 specimens that received the Malerba osteotomy versus 2 of 5 that received a standard osteotomy. Regardless of osteotomy type, lateralizing calcaneal osteotomy decreased TTV. In all specimens, the osteotomy was at the level of branches of the tibial nerve. Our results demonstrate that lateralizing calcaneal osteotomies must be performed with care to avoid excessive lateral translation as well as

  4. Mid-term follow up results of subtalar distraction arthrodesis using a double bone-block for calcaneal malunion.

    Science.gov (United States)

    Chung, Hyung-Jin; Bae, Su-Young; Choo, Ji-Woong

    2014-07-01

    This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8° in talocalcaneal angle, 5.1° in talar declination angle and 5.3° in talo-first metatarsal angle. Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.

  5. Feasibility of ultrasound-guided intraarticular contrast injection for MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Soo Jin; Lee, Jong Min; Kang, Duck Sick [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2005-07-15

    To assess the feasibility of ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography. Between June 2002 and October 2004, 132 patients (29 female, 103 male: mean age, 33.6 years) underwent ultrasound-guided intraarticular contrast media injection (40 ml saline + 10 ml 2% lidocaine + 0.2 ml gadopentetate dimeglumine + 0.4 ml epinephrine) for MR arthrography. The patients were classified into four groups, viz. the no leakage group, the minor leakage with successful intraarticular injection group, the major leakage with unsuccessful intraarticular injection group, and the injection failure group. The 'no leakage' and 'minor leakage' groups were considered to be technical successes, while the 'major leakage' and 'injection failure' groups were regarded as technical failures. The technical success rate of ultrasound-guided intraarticular contrast injection using the posterior approach for MR Arthrography was 99.2% (131/132 patients) and one patients 0.7% (1/132 patients) was included in the 'major leakage' group. Ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography was feasible with a high success rate.

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

    Directory of Open Access Journals (Sweden)

    Karen Van den Bussche

    2016-05-01

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

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

    Science.gov (United States)

    Van den Bussche, Karen; Herrmann, Diana; De Henauw, Stefaan; Kourides, Yiannis A.; Lauria, Fabio; Marild, Staffan; Molnár, Dénes; Moreno, Luis A.; Veidebaum, Toomas; Ahrens, Wolfgang; Sioen, Isabelle

    2016-01-01

    This study investigates differences and associations between urinary mineral concentrations and calcaneal bone measures assessed by quantitative ultrasonography (QUS) in 4322 children (3.1–11.9 years, 50.6% boys) from seven European countries. Urinary mineral concentrations and calcaneal QUS parameters differed significantly across countries. Clustering revealed a lower stiffness index (SI) in children with low and medium urinary mineral concentrations, and a higher SI in children with high urinary mineral concentrations. Urinary sodium (uNa) was positively correlated with urinary calcium (uCa), and was positively associated with broadband ultrasound attenuation and SI after adjustment for age, sex and fat-free mass. Urinary potassium (uK) was negatively correlated with uCa but positively associated with speed of sound after adjustment. No association was found between uCa and QUS parameters after adjustment, but when additionally adjusting for uNa, uCa was negatively associated with SI. Our findings suggest that urinary mineral concentrations are associated with calcaneal QUS parameters and may therefore implicate bone properties. These findings should be confirmed in longitudinal studies that include the food intake and repeated measurement of urinary mineral concentrations to better estimate usual intake and minimize bias. PMID:27164120

  8. Combination treatment with metrotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis

    DEFF Research Database (Denmark)

    Hetland, Merete; Stengaard-Pedersen, Kristian; Junker, Peter;

    2006-01-01

    OBJECTIVE: To investigate whether disease control can be achieved in early active rheumatoid arthritis (RA) by treatment with methotrexate and intraarticular betamethasone, and whether the addition of cyclosporine to the regimen has any additional effect. METHODS: Patients (n = 160) were randomized...... to receive methotrexate 7.5 mg/week plus cyclosporine 2.5 mg/kg of body weight/day (combination therapy) or methotrexate plus placebo-cyclosporine (monotherapy). At weeks 0, 2, 4, 6, and 8 and every 4 weeks thereafter, betamethasone was injected into swollen joints (maximum 4 joints or 4 ml per visit......). Beginning at week 8, if synovitis was present, the methotrexate dosage was increased stepwise up to 20 mg/week, with a subsequent stepwise increase in the cyclosporine or placebo-cyclosporine dosage up to 4 mg/kg. RESULTS: At 52 weeks, 20% improvement according to the American College of Rheumatology...

  9. Combination treatment with methotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Stengaard-Pedersen, Kristian; Junker, Peter

    2006-01-01

    OBJECTIVE: To investigate whether disease control can be achieved in early active rheumatoid arthritis (RA) by treatment with methotrexate and intraarticular betamethasone, and whether the addition of cyclosporine to the regimen has any additional effect. METHODS: Patients (n = 160) were randomized...... to receive methotrexate 7.5 mg/week plus cyclosporine 2.5 mg/kg of body weight/day (combination therapy) or methotrexate plus placebo-cyclosporine (monotherapy). At weeks 0, 2, 4, 6, and 8 and every 4 weeks thereafter, betamethasone was injected into swollen joints (maximum 4 joints or 4 ml per visit......). Beginning at week 8, if synovitis was present, the methotrexate dosage was increased stepwise up to 20 mg/week, with a subsequent stepwise increase in the cyclosporine or placebo-cyclosporine dosage up to 4 mg/kg. RESULTS: At 52 weeks, 20% improvement according to the American College of Rheumatology...

  10. Combination treatment with metrotrexate, cyclosporine, and intraarticular betamethasone compared with methotrexate and intraarticular betamethasone in early active rheumatoid arthritis

    DEFF Research Database (Denmark)

    Hetland, Merete; Stengaard-Pedersen, Kristian; Junker, Peter

    2006-01-01

    OBJECTIVE: To investigate whether disease control can be achieved in early active rheumatoid arthritis (RA) by treatment with methotrexate and intraarticular betamethasone, and whether the addition of cyclosporine to the regimen has any additional effect. METHODS: Patients (n = 160) were randomized...... to receive methotrexate 7.5 mg/week plus cyclosporine 2.5 mg/kg of body weight/day (combination therapy) or methotrexate plus placebo-cyclosporine (monotherapy). At weeks 0, 2, 4, 6, and 8 and every 4 weeks thereafter, betamethasone was injected into swollen joints (maximum 4 joints or 4 ml per visit......). Beginning at week 8, if synovitis was present, the methotrexate dosage was increased stepwise up to 20 mg/week, with a subsequent stepwise increase in the cyclosporine or placebo-cyclosporine dosage up to 4 mg/kg. RESULTS: At 52 weeks, 20% improvement according to the American College of Rheumatology...

  11. Luxación intra-articular de rótula Intra-articular dislocation of patella

    Directory of Open Access Journals (Sweden)

    S. García-Mata

    2006-08-01

    Full Text Available Presentamos el caso de una paciente de 73 años de edad que, tras una caída accidental en las escaleras, sufrió una luxación intra-articular aguda de rótula de la rodilla izquierda. Esta luxación excepcional presentaba incarceración del polo proximal rotuliano en el surco intercondíleo femoral. Se realizó reducción bajo anestesia general debido al dolor y contractura muscular en los intentos de reducción sin anestesia. Realizamos revision quirúrgica que descartó lesiones asociadas del aparato extensor, partes blandas, estructuras articulares y osteofitos. Presentaba artrosis avanzada, sobre todo fémoro-patelar. Tras dos semanas de inmovilización reinició movilidad. No ha presentado recidiva u otro tipo de complicaciones.The case of a patient aged 73 years who, following an accidental fall on a staircase, suffered an acute intraarticular dislocation in the left knee-cap is presented. This exceptional dislocation presented incarceration of the proximal kneecap pole in the femoral intercondylar groove. A reduction was carried out under general anaesthetic due to pain and muscular contraction in the attempts at reduction without anaesthetic. We made a surgical check that ruled out associated lesions to the extensor apparatus, soft parts, joint structures and osteophytes. The patient presented advanced arthrosis, above all femoral-patellar. Following two weeks of immobilisation, the patient restarted mobility. There has been no relapse or other type of complication.

  12. [Atlas fractures].

    Science.gov (United States)

    Schären, S; Jeanneret, B

    1999-05-01

    Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.

  13. Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures

    Institute of Scientific and Technical Information of China (English)

    DUAN Xiao-jun; YANG Liu; GUO Lin; CHEN Guang-xing; DAI Gang

    2008-01-01

    Objective: To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures.Methods: A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005,including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury.There were 4 cases of type I fracture,12 type II,9 type III,12 type IV and 2 type V according to Schatzker criteria.Firstly,the combined injuries were treated.Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed.Finally,the internal fixation was observed by X-ray equipment.Postoperative management was early motion and delayed weight bearing.Results: All the fractures healed in 3 or 4 months.All patients were followed up for 1 to 5 years after operation.No case had severe complications,such as poor wound healing,infection,osteofascial compartment syndrome and osteoarthritis.According to the Rasmussen scoring system,36 cases obtained excellent or good results and the other 3 cases had moderate clinical results.The average score was 26 ± 3.Conclusions: As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture,arthroscopy has many advantages.It can treat associated intraarticular soft tissue components,visualize the chondral surface reduction,lavage the hematoma and smaller loose fragments,decrease soft tissue dissection,reduce the risk of scarring and promote rapid recovery.

  14. A Clinically Realistic Large Animal Model of Intra-Articular Fracture

    Science.gov (United States)

    2014-12-01

    development of a definitive post-operative treatment protocol. These methods were used in a series of 22 animals to document the natural history of the...did not lead to deep infection. After ex-fix removal, animals gradually started to use the experimental legs, and load protective gait patterns...achieved in all 18 animals at 12 weeks. The only complication related to healing was in experimental Animal #3, in which a delayed union was apparent

  15. Fuzzy logic structure analysis of trabecular bone of the calcaneus to estimate proximal femur fracture load and discriminate subjects with and without vertebral fractures using high-resolution magnetic resonance imaging at 1.5 T and 3 T.

    Science.gov (United States)

    Patel, Priyesh V; Eckstein, Felix; Carballido-Gamio, Julio; Phan, Catherine; Matsuura, Maiko; Lochmüller, Eva-Maria; Majumdar, Sharmila; Link, Thomas M

    2007-10-01

    Newly developed fuzzy logic-derived structural parameters were used to characterize trabecular bone architecture in high-resolution magnetic resonance imaging (HR-MRI) of human cadaver calcaneus specimens. These parameters were compared to standard histomorphological structural measures and analyzed concerning performance in discriminating vertebral fracture status and estimating proximal femur fracture load. Sets of 60 sagittal 1.5 T and 3.0 T HR-MRI images of the calcaneus were obtained in 39 cadavers using a fast gradient recalled echo sequence. Structural parameters equivalent to bone histomorphometry and fuzzy logic-derived parameters were calculated using two chosen regions of interest. Calcaneal, spine, and hip bone mineral density (BMD) measurements were also obtained. Fracture status of the thoracic and lumbar spine was assessed on lateral radiographs. Finally, mechanical strength testing of the proximal femur was performed. Diagnostic performance in discriminating vertebral fracture status and estimating femoral fracture load was calculated using regression analyses, two-tailed t-tests of significance, and receiver operating characteristic (ROC) analyses. Significant correlations were obtained at both field strengths between all structural and fuzzy logic parameters (r up to 0.92). Correlations between histomorphological or fuzzy logic parameters and calcaneal BMD were mostly significant (r up to 0.78). ROC analyses demonstrated that standard structural parameters were able to differentiate persons with and without vertebral fractures (area under the curve [A(Z)] up to 0.73). However, none of the parameters obtained in the 1.5-T images and none of the fuzzy logic parameters discriminated persons with and without vertebral fractures. Significant correlations were found between fuzzy or structural parameters and femoral fracture load. Using multiple regression analysis, none of the structural or fuzzy parameters were found to add discriminative value to BMD

  16. Root fractures

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  17. Stress Fractures

    Science.gov (United States)

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

  18. Subtalar joint arthrodesis, ankle arthrodiastasis, and talar dome resurfacing with the use of a collagen-glycosaminoglycan monolayer.

    Science.gov (United States)

    Ramanujam, Crystal L; Sagray, Bryan; Zgonis, Thomas

    2010-04-01

    Intraarticular fractures of the calcaneus are a common injury to the hindfoot leading to posttraumatic arthrosis of the subtalar joint. Operative treatment with reduction and internal fixation at the time of initial presentation and once the soft tissue envelope is deemed suitable has become the standard of care for the surgical management of calcaneal fractures. However, numerous complications have been associated with calcaneal fractures, most notably subtalar joint arthrosis and calcaneal malunion. The authors describe a method of a delayed subtalar joint arthrodesis, ankle joint arthrodiastasis, and talar resurfacing with positive results for the management of painful posttraumatic concomitant arthrosis of the subtalar and ankle joints. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  19. Repositioning and stabilization of the radial styloid process in comminuted fractures of the distal radius using a single approach: the radio-volar double plating technique

    OpenAIRE

    Jacobi Matthias; Wahl Peter; Kohut Georges

    2010-01-01

    Abstract Background A possible difficulty in intra-articular fracture of the distal radius is the displacement tendency of the radial styloid process due to the tension of the brachioradialis tendon. Methods Ten patients treated within one year for complex distal radius fractures by double-plating technique with a radial buttress plate and volar locking plate, through a single volar approach, were followed prospectively during 24 months. Outcome measures included radiographic follow-up, range...

  20. Arthroscopic-Assisted Intraosseous Balloon-Assisted Repositioning of a Tibial Plateau Fracture: A Case Report.

    Science.gov (United States)

    Brinkmann, O; Rau, M; Maenz, S; Bungartz, M; Matziolis, G

    2015-01-01

    This is the first description of an arthroscopic-assisted intraosseous balloon-assisted repositioning and defect filling of a tibial plateau fracture. The bone defect was filled with calcium phosphate cement in a liquid/paste form. The described technique was therefore introduced in order to allow an arthroscopic control of reposition and intra-articular cement escape during defect filling. X-rays showed an exact reposition without cement escape and the clinical outcome was satisfactory.

  1. Previous physical exercise slows down the complications from experimental diabetes in the calcaneal tendon

    Science.gov (United States)

    Bezerra, Márcio Almeida; da Silva Nery, Cybelle; de Castro Silveira, Patrícia Verçoza; de Mesquita, Gabriel Nunes; de Gomes Figueiredo, Thainá; Teixeira, Magno Felipe Holanda Barboza Inácio; de Moraes, Silvia Regina Arruda

    2016-01-01

    Summary Background the complications caused by diabetes increase fragility in the muscle-tendon system, resulting in degeneration and easier rupture. To avoid this issue, therapies that increase the metabolism of glucose by the body, with physical activity, have been used after the confirmation of diabetes. We evaluate the biomechanical behavior of the calcaneal tendon and the metabolic parameters in rats induced to experimental diabetes and submitted to pre- and post-induction exercise. Methods 54-male-Wistar rats were randomly divided into four groups: Control Group (CG), Swimming Group (SG), Diabetic Group (DG), and Diabetic Swimming Group (DSG). The trained groups were submitted to swimming exercise, while unexercised groups remained restricted to the cages. Metabolic and biomechanical parameters were assessed. Results the clinical parameters of DSG showed no change due to exercise protocol. The tendon analysis of the DSG showed increased values for the elastic modulus (p<0.01) and maximum tension (p<0.001) and lowest value for transverse area (p<0.001) when compared to the SG, however it showed no difference when compared to DG. Conclusion the homogeneous values presented by the tendons of the DG and DSG show that physical exercise applied in the pre- and post-induction wasn’t enough to promote a protective effect against the tendinopathy process, but prevent the progress of degeneration. PMID:27331036

  2. 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.

  3. DETERMINING OSTEOPOROSIS RISK IN OLDER COLONO ADULTS FROM RURAL AMAZONIAN ECUADOR USING CALCANEAL ULTRASONOMETRY

    Science.gov (United States)

    MADIMENOS, FELICIA C.; LIEBERT, MELISSA A.; CEPON-ROBINS, TARA J.; SNODGRASS, J. JOSH; SUGIYAMA, LAWRENCE S.

    2014-01-01

    Objective Low bone density and osteoporosis prevalence, while well-documented in wealthy nations, are poorly studied in rural, non-clinical contexts in economically-developing regions such as Latin America. This study contributes preliminary osteoporosis risk data for a rural Colono (mestizo) population from Amazonian Ecuador. Methods Anthropometrics were collected for 119 adult participants (74 females, 45 males [50–90 years old]). Heel bone density and T-scores were recorded using calcaneal ultrasonometry Results Approximately 33.6% of the participants had low bone density and were at high-risk for osteoporosis. Four times as many females as males were considered high-risk. Consistent with epidemiological literature, advancing age was significantly associated with lower bone density values (p=0.001). Conclusions Low bone density and osteoporosis prevalence are expected to increase in this and other economically-transitioning populations, yet infrastructure to monitor this changing epidemiological landscape is almost non-existent. Human biologists are uniquely positioned to contribute data from remote populations, a critical step towards initiating increased resource allocation for diagnosis and prevention. PMID:25242164

  4. Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

    Science.gov (United States)

    Tang, Teresa; Taftian, David; Chhatre, Akhil

    2017-01-01

    Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80% decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches. PMID:28149652

  5. Intracortical chondroblastoma mimicking intra-articular osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Ishida, Tsuyoshi; Mukai, Kiyoshi [First Department of Pathology, Tokyo Medical University, Shinjuku 6-1-1, Shinjuku-ku, Tokyo 160-8402 (Japan); Goto, Takahiro [Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo (Japan); Motoi, Noriko [Department of Pathology, Toranomon Hospital, Tokyo (Japan)

    2002-10-01

    We report a case of intra-articular intracortical chondroblastoma of the femoral condyle which radiologically appeared to be osteoid osteoma. A 19-year-old woman presented with a 3-year history of gradually increasing pain in the right knee and had been on nonsteroidal anti-inflammatory drugs for pain relief. Laboratory data were within normal limits. Radiographs showed a well-demarcated lucent lesion in the medial condyle of the right femur. A nidus-like lesion with calcifications and a sclerotic rim located in the cortex was imaged by computed tomography scan. Magnetic resonance imaging revealed bone marrow edema and soft tissue swelling around the lesion, with low signal intensity of the nidus-like lesion on both T1- and T2-weighted images. The lesion was excised en bloc and the histological diagnosis of chondroblastoma was made. A mild inflammatory reaction was observed in the bone marrow and synovium around the tumor. The chondroblastoma cells were shown to express cyclooxygenase-2 with immunohistochemistry. (orig.)

  6. "Nutcracker Fracture" in a Ballet Dancer Performing in The Nutcracker.

    Science.gov (United States)

    Carsen, Sasha; Quinn, Bridget J; Beck, Elizabeth; Southwick, Heather; Micheli, Lyle J

    2015-09-01

    A 26-year-old female professional dancer sustained an acute injury to her mid-foot during a performance of The Nutcracker. An intra-articular, comminuted, minimally displaced fracture of the cuboid was found. The patient was treated non-operatively with cast and boot immobilization, modified weightbearing, and progressive rehabilitation. She was able to return to professional dance at 6 months post-injury and continues to dance professionally over 1 year out from injury without issue. The unique demands of classical ballet, especially dancing en pointe, increase the risk for mid-foot fractures, and clinicians should have a high-index of suspicion in dancers suffering an acute injury to the foot and ankle with greater than expected pain or swelling. Multiple imaging modalities can be used to make the diagnosis, to include plain film radiographs, MRI, and CT scan. Fracture characteristics and patient-specific factors should be taken into account when deciding on a treatment plan.

  7. STUDY OF FUNCTIONAL OUTCOME OF DISTAL FEMUR FRACTURES TREATED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    Sahaya R

    2016-04-01

    Full Text Available BACKGROUND Distal femur fractures account for about 7% of all femur fractures. These fractures can lead to knee stiffness and have the tendency to collapse into varus. The management of distal femur fractures has seen a paradigm shift from nonoperative measures to biological fixation and evolution of modern implants like Locking Compression Plate has been used in current times. With the use of Locking Compression Plate double plating can be avoided. In our study, we have evaluated the short-term Functional Outcome of patients who underwent open reduction internal fixation with Locking Compression Plate using Sander’s criteria. Ours is both prospective and retrospective study of 20 patients with distal femur fractures treated operatively from April 2013 to October 2015. Our surgical modality of treatment is open reduction and internal fixation with locking compression plate using standard lateral approach. We have used AO classification to classify the distal femur fractures. With the results of our study, we have come to a conclusion that locking compression plate is a best option for both intra-articular and extra-articular distal femur fractures. It avoids the use of dual plating of distal femur which requires extensive soft tissue stripping in both sides, resulting in reduced blood supply, potential non-union and implant failure. Locking Compression Plate also helps in anatomical reduction of comminuted intra-articular fractures and it could also be used effectively in osteoporotic bone.

  8. Intra-Articular Sufentanil Compared to Morphine for Pain Relief After Arthroscopic Knee Surgery

    Directory of Open Access Journals (Sweden)

    A P Kazemi

    2004-08-01

    Full Text Available Background: Prevention of postoperative pain by injecting opioid into the knee joint is believed to support the hypothesis of peripheral opioid receptor activation in inflammation. Main outcomes were reduction of pain intensity and need for supplementary analgesics. The aim of the present study was to evaluate the analgesic effects of intra-articular sufentanil in comparison with morphine, after arthreoscopic procedures of knee joint. Methods: In this prospective, double-blind study, 45 patients were randomized in three equal number groups to receive either sufentanil 5 µg (group s, morphine 3 mg (group M or normal saline 20 cc as placebo (group p, intra-articularly at the end of arthroscopic knee surgery, under general anesthesia, which was same in all three groups. Pain levels at rest were measured by Visual Analog Scale (VAS at intervals of 1,2,4,8,12,14 hours and during movement of knee at discharge time . Results: Significant difference between the groups (p<0.001 were found. Pain scores were statistically lower in the S and M groups in comparison with the P group, but intra-articular sufentanil was more effective than morphine. Conclusion: Intra-articular injection of morphine and sufentanil both reduce the post arthroscopic knee procedure’s pain and need for supplementary analgesics, but sufentanil, 5 µg is more effective than morphine (3 mg. Keywords: Postoperative analgesia, intra-articular opioids, sufentanil, Morphine, Knee arthroscopy.

  9. [Surgical treatment of humerus condylar fracture].

    Science.gov (United States)

    Gorodnichenko, A I; Guseĭnov, T Sh; Uskov, O N

    2014-01-01

    55 patients with intra-articular condyles fractures of humerus were operated in terms 1998 to 2013 year in the Clinic of Traumatology and Orthopedics of the Presidential Administration. All patients were operated by using of perosseous osteosynthesis method with external fixing device design A.I. Gorodnichenko. Indications for osteosynthesis were open and closed fractures of C1,2,3 types accordingly to AO Classification. Closed, atraumatic and reliable fixation of bone fragments intensifies patients faster, improves their life quality, decreases time of hospitalization and minimizes complications rate. Fractures consolidation was achieved in all cases. It was observed such complications as soft tissue inflammatory around shafts in 4 (7.3%) observations. Long-term results were studied in 51 (92.7%) patients including 9 (17.6%) patients with excellent results, 24 (47.1%) patients with good results and 18 (35.3%) patients with satisfactory results. It was not detected unsatisfactory results. The method permits early reconstructive treatment of patients and improves functional results in case of condyles fractures. This preserves active moving function of damaged elbow from the first day after operation and during all period of treatment.

  10. The influence of surface porosity on gap-healing around intra-articular implants in the presence of migrating particles

    DEFF Research Database (Denmark)

    Rahbek, Ole; Kold, Soren; Zippor, Berit;

    2005-01-01

    -pore coating (Fi) were inserted intra-articular in exact fit or with a 0.75 mm peri-implant gap. A weight-loaded implant device in the distal femur was used. We used a randomized paired design in eight dogs. PE particles were injected repeatedly intra-articular in the knee until the dogs were killed after 8...

  11. Isolation and characterization of connective tissue progenitor cells derived from human fracture-induced hemarthrosis in vitro.

    Science.gov (United States)

    Lee, Sang Yang; Miwa, Masahiko; Sakai, Yoshitada; Kuroda, Ryosuke; Oe, Keisuke; Niikura, Takahiro; Matsumoto, Tomoyuki; Fujioka, Hiroyuki; Doita, Minoru; Kurosaka, Masahiro

    2008-02-01

    In our search for alternative sources of connective tissue progenitor cells that can be obtained with minimal invasion, we studied human intraarticular fracture-induced hemarthrosis of the knee and attempted to isolate connective tissue progenitors from the hemarthrosis. Hemarthrosis was aspirated from the knee joints of 13 patients suffering from intraarticular osteochondral fractures of the knee. Mononuclear cells were isolated from the aspirated hemarthrosis by density gradient separation, and cultured. We were able to obtain fibroblastic adherent cells from the mononuclear cell fractions. Flow cytometry analysis after in vitro expansion on tissue culture plastic revealed that the fibroblastic cells were positive for CD29, CD44, CD105, and CD166, and negative for CD14, CD34, CD45, and CD133. These cells could differentiate in vitro into osteogenic, chondrogenic, and adipogenic cells in the presence of lineage-specific induction factors. These results demonstrate that human intraarticular fracture-induced knee hemarthrosis contains connective tissue progenitor cells with morphologic features, immunophenotypic markers, and differentiation potential that are similar to bone marrow stromal cells. This suggests that hemarthrosis, which is easy to harvest without unnecessary invasion to the patient, has possible future clinical applications such as in tissue-engineered therapies for severe osteochondral defects, posttraumatic osteoarthritis, and delayed fracture unions or nonunions.

  12. [Acetabular fractures].

    Science.gov (United States)

    Gänsslen, A; Oestern, H J

    2011-12-01

    Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results.The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed.The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results.Furthermore, epidemiological data on typical postoperative complications are evaluated.

  13. Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure

    Directory of Open Access Journals (Sweden)

    Devgan Ashish

    2013-04-01

    Full Text Available 【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

  14. Bicolumnar 90-90 plating of low-energy distal humeral fractures in the elderly patient.

    Science.gov (United States)

    Leigey, Daniel F; Farrell, Dana J; Siska, Peter A; Tarkin, Ivan S

    2014-09-01

    Fragility fractures of the distal humerus in elderly patients, especially the low transcondylar fracture pattern, can be difficult to optimally manage. Although the fractures are typically low energy resulting in either extra-articular or simple intra-articular patterns, gaining fixation into the distal fragments can be difficult with open reduction internal fixation (ORIF) using traditional 90-90 or parallel plating techniques. Anatomy preserving reconstruction with ORIF is preferred over total elbow arthroplasty (TEA) if possible. In this study, 15 patients were managed with a bicolumnar 90-90 plating construct as a novel method of enhancing distal fixation in these fractures. Fourteen patients went on to radiographic union at an average of 77 days after surgery with an average arc of motion of 105°. One patient was lost to follow-up. Bicolumnar 90-90 plating of distal humerus fractures in elderly patients may represent a viable alternative to traditional ORIF or TEA.

  15. Sports fractures.

    OpenAIRE

    DeCoster, T. A.; Stevens, M. A.; Albright, J. P.

    1994-01-01

    Fractures occur in athletes and dramatically influence performance during competitive and recreational activities. Fractures occur in athletes as the result of repetitive stress, acute sports-related trauma and trauma outside of athletics. The literature provides general guidelines for treatment as well as a variety of statistics on the epidemiology of fractures by sport and level of participation. Athletes are healthy and motivated patients, and have high expectations regarding their level o...

  16. Comparison of analgesic effects of intra-articular tenoxicam and morphine in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Guler, Gulen; Karaoglu, Sinan; Velibasoglu, Hediye; Ramazanogullari, Nesrin; Boyaci, Adem

    2002-07-01

    This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively.

  17. Intra-articular Nodular Fasciitis: An Unexpected Diagnosis for a Joint Lesion: A Case Report

    Directory of Open Access Journals (Sweden)

    MF Michelle Chan

    2014-07-01

    Full Text Available Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

  18. The Role of Intraarticular Platelet Rich Plasma (PRP) Injection in Patients with Internal Knee Derangements.

    Science.gov (United States)

    Razaq, Sarah; Ejaz, Amer; Rao, Sajid Ejaz; Yasmeen, Rehana; Arshad, M Aleem

    2015-09-01

    Platelet Rich Plasma (PRP) is an emerging biotechnology which uses patient's own blood components to create healing effect to their own injured tissues. This study was carried out to evaluate the clinical effects, adverse reactions and patient satisfaction after intraarticular injection of platelet rich plasma in a small group of patients with internal derangements of knee at Combined Military Hospital, Panoaqil, Pakistan. In this single center, open study, 10 patients with internal derangements of knee fulfilling the inclusion criteria received two doses of 3 ml of platelet rich plasma as intraarticular knee injection at two weeks interval. All patients were evaluated at 0, 4 and 12 weeks after treatment using IKDC, TEGNER, KOOS and VAS. Adverse events and patient's satisfaction was recorded. There was significant improvement in all scores. Intraarticular PRP injection is safe and effective method in the conservative treatment of internal knee derangements.

  19. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Lorentzen, Jan S; Larsen, Allan S

    2002-01-01

    We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups...... receiving intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. All patients were instructed to resume normal activities immediately after...... the procedure. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. A combination of bupivacaine and morphine reduced pain, duration of immobilization and of convalescence. The addition of methylprednisolone further reduced pain, use...

  20. Necrotizing Faciitis after shoulder mobilization and intra-articular infiltration with betametasone.

    Science.gov (United States)

    Bento-Rodrigues, Joana; Judas, Fernando; Pedrosa Rodrigues, Jorge; Oliveira, João; Simões, Pedro; Lucas, Francisco; Pais Lopes, António

    2013-01-01

    Necrotizing Fasciitis is a rapidly progressive, potentially fatal infection of superficial fasciae and subcutaneous tissue, usually resulting from an inciting trauma to the skin. Medical literature refers few cases of necrotizing fasciitis related to intra-articular infiltrations, that often lead to patients death. This report describes the clinical events on a 55 year-old diabetic patient who developed upper extremity Necrotizing Fasciitis, 18 days after shoulder mobilization and intra-articular infiltration, due to Staphylococcus epidermidis. An early surgical debridement was performed and antibiotherapy was established, resulting in a successful outcome, despite the functional disability. We point out, through this case, the possibility of intra-articular injections of drugs causing Necrotizing Fasciitis, especially in risk patients.

  1. Hamate fractures.

    Science.gov (United States)

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

    2015-01-01

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

  2. Colles Fracture

    OpenAIRE

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

    2014-01-01

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

  3. Calcaneal fillet flap: a new osteocutaneous free tissue transfer for emergency salvage of traumatic below-knee amputation stumps.

    Science.gov (United States)

    Januszkiewicz, J S; Mehrotra, O N; Brown, G E

    1996-09-01

    Traumatic below-knee amputations do not always leave enough soft tissue of bone with which to fashion a stump of sufficient length and durability to support a prosthesis. Composite free flaps can often be harvested from the amputated limb to provide immediate one-stage stump salvage and to preserve knee function. We report a new technique to increase stump length by incorporating the calcaneus into a foot fillet flap as a vascularized bone transfer. The calcaneal fillet flap is a useful addition to the inventory of available composite flaps. It is recommended for knee joint salvage when there is less than 11 cm of tibial remnant length.

  4. Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, M.R.; Chung, C.B.; Mendes, L.; Mohana-Borges, A.; Trudell, D.; Resnick, D. [Department of Radiology, Musculoskeletal Section, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161 (United States)

    2003-01-01

    To determine the relationship between sites of calcaneal plantar enthesophytes and surrounding fascial and soft tissue structures using routine radiography, MR imaging, and data derived from cadaveric and paleopathologic specimens.Design and patients. Two observers analyzed the MR imaging studies of 40 ankles in 38 patients (35 males, 3 females; mean age 48.3 years) with plantar calcaneal enthesophytes that were selected from all the ankle MR examinations performed during the past year. Data derived from these MR examinations were the following: the size of the enthesophyte; its location in relation to the plantar fascia (PF) and flexor muscles; and the thickness and signal of the PF. The corresponding radiographs of the ankles were evaluated at a different time by the same observers for the presence or absence of plantar enthesophytes and, when present, their measurements. A third observer reviewed all the discordant observations of MR imaging and radiographic examinations. Two observers analyzed 22 calcaneal specimens with plantar enthesophytes at an anthropology museum to determine the orientation of each plantar enthesophyte. MR imaging of a cadaveric foot with a plantar enthesophyte with subsequent sagittal sectioning was performed to provide further anatomic understanding.Results. With regard to MR imaging, the mean size of the plantar enthesophytes was 4.41 mm (SD 2.4). Twenty (50%) enthesophytes were located above the PF, 16 (40%) between the fascia and abductor digiti minimi, flexor digitorum brevis and abductor hallucis muscles, and only one (3%) was located within the PF. In three (8%) cases the location was not determined. The size of enthesophytes seen with MR imaging and radiographs was highly correlated (P<0.01). The interobserver agreement for all measurements was good (Pearson >0.8, kappa >0.9). Eleven of the 22 bone specimens had plantar enthesophytes oriented in the direction of the abductor digiti minimi and 11 oriented in the direction of the

  5. Usefulness of fluoroscopy-guided intra-articular injection of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Myung, Jae Sung; Lee, Joon Woo [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Ji Yeon [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)] (and others)

    2007-06-15

    To determine the accuracy of the intra-articular location of hyaluronic acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injection (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test ({rho} value = 0.14). Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

  6. [Arthrocentesis of the temporomandibular joint and intra-articular injections : An update].

    Science.gov (United States)

    Marty, P; Louvrier, A; Weber, E; Dubreuil, P-A; Chatelain, B; Meyer, C

    2016-09-01

    Arthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ? A bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used. 1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent. Numerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents. Copyright © 2016 Elsevier Masson SAS. All rights

  7. ROLE OF LOW PROFILE PRECONTOURED DISTAL TIBIAL LOCKING PLATE USING MIPPO TECHNIQUE IN PILON FRACTURE

    Directory of Open Access Journals (Sweden)

    Isaac Sunder

    2015-10-01

    Full Text Available : Tibial pilon fracture – Spectrum of injury ranging from fractures caused by low energy rotational foces to fractures caused by high energy axial compression forces due to RTA/ fall from height with significant metaphyseal communition articular communition with diaphyseal extension. Almost 80% patients will have fibula fracture. The aim of the study is study the efficacy of LP PD DTP in the management of closed pilon fractures (OTA type A Type B and Type C 1 and open pilon fractures (Grade 1 Grade II Grade III A (Gustilo Anterson grading. 1. I have studied 21 patients of pilon fracture classified using AO/OTA classification Type A-metaphyseal; Type B–Partially articular; Type C Metaphyseal fracture with articular involvement. 2. Used LP/ PC/ Distal tibial plate using MIPPO technique in OTA–A, B and C 1 closed & grade I II Grade III A compound fractures. OBSERVATIONS: 1. In contrary to stages protocol (Ist external fixation with fibular plating after 2-3 Weeks ORIF/MIPPO with/Without bone grafting, it is done percutaneously or minimally invasive and it can be done on day 1 without any major soft tissue problem & post-operative infection. 2. Duration of stay in the hospital can be reduced. 3. Since it is done through calcaneal traction or femoral distractor – fibula length restored & plating may not be necessary all the time and fibula plating can be avoid if the soft tissue condition is not favorable for plating laterally. 4. Since it is done through calcaneal traction/femoral distractor inspite of ground glass communition–good reduction is almost always possible. 5. Since MIPPO–need for bone grafting in less. 6. As in staged protocol more time is spent in soft tissue healing and after 2–3 weeks, fractures reduction if difficult and almost impossible with indirect reduction and may warrant open reduction. I conclude that LP PC distal tibial plate using MIPPO technique offers several advantages over two staged protocol and improved

  8. Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

    Science.gov (United States)

    Calafi, L Afshin; Routt, M L Chip

    2010-02-01

    Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.

  9. Intraarticular Sprifermin (Recombinant Human Fibroblast Growth Factor 18) in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Lohmander, L. S.; Hellot, S.; Dreher, D.

    2014-01-01

    Objective. To evaluate the efficacy and safety of intraarticular sprifermin (recombinant human fibroblast growth factor 18) in the treatment of symptomatic knee osteoarthritis (OA). Methods. The study was a randomized, double-blind, placebo-controlled, proof-of-concept trial. Intraarticular...... in joint space width (JSW) seen on radiographs, and pain scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. One hundred ninety-two patients were randomized and evaluated for safety, 180 completed the trial, and 168 were evaluated for the primary efficacy end...

  10. A Case of Recurrent Acute Pancreatitis Due to Intra-Articular Corticosteroid Injection

    Directory of Open Access Journals (Sweden)

    Patompong Ungprasert

    2014-03-01

    Full Text Available Context Corticosteroid is a well-established cause of drug-induced pancreatitis. However, acute pancreatitis from intraarticularinjection of corticosteroid has never been described. Case report A 69-year-old male presented with acuteabdominal pain and was diagnosed with acute pancreatitis. The patient had one episode of acute pancreatitis two yearearlier. Both episodes occurred after intra-articular cortisone injection. Investigations for other causes of pancreatitis werenegative. Conclusion We report the first case of acute pancreatitis from intra-articular corticosteroid injection. Physiciansshould be aware of this adverse reaction of corticosteroid that can even occur with local administration.

  11. The association between bone health indicated by calcaneal quantitative ultrasound and metabolic syndrome in Malaysian men.

    Science.gov (United States)

    Chin, Kok-Yong; Ima-Nirwana, Soelaiman; Mohamed, Isa Naina; Ahmad, Fairus; Mohd Ramli, Elvy Suhana; Aminuddin, Amilia; Wan Ngah, Wan Zurinah

    2015-01-01

    Previous studies on the relationship between bone health and metabolic syndrome (MS) have revealed heterogeneous results. There are limited studies employing bone quantitative ultrasonometry in evaluating this relationship. This study aimed to determine the relationship between MS and bone health in a group of Malaysian middle-aged and elderly men using bone quantitative ultrasonometry. This cross-sectional study recruited 309 free living Chinese and Malay men aged 40 years and above residing in Klang Valley, Malaysia. Their demographic and anthropometric data were collected. Their calcaneal speed of sound (SOS) was measured using a CM-200 bone ultrasonometer. Their blood was collected for the evaluation of lipid profile, total testosterone and sex hormone-binding globulin. The joint interim MS definition was used for the classification of subjects. Multiple linear regression analysis was used to assess the association between SOS and indicators of MS and the presence of MS, with suitable adjustment for confounders. There was no significant difference in SOS value between MS and non-MS subjects (p > 0.05). The SOS values among subjects with different MS scores did not differ significantly (p > 0.05). There were no significant associations between SOS values and indicators of MS or the presence of MS (p > 0.05). The relationship between bone health and MS is not significant in Malaysian middle-aged and elderly men. A longitudinal study should be conducted to evaluate the association between bone loss and MS to confirm this finding.

  12. A retrospective study of homoeopathic treatment in patients with heel pain with or without Calcaneal Spur

    Directory of Open Access Journals (Sweden)

    Suraia Parveen

    2017-01-01

    Full Text Available Background: Heel pain is a common clinical condition which significantly affects the quality of life. It is frequently associated with calcaneal spur (CS. Despite its high prevalence, the optimal treatment remains unclear. The aim and objective of this study is to evaluate the extent of CS in heel pain; correlation of CS with some sociodemographic and health-related factors; and outcome of homoeopathic treatment over a period of 6 months. Methodology: It was a retrospective study done at Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy, Kolkata. Samples were selected from the patients referred for ankle X-ray from August 2014 to July 2015 for nontraumatic heel pain. Their files were traced from outpatient department, and treatment records were reviewed over the next 6 months. Results: Totally 92 patients, 70 women and 22 men, had undergone lateral X-ray of ankle for nontraumatic heel pain, of which 76 (82.6% patients had CS. Extent of CS was found to be higher in case of females, older age, overweight, and profession of housemaid or manual labor. Homoeopathic treatment showed positive response in nearly 75% of the CS patients. The most useful medicines were Calcarea flouricum, Rhus toxicodendron, Ledum palustre, and Aranea diadema. Conclusion: CS was found in nearly 80% of patients presenting with heel pain, which showed association with female sex, overweight, increasing age, and profession requiring heel stress. Homoeopathic treatment was effective in 3/4th of CS patients, and Rhus toxicodendron and Calcarea flouricum are the two most commonly used medicines.

  13. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

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

  14. Analgesic effects of intra-articular botulinum toxin Type B in a murine model of chronic degenerative knee arthritis pain

    Directory of Open Access Journals (Sweden)

    Stephanie Anderson

    2010-09-01

    Full Text Available Stephanie Anderson1,2, Hollis Krug1,2, Christopher Dorman1, Pari McGarraugh1, Sandra Frizelle1, Maren Mahowald1,21Rheumatology Section, Veteran’s Affairs Medical Center, Minneapolis, Minnesota; 2Division of Rheumatology and Autoimmune Diseases, University of Minnesota Medical School, Minneapolis, Minnesota, USAObjective: To evaluate the analgesic effectiveness of intra-articular botulinum toxin Type B (BoNT/B in a murine model of chronic degenerative arthritis pain.Methods and materials: Chronic arthritis was produced in adult C57Bl6 mice by intra-articular injection of Type IV collagenase into the left knee. Following induction of arthritis, the treatment group received intra-articular BoNT/B. Arthritic control groups were treated with intra-articular normal saline or sham injections. Pain behavior testing was performed prior to arthritis, after induction of arthritis, and following treatments. Pain behavior measures included analysis of gait impairment (spontaneous pain behavior and joint tenderness evaluation (evoked pain response. Strength was measured as ability to grasp and cling.Results: Visual gait analysis showed significant impairment of gait in arthritic mice that improved 43% after intra-articular BoNT/B, demonstrating a substantial articular analgesic effect. Joint tenderness, measured with evoked pain response scores, increased with arthritis induction and decreased 49.5% after intra-articular BoNT/B treatment. No improvement in visual gait scores or decrease in evoked pain response scores were found in the control groups receiving intra-articular normal saline or sham injections. Intra-articular BoNT/B was safe, and no systemic effects or limb weakness was noted.Conclusions: This study is the first report of intra-articular BoNT/B for analgesia in a murine model of arthritis pain. The results of this study validate prior work using intra-articular neurotoxins in murine models. Our findings show chronic degenerative arthritis

  15. Medial displacement calcaneal osteotomy with posterior tibial tendon reconstruction for the flexible flatfoot with symptomatic accessory navicular.

    Science.gov (United States)

    Cao, Hong-Hui; Tang, Kang-Lai; Lu, Wei-Zhong; Xu, Jian-Zhong

    2014-01-01

    We investigated the clinical outcomes after medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular, in patients with flexible flatfoot with accessory navicular symptoms. From December 2008 to July 2011, 16 patients (21 feet) with a flexible flatfoot, symptomatic accessory navicular, and obvious heel valgus underwent medial displacement calcaneal osteotomy and reconstruction with posterior tibial tendon insertion on the navicular bone. The patients were evaluated preoperatively, 6 weeks and 3, 6, and 12 months postoperatively, and every 6 months thereafter. The clinical examination was undertaken using the American Orthopaedic Foot and Ankle Society ankle and midfoot scores. The radiologic assessments included the arch height, calcaneus inclination angle, talocalcaneal angle, and talar first metatarsal angle on the lateral weightbearing radiograph. The talocalcaneal angle and talar first metatarsal angle was assessed on the anteroposterior view of the weightbearing foot. Heel valgus alignment was assessed on the axial hindfoot radiographs. The mean follow-up duration was 28.5 months (range 18 to 48). All patients were satisfied with the clinical results and were pain free 6 months postoperatively. No cases of wound infection or nerve injury developed. The mean American Orthopaedic Foot and Ankle Society score improved from 53.3 ± 6.5 to 90.8 ± 1.4 at the last follow-up visit (p flatfoot with symptomatic accessory navicular, associated with excellent clinical outcomes and correction of the deformity.

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

    Science.gov (United States)

    Tateuchi, Hiroshige; Wada, Osamu; Ichihashi, Noriaki

    2011-06-01

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

  17. Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's Disease: a randomised control trial

    Directory of Open Access Journals (Sweden)

    Williams Cylie M

    2010-03-01

    Full Text Available Abstract Background Posterior Heel pain can present in children of 8 to 14 years, associated with or clinically diagnosed as Sever's disease, or calcaneal apophysitis. Presently, there are no comparative randomised studies evaluating treatment options for posterior heel pain in children with the clinical diagnosis of calcaneal apophysitis or Sever's disease. This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children. Method Design: Factorial 2 × 2 randomised controlled trial with monthly follow-up for 3 months. Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Sever's disease (n = 124. Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear foot control. The alternate condition in this factor is no footwear prescription/replacement, with the participant wearing their current footwear. Outcomes: Oxford Foot and Ankle Questionnaire and the Faces pain scale. Discussion This will be a randomised trial to compare the efficacy of various treatment options for posterior heel pain in children that may be associated with calcaneal apophysitis also known as Sever's disease. Trial Registration Trial Number: ACTRN12609000696291 Ethics Approval Southern Health: HREC Ref: 09271B

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

    Directory of Open Access Journals (Sweden)

    Craig R Lareau

    2015-01-01

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

  19. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Pfeiffer-Jensen, Mogens; Haraldsted, Viggo;

    2007-01-01

    BACKGROUND: Epidural analgesia gives excellent pain relief but is associated with substantial side effects. We compared wound infiltration combined with intraarticular injection of local anesthetics for pain relief after total hip arthroplasty (THA) with the well-established practice of epidural....../mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter (group A). RESULTS: Narcotic consumption was significantly reduced in group A compared to group E (p = 0.004). Pain levels at rest and during mobilization were similar...

  20. Foundation and static analysis of calcaneal three-dimensional finite element model%跟骨三维有限元模型的建立与静态分析

    Institute of Scientific and Technical Information of China (English)

    黄海晶; 王捷; 马建雄; 张清功; 王志彬; 金鸿宾

    2010-01-01

    目的 建立一个基于健康人体的跟骨三维有限元模型,静态分析双足站立相时跟骨内部的生物力学特性,探讨跟骨骨折疼痛的内外侧应力不均衡因素.方法 选取1名健康男性志愿者,年龄28岁,体重64kg.采用16排螺旋CT对足部沿横断面连续扫描,将符合DICOM 3.0标准的CT断层图像导入MIMICS10.1中,设定阈值为226~3071 Houfield unit,确定方位后经手动编辑、区域增长、形态学操作及空洞处理等,生成足部的三维模型,从整个足部模型中提取跟骨模型.对跟骨进行面网格的优化处理后,导入ANSYS10.0中得到体网格模型.根据CT断层图像的灰度值完成模型材质的添加,生成最终的三维有限元模型.模拟研究对象双足静止站立的状态,距下关节面在整个分析过程中被全约束,自足跟及跟腱附着点处对模型分别施加垂直向上的320 N和160 N载荷,观察跟骨的Vonmises应力分布.结果 MIMICS软件能够迅速建立更为精确的有限元模型,当垂直载荷作用于跟骨后,跟骨内、外侧存在一定的应力不均衡因素.跟骨的外侧结构是明显的薄弱区域,随着跟骨外侧壁的应力增加,导致继发外侧畸形,压迫腓骨长短肌及跟骰关节产生疼痛.结论 创建的跟骨三维有限元模型,经验证是一个较为精确的正常跟骨三维模型,可用于理解跟骨内部的应力分布变化.%Objective To establish a more rapid and precise calcaneal three-dimensional (3D) finite element model based on the healthy human foot, to analyze the internal biomechanical properties of calcaneus, and to explore the relationship between caleaneal fracture pain with the stress imbalance factors in medial and lateral side of calcaneus. Methods One healthy male volunteer (28 years old, 64 kg) was selected. Input DICOM 3.0 standard CT sectional images into MIMICS10.1 software, set the threshold of 226-3071 Houfield unit, generate foot 3D model, extract caleaneus

  1. Intra-articular injection of tenoxicam in osteoarthritic knee joints with effusion.

    Science.gov (United States)

    Oztuna, Volkan; Eskandari, Metin; Bugdayci, Resul; Kuyurtar, Fehmi

    2007-12-01

    Thirty patients who had grade II to III osteoarthritis according to Kellgren-Lawrence system and presenting with acute effusion of the knee joint were randomly assigned to 2 groups. All patients were treated with aspiration of the synovial fluid, cold application, and rest. Fifteen patients received an intra-articular injection of tenoxicam 20 mg following aspiration. The other group was administered oral tenoxicam 20 mg a day for 10 days. Patients were examined at 2, 4, and 8 weeks and then in 3-month intervals. At followup visits, pain was assessed using visual analog scale: range of motion, and effusion of the knee joint were recorded. A repeated measure test was used to determine the significance of changes in pain and mobility between the groups. Student's Neyman Keuls test was used to determine the significance of differences within the groups. Chi-square test was used for the number of episodes. The intra-articular injection group had more rapid pain relief than the oral treatment group (P < .01). At the end of 1 year, the number of effusions was significantly lower in the intra-articular treatment group (P < .01). These results indicate that intra-articular injection of tenoxicam provides rapid pain relief in the patients with acute flare-up of knee osteoarthritis and helps to prevent effusion.

  2. Polyethylene-glycol-modified single-walled carbon nanotubes for intra-articular delivery to chondrocytes.

    Science.gov (United States)

    Sacchetti, Cristiano; Liu-Bryan, Ru; Magrini, Andrea; Rosato, Nicola; Bottini, Nunzio; Bottini, Massimo

    2014-12-23

    Osteoarthritis (OA) is a common and debilitating degenerative disease of articular joints for which no disease-modifying medical therapy is currently available. Inefficient delivery of pharmacologic agents into cartilage-resident chondrocytes after systemic administration has been a limitation to the development of anti-OA medications. Direct intra-articular injection enables delivery of high concentrations of agents in close proximity to chondrocytes; however, the efficacy of this approach is limited by the fast clearance of small molecules and biomacromolecules after injection into the synovial cavity. Coupling of pharmacologic agents with drug delivery systems able to enhance their residence time and cartilage penetration can enhance the effectiveness of intra-articularly injected anti-OA medications. Herein we describe an efficient intra-articular delivery nanosystem based on single-walled carbon nanotubes (SWCNTs) modified with polyethylene glycol (PEG) chains (PEG-SWCNTs). We show that PEG-SWCNTs are capable to persist in the joint cavity for a prolonged time, enter the cartilage matrix, and deliver gene inhibitors into chondrocytes of both healthy and OA mice. PEG-SWCNT nanoparticles did not elicit systemic or local side effects. Our data suggest that PEG-SWCNTs represent a biocompatible and effective nanocarrier for intra-articular delivery of agents to chondrocytes.

  3. Intraarticular lesions in calcifying tendinitis: incidence and association with the acromion index.

    Science.gov (United States)

    Kappe, Thomas; Cakir, Balkan; Lippacher, Sabine; Reichel, Heiko; Elsharkawi, Mohammed

    2011-03-01

    Intraarticular pathologies are a common finding during arthroscopy for rotator cuff lesions. Both rotator cuff tears as well as cartilage lesions have been described as correlating with the acromion index. In the current study, we aimed to determine the incidence of intraarticular lesions in calcifying tendinitis, to compare the incidence in patients with partial- and full-thickness tears of the rotator cuff, and to determine the acromion index in these groups. The incidence and type of accompanying intraarticular lesions were compared between three consecutive, age-matched groups of 64 patients each: those with calcifying tendinitis (group A), and those with partial- (group B) and full-thickness rotator cuff tears (group C). Also, the acromion index was measured from plain radiographs and compared between the groups. The incidence of intraarticular pathology was 43% in group A, 41% in group B and 84% in group C. The differences between groups A and C as well as B and C were significant (p tendinitis are comparable to age-matched shoulders with partial- rather than full-thickness rotator cuff tears. The acromion index is not different between shoulders with calcifying tendinitis, and partial- or full-thickness rotator cuff tears.

  4. Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis.

    Science.gov (United States)

    Nordemar, D; Öberg, J; Brosjö, O; Skorpil, M

    2015-01-01

    Purpose. To determine the incidence of intra-articular synovial sarcomas and investigate if any radiological variables can differentiate them from localized (unifocal) pigmented villonodular synovitis (PVNS) and if multivariate data analysis could be used as a complementary clinical tool. Methods. Magnetic resonance images and radiographs of 7 cases of intra-articular synovial sarcomas and 14 cases of localized PVNS were blindedly reviewed. Variables analyzed were size, extra-articular growth, tumor border, blooming, calcification, contrast media enhancement, effusion, bowl of grapes sign, triple signal intensity sign, synovial low signal intensity, synovitis, age, and gender. Univariate and multivariate data analysis, the method of partial least squares-discriminant analysis (PLS-DA), were used. Register data on all synovial sarcomas were extracted for comparison. Results. The incidence of intra-articular synovial sarcomas was 3%. PLS-DA showed that age, effusion, size, and gender were the most important factors for discrimination between sarcomas and localized PVNS. No sarcomas were misclassified as PVNS with PLS-DA, while some PVNS were misclassified as sarcomas. Conclusions. The most important variables in differentiating intra-articular sarcomas from localized PVNS were age, effusion, size, and gender. Multivariate data analysis can be helpful as additive information to avoid a biopsy, if the tumor is classified as most likely being PVNS.

  5. Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

    Directory of Open Access Journals (Sweden)

    D. Nordemar

    2015-01-01

    Full Text Available Purpose. To determine the incidence of intra-articular synovial sarcomas and investigate if any radiological variables can differentiate them from localized (unifocal pigmented villonodular synovitis (PVNS and if multivariate data analysis could be used as a complementary clinical tool. Methods. Magnetic resonance images and radiographs of 7 cases of intra-articular synovial sarcomas and 14 cases of localized PVNS were blindedly reviewed. Variables analyzed were size, extra-articular growth, tumor border, blooming, calcification, contrast media enhancement, effusion, bowl of grapes sign, triple signal intensity sign, synovial low signal intensity, synovitis, age, and gender. Univariate and multivariate data analysis, the method of partial least squares-discriminant analysis (PLS-DA, were used. Register data on all synovial sarcomas were extracted for comparison. Results. The incidence of intra-articular synovial sarcomas was 3%. PLS-DA showed that age, effusion, size, and gender were the most important factors for discrimination between sarcomas and localized PVNS. No sarcomas were misclassified as PVNS with PLS-DA, while some PVNS were misclassified as sarcomas. Conclusions. The most important variables in differentiating intra-articular sarcomas from localized PVNS were age, effusion, size, and gender. Multivariate data analysis can be helpful as additive information to avoid a biopsy, if the tumor is classified as most likely being PVNS.

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

    Science.gov (United States)

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

    2013-01-01

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

  7. OUTCOME OF LOCKING PLATES IN DISTAL TIBIA FRACTURES TREATMENT

    Directory of Open Access Journals (Sweden)

    Lokesh

    2016-05-01

    Full Text Available INTRODUCTION Most of these fractures except intra-articular fractures are treated with interlocking nail. 1,2 These nails are a boon for these fractures. But as the fracture nears to the joint stability the fracture fixation will be compromised due to malreduction and alignment, it leads to increased chances of delayed and nonunion. 3 Locking anatomical plates are evaluated for anatomical and relative stability fixation. Since then most intra and near intra-articular fractures are fixed with these plates with minimally invasive percutaneous plate osteosynthesis method, these plates have given excellent result 4 . But again these plates have some disadvantages 5 . This study is done to see the outcome of locking plates in distal tibia fracture. METHODS This study is done in the Department of Orthopaedics, Bangalore Medical College, Bangalore. This study is done from 2013 to 2015. 30 patients who came to outpatient department were treated with locking plates. All patients above 16 years having distal third tibia fracture are included. All open fractures except type 1 and elderly above 60 years and pathological fractures are excluded in our study. All patients were followed up for initial 5 months, thereafter, once in 3 months, for clinical and radiological evaluation of union status, knee range of motion, ankle range of motion and other complications. Assessment of the patient with functional recovery was done with American Orthopaedic Foot and Ankle Surgery(AOFAS 6 minimum 5 months after injury. RESULTS Majority of the patients are from age group 18-29 years (50%. Average age group was 30 years. Majority of the patients were males 80.6% (25. All fractures were closed fractures except 2 cases which are type 1. There were 12 cases of AO type A, 8 patients were AO type B and 10 patients were type C. Majority of the patients had fracture due to road traffic accidents, 74%. All fractures were united by the end of 20 weeks. There was delayed union in

  8. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures.

    Science.gov (United States)

    Boretto, J G; Pacher, N; Giunta, D; Gallucci, G L; Alfie, V; De Carli, P

    2014-09-01

    The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.

  9. Combined Isolated Laugier's Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Science.gov (United States)

    Osman, Walid; Alaya, Zeineb; Naouar, Nader; Ben Ayeche, Mohamed

    2016-01-01

    Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes. PMID:28070435

  10. Combined Isolated Laugier’s Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Directory of Open Access Journals (Sweden)

    Walid Osman

    2016-01-01

    Full Text Available Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

  11. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

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

  12. Fracture mechanics

    Science.gov (United States)

    Shannon, John L., Jr.

    1986-01-01

    The application of fracture mechanics to the design of ceramic structures will require the precise measurement of crack growth and fracture resistance of these materials over their entire range of anticipated service temperatures and standardized test methods for making such measurements. The development of a standard test for measuring the plane strain fracture toughness is sought. Stress intensity factor coefficients were determined for three varieties of chevron-notch specimens, and fracture toughness measurements were made on silicon nitrides, silicon carbides, and aluminum oxides to assess the performance of each specimen variety. It was determined that silicon nitride and silicon carbides have flat crack growth resistance curves, but aluminum oxide does not. Additionally, batch-to-batch differences were noticed for the aluminum oxide. Experiments are continuing to explain the rising crack growth resistance and batch-to-batch variations for the aluminum oxide.

  13. A Sandwich Method Using Kapandji Intrafocal Pinning to Facilitate Palmar Plating of Displaced Distal Radius Fractures.

    Science.gov (United States)

    Huang, Hui-Kuang; Huang, Yi-Chao; Wang, Jung-Pan; Chang, Ming-Chau

    2017-09-01

    The use of palmar plating in the treatment of dorsally displaced distal radius fracture is very common, and can result in a good functional outcome. We present an easy "sandwich method" to reduce the fracture and to facilitate osteosynthesis. Firstly, the dorsal Kapandji intrafocal wire was applied to achieve the reduction of the dorsally displaced fracture and provide a volar-directed force. Then the intra-articular fractures were reduced or the metaphyseal defect is stuffed with bone graft if necessary. Finally, the anatomical plate is used to buttress and push back the distal fragment to complete the osteosynthesis. The postoperative radiographic parameters, comparing with the contralateral noninjured side, could achieve similar radial height, radial inclination, volar tilt, and ulnar variance without significant difference.

  14. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

    Science.gov (United States)

    Gamulin, Axel; Lübbeke, Anne; Belinga, Patrick; Hoffmeyer, Pierre; Perneger, Thomas V; Zingg, Matthieu; Cunningham, Gregory

    2017-07-18

    The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

  15. [Relation between calcaneal bone mass and lifestyles in young adult women. Influence of experience of delivery and months post delivery].

    Science.gov (United States)

    Koitaya, N; Ishikawa, K; Oota, T; Yoshimoto, K; Tanaka, S; Ezawa, I

    1999-11-01

    The aim of this study was to clarify the cross-sectional relation between calcaneal bone mass and lifestyles in healthy pre-menopausal young adult women classified by the experience of pregnancy and the months after delivery. The 457 healthy Japanese women aged 20-39 years living in an urban community underwent a health check up for osteoporosis. Calcaneal bone was measured by ultrasound using the Lunar Achilles, and stiffness was used as an index of bone mass. The information on pregnancy, delivery and lactation, and lifestyles including past and current exercise and frequency of food consumption were collected by a questionnaire. In addition, two-day dietary records were obtained to assess the nutrient intake, and seven-day walking records as an index of physical activities. These subjects were divided into 3 groups according to the experience of pregnancy, and the time after delivery (subgroups of no experience of pregnancy, 12-35 months post-delivery and 36 months or more post-delivery), and the relation between stiffness index and lifestyle factors was examined in the 3 groups. 1) Stiffness correlated significantly with experience of pregnancy, age at menarche, current exercise and frequency of intake of dairy products. 2) In the group without experience of pregnancy, stiffness in women with current exercise habit was significantly higher than women without the habit. Those with past exercise habit, current milk consumption and current calcium intake showed relatively greater stiffness. 3) In the 12-35 months post-delivery group, there was no relation of past and current physical activity to stiffness. For women whose frequency of milk consumption or daily calcium intake were high, the stiffness was significantly greater. In addition, past milk consumption and current frequency of dairy products consumption tended to show higher stiffness. 4) In 36 months or more post-delivery group, women with current exercise habit exhibited significantly higher stiffness

  16. A rare case of bicondylar Hoffa fracture associated with ipsilateral tibial spine avulsion and extensor mechanism disruption

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Aditya Krishna Mootha; Vibhu Krishnan; Vishal Kumar; Saurabh Rawall

    2011-01-01

    Intra-articular coronal fractures (Hoffas fractures) of distal femur are rare. Although bicondylar involvement in these fractures has been reported in the literature in association with high velocity traumata, the occurrence of these fractures involving extensor mechanism rupture and avulsion of ipsilateral tibial spine is extremely rare. To our acquaintance, such a fracture pattern has not yet been reported in the literature so far. In this article, we report one such case and discuss the importance of early diagnosis and prompt internal fixation in the management of such cases. We believe that these rare combinations of injuries should be treated aggressively by early open reduction and anatomic rigid internal fixation in order toachieve good recovery of function.

  17. CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Walter W. Virkus

    2008-12-01

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

  18. The effect of intra-articular hyaluronate and tramadol injection on patients with adhesive capsulitis of the shoulder.

    Science.gov (United States)

    Kim, Kyung-Hee; Suh, Jung-Woo; Oh, Ki Young

    2017-08-03

    Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis. To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone. Thirty patients with adhesive capsulitis of the shoulder were randomized to the hyaluronate group (n= 16) or the tramadol group (n= 14). Hyaluronate group members were administered five weekly intra-articular hyaluronate injections; tramadol group members were administered three weekly intra-articular hyaluronate and tramadol injections and then two weekly intra-articular injections of hyaluronate. Visual Analog Scale (VAS), passive range of motion (PROM) of the shoulder joint, and Shoulder Pain and Disability Index (SPADI) scores were assessed at baseline and weeks 1, 2, 3, 4, and 6 after the initial injection. A significant improvement was observed in VAS, PROM, and SPADI scores between time points in both groups. In comparison in both groups at weeks 1 and 2 after the initial injection the VAS scores of the tramadol group were significantly lower than those of the hyaluronate group. Intra-articular hyaluronate with tramadol showed more rapid and strong analgesic effects than intra-articular hyaluronate alone and did not induce any adverse effects.

  19. Comparing the Efficacy of Intra-Articular Application of Morphine and Tramadol on Postoperative Pain After Arthroscopic Knee Surgery

    OpenAIRE

    Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza

    2012-01-01

    Background: Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. Objectives: The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery. Patients and Methods: For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg ...

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

    Directory of Open Access Journals (Sweden)

    Deepak Thapa

    2014-01-01

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

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

    Science.gov (United States)

    Thapa, Deepak; Ahuja, Vanita

    2014-03-01

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

  2. Comparison of intra-articular drilling and diode laser treatment for arthrodesis of the distal tarsal joints in normal horses.

    Science.gov (United States)

    Scruton, C; Baxter, G M; Cross, M W; Frisbie, D D

    2005-01-01

    Anecdotal reports suggest that laser-facilitated arthrodesis of the distal tarsal joints improves the prognosis compared with intra-articular drilling but no objective comparisons have been performed. To evaluate intra-articular drilling and laser-facilitated arthrodesis using in situ and in vivo techniques. Fourteen cadaver limbs were evaluated in situ for chondrocyte viability after both surgical techniques. In vivo, one randomly selected limb was subjected to laser-facilitated arthrodesis and the other underwent intra-articular drilling in 6 normal horses. Clinical examinations were performed at 1, 3 and 5 months. Two horses were subjected to euthanasia at 1, 3 and 5 months. Significantly more chondrocyte death was observed with laser-facilitated arthrodesis compared to drilling, but the overall degree suggested only a focal effect. In vivo, both groups demonstrated minimal post operative morbidity. There was more evidence of arthrodesis seen at all time points with intra-articular drilling. This study demonstrated that changes associated with ultimate arthrodesis occur earlier after intra-articular drilling of the distal tarsal joints than laser-facilitated arthrodesis, although clinically affected horses may respond differently. Intra-articular drilling may provide earlier arthrodesis of the distal tarsal joints, but not necessarily a better long-term result.

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

    Directory of Open Access Journals (Sweden)

    Sendeht Ayuba J

    2008-05-01

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

  4. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  5. Concomitant physeal fractures of the distal femur and proximal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  6. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M

    2011-02-01

    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  7. Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie

    2016-01-01

    participants with clinical and radiographic knee OA that were randomized to one intra-articular injection on the knee with either 1 ml of 40 mg/ml methylprednisolone (corticosteroid) dissolved in 4 ml lidocaine (10 mg/ml) or 1 ml isotonic saline (placebo) mixed with 4 ml lidocaine (10 mg/ml). Two weeks after....... The mean group difference in changes from baseline at week 14 was 0.6 kPa (95% CI: -1.7 to 2.8; P = 0.626) for PPT and 384 mm×sec (95% CI: -2980 to 3750; P = 0.821) for TS. CONCLUSIONS: These results suggest that adding intra-articular corticosteroid injection 2 weeks prior to an exercise program does...

  8. Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

    Directory of Open Access Journals (Sweden)

    Jake Sloane

    2010-01-01

    Full Text Available A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL, extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

  9. External fixation combined with limited internal fixation in the treatment of pilon tibia fractures

    Directory of Open Access Journals (Sweden)

    Golubović Zoran

    2007-01-01

    Full Text Available Background/Aim. Intraarticular fractures of the tibial plafond (pilon fractures belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. Methods. The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Niš (1995-2004. Within the analyzed group there were 33 (70.2% males and 14 (29.8% females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitković" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. Conclusion. Considering the results obtained in this study, it can be concluded that external fixation by the "Mitković" external fixator with the minimal internal fixation is a satisfactory method for the treatment of fractures of the tibial plafond causing less complications than internal fixation. .

  10. Intra-Articular Lubricin Gene Therapy for Post-Traumatic Arthritis

    Science.gov (United States)

    2016-09-01

    C (LubC) in adeno-associated virus (AAV) vectors and retroviral vectors and have begun to assess intra-articular PRG4 gene therapy as a means to...mitigate OA in ACL-deficient joints in the rabbit. 2. KEYWORDS: ACL replacement, post-traumatic OA, PRG4, lubricin, gene therapy, adeno-associated virus ...was completed. Histologic processing of tissues was completed. Results will be gathered and analyzed for statistical significance and write -ups begun

  11. Intra-articular membranous interposition detected by MRI in developmental dysplasia of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, W.; Itoi, Eiji; Sato, Kozo [Akita Univ. (Japan). Dept. of Orthopedic Surgery

    2000-12-01

    Intra-articular membranous interposition was detected by MRI in the hip joint with residual subluxation of a girl aged 5 years 10 months. This structure, which had low signal intensity on both T1- and T2-weighted images, separated the femoral head from the acetabulum. Histological examination revealed chondrometaplasia, which suggested that this interposition might be transformed to a surface cartilaginous tissue of the secondary acetabulum often observed in residual subluxation of the hip. (orig.)

  12. Iatrogenic Cushing syndrome after intra-articular triamcinolone in a patient receiving ritonavir-boosted darunavir.

    Science.gov (United States)

    Hall, Jill J; Hughes, Christine A; Foisy, Michelle M; Houston, Stan; Shafran, Stephen

    2013-09-01

    Drug interactions involving human immunodeficiency virus protease inhibitors are common due to their inhibition of the cytochrome P450 3A4 isoenzyme. We describe the case of an HIV-infected patient treated with ritonavir-boosted darunavir who developed cushingoid features following an intra-articular injection of triamcinolone acetate. We review the probable mechanism for this interaction and describe similar cases of Cushing syndrome in patients receiving concomitant ritonavir and triamcinolone.

  13. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, L Ø; Husted, H; Kristensen, B B

    2010-01-01

    -articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. Analgesic efficacy was assessed for 3 h after each injection, using a visual analogue score, where 0 = no pain and 100 = worst pain. There was no statistically significant difference between groups. Maximum pain relief...... anaesthetic has similar analgesic efficacy to intra-articular after total knee arthroplasty....

  14. Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction

    OpenAIRE

    Escoda Francolí, Jaume; Vázquez Delgado, Eduardo; Gay Escoda, Cosme

    2010-01-01

    Hyaluronic acid (HA) is found in high concentrations in cartilage and synovial fluid, and is an important component of the extracellular matrixes- exerting joint lubrication and buffering actions thanks to its viscoelastic properties. The present study examines the scientific evidence found in the current literature on the usefulness of the intraarticular injection of HA in patients with temporomandibular dysfunction. A literature search was made up until May 2008 in the following databases: ...

  15. Hand Fractures

    Science.gov (United States)

    ... Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is ... serve as a framework. This framework supports the muscles that make the wrist ... When one of these hand bones is broken (fractured), it can prevent you ...

  16. Fracture source

    Directory of Open Access Journals (Sweden)

    2003-07-01

    Full Text Available The fracture properties of many different types of fibers are covered in a timely new book that will prove to be a tremendous source of information and references for researchers in the wide and diverse field of fibers and composites, says Bill Clegg.

  17. Rib Fractures

    Science.gov (United States)

    ... Commentary Recent News Scientists Working on Solar-Powered Prosthetic Limbs Exercise a Great Prescription to Help Older Hearts Bavencio Approved for Rare Skin Cancer Older Mothers May Raise Better-Behaved Kids, Study ... or a collapsed lung (pneumothorax—see Traumatic Pneumothorax ). An injury that fractures the lower ribs sometimes also damages the liver (see Liver ...

  18. [Thoracolumbar fractures].

    Science.gov (United States)

    Freslon, M; Bouaka, D; Coipeau, P; Defossez, G; Leclercq, N; Nebout, J; Marteau, E; Poilbout, N; Prebet, R

    2008-06-01

    Thoracolumbar fractures are frequent and the functional outcomes are sometimes severe. This multicentric study, including five medical centers, was performed to evaluate the long-term outcomes of the patients. One hundred and thirty six patients with thoracolumbar fracture (T11 to L2) was evaluated with a minimal follow-up of two years. Every one had a clinical exam with a score of Oswestry and an X-Ray study (before and after treatment and at revision). Most of them presented compression fractures, the most often at L1 level. On X-rays, a gain was noted on the vertebral kyphosis immediately after surgery, but there is a loss of correction over time whatever the treatment. The clinical outcomes for the patients were great, with an Oswestry average score of 6,4. A correlation was noted between this functional score and vertebral kyphosis. So, an anterior column strengthening (isolated or performed during the surgery) could improve these functional outcomes. Moreover, the Thoraco Lumbar Injury Severity Score (TLISS) seems to be a simple organigram to determine the most appropriate treatment of these fractures, with particular attention to the distraction mechanism or posterior ligamentous complex lesions. However, RMI before surgery is necessary to evaluate these lesions.

  19. Conservative treatment of temporomandibular joint osteoarthrosis: intra-articular injection of sodium hyaluronate.

    Science.gov (United States)

    Guarda-Nardini, L; Masiero, S; Marioni, G

    2005-10-01

    Promising short-term results in the treatment of temporomandibular joint osteoarthrosis with intra-articular injections of sodium hyaluronate (SH) have been reported in preliminary studies. The present prospective study compared long-term outcomes of temporomandibular joint SH injections with those of a conventional non-surgical treatment (bite-plane). Data from three groups of 20 patients with degenerative temporomandibular joint disease were considered. Group A underwent one cycle of five injections of 1 mL SH. Group B underwent a bite-plane treatment for at least 6 months. We considered a control group of 20 patients who refused any treatments. The description of the outcomes was based on objective and subjective parameters after a 6-month follow-up. Sodium hyaluronate and bite-plane treatments significantly improved patients conditions in all considered parameters. No significant differences in outcomes were confirmed by the statistical analysis. The tolerability of SH treatment resulted to be significantly higher. The analysis of results of serial controls in the SH treated group disclosed a significant worsening in pain at rest by comparing 1 and 6 months follow-up. Sodium hyaluronate infiltration resulted a valid non-surgical treatment for temporomandibular joint degenerative disease. Five well-tolerated intra-articular SH injections achieved equivalent results to those of a 6 months bite-plane treatment. We did not diagnose any complications of SH intra-articular injections. Longer time follow-up is necessary to determine the stability of SH properties.

  20. Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Harel Liora

    2008-01-01

    Full Text Available Abstract Background Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO, a volatile gas with analgesic, anxiolytic and sedative properties. Objective To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment. Methods NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS (0–10 for pain, and a 5-point satisfaction scale. Change in heart rate (HR during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded. Results 54 procedures (72 joints were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 ± 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased ≥ 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild. Conclusion NO provides effective and safe sedation for JIA children undergoing intra-articular injections.

  1. Measurement of three-dimensional intra-articular kinematics: methodological and interpretation problems.

    Science.gov (United States)

    Baeyens, J-P; Cattrysse, E; Van Roy, P; Clarys, J-P

    Intra-articular kinematics evaluates joint motion in terms of the configuration of the joint. Therefore data are needed concerning joint kinematics as well as joint configuration. We have developed accurate measurement methods for both in vivo and in vitro evaluation. Interpretation of the processed data is more complex than simply setting up a coordinate system based on the joint configuration. Although the description of intra-articular motion in terms of Euler-Cardan or helical angles may be complete, the therapeutic interpretation may be doubtful. Using the the ulno-humeral joint during flexion-extension as an example, we found the combination of helical angles in the directions of extension/external rotation/varus. In the case of the Cardan angles, inconsistent patterns of rotation resulted from a different choice of sequence order and were different from the helical angles. The finite helical axis (FHA) provides a functional representation of the joint movement, i.e. pathways of motion, whereas the sequence dependency of Euler-Cardan angles produces problems in the therapeutic interpretation of the movement. Therefore we believe that an FHA approach should be used in intra-articular kinematics research.

  2. Extreme Postinjection Flare in Response to Intra-Articular Triamcinolone Acetonide (Kenalog).

    Science.gov (United States)

    Young, Porter; Homlar, Kelly C

    2016-01-01

    As intra-articular corticosteroid injections (CSIs) are a common treatment for osteoarthritis, physicians must well understand their potential side effects. Postinjection flares are an acute side effect of intra-articular CSIs, with symptoms ranging from mild joint effusion to disabling pain. The present case involved a severe postinjection flare that occurred after the patient, a 56-year-old woman with moderate osteoarthritis in the left knee, received 2 mL of 1% lidocaine and 2 mL (40 mg) of triamcinolone acetonide (Kenalog). Two hours after injection, she experienced swelling and intense pain in the knee and was unable to ambulate. The knee was aspirated with a return of 25 mL of "butterscotch"-colored fluid. This case is novel in that its acuity of onset, severity of symptoms, and synovial fluid analysis mimicked septic arthritis, which was ultimately ruled out with negative cultures and confirmation of triamcinolone acetonide crystals in the synovial aspirate, viewed by polarized light microscopy. Thus, the patient's reaction represents an acute crystal-induced inflammatory response. Although reactions to an intra-articular CSI of this severity are rare, it is important for treating physicians to inform patients of this potential side effect.

  3. Intra-articular mepivacaine reduces interventional analgesia requirements during arthroscopic surgery in dogs.

    Science.gov (United States)

    Dutton, T A G; Gurney, M A; Bright, S R

    2014-08-01

    To document efficacy of intra-articular mepivacaine in dogs based on the hypothesis that this would blunt the haemodynamic response to a nociceptive stimulus (arthroscopic surgery), reducing interventional analgesia requirements. A dose of mepivacaine 2% 0 · 1 ml/kg (2 mg/kg) was injected intra-articularly into one randomly assigned elbow joint before surgery in eight dogs undergoing bilateral elbow arthroscopy. Baseline haemodynamic measurements were recorded immediately before the start of each arthroscopic procedure and repeated at arthrocentesis, saline distension of the joint, incision, arthroscopic cannula and obturator insertion and placement of the second portal and haemodynamic variability calculated. If baseline parameters increased by more than 20% suggesting nociception, 1 µg/kg fentanyl was administered intravenously. Significantly less fentanyl was required during arthroscopy on the mepivacaine treated elbows compared to the non-treated elbows (P = 0 · 003) and the time to first fentanyl administration was significantly longer (P = 0 · 0001) in the mepivacaine treated elbows (21 · 2 ± 4 · 9 minutes) compared to the non-treated elbows (6 · 1 ± 2 · 3 minutes). Haemodynamic variability was significantly reduced in the mepivacaine group (heart rate P = 0 · 04, mean arterial pressure P = 0 · 003). Intra-articular mepivacaine blunts the haemodynamic response to arthroscopic surgery in dogs and reduces interventional analgesia requirement. © 2014 British Small Animal Veterinary Association.

  4. Analgesic efficacy of intra-articular morphine after arthroscopic knee surgery in sport injury patients

    Directory of Open Access Journals (Sweden)

    Mitra Yari

    2013-07-01

    Full Text Available BACKGROUND: Anterior Cruciate Ligament (ACL tearing is a common injury among football players. The present study aims to determine the best single-dose of intra-articular morphine for pain relief after arthroscopic knee surgery that, in addition to adequate and long-term analgesia, leads to fewer systemic side effects. METHODS: This clinical trial was conducted on 40 ASA-I athletes. After surgery, all participants received an injection of 20cc of 0.5% intra-articular bupivacaine. In addition, the first control group received a saline injection and 5, 10 and 15 mg of morphine were respectively injected into the joints of the second, third and fourth groups by use of Arthroscopic equipment before the Arthroscopic removal. The amount of pain based on VAS at 1, 2, 4, 6 and 24 hours after surgery, duration of analgesia and the consumption of narcotic drugs were recorded. RESULTS: The VAS scores in the fourth, sixth and twenty-fourth hours after surgery showed a significant difference between the study groups. The average time to the first analgesic request from the bupivacaine plus 15 mg morphine group was significantly longer than other groups and total analgesic requests were significantly lower than other groups. No drowsiness complications were observed in any of the groups in the first 24 hours after injection. CONCLUSION: Application of 15 mg intra-articular morphine after Arthroscopic knee surgery increases the analgesia level as well as its duration (IRCT138902172946N3 .

  5. 经皮克氏针内固定结合术后康复训练治疗Bennett骨折对关节功能恢复的观察%Internal fixation with Kirschner pins in combination of postoperative trainig recovering joint function following Bennett fracture

    Institute of Scientific and Technical Information of China (English)

    查天文; 聂梅

    2002-01-01

    Background:Bennett fracture belongs to intraarticular injury.Conventionally,external fixation with splint or plaster failures to maintain postrepair position,leading to fracture and translocation.On the other hand,longer term outer fixation will result in joint stiffness.Internal fixation with Kirschner pins in combination of postoperative training was characterized by stable fixation,less injury,allow early functional exercise and is beneficial to recovery of joint function.

  6. Monteggia fracture dislocation equivalents - analysis of eighteen cases treated by open reduction and internal fixation

    Directory of Open Access Journals (Sweden)

    Singh Ajay Pal

    2012-02-01

    Full Text Available 【Abstract】 Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008 was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II & III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia

  7. Intra-articular temperatures of the knee in sports – An in-vivo study of jogging and alpine skiing

    Directory of Open Access Journals (Sweden)

    Cerulli Guiliano

    2008-04-01

    Full Text Available Abstract Background Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. Methods In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19°C room temperature and skiing in a ski resort at -3°C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Results Median intra-articular temperatures increased from 31.4°C before activity by 2.1°C, 4°C, 5.8°C and 6.1°C after 15, 30, 45 and 60 min of jogging (all p ≤ 0.05. Median intra-articular temperatures dropped from 32.2°C before activity by 0.5°C, 1.9°C, 3.6°C and 1.1°C after 15, 30, 45 and 60 min of skiing (all n.s.. After 60 minutes of skiing (jogging, the median intra-articular temperature was 19.6% (8.7% higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. Conclusion This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

  8. MRI features of three paediatric intra-articular synovial lesions: a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States)], E-mail: herman.kan@vanderbilt.edu; Hernanz-Schulman, M. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States); Damon, B.M.; Yu, Chang [Vanderbilt University, Nashville, TN (United States); Connolly, S.A. [Boston Children' s Hospital, Boston, IL (United States)

    2008-07-15

    Aim: To determine reliable magnetic resonance imaging (MRI) features differentiating three paediatric intra-articular congenital or neoplastic synovial lesions that contain blood products, from post-traumatic or haemorrhagic inflammatory processes. Materials and methods: This was a retrospective review of MRI findings of 22 paediatric intra-articular congenital or neoplastic synovial lesions, including venous malformation (VM) (n = 12), pigmented villonodular synovitis (PVNS; n = 8), and synovial sarcoma (SS; n = 2). These MRI features were compared with 22 paediatric post-traumatic or inflammatory intra-articular processes containing blood products and producing mass effect. The following imaging features were assessed: presence of a discrete mass, extension, extra-articular oedema, susceptibility, joint effusion, and size. Fisher's exact test was used and results were considered statistically significant when p < 0.05. Results: The three intra-articular synovial lesions, compared with controls, were more likely to directly invade osseous structures when a discrete mass was present (13/16, 81.3% versus 1/9, 11.1%; p < 0.002) and extend into extra-articular soft tissues (13/21, 61.9% versus 2/17, 11.8%; p < 0.003), but were less likely to show extra-articular oedema (3/22, 13.6% versus 13/22, 59.1%; p < 0.004), a joint effusion (10/22,45.5% versus 19/22, 86.4%, p < 0.01), susceptibility within a joint effusion (0/22, 0% versus 11/22, 40.9%; p = 0.00), osseous oedema (3/16, 18.8% versus 7/9, 77.8%; p < 0.009), and synovial enhancement (8/21, 38.1% versus 14/16, 87.5%; p < 0.003). VMs had characteristic tubular vessels with internal fluid-fluid levels (11/12) that extended into bone (10/12) and extracapsular soft tissues (11/12). Conclusion: Our study indicates that, despite the overlapping presence of haemorrhagic products, intra-articular VM, PVNS, and SS show MRI features that permit distinction from acquired post-traumatic and haemorrhagic inflammatory

  9. Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization.

    Science.gov (United States)

    Weil, Wayne M; Trumble, Thomas E

    2005-08-01

    The technique of intrafocal pinning was originally described by Kapandji. This technique, along with the addition of supplemental external or internal bridging fixation, can be performed quickly with minimal soft tissue damage. This technique is indicated for the treatment of unstable extra-articular or minimally displaced intra-articular fractures of the distal radius. Studies demonstrate that young patients with displaced extra-articular distal radius fractures and minimal comminution can be treated by percutaneous intrafocal pin fixation alone, whereas, patients over 55 years of age and younger patients with comminution involving two or more surfaces of the radial metaphysis (or > 50% of the metaphyseal diameter) require bridging fixation besides percutaneous pin fixation. The use of this technique achieves the goal of surgical treatment of distal radius fractures: restoration of hand and wrist function through the restoration of alignment and articular surface congruity.

  10. Fractures of the knee in children-what can go wrong?

    DEFF Research Database (Denmark)

    Leeberg, Veronica; Sonne-Holm, S; Krogh Christoffersen, J;

    2015-01-01

    treatment, and insufficient surgery or complications relating to surgery. Eight of the complaints were acknowledged, with six receiving financial compensation ranging from EUR 9,600 to EUR 70,000. Five out of the six cases of missed diagnosis were acknowledged. CONCLUSIONS: This study indicates......INTRODUCTION: Intra-articular knee fractures in children are rare. The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the health care system. We used relevant cases of closed claims...... was missed diagnosis (6 cases)-fractures of the tibial eminence were the main culprit, with damage to the popliteal artery caused by a medial condyle fracture being the most serious. All cases were missed by junior doctors. Secondary complaints were problems with casting, dissatisfaction with correct...

  11. Progresses in the treatment of coronal shear fractures of the capitellum%肱骨小头冠状面骨折治疗进展

    Institute of Scientific and Technical Information of China (English)

    姜刚强; 李海峰; 阮狄克

    2013-01-01

    Coronal shear fractures of the capitellum are uncommon elbow fractures, and the major injury mechanism is that axial extrusion forces from the radius were transmitted to the capitellum. Computerized tomography ( CT ) examination plays an important role in preoperative assessment of fractures and surgical plan-making. Dubberley classiifcation is usually used to direct the surgical treatment of fractures and judge the healing. Most of such fractures belong to intra-articular fractures, so the effects of conservative treatment are not good, and the incidence of postoperative complications such as avascular necrosis and joint stiffness is higher. Open reduction and internal ifxation ( ORIF ) is considered to be an ideal plan in the treatment of coronal shear fractures of the capitellum. Posterior and lateral approaches are commonly used in the treatment of such fractures. But currently, the choice of internal ifxation screws remains controversial. The effects of resection of fracture fragments are satisfactory in the treatment of coronal shear fractures with trochlea of humerus not involved. Minimally invasive arthroscopic surgery provides a new train of thought for the treatment of fractures. Elbow arthroplasty and ORIF combined with external ifxator can be used in the treatment of special type fractures. Functional exercise in the early stage after the operation plays an important role for the elbow joint function recovery.

  12. Surgical treatment of proximal humerus fractures using PHILOS plate

    Directory of Open Access Journals (Sweden)

    Vijay Sharma

    2014-10-01

    Full Text Available 【Abstract】Objective: To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS plate for proximal humerus fractures. Methods: We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012. There were 35 men and 16 women with a mean age of 38 years (range 24-68. There were 41 patients in the age group of <60 years and 10 patients in the age group of >60 years. According to Neer classification system, 8, 15 and 23 patients had 2-part, 3-part, and 4-part fractures, respectively and 5 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma centre. Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score. Results: The mean follow-up period was 30 months (range 12-44 months. Two patients were lost to followup. Of the remaining 49 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 12 weeks (range 8-20 weeks. At the final follow-up the mean Constant-Murley score was 79 (range 50-100. The results were excellent in 25 patients, good in 13 patients, fair in 6 atients and poor in 5 patients. During the follow-up, four cases of varus malunion, one case of subacromial impingement, one case of deep infection, one case of intraarticular screw penetration and one case of failure of fi xation were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or nonunion were noted. Conclusion: PHILOS provides stable fixation in proximal humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary. Key words: Proximal humerus fracture; Fracture fixation, internal; Proximal humeral internal locking system

  13. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Selahattin Ozyurek

    2015-07-01

    Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

  14. Proximal humeral fractures: a biomechanical comparison of locking plate constructs in a cadaveric 3-part fracture model.

    Science.gov (United States)

    Rose, David M; Sutter, Edward G; Mears, Simon C; Gupta, Rohit R; Belkoff, Stephen M

    2010-11-01

    The purpose of our study was to biomechanically compare, under cyclic loading conditions, fracture site motion, humeral head collapse, and intra-articular hardware penetration in simulated 3-part osteoporotic proximal humeral fractures stabilized with 1 of 2 locking-plate constructs. We performed fixation on simulated 3-part proximal humeral fractures in 10 pairs of cadaveric osteoporotic humeri with a Hand Innovations S3 Proximal Humerus Plate (S3 plate) or an LCP Proximal Humerus Plate (LCP plate; 1 each for each pair). The specimens were potted, mounted on a materials testing machine, and subjected to 5000 cycles of abduction in the scapular plane, loading through the supraspinatus tendon. Interfragmentary displacement at 2 virtual points (the most medial aspect of the calcar and the most superior aspect of the osteotomy line between the greater tuberosity and humeral head) was measured using an optical tracking system. Humeral head rotation was also measured. We used a generalized linear latent and mixed model to check for an effect of cyclic loading and treatment on the parameters of interest (significance, P fracture site motion, it is unknown whether the magnitude of the motion is clinically significant.

  15. Identical fracture patterns in combat vehicle blast injuries due to improvised explosive devices; a case series

    Directory of Open Access Journals (Sweden)

    Commandeur Joris

    2012-10-01

    Full Text Available Abstract Background In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar. During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. Case presentation The described cases comprise paired thoracic vertebral fractures, radial neck fractures, calcaneal fractures and talar fractures. Moreover, the different types of blast injury are mentioned and related to the injuries described in our series. Acknowledging the different blast mechanisms is important for understanding possible injury patterns. Conclusion From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS.

  16. Comparison of 2 dosages of intraarticular triamcinolone for the treatment of knee arthritis: results of a 12-week randomized controlled clinical trial

    NARCIS (Netherlands)

    Popma, J.W.; Snel, Frank W.; Haagsma, Cees J.; Brummelhuis-Visser, Petra; Oldenhof, Hans G.J.; van der Palen, Jacobus Adrianus Maria; van de Laar, Mart A F J

    2015-01-01

    Objective. To determine whether a double dose of intraarticular triamcinolone acetonide is more effective for knee arthritis than a 40-mg dose. Methods. In this 12-week randomized controlled clinical trial, 40 mg and 80 mg of intraarticular triamcinolone acetonide were compared in patients with knee

  17. Ten Years' Follow-Up on Combined Palmar and Dorsal Internal Fixation of Complex Distal Radius Fractures.

    Science.gov (United States)

    Iselin, Lukas Daniel; Massy-Budmiger, Anne-Sophie; Droeser, Raoul A; Mett, Tobias R; Babst, Reto; Rikli, Daniel A

    2016-05-01

    Complex distal intra-articular radial fractures (AO Type C3) are rare, but are life-changing injuries. They are usually related to high-velocity trauma mechanisms in a working male population.We surveyed a cohort of these fractures treated in our institution to assess the functional long-term outcome.Twelve consecutive patients with comminuted intra-articular distal radial fractures were treated at our institution. Osteosynthesis was performed by a single senior surgeon with volar and dorsal extended approaches. The intermediate and final control included conventional X-ray, range of motion (ROM), grip strength, and the Disabilities of the Arm, Shoulder, and Hand index (DASH), as well as the Patient-rated Wrist Evaluation (PRWE) score for functional outcome at 1 and 10 years' of follow-up.At 10 years' follow-up, anatomic reconstruction with a step or gap of radius fractures and reveal good functional outcomes at intermediate and long-time follow-up.

  18. Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Beerekamp, M.S.H., E-mail: m.s.beerekamp@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Sulkers, George S.I., E-mail: georgesulkers@gmail.com [Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Ubbink, Dirk T., E-mail: D.Ubbink@amc.nl [Department of Quality and Process Innovation, Academic Medical Center, Amsterdam (Netherlands); Maas, Mario, E-mail: M.Maas@amc.nl [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Schep, Niels W.L., E-mail: N.W.Schep@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Goslings, J. Carel, E-mail: J.C.Goslings@amc.nl [Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands)

    2012-12-15

    Objectives: The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity fractures. Methods: A systematic literature search was performed in MEDLINE, EMBASE and the Cochrane library. In total 673 articles were identified (up to March 2012). The 19 included studies described patients/cadavers with intra-articular upper/lower extremity fractures and compared 3D-fluoroscopy to standard imaging. The study was performed in accordance with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines. Diagnostic accuracy was defined by the quality of fracture reduction or implant position and, if possible, expressed as sensitivity and specificity; subjective image quality was determined by the quality of depiction of bone or implants; clinical consequences were defined as corrections in reduction or implant position following 3D-fluoroscopy. Results: Ten cadaver- and nine clinical studies were included. A meta-analysis was not possible, because studies used different scoring protocols to express diagnostic accuracy and reported incomplete data. Based on the individual studies, diagnostic accuracy of 3D-fluoroscopy was better than 2D-fluoroscopy and X-ray, but similar to CT-scanning. Subjective image quality of 3D-fluoroscopy was inferior compared to all other imaging modalities. In 11–40% of the operations additional corrections were performed after 3D-fluoroscopy, while the necessity for these corrections were not recognized based on 2D-fluoroscopic images. Conclusions: Although subjective image quality is rated inferior compared to other imaging modalities, intra-operative use of 3D-fluoroscopy is a helpful diagnostic tool for improving the quality of reduction and implant position in intra-articular fractures.

  19. Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions; Acuracia da ressonancia magnetica para identificar lesoes traumaticas intra-articulares do joelho

    Energy Technology Data Exchange (ETDEWEB)

    Vaz, Carlos Eduardo Sanches; Camargo, Olavo Pires de; Santana, Paulo Jose de; Valezi, Antonio Carlos [Universidade Estadual de Londrina, PR (Brazil). Hospital Regional do Parana. Dept. de Ortopedia e Traumatologia]. Email: carvaz@uol.com.br

    2005-12-15

    Purpose: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. Method: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). Results: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. Conclusion: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly

  20. Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

    DEFF Research Database (Denmark)

    Andersen, L.O.; Kristensen, B.B.; Husted, H.;

    2008-01-01

    BACKGROUND: High-volume local infiltration analgesia with additional intraarticular and wound administration of local anesthetic has been shown to be effective after knee replacement, but the optimum site of administration of the local anesthetic (i.e. intraarticular or extraarticular) has not been...... or to receive 20 mL ropivacaine (0.2%) intraarticularly plus 30 mL ropivacaine (0.2%) in the extraarticular wound space 24 hours postoperatively. Pain intensity at rest and with mobilization was recorded for 4 hours after administration of additional local anesthetics. RESULTS: Intensity of pain at rest, during...... flexion, or straight leg lift was not statistically significantly different between the two groups, but there was a tendency of improved analgesia with administration of additional local anesthetic in the extraarticular wound space. INTERPRETATION: The optimal site of administration of local anesthetic...

  1. Intra-articular synovial sarcoma treated with a transfemoral amputation: a case report and review of the literature.

    Science.gov (United States)

    Gresswell, Steven D; Corsini, Anthony A; Balsamo, Luke H; Miles, Edward F

    2013-08-01

    A case of monophasic intra-articular synovial sarcoma in the right knee of a 39-year-old active duty serviceman treated with a transfemoral amputation is presented. The patient was evaluated for right knee pain and fullness. After further workup, the patient underwent computed tomography guided biopsy, with the tissue specimen consistent with intra-articular synovial sarcoma. The patient elected for a transfemoral amputation rather than limb or joint-sparing surgery. The gross specimen measured 3.5 × 3.0 × 1.7 cm in the posteromedial knee. No metastatic lesions were seen on positron emission tomography-computed tomography. Chemotherapy and radiation therapy have not been utilized. The transfemoral amputation adds to the uniqueness of this report and is discussed with a review of the multimodality treatment toward intra-articular synovial sarcoma in prior published literature.

  2. Growth Plate Fractures

    Science.gov (United States)

    ... the most widely used by doctors is the Salter-Harris system, described below. Type I Fractures These ... incidence of growth plate fractures peaks in adolescence. Salter-Harris classification of growth plate fractures. AAOS does ...

  3. FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF CLOSED TIBIAL CONDYLAR FRACTURES IN ADULTS

    Directory of Open Access Journals (Sweden)

    Ravish

    2014-02-01

    Full Text Available BACKGROUND AND OBJECTIVE: Tibial plateau fractures are one of the commonest intra-articular fractures. It results from indirect coronal or direct axial compressive forces. It comprises of 1% of all fractures. These fractures encompass many and varied fracture configurations that involve medial, lateral or both plateaus with many degrees of articular depressions and displacements. Being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. METHODS: 30 cases of tibial plateau fractures treated by various modalities were studied from September 2009 to september 2011 at Kempegoda Institute of Medical Sciences and followed for minimum of 6 months. RESULTS: The selected patients evaluated thoroughly clinically and radiologically, after the relevant lab investigations, were taken for surgery. The indicated fractures treated as per the SCHATZKER’S types, accordingly with CRIF with percutaneous cannulated cancellous screws, MIPPO with LCP/ Butress plate and screw, ORIF with buttress plate/ LCP and screw. Early range of motion started soon after the surgery. No weight bearing upto 6 weeks. The full weight bearing deferred until 12 weeks or complete fracture union. Immobilization in insecurely fixed fractures continued for 3-6 weeks by POP cast. The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory. Infection in two cases and stiffness in 2 cases were seen and there was no non-union in our cases. CONCLUSION: Surgical management of tibial condylar fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion, hence to achieve optimal knee function and reducing post-traumatic osteo arthritis

  4. Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine.

    Science.gov (United States)

    Alagol, A; Calpur, O U; Usar, P Saral; Turan, N; Pamukcu, Z

    2005-11-01

    We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

  5. Intraarticular Injection of Allogenic Mesenchymal Stem Cells has a Protective Role for the Osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    Xin Yang; Tian-Yue Zhu; Li-Cheng Wen; Yong-Ping Cao; Chao Liu; Yun-Peng Cui; Zhi-Chao Meng

    2015-01-01

    Background:Researchers initially proposed the substitution of apoptotic chondrocytes in the superficial cartilage by injecting mesenchymal stem cells (MSCs) intraarticularly.This effect was termed as bio-resurfacing.Little evidence supporting the treatment ofosteoarthritis (OA) by the delivery ofa MSC suspension exists.The aim of this study was to investigate the effects of injecting allogenic MSCs intraarticularly in a rat OA model and to evaluate the influence of immobility on the effects of this treatment.Methods:We established a rat knee OA model after 4 and 6 weeks and cultured primary bone marrow MSCs.A MSC suspension was injected into the articular space once per week for 3 weeks.A subgroup of knee joints was immobilized for 3 days after each injection,while the remaining joints were nonimmobilized.We used toluidine blue staining,Mankin scores,and TdT-mediated dUTP-biotin nick end labeling staining to evaluate the therapeutic effect of the injections.Comparisons between the therapy side and the control side of the knee joint were made using paired t-test,and comparisons between the immobilized and nonimmobilized subgroups were made using the unpaired t-test.A P value < 0.05 was considered significant.Results:The three investigative approaches revealed less degeneration on the therapy sides of the knee joints than the control sides in both the 4-and 6-week groups (P < 0.05),regardless of immobilization.No significant differences were observed between the immobilized and nonimmobilized subgroups (P > 0.05).Conclusions:Therapy involving the intraarticular injection of allogenic MSCs promoted cartilage repair in a rat arthritis model,and 3-day immobility after injection had little effect on this therapy.

  6. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Deshmukh, Ajit J.; Rodriguez, Jose A. [North Shore LIJ Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY (United States); Panagopoulos, Georgia [North Shore LIJ Lenox Hill Hospital, Department of Research, New York, NY (United States); Alizadeh, Ahmadreza; Klein, Devon A. [North Shore LIJ Lenox Hill Hospital, Department of Radiology, New York, NY (United States)

    2011-11-15

    Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren-Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p < 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty. (orig.)

  7. 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.

  8. 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

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

    Science.gov (United States)

    Ginot, Samuel; 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.

  10. Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series.

    Science.gov (United States)

    Schwartz, Jaclyn M; Kihm, Carl A; Camasta, Craig A

    2015-01-01

    Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients. The tight, press-fit nature of the tricortical iliac crest allograft provides stability and can negate the need for internal fixation. We retrospectively reviewed 9 pediatric subtalar joint distraction arthrodesis procedures performed on 8 patients during a 6-year period. All patients began weightbearing at 6 weeks after surgery. All patients had osseous union, and no complications developed that required a second surgery. The clinical outcomes, assessed at a mean of 25.5 (range, 6.3 to 75.8) months postoperatively, were satisfactory. The mean American Orthopaedic Foot and Ankle Society score was 90.1 (range, 79 to 94), on a 94-point scale. The wedged distraction arthrodesis technique has not been previously described for correction of pediatric patients with lateral tarsal wedging, but it is an effective option and yields successful outcomes. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. THEORETICAL AND EXPERIMENTAL STUDY ON DURABILITY OF THE CALCANEAL TENDON AND THE PATHOMECHANISM OF ITS ATRAUMATIC, SUBCUTANEOUS BREAK

    Directory of Open Access Journals (Sweden)

    K. Skiba

    2011-11-01

    Full Text Available The pathology of the calcaneal tendon (Achilles presents a serious medical and social problem. This tendon is the strongest plantar flexor of the foot that plays a fundamental role in the accomplishment of human gait. Although this role has long been recognized, neither in medical nor in biomechanical literature can one find a clear description of subcutaneous break of the Achilles tendon. Its pathomechanism and the causes have not been fully accounted for. Many authors concentrate mainly on medical and biological aspects of the damage of the Achilles tendon.They often claim that the vasculature of the tendon itself plays a significant role in the pathogenesis, because the blood supply to the tendon changes with human age, decreasing substantially after the age of 30, leading both to regressive changes in the tendon as well as to a reduction of the tendon’s mechanical strength. The refore a comprehensive description and explanation of this phenomenon needs an interdisciplinary approach, taking into account not only the medical and biological aspects, but also the mechanics sensu largo. The aim of the paper is to put forward a complete description of the pathomechanism of the Achilles tendon spontaneous break, within the framework of its mechanics. The conclusions are based upon a kinematical analysis of the knee joint, a trajectory determination of the point of origin of the gastrocnemius from the initial position of 90 degrees bent up to the full knee extension, and an experimental examination of uniaxial stretching of the Achilles tendon.

  12. Hypersensitivity to mechanical and intra-articular electrical stimuli in persons with painful temporomandibular joints

    DEFF Research Database (Denmark)

    Ayesh, Emad; Jensen, Troels Staehelin; Svensson, P

    2007-01-01

    This study tested whether persons with TMJ arthralgia have a modality-specific and site-specific hypersensitivity to somatosensory stimuli assessed by quantitative sensory tests (QST). Forty-three healthy persons and 20 with TMJ arthralgia participated. The QST consisted of: sensory and pain...... detection thresholds and summation threshold to intra-articular electrical stimulation, tactile and pin-prick sensitivity in the TMJ area, pressure-pain threshold and tolerance on the lateral side of the TMJ and on the finger. Persons with TMJ arthralgia had lower pain detection and summation thresholds (P...

  13. Pre and Post Treatment Comparative Study of Meniscus Tears Treated with Intraarticular Steroid Injection

    OpenAIRE

    Janak A Rathod, Dhaval I Patel, Vikram Jasoliya

    2014-01-01

    Objective: To evaluate the safety and efficacy of long-term intraarticular (IA) steroid injections for knee pain related to meniscus tear. Methods: In this study 50 patients with meniscus tear of the knee re-ceived IA injections of triamcinolone acetonide 40 mg (50 patients) into the knee every 3 months for up to 2 years. The clinical efficacy measure of primary interest was the pain subscale from the Western Ontario and McMaster Universities OA Index (WOMAC). Efficacy measures of secondar...

  14. Intra-articular nodular fasciitis of the knee: a rare cause of recurrent hemarthrosis.

    Science.gov (United States)

    Matsuzaki, Tokio; Akisue, Toshihiro; Kishimoto, Kenta; Kishimoto, Shin-ichiro; Imabori, Masaya; Hara, Hitomi; Okada, Yoshiyuki; Hitora, Toshiaki; Kuroda, Ryosuke; Kurosaka, Masahiro; Yamamoto, Tetsuji

    2012-06-01

    A 20-year-old man presented with pain and recurrent hemarthrosis in the right knee. Magnetic resonance imaging of the knee showed a lesion with homogeneous low signal intensity on T1-weighted images and a heterogeneous, low to high signal intensity on T2-weighted images. At arthroscopy, the mass was located between the posterior cruciate ligament and the posterior knee joint capsule. The tumor was excised through a posterior approach and histologically diagnosed as a nodular fasciitis. Intra-articular nodular fasciitis is a very rare clinicopathologic entity. The current case showed the unique clinical feature of recurrent hemarthrosis at initial presentation, which has not been previously reported.

  15. Intraarticular hemorrhage due to bevacizumab in a patient with metastatic colorectal cancer: a case report

    Directory of Open Access Journals (Sweden)

    Uysal Mukremin

    2012-07-01

    Full Text Available Abstract Introduction Bevacizumab is a monoclonal antibody against vascular endothelial growth factor. It is widely used in the treatment of metastatic colorectal cancer. It has some specific side effects including severe bleeding, wound healing problems, gastrointestinal perforation, proteinuria and hypertension. Case presentation We present the case of a 65-year old Asian man with synovial metastasis of the knee who experienced intraarticular hemorrhage after bevacizumab treatment. He presented with monoarthritis of the left knee. Conclusion Bevacizumab-related hemorrhage can cause serious morbidity and unusual sites of hemorrhage may be seen.

  16. An intra-articular ganglion cyst in a patient with juvenile idiopathic arthritis.

    Science.gov (United States)

    Deng, Donna Y; Yee, Keolamau; Burkhalter, William; Okimoto, Kelley Chinen; Kon, Kevin; Kurahara, David K

    2014-01-01

    We report an intra-articular ganglion cyst (IAGC) presenting as knee pain and a mass in a patient with longstanding Juvenile Idiopathic Arthritis (JIA). We could not find a similar case of an IAGC occurring in the knee of JIA patients in the literature. IAGC may need to be included as a possibility in patients with inflammatory arthritis with new-onset knee pain, especially in those with a palpable mass. MRI was useful in distinguishing IAGC from more worrisome causes of a knee mass. Orthopedic input was helpful in diagnosis and treatment. In addition, methotrexate therapy was effective in bringing about a long-lasting remission.

  17. Fluoroscopy-Guided Sacroiliac Intraarticular Injection via the Middle Portion of the Joint.

    Science.gov (United States)

    Kurosawa, Daisuke; Murakami, Eiichi; Aizawa, Toshimi

    2016-12-30

    OBJECTIVE : Sacroiliac intraarticular injection is necessary to confirm sacroiliac joint (SIJ) pain and is usually performed via the caudal one-third portion of the joint. However, this is occasionally impossible for anatomical reasons, and the success rate is low in clinical settings. We describe a technique via the middle portion of the joint. DESIGN : Observational study. SUBJECTS : Enrolled were 69 consecutive patients (27 men and 42 women, with an average age of 53 years) in whom the middle portion of 100 joints was targeted.

  18. Chopart fractures.

    Science.gov (United States)

    Klaue, Kaj

    2004-09-01

    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  19. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong Ho; Choi, Sun Seob; Kim, Soo Jin; Lih, Wang [Dong-A University Medical Center, Busan (Korea, Republic of)

    2015-02-15

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  20. Horizontal intra-articular patellar dislocation resulting in quadriceps avulsion and medial patellofemoral ligament tear: a case report.

    Science.gov (United States)

    Kramer, Dennis E; Simoni, Michael K

    2013-07-01

    Intra-articular patellar dislocations are rare. We present a 13-year-old boy who sustained a complete horizontal intra-articular patellar dislocation following blunt trauma to the flexed knee. Closed reduction was unsuccessful and open reduction indicated a repairable quadriceps avulsion and medial patellofemoral ligament tear. He is the youngest patient to sustain a quadriceps rupture and the only patient to sustain a medial patellofemoral ligament tear to date. His flexed knee and the horizontally positioned patella (seen on lateral radiograph) were indicative of a complete rotational injury with extensor mechanism involvement. Open reduction allowed for the repair of both injuries and a favorable outcome.

  1. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome.

    Science.gov (United States)

    Ha, Dong-Ho; Choi, Sunseob; Kim, Soo-Jin; Lih, Wang

    2015-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  2. Fractures of the distal radius (Colles' fracture)

    National Research Council Canada - National Science Library

    João Carlos Belloti; João Baptista Gomes dos Santos; Álvaro Nagib Atallah; Walter Manna Albertoni; Flavio Faloppa

    2007-01-01

    CONTEXT AND OBJECTIVE: Although Colles' fracture is a common clinical situation for the orthopedist, we did not find any information in the literature that would allow safe decision-making on the best treatment for each fracture type...

  3. Osteosynthesis of Intercondylar Humerus Fracture Using Bryan and Morrey Approach

    Directory of Open Access Journals (Sweden)

    S Lakhey

    2010-06-01

    Full Text Available INTRODUCTION: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, nonunion and implant related complications at the osteotomy site. OBJECTIVE: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. MATERIALS AND METHODS: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixationof the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. RESULTS: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º-15º and the mean arc of motion was 115.0 º (range 85 º- 130º. All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. CONCLUSIONS: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. KEYWORDS: fracture, Humerus, intercondylar, osteosynthesis.

  4. VOL AR PLATING OF DISTAL RADIUS FRACTURE : A RETROSPECTIVE ANALYSIS

    Directory of Open Access Journals (Sweden)

    Victor

    2015-06-01

    Full Text Available BACKGROUND: Treatment of distal radius has undergone remarkable changes since the time of Abraham colles. Conservative treatment with cast application has given way to operative techniques for better o utcome in high demand young individuals. Volar plating fo r distal end radius fractures is an effective technique which allows early mobilisation with re storation of r adial inclination , radial length , articular congruity and palmar tilt. MATERIALS AND METHODS: T his study was performed in chettinad hospital and research institute between January 2013 and M arch 2014. 24 patients with closed isolated distal end radius fractures treated with open reduction and internal fixation with plates and screws by volar approach were followed up retrospectively for a minimum period of one year . There were 17 men and 7 women. Mean age was 44 years (Range, 22 - 75 years. The fractures were classified based on the AO system. There were 4 A2, 12 B3, 5 C1, 3 C2 fracture types. RESULTS : All the patients were evaluated with standard anteroposterior and lateral radiographs and CT scans in c ase of intraarticular fractures . In all patie nts plating of distal end radius done by volar approach. Patients were followed postoperatively for one y ear radiologically and clinically by modified clinical scoring system by Green and O Brien. Five patients had excellent results, thirteen patients had good results with twenty five percent restriction of wrist function . Five patients had fair results. One patient had postop wound infection which required implant removal and external fixator application . CONCLUSION: With proper patient selection a nd accurate surgical techniques , volar plating continues to be a useful method of treatment for distal end radius fractures with minimal complications and allowing early return of patients to normal activities.

  5. The use of parallel pre-contoured plates in the treatment of A and C fractures of the distal humerus.

    Science.gov (United States)

    Rebuzzi, Enrico; Vascellari, Alberto; Schiavetti, Stefano

    2010-05-01

    The purpose of this study was to retrospectively evaluate the clinical and radiological results of fixation with parallel pre-contoured plates in intra-articular and extra-articular distal humerus fractures. We retrospectively evaluate seven cases of type A and six cases of type C fracture treated with the Mayo Clinic Congruent Elbow Plate system (Acumed, Hillsboro, Oregon) after a mean follow-up of 14.8 and 21.3 months, respectively. Mayo Elbow Performance Score (MEPS) was utilized for functional evaluation. Mean MEPS was (92.86 +/- 16.8) in the first group showing 6 excellent and one poor result, while (94.17 +/- 12) showing five excellent and one fair in the second group, showing no significant difference between the two groups (P = 0.87). The mean active motion recovered postoperatively was 120 degrees (+/-34.5 degrees) in type A fractures and 113 degrees (+/-14.7 degrees) in type C fractures, and there was no significant difference (P = 0.67). Complications occurred in 6 of the 13 patients analysed at follow-up (3 radial neuropathy, one ulnar neuropathy, one screw mobilization and one heterotopic ossification). The fractures healed in every patient, and no synthesis failed. The parallel plate system has proved to be extremely useful in the treatment of intra-articular and extra-articular distal humerus fractures. The pre-contoured geometry allows easier reduction and stabilization of complex fractures. The higher stability achieved permits early mobilization, thus obtaining a higher percentage of excellent results.

  6. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP approach

    Directory of Open Access Journals (Sweden)

    Pankaj Amite

    2007-01-01

    Full Text Available Background: Operative fixation of intra-articular fractures of the distal humerus requires adequate exposure. The transolecranon approach is a commonly used approach. The olecranon osteotomy has potential complications related to prominence/migration of hardware, displacement/nonunion of osteotomy and triceps weakness. Triceps-reflecting anconeus pedicle (TRAP approach avoids the olecranon osteotomy without compromising the operative exposure. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach. Materials and Methods: We reviewed the functional and radiological results of 40 consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. There were 28 males and 12 females and the average age was 32 ± 4.5 years. The right elbow was involved in 27 patients and the left elbow in 13 patients. The mechanism of injury was a fall in 20 patients, a motor-vehicle accident in 16 patients and direct trauma in four patients. Results: At a minimum follow-up of 12 months (average 18 ± 4 months 35 (87.5% patients had good triceps strength. The average range of motion was 118.4 ± 7 degrees (range 80 o -130 o . The average time to union was 3.2 ± 1.6 months (range two to six months. No patient had triceps rupture, implant failure, neurovascular deficit or nonunion. Two patients needed removal of the implant because of subcutaneous prominence. Conclusions: The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fracture of the olecranon and its associated complications.

  7. Fixed-angle plates in patella fractures - a pilot cadaver study

    Science.gov (United States)

    2011-01-01

    Objective Modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring are currently the fixation of choice for patellar fractures. Failure of fixation, migration of the wires, postoperative pain and resulting revision surgery, however, are not uncommon. After preliminary biomechanical testing of a new fixed-angle plate system especially designed for fixation of patella fractures the aim of this study was to evaluate the surgical and anatomical feasibility of implanting such a plate-device at the human patella. Methods In six fresh unfixed female cadavers without history of previous fractures around the knee (average age 88.8 years) a bilateral fixed-angle plate fixation of the patella was carried out after previous placement of a transverse central osteotomy. Operative time, intra-operative problems, degree of retropatellar arthritis (following Outerbridge), quality of reduction and existence of any intraarticular screw placement have been raised. In addition, lateral and anteroposterior radiographs of all specimens were made. Results Due to the high average age of 88.8 years no patella showed an unimpaired retropatellar articular surface and all were severely osteoporotic, which made a secure fixation of the reduction forceps during surgery difficult. The operation time averaged 49 minutes (range: 36-65). Although in postoperative X-rays the fracture gap between the fragments was still visible, the analysis of the retropatellar surface showed no residual articular step or dehiscence > 0.5 mm. Also in a total of 24 inserted screws not one intraarticular malposition was found. No intraoperative complications were noticed. Conclusions Osteosynthesis of a medial third patella fracture with a bilateral fixed-angle plate-device is surgically and anatomically feasible without difficulties. Further studies have to depict whether the bilateral fixed-angle plate-osteosynthesis of the patella displays advantages over the established

  8. Mitochondrial Based Treatments that Prevent Post-Traumatic Osteoarthritis in a Translational Large Animal Intraarticular Fracture Survival Model

    Science.gov (United States)

    2013-09-01

    performed to access the weight-bearing portion of the medial condyle. A pendulum device imparts a blow to a 3 mm metal indentor resting on the cartilage...p = 0.065). The injury effect on ATP was profound and was not reversed by NAC at any of the three doses tested. On the other hand, cytochalasin B

  9. Joint Distraction Treatments of Intra-Articular Fracture-Induced Posttraumatic Osteoarthritis in a Large Animal Model

    Science.gov (United States)

    2016-10-01

    short, at odd angles, etc.) This device was able to achieve symmetric medial/lateral and symmetric anterior/posterior distraction with installation...They are a relatively local source (for cheaper shipping) with economically priced animals. Unfortunately, as described above, this vendor was...source was Sinclair Bioresources, and that vendor did have animals of the necessary age available. However purchase price was approximately ~$2,300

  10. External Fixation versus two-stage Open Reduction Internal Fixation of distal intra-articular Tibia fractures; a Systematic Review

    DEFF Research Database (Denmark)

    Ladeby Erichsen, Julie; Jensen, Carsten; Damborg, Frank Lindhøj

    Internal Fixation (ORIF) or External Fixation (EF). Method : A search was conducted using PUBMED, Embase, Cochrane Central, Open Grey, Orthopaedic Proceedings and WHO International Clinical Trials Registry Platform. Studies with level of evidence I-IV comparing EF with two-stage ORIF of DIATF in patients...

  11. Mitochondrial-Based Treatments that Prevent Post-Traumatic Osteoarthritis in a Translational Large Animal Intraarticular Fracture Survival Model

    Science.gov (United States)

    2016-09-01

    AWARD NUMBER: W81XWH-11-1-0583 TITLE: Mitochondrial -Based Treatments that Prevent Post-Traumatic Osteoarthritis in a Translational Large...REPORT TYPE Annual 3. DATES COVERED 1 Sep 2015 – 31 Aug 2016 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Mitochondrial -Based Treatments that Prevent...Introduction The purpose of this research is to investigate a novel therapeutic approach to prevent PTOA by treating mitochondrial dysfunction in

  12. In Situ Subtalar Arthrodesis for Posttraumatic Arthritis of the Calcaneus.

    Science.gov (United States)

    Probe, Robert

    2016-08-01

    One of the most frequent complications after intraarticular fracture of the calcaneus is the development of posttraumatic arthritis of the subtalar joint. If conservative measures fail in the treatment of this condition, consideration of arthrodesis should be given. This video depicts the preoperative assessment and surgical technique applied to one such 54-year-old patient who had undergone internal fixation of a calcaneal fracture 9 years before. Shown within the video is exposure of the subtalar joint through a lateral incision, joint preparation, and the application of stable fixation. Subtleties of exposure, osteogenesis maximization, and postoperative management are covered.

  13. Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study.

    Science.gov (United States)

    Aktas, I; Yalcin, S; Sencer, S

    2010-05-01

    This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.

  14. Intraarticular Injections of Platelet-rich Plasma (PRP) in the Management of Knee Osteoarthritis.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos

    2013-09-01

    The clinical use of PRP therapy in the practical setting of orthopaedic fields is increasing partly because of the accessibility of devices that are used in outpatient preparation and delivery. Another reason is the strong advertisement of PRP procedures as the ultimate treatment and novel technology for knee problems by a few orthopaedic surgeons based on claims of abundant scientific evidence. Hence, PubMed articles related to the clinical use of PRP in knee osteoarthritis were searched using the key words: PRP, knee and osteoarthritis in order to study these claims. A total of 20 reports were found directly related to the topic. The aforementioned clinical studies suggest that intraarticular injections of PRP could have preventive effects against osteoarthritis progression. However, presently there is no clear evidence from well-designed clinical trials that intraarticular injections of PRP are efficacious in osteoarthritis. Therefore, at this time the efficacy of PRP requires more investigation, wherein better scientific studies should be performed that include high powered randomized controlled trials.

  15. Intraarticular Injections of Platelet-rich Plasma (PRPin the Management of Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2013-09-01

    Full Text Available   The clinical use of PRP therapy in the practical setting of orthopaedic fields is increasing partly because of the accessibility of devices that are used in outpatient preparation and delivery. Another reason is the strong advertisement of PRP procedures as the ultimate treatment and novel technology for knee problems by a few orthopaedic surgeons based on claims of abundant scientific evidence. Hence, PubMed articles related to the clinical use of PRP in knee osteoarthritis were searched using the key words: PRP, knee and osteoarthritis in order to study these claims. A total of 20 reports were found directly related to the topic. The aforementioned clinical studies suggest that intraarticular injections of PRP could have preventive effects against osteoarthritis progression. However, presently there is no clear evidence from well-designed clinical trials that intraarticular injections of PRP are efficacious in osteoarthritis. Therefore, at this time the efficacy of PRP requires more investigation, wherein better scientific studies should be performed that include high powered randomized controlled trials.

  16. The Effect of Preoperative Intra-Articular Methylprednisolone on Pain after TKA

    DEFF Research Database (Denmark)

    Luna, Iben E; Kehlet, Henrik; Jensen, Claus M

    2017-01-01

    postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind up from temporal summation) and inflammatory changes (systemic CRP, intra-articular IL-6). No difference in proportion of patients...... with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ(2)=0.2, p=0.63, odds ratio 0.7, 95% CI 0.2 to 2.8) or at 48 hours (57% and 68%, χ(2)=0.5, p=0.46, odds ratio 0.6 95% CI 0.2 to 2.3), and no difference between groups in postoperative sensitization was found (p > 0......In a randomized, double-blinded, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered one week prior to total knee arthroplasty (TKA). Forty-eight patients with high pain...

  17. Stem cells and other innovative intra-articular therapies for osteoarthritis: what does the future hold?

    Directory of Open Access Journals (Sweden)

    Singh Jasvinder A

    2012-05-01

    Full Text Available Abstract Osteoarthritis (OA, the most common type of arthritis in the world, is associated with suffering due to pain, productivity loss, decreased mobility and quality of life. Systemic therapies available for OA are mostly symptom modifying and have potential gastrointestinal, renal, hepatic, and cardiac side effects. BMC Musculoskeletal Disorders recently published a study showing evidence of reparative effects demonstrated by homing of intra-articularly injected autologous bone marrow stem cells in damaged cartilage in an animal model of OA, along with clinical and radiographic benefit. This finding adds to the growing literature showing the potential benefit of intra-articular (IA bone marrow stem cells. Other emerging potential IA therapies include IL-1 receptor antagonists, conditioned autologous serum, botulinum toxin, and bone morphogenetic protein-7. For each of these therapies, trial data in humans have been published, but more studies are needed to establish that they are safe and effective. Several additional promising new OA treatments are on the horizon, but challenges remain to finding safe and effective local and systemic therapies for OA. Please see related article: http://www.biomedcentral.com/1471-2474/12/259

  18. Safety of intra-articular use of atelocollagen for enhanced tissue repair.

    Science.gov (United States)

    Magarian, Elise M; Vavken, Patrick; Connolly, Susan A; Mastrangelo, Ashley N; Murray, Martha M

    2012-01-01

    Collagen is an important biomaterial in intra-articular tissue engineering, but there are unanswered questions about its safety. We hypothesize that the addition of type-I-collagen for primary repair of the Anterior Cruciate Ligament (ACL) might result in a local and systemic reaction in a porcine model after 15 weeks as demonstrated by joint effusion, synovial thickening, elevated intraarticular and systemic leukocyte counts. Further, this reaction might be aggravated by the addition of a platelet concentrate. Eighteen porcine ACLs were transected and repaired with either sutures (n=6), a collagen sponge (n=6), or a collagen-platelet-composite (CPC; n=6). Twelve intact contralateral knees served as controls (n=12). No significant synovial thickening or joint effusion was seen in the collagen-treated knees. Synovial fluid leukocyte counts showed no significant differences between surgically treated and intact knees, and no differences were seen in leukocyte counts of the peripheral blood. The addition of a platelet concentrate to the knee joint resulted in lower serum levels of IL-1β, but serum levels of TNF-α were not significantly different between groups. In conclusion, the presence of collagen, with or without added platelets, did not increase the local or systemic inflammatory reactions following surgery, suggesting that Type I collagen is safe to use in the knee joint.

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

    Directory of Open Access Journals (Sweden)

    Nelson Pelozo Gomes Júnior

    2016-02-01

    Full Text Available ABSTRACT The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome.

  20. Effect of Natural Fractures on Hydraulic Fracturing

    Science.gov (United States)

    Ben, Y.; Wang, Y.; Shi, G.

    2012-12-01

    Hydraulic Fracturing has been used successfully in the oil and gas industry to enhance oil and gas production in the past few decades. Recent years have seen the great development of tight gas, coal bed methane and shale gas. Natural fractures are believed to play an important role in the hydraulic fracturing of such formations. Whether natural fractures can benefit the fracture propagation and enhance final production needs to be studied. Various methods have been used to study the effect of natural fractures on hydraulic fracturing. Discontinuous Deformation Analysis (DDA) is a numerical method which belongs to the family of discrete element methods. In this paper, DDA is coupled with a fluid pipe network model to simulate the pressure response in the formation during hydraulic fracturing. The focus is to study the effect of natural fractures on hydraulic fracturing. In particular, the effect of rock joint properties, joint orientations and rock properties on fracture initiation and propagation will be analyzed. The result shows that DDA is a promising tool to study such complex behavior of rocks. Finally, the advantages of disadvantages of our current model and future research directions will be discussed.

  1. Fracture channel waves

    Science.gov (United States)

    Nihei, Kurt T.; Yi, Weidong; Myer, Larry R.; Cook, Neville G. W.; Schoenberg, Michael

    1999-03-01

    The properties of guided waves which propagate between two parallel fractures are examined. Plane wave analysis is used to obtain a dispersion equation for the velocities of fracture channel waves. Analysis of this equation demonstrates that parallel fractures form an elastic waveguide that supports two symmetric and two antisymmetric dispersive Rayleigh channel waves, each with particle motions and velocities that are sensitive to the normal and tangential stiffnesses of the fractures. These fracture channel waves degenerate to shear waves when the fracture stiffnesses are large, to Rayleigh waves and Rayleigh-Lamb plate waves when the fracture stiffnesses are low, and to fracture interface waves when the fractures are either very closely spaced or widely separated. For intermediate fracture stiffnesses typical of fractured rock masses, fracture channel waves are dispersive and exhibit moderate to strong localization of guided wave energy between the fractures. The existence of these waves is examined using laboratory acoustic measurements on a fractured marble plate. This experiment confirms the distinct particle motion of the fundamental antisymmetric fracture channel wave (A0 mode) and demonstrates the ease with which a fracture channel wave can be generated and detected.

  2. Traumatic thoracolumbar spine fractures

    NARCIS (Netherlands)

    J. Siebenga (Jan)

    2013-01-01

    textabstractTraumatic spinal fractures have the lowest functional outcomes and the lowest rates of return to work after injury of all major organ systems.1 This thesis will cover traumatic thoracolumbar spine fractures and not osteoporotic spine fractures because of the difference in fracture

  3. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

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

    Directory of Open Access Journals (Sweden)

    Duo Wai-Chi Wong

    Full Text Available Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis.A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval.At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites.The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.

  5. Comparing the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery.

    Science.gov (United States)

    Jazayeri, Seyed Mohammad; Mosaffa, Faramarz; Abbasian, Mohammadreza; Hosseinzadeh, Hamid Reza

    2012-01-01

    Intra-articular analgesia is a pain reliever that is frequently administered following arthroscopic knee surgery. The purpose of this study was to compare the efficacy of intra-articular application of morphine and tramadol on postoperative pain after arthroscopic knee surgery. For this randomized double blinded clinical trial, 132 patients undergoing minor arthroscopic knee surgery were randomly assigned to receive either; 5 mg morphine or 50 mg tramadol intra-articularly. Pain was evaluated by means of the verbal pain rating score (VRS) preoperatively (at rest and on movement of the knee joint) and postoperatively at 0, 1, 2, 3, 4, 6, 12 and 24 hours. Meanwhile, the time of the first analgesic request and need for supplemental analgesic were also recorded. There was no statistically significant difference in VRS scoring between the two groups during the preoperative period either at rest or on knee movement. Meanwhile, VRS scores did not differ significantly between the morphine and tramadol treated groups postoperatively, except for in the one-hour post-operative scores in which the tramadol-treated group experienced less pain (P tramadol prescribed subjects (P intra-articularly administered morphine and tramadol following minor arthroscopic knee surgeries with a maximum effect 6 hours post injection.

  6. Intra-articular delivery of glucosamine for treatment of experimental osteoarthritis created by a medial meniscectomy in a rat model

    NARCIS (Netherlands)

    Gibson, Matthew; Li, Hanwei; Coburn, Jeannine; Moroni, Lorenzo; Nahas, Zayna; Bingham, Clifford; Yarema, Kevin; Elisseeff, Jennifer

    2014-01-01

    Glucosamine (GlcN) is a naturally occurring amino-monosaccharide with putative chondroprotective activity. Optimum responses to GlcN are achieved at concentrations which are impractical with oral dosing. Intra-articular delivery of a bolus dose of GlcN is one way to overcome these pharmacokinetic ob

  7. The Effect of Local Heat and Cold Therapy on the Intraarticular and Skin Surface Temperature of the Knee

    NARCIS (Netherlands)

    Oosterveld, F.G.J.; Rasker, J.J.; Jacobs, J.W.G.; Overmars, H.J.A.

    1992-01-01

    Objective. To evaluate the effects of local application of ice chips, ligno-paraffin, short-wave diathermy, and nitrogen-cold air on skin and intraarticular temperature. Methods. Forty-two healthy subjects were divided into 4 treatment groups. A temperature probe was inserted into the knee joint ca

  8. Analgesic control after hip arthroscopy: a randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2011-06-07

    Abstract: The optimum anaesthetic and analgesic management following hip arthroscopy is yet to be determined. There is, in addition, some concern over the use of intraarticular local anaesthetic. We compared the analgesic efficacy of intra-articular infiltration compared with portal infiltration of bupivacaine following hip arthroscopy. Patients were randomised to receive either 10ml of 0.25% bupivacaine either into the joint or around the portal sites following completion of surgery. 73 patients were recruited (40 intra-articular). The portal infiltration group required significantly more rescue analgesia immediately after surgery (2.33mg vs.0.57mg, p=0.036). Visual Analogue Scale pain scores were not significantly different at 1 and 2 hours following surgery, but at 6 hours the portal group had significantly lower VAS scores (p=0.0036). We believe that the initial pain following surgery results from capsular injury and this explains the need for more rescue analgesia in the portal infiltration group. Further work is needed to establish the ideal regimen. A combination of portal and intra-articular infiltration may be the most efficacious.

  9. Comparison of MR arthrography with arthroscopy of the hip for the assessment of intra-articular loose bodies

    Energy Technology Data Exchange (ETDEWEB)

    Neckers, Andrew C. [Columbus Radiology Corporation, Columbus, OH (United States); Polster, Joshua M.; Winalski, Carl S.; Sundaram, M. [The Cleveland Clinic Foundation, Diagnostic Radiology/A21, Cleveland, OH (United States); Krebs, Viktor E. [The Cleveland Clinic Foundation, Department of Orthopedic Surgery, Cleveland, OH (United States)

    2007-10-15

    To assess the specificity and sensitivity of MR arthrography of the hip in comparison with arthroscopy for the evaluation of intra-articular loose bodies. Over a 3-year period, 81 consecutive patients underwent a total of 82 hip arthroscopies by a single orthopedic surgeon for intractable hip pain. Of the 82 arthroscopies, 70 had pre-operative MR arthrograms. Of these, 57 were available for retrospective review, after which they were compared with the operative notes of the subsequent arthroscopies. Of 82 arthroscopies 16 (20%) demonstrated intra-articular loose bodies, while, in the study group, nine of 57 had loose bodies (16%). There was a total of seven discordant cases (five false negatives and two false positives). The sensitivity of MR arthrography for detection of intra-articular loose bodies was 44%, while the specificity was 96%. While the specificity of MR arthrography for the detection of intra-articular loose bodies was high (96%), the sensitivity was not nearly as good (44%). (orig.)

  10. Computed tomography in pelvic and acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Born, H.; Schmidt, C.

    1988-06-01

    In a retrospective study we analyzed the results of 127 patients, who were examined not only by means of conventional radiography but also by means of computed tomography after a trauma of the pelvic. Our investigations were based upon such patients, to whom a definite diagnostic procedure of plain radiography had been performed. Therefore all polytraumatized patients were inapplicable. They were only examined by computed tomography because of other more important accompanying injuries of other body regions. We compared the results of 127 patients with pelvic trauma. The results of the CT were in accordance with the results of the plain radiography for 103 patients. The results of the CT concerning the availability and the localization of the fractures were basically coincident with the plain radiography for 22 patients, but the CT showed a higher degree of trauma and additional intraarticular fragments. Two isolated lesions of the sacroiliac joint could not be recognized by both methods. They could only be diagnosed by bone scintigraphy on the third day after trauma.

  11. Intra-articular methotrexate associated to lipid nanoemulsions: anti-inflammatory effect upon antigen-induced arthritis

    Directory of Open Access Journals (Sweden)

    Mello SB

    2013-02-01

    Full Text Available Suzana BV Mello,1 Elaine R Tavares,2 Adriana Bulgarelli,2 Eloisa Bonfá,1 Raul C Maranhão2,31Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; 2Lipid Metabolism Laboratory, the Heart Institute (INCOR of the Medical School Hospital, São Paulo, Brazil; 3Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, BrazilObjective: Commercial methotrexate formulations (MTX have poor anti-inflammatory action for intra-articular treatment of rheumatoid arthritis. Our aim was to investigate whether an association between methotrexate and lipidic nanoemulsions (LDE could improve MTX intra-articular action.Methods: For its association to LDE, MTX was previously esterified with dodecyl bromide. LDE-MTX was prepared by high pressure homogenization. Antigen-induced arthritis (AIA was achieved in rabbits sensitized with methylated bovine serum albumin, and the rabbits were subsequently intra-articularly injected with the antigen. Twenty-four hours after AIA induction, groups of four to nine rabbits were intra-articularly injected with increasing doses (0.0625–0.5 µmol/kg of LDE-MTX, and were compared to treatment with 0.5 µmol/kg commercial MTX, LDE alone, and saline (controls. Synovial fluid was collected 48 hours after AIA induction for analysis of protein leakage and cell content. Synovial membranes were collected for histopathology. Uptake of LDE labeled with 3H-cholesteryl ether by the synovial tissue was also determined.Results: Uptake of radioactive LDE by arthritic joints was 2.5-fold greater than by normal joints. Treatment with intra-articular LDE-MTX elicited a clear dose response pattern by reducing the synovial leukocyte infiltrate (P = 0.004 and protein leakage (P = 0.032 when compared with arthritic non-treated joints. In contrast, the intra-articular injection of commercial MTX and LDE did not reduce leukocyte infiltrate or protein leakage. Toxicity to treatment was not observed

  12. Exhaustive exercise with different rest periods changes the collagen content and MMP-2 activation on the calcaneal tendon.

    Science.gov (United States)

    De Aro, Andrea Aparecida; Ferrucci, Danilo Lopes; Borges, Frederico Padovan; Stach-Machado, Dagmar Ruth; Macedo, Denise Vaz; Pimentel, Edson Rosa

    2014-02-01

    Tendons adapt to different mechanical stimuli through a remodeling process involving metalloproteinases (MMPs) and collagen synthesis. The purpose of this study was to investigate the activities of MMP-2 and MMP-9 and the collagen content in tendons after exhaustive acute exercise sessions over the course of 1, 3, or 6 days, with 1-hr or 3-hr rest periods between each session. Wistar rats were grouped into control (C), trained with 1-hr (groups 1d1h, 3d1h, and 6d1h) and trained with 3-hr (groups 1d3h, 3d3h and 6d3h) groups with rest periods between the treadmill running sessions, for 1, 3, and 6 days. The analysis of MMP-2 showed a larger presence of the latent isoform in the 1d3h group and a larger presence of the active isoform in the 6d3h group compared to the control. No differences were detected for MMP-9. A lower concentration of hydroxyproline was found in the 6d3h group compared to the 6d1h group. Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis showed more prominent collagen bands in the 6d3h group, which was confirmed by Western blotting for collagen type I. A higher concentration of glycosaminoglycans was observed in the 3d3h group compared to the 3d1h group, and the 6d3h group presented the highest value for non-collagenous proteins compared to other groups. In conclusion, different rest periods between exercise sessions had different effects on the composition of the calcaneal tendon because a greater activation of MMP-2 and a reduction of total collagen were observed on day 6 of exercise with 3-hr rest periods compared to 1-hr rest periods. Copyright © 2013 Wiley Periodicals, Inc.

  13. Effect of Aloe vera application on the content and molecular arrangement of glycosaminoglycans during calcaneal tendon healing.

    Science.gov (United States)

    Aro, Andrea Aparecida de; Esquisatto, Marcelo Augusto Marretto; Nishan, Umar; Perez, Mylena Oliveira; Rodrigues, Rodney Alexandre Ferreira; Foglio, Mary Ann; Carvalho, João Ernesto de; Gomes, Laurecir; Vidal, Benedicto De Campos; Pimentel, Edson Rosa

    2014-12-01

    Although several treatments for tendon lesions have been proposed, successful tendon repair remains a great challenge for orthopedics, especially considering the high incidence of re-rupture of injured tendons. Our aim was to evaluate the pharmacological potential of Aloe vera on the content and arrangement of glycosaminoglycans (GAGs) during tendon healing, which was based on the effectiveness of A. vera on collagen organization previously observed by our group. In rats, a partial calcaneal tendon transection was performed with subsequent topical A. vera application at the injury site. The tendons were treated with A. vera ointment for 7 days and excised on the 7(th) , 14(th) , or 21(st) day post-surgery. Control rats received ointment without A. vera. A higher content of GAGs and a lower amount of dermatan sulfate were detected in the A. vera-treated group on the 14(th) day compared with the control. Also at 14 days post-surgery, a lower dichroic ratio in toluidine blue stained sections was observed in A. vera-treated tendons compared with the control. No differences were observed in the chondroitin-6-sulfate and TGF-β1 levels between the groups, and higher amount of non-collagenous proteins was detected in the A. vera-treated group on the 21(st) day, compared with the control group. No differences were observed in the number of fibroblasts, inflammatory cells and blood vessels between the groups. The application of A. vera during tendon healing modified the arrangement of GAGs and increased the content of GAGs and non-collagenous proteins.

  14. Management of Intrarticular Fractures of Distal End of Humerus using Modification of the Triceps Aponeurosis Tongue Approach

    Directory of Open Access Journals (Sweden)

    Saurabh Sharma

    2015-10-01

    Full Text Available Objective: To evaluate the functional outcome and extensor apparatus of operative management of intra-articular fractures of distal humerus using modification of the Triceps Tongue Flap approach. Methods: This prospective study was conducted between June, 2012 to April,2014 in NIMS Medical College and Hospital, Jaipur, Rajasthan(India. We included 23 patients with intraarticular fractures of distal humerus that were managed surgically. Modification of Triceps Tongue Flap approach with Triceps flap in inverted ‘V’ shape was used. Follow-up was done using standard radiograph anteroposterior/lateral (AP/Lat at immediate postoperative day, 1,3, 6 and 12 month intervals. Functional outcome was assessed using range of motion at elbow joint, Disability of Arm, Shoulder and Hand (DASHScore and Objective Muscle Strength Testing (MRC Grade of triceps muscle at 1,2, 3,6 and 12 month follow-up. Results: Overall we included 23 patients of whom 16 (69.5% were men and 7 (30.5% were women with mean age of 34.6+4.8years. Mean duration of the follow-up was 12.9+1.1 months. Mean DASH Score at final follow up was 7.7+1.1(indicating mild residal impairment. Mean muscle strength at final follow-up was 4.7 ± 0.4 (Range 3 to 5. Mean flexion deformity at elbow was 9.2 ±0.9 (Range 5 to 45 degrees and mean arc of flexion extension as 119 ± 3.4(Range 65to 140 degrees. Conclusion: This approach provides an excellent exposure as well as a good functional outcome as measured by DASH score and full range of motion at the elbow joint with return of almost complete power of the extensor apparatus in patients with intra-articular fractures of distal humerus.

  15. [Periprosthetic Acetabulum Fractures].

    Science.gov (United States)

    Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G

    2016-12-01

    In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered. Georg Thieme Verlag KG Stuttgart · New York.

  16. Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the knee.

    Science.gov (United States)

    Unlu, Zeliha; Ay, Kamuran; Tuzun, Cigdem

    2006-02-01

    This study was designed to compare efficacy of local administration of a nonsteroidal anti-inflammatory drug with systemic administration in patients with osteoarthritis (OA) of the knee. For this purpose, intra-articular tenoxicam and oral tenoxicam therapies were applied and the improvement in control of pain and physical functioning were evaluated. A total of 69 patients with OA of the knee were randomized into three groups. Patients in the first group (41 knees of 23 patients) were treated for 1-3 weeks with once weekly intra-articular injection of tenoxicam 20 mg. Patients in the second group (45 knees of 26 patients) received 20 mg/day tenoxicam orally for 3 weeks and only physical exercises were applied to the third group (32 knees of 20 patients). Physical examination of the knee joint, Western Ontario and McMaster Universities Index and the Lequesne Algofunctional Index were used as outcome measurements at baseline, and the 1st, 3rd and 6th months. More significant improvement in pain and disability parameters was observed in groups 1 and 2 than group 3 compared with baseline measures. Among the patients' responses a few of the differences were statistically significant, more in favour of tenoxicam, and tenoxicam seemed to be superior to exercise alone especially at the final evaluation. There was no significant difference between the oral and intra-articular tenoxicam treatment regimens. The results of this study showed that treatment of OA of the knee with intra-articular tenoxicam is as effective as that with oral tenoxicam. It can be thought that intra-articular administration can be preferred to oral therapy due to minimal possibility of systemic side effects.

  17. Utility of double-contrast multi-detector CT scans to assess cartilage thickness after tibial plafond fracture

    Science.gov (United States)

    Thomas, Thaddeus P.; Van Hofwegen, Christopher J.; Anderson, Donald D.; Brown, Thomas D.; Marsh, J. Lawrence

    2010-01-01

    The pathophysiology of post-traumatic osteoarthritis (PTOA) after intra-articular fractures is poorly understood. Pursuit of a better understanding of this disease is complicated by inability to accurately monitor its onset, progression and severity. Common radiographic methods used to assess PTOA do not provide sufficient image quality for precise cartilage measurements. Double-contrast MDCT is an alternative method that may be useful, since it produces high-quality images in normal ankles. The purpose of this study was to assess this technique’s performance in assessing cartilage maintenance in ankles with an intra-articular fracture. Thirty-six tibial plafond fractures were followed over two years, with thirty-one MDCTs being obtained four months after injury, and twenty-two MDCTs after two years. Unfortunately, clinical results with this technique were unreliable due to pathology (presumed arthrofibrosis) and technical problems (pooling of contrast). The arthrofibrosis that developed in many patients inhibited proper joint access and contrast infiltration, although high-quality images were obtained in eleven patients. In this patient subset, in which focal regions of cartilage degeneration could be visualized, thickness could be measured with a high degree of fidelity. While thus useful in selected instances, double-contrast MDCT was too unreliable to be recommended to assess these particular types of injuries. PMID:20634971

  18. Surgical treatment of proximal humerus fractures using PHILOS plate

    Institute of Scientific and Technical Information of China (English)

    GN Kiran Kumar; Gaurav Sharma; Vijay Sharma; Vaibhav Jain; Kamran Farooque; Vivek Morey

    2014-01-01

    Objective:To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods:We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years (range 24-68).There were 41 patients in the age group of <60 years and 10 patients in the age group of >60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results:The mean follow-up period was 30 months (range 12-44 months).Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks (range 8-20 weeks).At the final follow-up the mean Constant-Murley score was 79 (range 50-100).The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion:PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.

  19. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations.

    Science.gov (United States)

    Ross, Adrianne; Catanzariti, Alan R; Mendicino, Robert W

    2011-01-01

    Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time.

  20. Intra-articular block for knee arthroscopy: a study on 41 patients

    Directory of Open Access Journals (Sweden)

    Emami A

    2009-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: During recent three decades, parallel to the improvement of arthroscopic techniques, intra-articular block by direct injection of anesthetics into the joint has been used in knee arthroscopy. In this study the efficacy of intra- articular block by complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been assessed. "n"nMethods: Forty one healthy adults (age range: 18-55 years with knee problems selected for diagnostic arthroscopy. Anesthesia was induced by direct injection of 10ml 2% bupivacaine, 10ml 0.5% lidocaine plus 1/100000 adrenaline into the knee joint.  Duration of operation and volume of serum used for irrigation during the procedure; pain and analgesics requirement, during and after arthroscopy; VAS (Visual Analogue Scale score, at time of discharge from recovery and also patient's and surgeon's satisfaction were assessed. "n"n Results: Sixty eight percent and 29% of cases reported mild and moderate degree of pain perception during arthroscopy, respectively, and only one case for which general anesthesia was performed, reported severe pain. VAS mean was 2.78. Seventy eight percent of cases and the surgeon in 80% of procedures had excellent or good satisfaction with

  1. Imaging of vertebral fractures

    Directory of Open Access Journals (Sweden)

    Ananya Panda

    2014-01-01

    Full Text Available Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.

  2. 跟骨内移截骨治疗获得性扁平足临床分析%Acquired flat foot medial displacement calcaneal osteotomy

    Institute of Scientific and Technical Information of China (English)

    张奉琪; 王慧娟; 张奇; 赵海涛; 李智勇; 高巍; 张英泽

    2011-01-01

    [ Objective] To study the c haracteristic and clinic curative effect of the acquired flatfoot treated by a medial displacement calcaneal osteotomy. [ Methods] From Jan. 2006 ~ Dec. 2008, 31 patients with an average age of 26. 7 years (range, 19 ~50 years), were treated by a medial displacement calcaneal osteotomy together with other technique. Seventeen of them were male and 14 were female. The lateral position, calcaneal axial and CT of calcaneal were taken preoperatively. The mean first talocalcaneal angle was 22.3° ( range, 5° ~ 32°) . All patients had contracture of achilles tendon, posterior tibial tendon dysfunction, calcaneovalgus, forefoot pronation and abduction ( weight bearing ) and pains. The American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale was 45.8. Posterior tibial tendon irsufficiency (PTTI) were stageⅡ. Thirteen feet were treated by a medial displacement calcaneal osteotomy, 4 feet by a medial displacement calcaneal osteotomy and tendocalcaneus lengthening, 14 feet by a medial displacement calcaneal osteotomy , tendo calcaneus lengthening and flexor digitorum longus tendon transfer. [ Results] After a mean follow up of 18. 8 months (range, 6 ~ 26 months), the medial longitudinal arch improved postoperatively, 10 feets pain disappeared, 15 foot reliefed and 6 foot remained. The mean first talocalcaneal angle was 3.2° (range, 0° ~7°) (t = 22. 57, P≤0. 001 ), strephexopodia and the abduction of foot obviously improved . The rating of clinic curative effect was 80. 6% (25/31) . The American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale was 84. 5. [ Conclusion ] Medial displacement calcaneal osteotomy treating the flexible flatfoot can reliablely correct calcaneovalgus , partly resume the medial longitudinal arch, improve weight bearing and biomechanical characteristic of foot and ankle. We can combine with other technique to improve curativeeffect of the acquired flat foot. The operative indication

  3. Utility of double-contrast multidetector CT scans to assess cartilage thickness after tibial plafond fracture

    Directory of Open Access Journals (Sweden)

    Thaddeus P Thomas

    2009-11-01

    Full Text Available Thaddeus P Thomas1,2, Christopher J Van Hofwegen1, Donald D Anderson1,2, Thomas D Brown1,2, J Lawrence Marsh11Department of Orthopedics and Rehabilitation, 2Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USAAbstract: The pathophysiology of posttraumatic osteoarthritis (PTOA after intraarticular fractures is poorly understood. Pursuit of a better understanding of this disease is complicated by inability to accurately monitor its onset, progression and severity. Common radiographic methods used to assess PTOA do not provide sufficient image quality for precise cartilage measurements. Double-contrast multidetector computed tomography (MDCT is an alternative method that may be useful, since it produces high-quality images in normal ankles. The purpose of this study was to assess this technique’s performance in assessing cartilage maintenance in ankles with an intraarticular fracture. Thirty-six tibial plafond fractures were followed over two years, with 31 MDCTs being obtained four months after injury, and 22 MDCTs after two years. Unfortunately, clinical results with this technique were unreliable due to pathology (presumed arthrofibrosis and technical problems (pooling of contrast. The arthrofibrosis that developed in many patients inhibited proper joint access and contrast infiltration, although high-quality images were obtained in 11 patients. In this patient subset, in which focal regions of cartilage degeneration could be visualized, thickness could be measured with a high degree of fidelity. While thus useful in selected instances, double-contrast MDCT was too unreliable to be recommended to assess these particular types of injuries.Keywords: posttraumatic osteoarthritis, cartilage, imaging, fracture

  4. Fracture Criterion for Fracture Mechanics of Magnets

    Institute of Scientific and Technical Information of China (English)

    潘灏; 杨文涛

    2003-01-01

    The applicability and limitation of some fracture criteria in the fracture mechanics of magnets are studied.It is shown that the magnetic field intensity factor can be used as a fracture criterion when the crack in a magnet is only affected by a magnetic field. For some magnetostrictive materials in which the components of magnetostriction strain do not satisfy the compatibility equation of deformation, the stress intensity factor can no longer be effectively applicable as a fracture criterion when the crack in a magnet is affected by a magnetic field and mechanical loads simultaneously.

  5. Treatment of calcaneal fracture with the traction and external fixator apparatus%跟骨外固定牵引器治疗跟骨骨折

    Institute of Scientific and Technical Information of China (English)

    隋福革; 符强; 张达; 汪群; 滕家松; 赵丛然; 郭明峰; 冀成山; 韩秀英

    2005-01-01

    目的:探讨应用跟骨外固定牵引器治疗跟骨骨折的疗效.方法:采用自行研制的跟骨外固定牵引器,于跟骨结节横穿1枚斯氏针配合手法复位治疗跟骨骨折病人53例,55个跟骨,进行临床观察.结果:本组跟骨骨折病人48例得到平均3.4年的随访,功能恢复良好,优良率91.6%.结论:跟骨外固定牵引器治疗跟骨骨折复位好,牵引固定可靠,损伤小,感染率低,可早期功能锻炼,外固定器本身结构简单,便于操作.

  6. 闭合复位联合外固定器治疗移位跟骨骨折%Close reduction and external fixation for displaced calcaneal fracture

    Institute of Scientific and Technical Information of China (English)

    许伟华; 杨述华; 叶树楠; 张宇坤

    2009-01-01

    目的 探讨闭合复位联合外固定器治疗移位跟骨骨折的疗效.方法 回顾性随访2005~2008年采用闭合复位联合外固定器治疗移位跟骨骨折17例(21足),男性14例(18足),女性3例(3足);年龄19~56岁,平均34.2岁.按Sanders分类:Ⅱ型7足,Ⅲ型10足,Ⅳ型4足.测量并比较术前术后跟骨结节关节角(Bohler角),术后根据美国足踝骨科协会(American Orthopedic Foot & Ankle Society, AOFAS )踝-后足评分系统评分.结果 本组随访时间3~42个月,平均23.2个月.术前Bohler角-31°~20°,平均-0.6°,术后拆除外固定后Bohler角18°~40°,平均33.6°,两者有显著性差异(t检验,P<0.01);术后踝-后足评分,平均得分85.6分(67~95分),优7足,良11足,可2足,差1足;优良率85.7%.结论 闭合复位联合外固定器治疗移位跟骨骨折具有损伤小、并发症少等优点,疗效与切开复位内固定疗效相当,值得推广.

  7. Monteggia fracture dislocation equivalents——analysis of eighteen cases treated by open reduction and internal fixation

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Ish Kumar Dhammi; Anil Kumar Jain; Rajeev Raman; Prashant Modi

    2011-01-01

    Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re view of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008) was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade Ⅱ & Ⅲ cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1 -4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia fracture dislocation equivalents

  8. Combined Intra-Articular and Intravenous Tranexamic Acid Reduces Blood Loss in Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Nielsen, Christian Skovgaard; Jans, Øivind; Ørsnes, Thue;

    2016-01-01

    BACKGROUND: In total knee arthroplasty, both intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) have been shown to reduce blood loss in several randomized controlled trials, although routine use of systemic TXA is considerably more common. However, to our knowledge......-only administration of TXA. METHODS: In this randomized, double-blind, placebo-controlled trial, 60 patients scheduled for total knee arthroplasty were randomized to one of two interventions. The TXA IV and IA group received combined administration of TXA consisting of 1 g administered intravenously preoperatively......, the additional benefit of IA administration of TXA when combined with IV administration, without the use of a tourniquet, has not been previously investigated. Thus, the aim of this study was to evaluate whether combined IV and IA administration of TXA reduced total blood loss compared with IV...

  9. Intra-articular fibroma of tendon sheath arising in the acromioclavicular joint.

    Science.gov (United States)

    Glover, McKinley; Chebib, Ivan; Simeone, F Joseph

    2014-05-01

    Fibroma of the tendon sheath, a rare benign soft tissue tumor that most often occurs in the distal upper extremities (hands and wrist), is exceedingly rare to present as an intraarticular mass. Presented here is the first case in the English literat