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Xiao W, Jin X, Wang X, Bai J, Zhang W, He T, Mao Z, Dong Y, Zhang C. Factors influencing functional outcome of fractures of the anterior process of the calcaneus. Orthop Traumatol Surg Res 2024; 110:103572. [PMID: 36739963 DOI: 10.1016/j.otsr.2023.103572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fractures of the anterior process of the calcaneus (APC) are easily overlooked in clinical practice. Most patients have good to excellent clinical outcome after conservative treatment, while some patients may have persisting symptoms and unfavorable functional outcomes. The aim of this study was to identify the risk factors associated with unfavorable functional outcome after conservative treatment in APC fractures. METHODS All patients presenting with APC fractures and receiving conservative treatment from April 2019 to April 2020 were retrospectively assessed. The primary outcome measurement was the ankle joint function assessed using Karlsson Scoring System at 2 years post-injury. The risk factors associated with unfavorable functional outcomes (Karlsson score ≤ 80) were evaluated by logistic regression analysis. RESULTS In total, 84 patients were included with a mean age of 40 years. 26 (31%) patients presented with unfavorable functional outcome at 2 years post-injury. In multivariate logistic regression, concomitant fractures of talonavicular (TN) joints and older age were significantly associated with unfavorable functional outcome (p<0.05). Patients with concomitant fractures of TN joints had an odds ratio of 3.623 for unfavorable functional outcome. The optimal cutoff age for an unfavorable outcome was ≥ 47.5 years, with an odds ratio of 5.010. CONCLUSION Most patients with APC fractures achieved good to excellent results when treated conservatively. Attention should be paid to those with concomitant fractures of TN joints and with age ≥ 47.5 years, which might lead to unfavorable functional recovery. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
- Weiyuan Xiao
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Xiangyun Jin
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Xinyi Wang
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Jiarun Bai
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Wei Zhang
- Clinical Research Center, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Tao He
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Zhenyang Mao
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Yuqi Dong
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China
| | - Chao Zhang
- Department of Orthopaedic Trauma, School of Medicine, Shanghai Jiaotong University, Renji Hospital, 200127 Shanghai, People's Republic of China.
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Koetser ICJ, Espinosa Hernández EA, Kerkhoffs PDGMMJ, Goedegebuure S, Smithuis FF, Maas PDM. Don't Miss Me: Midfoot Sprains, A Point-of-Care Review. Semin Musculoskelet Radiol 2023; 27:245-255. [PMID: 37230125 DOI: 10.1055/s-0043-1767766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.
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Affiliation(s)
- Inge C J Koetser
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Enrique A Espinosa Hernández
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Prof Dr Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centers (AUMC), Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), The Netherlands Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Simon Goedegebuure
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centers (AUMC), Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), The Netherlands Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Frank F Smithuis
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Prof Dr Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
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Fenech M, Wylie B. Sonographic anatomy and imaging of the dorsal supportive ligaments of the Chopart joint complex. SONOGRAPHY 2022. [DOI: 10.1002/sono.12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michelle Fenech
- College of Clinical Sciences, School of Health, Medical and Applied Sciences CQUniversity Rockhampton Queensland Australia
| | - Bridie Wylie
- Qscan Radiology Clinics Brisbane Queensland Australia
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Kobayashi T, Watanabe K, Teramoto A, Suzuki D, Fujimiya M, Yamashita T. Biomechanical Analysis of Midfoot Instability After Bifurcate Ligament Injury and Ankle Brace Application: A Cadaveric Study. J Foot Ankle Surg 2021; 59:711-715. [PMID: 31954599 DOI: 10.1053/j.jfas.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/17/2019] [Accepted: 12/09/2019] [Indexed: 02/03/2023]
Abstract
This cadaveric study investigated the biomechanical characteristics and stabilizing contribution of the bifurcate ligament using a multidirectional loading method and assessed the stabilizing effect of a brace after injury of the ligament. Eight freshly frozen cadaveric feet were tested for forefoot torque in inversion, eversion, adduction, and plantarflexion. Each band of the bifurcate ligament was transected sequentially, and the contribution of each portion of the ligament, as well as the stabilizing effects of the ankle brace, were examined. Stability decreased substantially after calcaneocuboid ligament transection for inversion and adduction loading. Bracing restored some stability, except for the adduction loading direction, for which it had only limited effect. The data indicate that inversion and adduction loading are strongly related to bifurcate ligament injury. The stabilizing effect of the ankle brace may have limited effectiveness for loads under adduction.
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Affiliation(s)
- Takuma Kobayashi
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | - Kota Watanabe
- Professor, Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Lecturer, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Daisuke Suzuki
- Professor, Department of Health Sciences, Hokkaido Chitose College of Rehabilitation, Chitose, Hokkaido, Japan
| | - Mineko Fujimiya
- Professor, Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Professor, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Abstract
This article reviews the magnetic resonance imaging (MRI) findings of the normal anatomy and various pathologic conditions of the ankle and foot commonly encountered in clinical practice. The spectrum of entities discussed includes osseous and osteochondral injuries, ligamentous injuries, common traumatic and degenerative tendon pathology, abnormalities of transverse tarsal joint (Chopart) and tarsometatarsal joint (Lisfranc) complexes, pathological conditions affecting capsuloligamentous structures of the great toe and lesser toes, as well as pedal infection, with a focus on diabetic osteomyelitis and neuropathic osteoarthropathy.
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Albee ME. Diagnosing tarsal coalition in medieval Exeter. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 28:32-41. [PMID: 31911394 DOI: 10.1016/j.ijpp.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study is to estimate the frequency and types of tarsal coalition represented in medieval remains from Exeter, England. MATERIALS 183 individuals from the Cathedral Green site in Exeter, England. METHODS Gross macroscopic analysis combined with radiographic examination and comparison with clinical and archaeological literature. RESULTS Eight coalitions of various forms were ultimately identified; these include five calcaneonavicular, one talocalcaneal, one calcaneocuboid, and one lateral cuneiform-third metatarsal coalition. CONCLUSIONS These frequencies are quite high for clinical imaging estimations, but consistent with other reported archaeological frequencies. SIGNIFICANCE This study contributes to known frequencies of tarsal coalition in the past. It also provides descriptive diagnostic criteria for identifying tarsal coalition in archaeological populations. LIMITATIONS Poor preservation of some of the individuals in this sample means that the true frequencies of tarsal coalition may be underrepresented. SUGGESTIONS FOR FURTHER RESEARCH This study should be expanded to include more archaeological sites, especially medieval British sites, to determine overall prevalence rates. Additionally, the diagnostic criteria should be compared with other examples of known tarsal coalition to further our understanding of this rare pathology.
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Kafka RM, Aveytua IL, Choi PJ, DiLandro AC, Tubbs RS, Loukas M, Mintz DN, Baidya R, Kumar S, Sangari SK, Mtui EP, D'Antoni AV. Anatomico-radiological Study of the Bifurcate Ligament of the Foot with Clinical Significance. Cureus 2019; 11:e3847. [PMID: 30891387 PMCID: PMC6411328 DOI: 10.7759/cureus.3847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Lateral ankle sprain caused by forcible plantar flexion and inversion of the foot commonly damages the anterior talofibular ligament and other ligaments. Unfortunately, involvement of the bifurcate ligament (BL) is often overlooked when assessing such injuries in clinical practice and identification of this ligament on magnetic resonance (MR) scans can be challenging. Anatomically, the BL is a Y-shaped structure with two bands: the calcaneonavicular ligament (CNL) and calcaneocuboid ligament (CCL). There are few anatomical studies on the morphometric characteristics of the BL and even fewer biomechanical studies. Therefore, the objective of this anatomico-radiological study was to investigate the morphology of the BL using a multifaceted approach, and classify the fiber characteristics of the CNL and CCL. Materials and methods We measured the length and the width of 53 embalmed cadaveric feet. Meticulous dissection of each foot was performed to expose the BL. Measurements of the length, width, thickness, and shape of the CNL and CCL were taken using a digital caliper. We also documented the fiber orientation of each ligament, and used a goniometer to measure the bifurcation angle between the CNL and CCL via two methods. Confirmatory histologic analysis of the ligaments was performed and digital radiographs of the ligaments with attached radiopaque monofilament were taken. We also included an MR scan of the BL. Using descriptive and inferential statistics, we documented any significant relationships between the variables. Results Mean (range) age at death of cadavers was 76 (42-94) years. The CNL was found in all the feet and the CCL was not present in 9.4% of the feet. Mean (standard deviation) length of the CNL and CCL was 22.7 (4.12) mm and 10.9 (2.53) mm, respectively. Mean (standard deviation) thickness of the CNL and CCL was 3.23 (1.56) mm and 1.48 (0.71) mm, respectively. Related to ligament morphology, the CNL was most frequently cord shaped (67.92%) and the CCL was most frequently flat shaped (83.33%). The mean bifurcation angle measured 32.75o and 29.31o in methods 1 and 2, respectively. The correlation between the two measured angles was very strong (p < 0.001). Discussion We found that 90.6% of feet had both the CNL and CCL, 9.4% had the CNL and no CCL, and none (0%) had the CCL and no CNL. These frequencies are similar to a recent Japanese study. Our sample of donors were American and predominantly white. Whether the difference in frequencies between the studies is related to ethnicity is unknown and requires future investigation. Interestingly, on average the CNLs were twice as long and twice as thick as the CCLs. The CCLs tended to be wider distally and tapered compared to the CNLs. Conclusions Our findings better classify the morphology and fiber orientation of the BL. Coupled with the radiographs and MR scan, our data may be of particular value to radiologists and surgeons. Our BL fiber orientation classification system and angle measurements can pave the way for future biomechanical studies to investigate any relationships between fiber type, angle, and strength of the constituent bands. More accurate descriptions of the BL should lead to improved diagnosis and treatment of ligamentous injuries of the foot.
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Affiliation(s)
- Rene M Kafka
- Podiatry, Eastern Colorado Health Care System, Denver, USA
| | | | - Paul J Choi
- Surgery, Seattle Science Foundation, Seattle, USA
| | | | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
| | | | | | - Ritwik Baidya
- Radiology, Weill Cornell Medical College, New York, USA
| | - Sushil Kumar
- Radiology, Weill Cornell Medical College, New York, USA
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Abstract
Tarsal coalitions are the result of impaired mesenchymal separation of the tarsal bones. The most common types include calcaneonavicular or talocalcaneal coalitions. Subtalar stiffness results in pathologic kinematics with increased risk of ankle sprains, planovalgus foot deformity, and progressive joint degeneration. Resection of the coalition yields good results. Tissue interposition may reduce the risk of reossification, and concomitant deformity should be addressed in the same surgical setting.
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Affiliation(s)
- Georg Klammer
- Foot and Ankle Surgery, FussInstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Norman Espinosa
- Foot and Ankle Surgery, FussInstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| | - Lukas Daniel Iselin
- Foot and Ankle Surgery, Department of Orthopaedic Surgery and Traumatology, Spitalstrasse 16, Kantonsspital Lucerne, Lucerne 6000, Switzerland
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Imaging of Chopart (Midtarsal) Joint Complex: Normal Anatomy and Posttraumatic Findings. AJR Am J Roentgenol 2018; 211:416-425. [PMID: 29927330 DOI: 10.2214/ajr.17.19310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this article is to review the normal anatomy and posttraumatic findings of the Chopart joint complex. Key imaging features of the normal ligaments and patterns of ligamentous and osseous injuries are discussed. CONCLUSION Traumatic midtarsal injuries, particularly midtarsal sprain, are often overlooked clinically and on imaging but are relatively common and typically are associated with inversion ankle injuries. Radiologists should be familiar with Chopart joint anatomy and the imaging features of midtarsal injuries because early diagnosis may help optimize clinical management.
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10
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Massen FK, Baumbach SF, Böcker W, Kammerlander C, Herterich V, Polzer H. [Fractures of the anterior process of the calcaneus-frequently overlooked injuries following ankle sprains]. Unfallchirurg 2018; 121:730-738. [PMID: 29845370 DOI: 10.1007/s00113-018-0514-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures to the anterior process of the calcaneus (PAC) have long been considered rare injuries and have received little attention in clinical research. On the contrary, recent studies have reported a distinct higher incidence, especially following ankle sprains. Decisive reasons are that fractures of the PAC are regularly missed on plain radiographs and that a clinical differentiation from injuries to the lateral ankle ligaments is difficult. With the broad availability of cross-sectional imaging modalities fractures of the PAC are diagnosed more frequently and more reliably. The purpose of this review is to give an overview on the diagnostics, classification and treatment recommendations to this topic and discuss the studies available. To date no evidence-based recommendations are available for the treatment of fractures of the PAC. The few case reports and case series published, predominantly recommend conservative treatment; however, the treatment regimens vary considerably, ranging from immobilization in a lower leg cast (2-10 weeks) to early functional treatment with full weight-bearing. The surgical treatment by open reduction and internal fixation has been described primarily for large dislocated fractures. Surgical excision is considered mainly in cases of persistent pain or symptomatic non-union following non-operative treatment. For both, non-operative and operative treatment, the case reports and case series report satisfactory outcomes for the majority of patients. Nevertheless, comparative studies and patient-rated outcome measures are missing. Therefore, evidence-based recommendations cannot be given.
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Affiliation(s)
- F K Massen
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - S F Baumbach
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - W Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - C Kammerlander
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität, Nußbaumstr. 20, 80336, München, Deutschland
| | - V Herterich
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - H Polzer
- Sektion für Fuß- Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.
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Acute Fracture of the Anterior Process of Calcaneus: Does It Herald a More Advanced Injury to Chopart Joint? AJR Am J Roentgenol 2018; 210:1123-1130. [DOI: 10.2214/ajr.17.18678] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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JOURNAL CLUB: MRI Evaluation of Midtarsal (Chopart) Sprain in the Setting of Acute Ankle Injury. AJR Am J Roentgenol 2018; 210:386-395. [DOI: 10.2214/ajr.17.18503] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Galluzzo M, Greco F, Pietragalla M, De Renzis A, Carbone M, Zappia M, Maggialetti N, D'andrea A, Caracchini G, Miele V. Calcaneal fractures: radiological and CT evaluation and classification systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:138-150. [PMID: 29350643 PMCID: PMC6179077 DOI: 10.23750/abm.v89i1-s.7017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
Background and aim of the work: The calcaneus, the more lower bone of the body, has the task of supporting the axial load from the weight of the body. Calcaneal fractures represent about 1-2% of all fractures and 60% of the tarsal bones fractures. The articular involvement has been associated with a poor functional outcome. The aim of this work is to describe the radiologic evaluation, the classification systems, the morphological preoperative diagnostic imaging features of calcaneal fractures, highlighting the correlation with the choice of treatment and predictive capacity for the fracture surgical outcome. Methods: A PubMed search was performed for the terms Imaging calcaneus fracture, selecting articles in English language, published in the last two years, where preoperatively diagnostic imaging of fractures of the calcaneus are described. Case reports have not been included. Results: We have collected a number of data that provide important help in preoperative evaluation of calcaneal fractures, such as the new classification system created by Harnroongroj et al, the association of calcaneal fractures with fractures of other bone structures or soft tissue impairment, the use of calcaneotalar ratio in assessing the length of heel. Conclusions: These data suggest an approach geared to the specific choice of treatment and to improving patient outcomes. (www.actabiomedica.it)
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Abstract
The anterior end of calcaneum fractures can present as inversion injuries, stress fractures or as a part of displaced intraarticular calcaneum fracture. Rarely, these may occur due to abduction injury from a laterally directed force that crushes the anterior calcaneum instead of the cuboid, and has associated medial column injuries which are unrecognized. Compression fractures of the anterior calcaneum are actually lateral column shortening injuries with poor outcomes in the few published reports. We describe three patients with compression fractures of the anterior end of calcaneum resulting from foot abduction injury which were managed by reduction and column length restoration via distraction by external fixator. All three fractures showed good to excellent outcomes using the American Orthopedic Foot and Ankle Society midfoot score at followup >1 year. Awareness of this injury pattern is important, and appropriate measures to reduce and maintain the fracture reduction are needed to avoid long term disability.
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Affiliation(s)
| | - Ankit Khurana
- Department of Orthopaedics, AIIMS, New Delhi, India,Address for correspondence: Dr. Ankit Khurana, Department of Orthopaedics, AIIMS, New Delhi, India. E-mail:
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Multiple abnormalities in the feet and associated changes elsewhere in the skeleton: The case of 3A-7 from a Capsian Site in Algeria. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:199-212. [PMID: 28549622 DOI: 10.1016/j.jchb.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/03/2017] [Indexed: 11/22/2022]
Abstract
A skeleton with a number of abnormalities is described involving full discussion of alternative diagnoses. In this complex case, the primary diagnosis is of avulsion of the stem of the bifurcate ligament causing a fracture of the anterior process of the calcaneus. The bilateral fracture identified in Skeleton 3A-7 from Site 12, a Capsian site in Algeria, is a result of the feet being inverted and plantar flexed: the fracture is prone to non-union, which is asymmetrical here. There is also a separate anatomical variation of the feet, 3rd cuneiform and 3rd metatarsal coalition, which was not the cause of trauma. The bifurcate ligament is a major stabilizer of the lateral transverse talar joint, and the trauma could lead to further issues: however, multiple other traumatic changes in 3A-7 most likely occurred at the same time, rather than as the result of pre-existing foot trauma. The asymmetry of the calcaneal condition and asymmetry of the sequelae of the original trauma led to long bone asymmetry, the result of locomotor difficulties.
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Meehan TM, Martinez-Salazar EL, Torriani M. Aftermath of Ankle Inversion Injuries. Magn Reson Imaging Clin N Am 2017; 25:45-61. [DOI: 10.1016/j.mric.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Gibbons L, Cunningham P. Anterior process of the Calcaneum - Not to be missed. Int Emerg Nurs 2016; 30:36-40. [PMID: 27773602 DOI: 10.1016/j.ienj.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/29/2016] [Accepted: 09/04/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Lynda Gibbons
- Our Lady's Hospital, Navan, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland.
| | - Patricia Cunningham
- Our Lady's Hospital, Navan, Ireland; Our Lady of Lourdes Hospital, Drogheda, Ireland; Faculty of Radiologists in Ireland, Royal College of Surgeons (RCSI), Ireland
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19
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20
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Abstract
As long as radiography remains cheap and provides value in patient care, it will continue to be widely used as a front-line imaging technique. There are limitations to what a radiograph can depict, however. It is imperative to understand the limitations of radiography to avoid pitfalls owing to the overlap of numerous osseous structures. This article reminds the reader of the association between certain radiographic abnormalities and the anatomic relevance in the patient. Although interpretive errors occur in fast-paced, high-volume emergency settings, meticulous attention to changes in the cortex and medullary bone may help to keep errors to a minimum.
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Affiliation(s)
- Joseph S Yu
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 481, Columbus, OH 43210, USA.
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Tuthill HL, Finkelstein ER, Sanchez AM, Clifford PD, Subhawong TK, Jose J. Imaging of tarsal navicular disorders: a pictorial review. Foot Ankle Spec 2014; 7:211-25. [PMID: 24686907 DOI: 10.1177/1938640014528042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The tarsal navicular is a bone within the midfoot that plays a critical role in maintaining the arch of the foot. This bone is clinically relevant because it may be affected by a wide array of pathologies. Our approach includes a detailed description of the imaging characteristics and disorders affecting the tarsal navicular. Organization includes (a) normal imaging, (b) accessory ossicles, (c) coalition, (d) fractures, (e) Kohler's disease, (f) osteonecrosis, (g) osteochondral lesions, (h) arthropathies, and (i) tumors. The purpose of this article is to discuss normal variants and pathological processes that can affect the tarsal navicular, with emphasis on the often-overlooked imaging findings.
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Affiliation(s)
- Heidi L Tuthill
- University of Miami Miller School of Medicine/Jackson Health System, Miami, Florida (HLT, ERF, AMS, PDC, TKS, JJ)
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Aykanat F, Kose O. Chronic Ankle Pain After An Initial 'Twisting' Injury To The Ankle. Turk J Emerg Med 2014; 14:46. [PMID: 27331168 PMCID: PMC4909873 DOI: 10.5505/1304.7361.2014.02069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/04/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Faruk Aykanat
- Department of Orthoapedics and Traumatology, Islahiye State Hospital, Gaziantep
| | - Ozkan Kose
- Department of Orthoapedics and Traumatology, Antalya Education and Research Hospital, Antalya
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Frakturen des Processus anterior calcanei. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:579-91. [DOI: 10.1007/s00064-013-0248-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 01/28/2023]
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Choudhary S, McNally E. Review of common and unusual causes of lateral ankle pain. Skeletal Radiol 2011; 40:1399-413. [PMID: 20972871 DOI: 10.1007/s00256-010-1040-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 09/15/2010] [Accepted: 09/19/2010] [Indexed: 02/02/2023]
Abstract
Lateral ankle pain is a common clinical presentation having several important causes, including lateral ligament injury, peroneal tendon injury, sinus tarsi syndrome, and nerve entrapments. However, other causes should be kept in mind in patients with unusual patterns of pain or intractable symptoms. We present a review of common and some unusual causes of lateral ankle pain including a review of post-operative imaging findings following surgery for lateral ankle ligament and peroneal tendon injuries.
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Affiliation(s)
- Surabhi Choudhary
- Musculoskeletal Radiology, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK.
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25
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Lui TH. Endoscopic excision of symptomatic nonunion of anterior calcaneal process. J Foot Ankle Surg 2011; 50:476-9. [PMID: 21601485 DOI: 10.1053/j.jfas.2011.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Indexed: 02/03/2023]
Abstract
Most fractures of the anterior process of the calcaneus are successfully treated with cast immobilization. Large fragments might be amenable to open reduction and internal fixation. The correct initial diagnosis and treatment are important, particularly if the fracture fragment is large. An improper initial diagnosis will lead to painful nonunion requiring surgical intervention. We present a case of symptomatic nonunion of the anterior calcaneal process that was successfully treated by endoscopic resection of the fragment. The adjacent structures can be examined arthroscopically for concomitant lesions and treated accordingly.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China.
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26
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Vijayanathan S, Butt S, Gnanasegaran G, Groves AM. Advantages and Limitations of Imaging the Musculoskeletal System by Conventional Radiological, Radionuclide, and Hybrid Modalities. Semin Nucl Med 2009; 39:357-68. [DOI: 10.1053/j.semnuclmed.2009.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Yu JS, Cody ME. A template approach for detecting fractures in adults sustaining low-energy ankle trauma. Emerg Radiol 2009; 16:309-18. [DOI: 10.1007/s10140-009-0796-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 01/15/2009] [Indexed: 10/21/2022]
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28
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Demographics of extra-articular calcaneal fractures: including a review of the literature on treatment and outcome. Arch Orthop Trauma Surg 2008; 128:1099-106. [PMID: 18094984 DOI: 10.1007/s00402-007-0517-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Indexed: 12/19/2022]
Abstract
INTRODUCTION 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 was to investigate the incidence of extra-articular calcaneal fractures in a Level 1 trauma centre, define the distribution of the various types of fractures and compare patient demographics between extra- and intra-articular calcaneal fractures. In addition the literature was reviewed for the most common types of extra-articular calcaneal fractures with regard to incidence, treatment and clinical outcome. METHODS The radiological records between 2003 and 2005 were reviewed for intra- and extra-articular calcaneal fractures. Patient gender-distribution and age were compared. A literature search was conducted for the treatment of extra-articular calcaneal fractures. RESULTS In this 3-year study period a total of 49 patients with 50 extra-articular calcaneal fractures and 91 patients with 101 intra-articular fractures were identified. The median age for the first group was 32.7 years, and for the second group 40.3 years; P = 0.04. Male predominance was significantly less pronounced for extra-articular (63%) compared with intra-articular fractures (79%; P = 0.04). CONCLUSION One-third of all calcaneal fractures are extra-articular. Significant differences exist between the intra- and extra-articular groups, in terms of lower age and male-female ratio. The literature study shows inconsistencies in treatment options, but most extra-articular fractures are well manageable conservatively.
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29
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Abstract
Sprains are disruptions of the ligamentous anatomy about a joint. The ankle sprain is one of the most common injuries seen in podiatric and orthopedic practice. It usually is incurred from an inversion force on the ankle, but eversion forces also can traumatize the ankle. Many times, this injury is taken for granted because of the frequency of its presentation. The patient usually is given appropriate initial care, but the patient can experience continued or residual pain. Podiatrists have found this problem is common and have come to recognize that secondary or accessory injuries occur that slow the natural recovery of this injury.
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