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Rathjen J, Völlmecke M, Bieler D, Franke A, Kollig E. [Calcaneoplasty with radiofrequency cementing following balloon reduction]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:151-159. [PMID: 37875588 PMCID: PMC10834604 DOI: 10.1007/s00113-023-01365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 10/26/2023]
Abstract
The standard surgical procedure for complex calcaneal fractures is open reduction, internal reduction and internal stable angle plate osteosynthesis via a lateral approach. More recently, options for minimally invasive and percutaneous surgical strategies have been presented [4, 7]. As a possible procedural alternative for a covered, surgical treatment of calcaneal fractures, calcaneoplasty is discussed and applied in this context [5]. In this case series of five complex calcaneal fractures presented here, a balloon catheter was used for percutaneous reduction to restore the alignment of the calcaneus.This was followed by placement of PMMA cement in radiofrequency application and osteosynthesis using percutaneous cannulated screws. This Vicenti technique allows stable reduction and retention with early partial weight bearing with an overall low complication rate [17].
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Affiliation(s)
- J Rathjen
- Klinik für Unfallchirurgie und Orthopädie, Hand- und Wiederherstellungschirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - M Völlmecke
- Klinik für Unfallchirurgie und Orthopädie, Hand- und Wiederherstellungschirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland.
| | - D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Hand- und Wiederherstellungschirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - A Franke
- Klinik für Unfallchirurgie und Orthopädie, Hand- und Wiederherstellungschirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie und Orthopädie, Hand- und Wiederherstellungschirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
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Calcaneal insufficiency fractures following total knee arthroplasty: Classification and clinical findings. Injury 2019; 50:2339-2345. [PMID: 31606135 DOI: 10.1016/j.injury.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Calcaneal insufficiency fracture (IF) following total knee arthroplasty (TKA) is a rare disorder. This study aimed to examine the prevalence and clinical findings of calcaneal IF following TKA. METHODS We retrospectively reviewed 3,585 consecutive patients undergoing primary TKA between 2012 and 2017 in four hospitals. Calcaneal IF following TKA was diagnosed by plain radiography or magnetic resonance imaging. First, we investigated the prevalence and clinical findings of calcaneal IF following TKA. Second, we classified calcaneal IF into three types based on its location: type 1, fracture by traction force around the Achilles tendon insertion; type 2, compression fracture around the posterior subtalar joint; and type 3, fracture by ground reaction force at the bottom of the calcaneus. Finally, we compared the clinical findings between calcaneal IF with and without TKA. RESULTS Calcaneal IF following TKA was seen in 17 (0.5%) of the 3,585 patients undergoing primary TKA. All patients were female, with a mean age of 76.5 ± 5.9 years, relatively high body mass index (BMI), and osteoporosis. All fractures achieved bone union with conservative treatment. Type 1 fractures were the most common. Calcaneal IFs following TKA were significantly shorter in height and the patients had higher BMI than those without TKA. The locations of calcaneal IF following TKA varied, while only type 1 calcaneal IFs were seen in cases without TKA. However, there were no significant differences with regard to the bone union period or malunion between the two groups. CONCLUSIONS Calcaneal IF should be suspected in patients presenting with ipsilateral foot pain following TKA, particularly in female patients with a relatively high BMI and osteoporosis. Calcaneal IF can be classified into three types based on the fracture location. These variations in calcaneal IF may be due to differences in conditions and changes in mechanical loading of the lower extremity and bone quality following TKA.
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Toro G, Langella F, Gison M, Toro G, Moretti A, Toro A, Iolascon G. Stentoplasty of calcaneal fractures: Surgical technique and early outcomes. Injury 2019; 50 Suppl 2:S70-S74. [PMID: 30739765 DOI: 10.1016/j.injury.2019.01.049] [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] [Indexed: 02/08/2023]
Abstract
Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. Minimally invasive percutaneous calcaneoplasty should be an alternative to ORIF aiming to reach a stable reduction, early functional recovery and short hospital stay. The aim of our study was to evaluate the clinical and radiographic outcomes of calcaneus fractures treated with balloon calcaneoplasty (BCP) by using a new generation vertebral augmentation system, VBS™-Vertebral Body Stent-DePuy Synthes. A total of 10 patients treated with VBS™ system were recruited for the study. Nine fractures were caused by a fall from height and one case by traffic accident. The mean follow-up was 8.9 months (range 2.6-23.1). The fractures were categorized according to Sanders and Essex-Lopresti classifications (5: type II, 3: type III and 2: type IV; 9: "joint depression" type and 1 case "tongue" type). Radiographic measurement (Böhler's and Gissane's angles) were evaluated at both pre-operative and immediate postoperative time. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score as well as a subjective evaluation (Visual Analog Scale, VAS) were used for the clinical assessment at the last follow-up. Mean preoperative Böhler's angle was 12.3 ± 8.41° (95% CI 6.3-18.3°), whereas mean preoperative Gissane's angle was 123.66 ± 20.47° (95% CI 109.0-138.3°). At postoperative follow-up mean Böhler's angle increased to 21.51 ± 4.17° (95% CI 18.5-24.5°; p < 0.01), and mean postoperative Gissane's angle was 121.74°±6.82° (95% CI 116.8°-126.6°). Mean AOFAS at the last follow-up was 70.4 ± 17.44 (95% CI 57.9-82.8). Our study demonstrates that percutaneous calcaneoplasty using VBS™ is an effective treatment for calcaneus fracture and capable to implement correction manoeuvre with clinical and radiographic outcomes comparable with other percutaneous stentoplasty.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Francesco Langella
- Unit of Orthopaedics and Traumatology, Santa Maria della Speranza Hospital, Battipaglia, Italy
| | - Michele Gison
- Unit of Orthopaedics and Traumatology, Martiri del Villa Malta Hospital, Sarno, Italy
| | - Gabriella Toro
- Unit of Radiology and Nuclear Medicine, Santa Maria della Speranza Hospital, Battipaglia, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, Martiri del Villa Malta Hospital, Sarno, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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No YJ, Xin X, Ramaswamy Y, Li Y, Roohaniesfahani S, Mustaffa S, Shi J, Jiang X, Zreiqat H. Novel injectable strontium-hardystonite phosphate cement for cancellous bone filling applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 97:103-115. [PMID: 30678894 DOI: 10.1016/j.msec.2018.11.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 10/10/2018] [Accepted: 11/27/2018] [Indexed: 12/16/2022]
Abstract
Injectable bone cement (IBC) such as those based on methacrylates and hydraulic calcium phosphate and calcium sulfate-based cements have been used extensively for filling bone defects with acceptable clinical outcomes. There is a need however for novel IBC materials that can address some of the inherent limitations of currently available formulations to widen the clinical application of IBC. In this study, we characterized a novel hydraulic IBC formulation consisting of bioactive strontium-doped hardystonite (Sr-HT) ceramic microparticles and sodium dihydrogen phosphate, herein named Sr-HT phosphate cement (SPC). The resultant cement is comprised of two distinct amorphous phases with embedded partially reacted crystalline reactants. The novel SPC formulation possesses a unique combination of physicochemical properties suitable for use as an IBC, and demonstrates in vitro cytocompatibility when seeded with primary human osteoblasts. In vivo injection of SPC into rabbit sinus defects show minor new bone formation at the SPC periphery, similar to those exhibited in sinus defects filled with a clinically available calcium phosphate cement. The current SPC formulation presented in this paper shows promise as a clinically applicable IBC which can be further enhanced with additives.
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Affiliation(s)
- Young Jung No
- Biomaterials and Tissue Engineering Unit, School of AMME, Faculty of Engineering and IT, University of Sydney, NSW 2006, Australia; Joint Bioengineering and Regenerative Medicine Lab, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China
| | - Xianzhen Xin
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China; Joint Bioengineering and Regenerative Medicine Lab, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China
| | - Yogambha Ramaswamy
- Biomaterials and Tissue Engineering Unit, School of AMME, Faculty of Engineering and IT, University of Sydney, NSW 2006, Australia; Joint Bioengineering and Regenerative Medicine Lab, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China
| | - Yihan Li
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China; Joint Bioengineering and Regenerative Medicine Lab, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China
| | - Seyediman Roohaniesfahani
- Biomaterials and Tissue Engineering Unit, School of AMME, Faculty of Engineering and IT, University of Sydney, NSW 2006, Australia
| | - Siti Mustaffa
- Biomaterials and Tissue Engineering Unit, School of AMME, Faculty of Engineering and IT, University of Sydney, NSW 2006, Australia
| | - Jeffrey Shi
- School of Chemical and Biomolecular Engineering, Faculty of Engineering and IT, University of Sydney, NSW 2006, Australia
| | - Xinquan Jiang
- Department of Prosthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China; Joint Bioengineering and Regenerative Medicine Lab, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China.
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Unit, School of AMME, Faculty of Engineering and IT, University of Sydney, NSW 2006, Australia; Joint Bioengineering and Regenerative Medicine Lab, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200011, China.
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Hoogervorst P, Bergen CV, Van den Bekerom M. Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly. CURRENT GERIATRICS REPORTS 2017; 6:9-14. [PMID: 28316904 PMCID: PMC5334400 DOI: 10.1007/s13670-017-0196-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose of Review Treatment of osteoporotic and neuropathic ankle fractures in the elderly is challenging. The purpose of this paper is to review recent publications on this topic and to identify the optimal treatment for these fractures. Recent Findings Treatment consists of a variety of conservative or operative options all with advantages and disadvantages as described in this review. Little research has been published that specifically focuses on elderly patients with ankle fractures. Operative treatment has a high complication rate. Multiple comorbidities are predictors for complications. Summary An optimal treatment could not be distilled but based on the available literature, a general treatment algorithm is proposed. Since the elderly typically are accompanied by multiple comorbidities as well as impaired mobility, the physician should focus not only on treating the fractured ankle but also on the patient as a whole. Further research on this specific topic is needed.
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Affiliation(s)
- P Hoogervorst
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - Cja Van Bergen
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, the Netherlands
| | - Mpj Van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
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