Ewing's sarcoma in bones of the hands and feet: a clinicopathologic study and review of the literature

Review of current data from the Intergroup Ewing's Sarcoma Study (IESS) shows that Ewing's sarcoma (ES) is rare in bones of the hands and feet. Only 12 of 377 evaluable patients in the first two IESS studies had a primary tumor in these small, distal bones. The age distribution was typical for that seen in patients with ES at other sites. Males were affected twice as often as females, and tumors in the bones of the feet were much more common than those in the hands. All signs and symptoms were local in distribution. As in other sites, the dominant histologic pattern was categorized as diffuse. With the exception of those patients with lesions in the calcaneus, the prognosis for disease-free survival was excellent. A literature review of cases of ES reported in bones of the hands and feet showed generally comparable results.

Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease)

Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with a normal Achilles tendon and superficial soft tissue contour, and intact cortex of the underlying os calcis.

The calcaneal index in the determination of osteoporosis

The authors tested the reliability of a new method of evaluating osteoporosis and osteopenia radiographically. This is based on the calcaneal index, which can be correlated directly with Singh's femoral neck index and is inversely proportional to the age of the subjects tested.

The neuroectodermal tumor of bone

Four small round cell malignant tumors of bone occurring in children are described. There was no catecholamine secretion and the clinical, radiologic, and biopsy diagnosis in each was Ewing's sarcoma. Glycogen was sparse both on imprints and in tissue sections. The tumors, when extensively sampled, had areas of a lobular growth pattern and Homer Wright rosettes. The rosettes were always focal and varied in complexity from case to case; they were rudimentary in one instance and markedly fibrillar in the most obvious instance. Neuron-specific enolase was demonstrated in tissue sections and in longterm cell cultures from three of the tumors. The cultured cells put out moderately long beaded processes in serum-free medium but had no catecholamine fluorescence. Electron microscopy of the tumor rosettes and the cultured cells showed processes containing aggregates of microtubules and only one case had rare neurosecretory granules. This study suggests that some small round cell tumors of bone and soft tissue in children, which present as Ewing's sarcoma, are neuroectodermal in nature.

Myxoid chondrosarcoma of the os calcis: a case report

This case report of a myxoid chondrosarcoma of the os calcis is presented because of its rarity. The clinical, roentgenographic, and pathological features are discussed, and the difficulty in diagnosis is elaborated.

Can a calcaneal morphologic index determine the degree of osteoporosis?

The proposal that a scoring system of the radiographic trabecular patterns of the os calcis could be related to degree of osteoporosis was tested. The technique fails as it showed no correlation with actual bone density determined by a Compton scatter technique and because of a low level of observer concordance. Possible reasons for the poor performance of the index developed in India when applied to North Americans are discussed.

Aneurysmal bone cyst of the calcaneus

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

Desmoplastic fibroma of bone. A report of six cases

The clinical and pathological features of six cases of desmoplastic fibroma of bone are presented. Desmoplastic fibroma is rarely seen as a primary tumour of bone; when it does occur the sites of predilection are the long bones, but other sites such as the scapula and os calcis can be involved. Radiographically the lesion tends to expand the bone from within; it is well-demarcated and lytic, often with a trabeculated soap-bubble appearance. The cellular structure and the morphological arrangement are similar to those of aggressive fibromatosis of soft tissues. Differential diagnosis from malignant spindle-cell lesions of bone is important because the treatment of choice for desmoplastic fibroma of bone is simply excision with a thin layer of healthy tissue.

Invasive retrocalcaneal bursitis: a report of three cases

The authors describe three cases of retrocalcaneal bursitis, characterized by considerable local clinical symptomatology. The diagnosis was made clinically and confirmed histopathologically. In none of these cases, even after several years, did systemic rheumatic disease develop. Removal of the bursa brought about clinical cure.

[Subarticular spongiosa and its relation to the remaining internal structure of the calcaneus in the human]

The subarticular cancellous bone of the human calcaneus has been investigated in sixty nine cases of known age and sex. In addition eleven calcanei without corresponding informations were used. The three forms of cancellous bone and their threedimensional junctions were analysed by means of the dental burr. It is shown an age bound transformation of the roundmeshed cancellous bone into tubular structures and finally into bone plates or an trabecular network. A tubular construction is presumed as intermediate stage changing by osteolysis into bone plates or trabecular meshwork. The conception of the trajectorial structure presented by Gierse (1976) is more differentiated and enlarged. Considering the calcaneus the normal osteoporosis of old age can be understood to be an age controlled exactly adjusting process. The findings of wide spaced an enlarged cancellous bone elements in a few elder individuals is thought to be a secondary adaptation after preceding normal reduction. Histologic and biometric investigations of this subject will be following.

Congenital dislocation of the peroneal tendons in the calcaneovalgus foot

Congenital dislocation of the peroneal tendons is a rare and infrequently reported deformity of the foot in the neonate. Four cases of this deformity associated with a congenital calcaneovalgus deformity of the foot have been treated and followed to the resolution of both of the deformities. The calcaneovalgus foot proved more resistant to correction and required more prolonged and aggressive treatment than was usual when it was found as an isolated deformity. All four patients demonstrated other stigmata of intra-uterine malposition and oligohydramnios or both. Our anatomical studies suggested that the superior peroneal retinacular ligament was the critical stabilising structure for the peroneal tendons. A concept of the pathogenesis of this deformity is discussed and a proven regimen for its treatment presented.

An anatomic study of the anterior superior process of the os calcis and its clinical application

The anatomy of the anterior superior process of the calcaneus was studied from 15 fresh amputation specimens and from two cases of surgical intervention of fractures of this process. Specific anatomic relationship exist between the associated ligamentous attachments and the production of fractures of this process. It was found that both the anterior interosseus talocalcaneal and calcaneocuboid ligaments were tight on inversion and on inversion plus plantarflexion, suggesting that both of these ligaments may play a part in the production of avulsion fractures of the anterior calcaneal process. The relationship between the articular facets of the calcaneal process, including the inconstant anterior talocalcaneal facet, and the occasional unexpected poor results encountered with these fractures is described. Finally, the local anatomy is correlated with tarsal coalitions found in this area.

A radiographic study of skeletal deformities in treated clubfeet

Thirty-two patients with treated unilateral clubfoot deformity were followed for a period of 13 to 30 years. The functional results were satisfactory in 28 feet. A comparison of the skeletal features of the normal and the clubfeet was made on roentgenographs. Many clubfeet had small, slightly flattened talar heads, decreased talocalcaneal angles, undersized or misshapen facets of the subtalar joint, and medially displaced navicular. The residual deformity of the hindfoot was compensated by the lateral displacement and lateral angulation of the cuneiforms with respect to the navicular resulting in a normal alignment of the forefoot in relation to the hindfoot. The range of ankle dorsiflexion, subtalar and midtarsal joint motion was restricted in the clubfeet.

Neonatal osteomyelitis of the os calcis: a complication of repeated heel punctures

Neonatal osteomyelitis has been frequently reported, but only rarely as a complication of repeated heel punctures. The need for constant monitoring of premature newborns and those having low birthweight and serious deformities necessitates repeated blood samples, usually obtained by heel puncture. Os calcis osteomyelitis occurred in three patients, possibly secondary to heel puncture. A swollen lower extremity in newborns should alert clinicians to the possibility of infection originating in the heel. Treatment involves adequate doses of appropriate antibiotics, but if the infection does not respond within 48 hours, then surgical drainage is indicated. Secondary extension to more proximal areas can and may occur with catastrophic consequences. Orthopedic surgeons should help other physicians become aware that repeated heel punctures may cause os calcis osteomyelitis and that they should be avoided.

Unfavourable radiological signs in fractures of the calcaneum

Although 28 radiological signs in both primary and late radiographs were analysed for 67 patients with 86 fractures of the calcaneum. The fracture type is correlated with the clinical late result in Table 1. The radiological signs which predict or correlate with a poor late result are presented in Table 2. The operative reduction is mainly directed to improve the architecture of the posterior talocalcaneal joint: in our series the improvement was observed in half of the postoperative radiographs. However, this improvement was not usually followed by a favourable late result; mainly because the operated patients had also the most severe injuries.

Multifocal benign chondroblastomas: report of a case

Benign chondroblastoma is an unusual solitary bone tumor occurring usually in the second decade in a long bone. The tumor is often sited on epiphyseal cartilages. Very few examples of malignant variants have been documented, although local recurrence of benign tumors is not unusual. We wish to report a patient who developed two chondroblastomas in two distinct anatomical sites (tibia and calcaneus) over the space of seven years, with no clinical or histological features of malignant disease.

Effects of 1 alpha,25-dihydroxycholecalciferol on disuse osteoporosis in the dog: a histomorphometric study

Disuse osteoporosis was produced in dogs by immobilization of the left rear limb in a plaster cast. The trabecular bone volume of the calcaneus was then determined following treatment with 1 alpha,25-dihydroxycholecalciferol for 4 weeks with oral dosages of 60 to 240 ng/kg of body weight. The trabecular bone volume percentage of the immobilized calcaneus was in direct relation to the dosage of 1 alpha,25-dihydroxycholecalciferol.

Calcaneal cysts. A radiological and anatomico-pathological study

A radiological and anatomico-pathological study of 17 cases of calcaneal cysts in young patients without other known affections is documented. There are two essential histological characteristics of the fibrous wall lining the cysts: (1) hemosiderin deposits together with cholesterol and an associated giant cell reaction, which can be attributed to previous hemorrhages; (2) newly formed bone--similar to that observed in solitary cysts of the humerus and femur--applied to preexisting trabeculae which forms a bony wall explaining the typical radiological picture. These uncommon cysts may be the evolution of purely local hemorrhages in the trigonum calcis.

[Dislocations of the calcaneum, talus and navicular bones. Report of 7 cases (author's transl)]

The authors report 7 cases of sub-taloid dislocation, to which they prefer Allieu's term of talo-navicular-calcaneal dislocation, either internal (the most frequent) or external (rare) depending on the direction of displacement of the foot. After studying their mechanism, they analyse the results, which, contrary to dislocation-fractures of the talus, are usually good, in spite of the frequency of subtalal arthritis.

Metastatic osteomyelitis following BCG vaccination

An 8-year-old girl, who had been vaccinated with BCG without subsequent regional reactions, developed osteomyelitis in the left calcaneus 7 months later. The process healed after surgical treatment and chemotherapy for 1 year. Culture from the bone abscess gave growth of mycobacteria which could not be distinguished from BCG.

A spontaneous ankle deformity in an inbred strain of mouse

A spontaneous subluxation and subsequent dislocation of the bones of the ankle has been described in the males of an inbred strain of mouse (STR/ORT). It consisted of a gradual elevation of the calcaneum which eventually came to lie along the distal end of the tibia after 6--8 mth. The astragalus rotated forward. Articulations with the navicular and tarsal bones were severely disrupted with the accompanying development of peri-articular calcifications and ossifications. With one exception the arthropathy only occurred in male mice. Of the male members of the colony over the age of 3 mth, 26.7 per cent. had at least one ankle affected. Possible aetiological factors are discussed.

Intraosseous lipoma. A report of two cases

Intraosseous lipoma seems to be a rare condition as only some 20 cases have been reported so far. A further two cases are described the lesions being in the calcaneus and in the tibia. Radiographically the lesions appeared osteolytic and well delineated, containing calcified areas. The microscopic features were those of mature adipose tissue. Curettage and packing with autogenous bone grafts is recommended, if the lesion causes pain or a correct diagnosis cannot otherwise be obtained.

Calcaneal abnormalities in articular disorders. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Reiter syndrome

The calcaneus of normal control patients, and those with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and Reiter syndrome was studied. Pathological abnormalities of the plantar aponeurosis, Achilles tendon, and retrocalcaneal bursa account for the radiographic alterations. In normal individuals, lateral radiographs show the thickness of the Achilles tendon to be not greater than 8 mm; the retrocalcaneal bursa creates a radiolucency which extends at least 2 mm below the superior surface of the calcaneus. In patients with any of these 4 articular disorders, Achilles tendinitis produces thickening of the tendon, and retrocalcaneal bursitis obliterates the normal radiolucency.

Aggressive chondroblastoma. Report of a case with multiple bone and soft tissue involvement

A 14-year-old male had a recurrent chondroblastoma in his right talus which involved the right calcaneus and the soft tissue of that ankle. While the initial lesion had a typical, benign appearance, the recurrent lesion and the soft tissue nodules showed a significantly elevated mitotic rate. Although some extraosseous involvement by chondroblastomas may be secondary to soft tissue or hematogeneous seeding at the time of surgery, and aggressive variant of chondroblastoma appears to exist. Previous reports of these aggressive cases show a poor correlation between histologic appearance and biologic behavior. When objective quantitation of cytologic features such as mitotic rate are made, we believe that these features may serve as a marker for identification of those cases of chondroblastoma which have a propensity for aggressive behavior.

Chondroblastoma of the calcaneus: radiographic features with emphasis on location

Fourteen cases of chondroblastoma of the calcaneus have been examined and the radiographic features described. Thirteen occured in males. In all but one case the location was either at the talocalcaneal articulation or adjacent to the posterior calcaneal cortex. A sclerotic margin was present in all instances. Occasionally calcifications and septations were seen.

Intraosseous lipoma of the calcaneus. Report of a case and a short review of the literature

One case of an intraosseous lipoma of the calcaneus bone is presented together with a short review of the literature. Only 20 cases of tumors in the extremities have so far been published. The typical X-ray picture shows a cystic, sharply demarcated cavity, which macroscopically at operation is filled with yellowish, adipose tissue. In the present case and one previously published a central sclerotic mass was observed. The histological picture is typical, with mature adipose tissue mixed with a few degenerated bone trabeculae.