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Takahashi Y, Takegami Y, Tokutake K, Asami Y, Takahashi H, Kato M, Kanemura T, Imagama S. Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically: A Retrospective Multicenter Study. JB JS Open Access 2024; 9:e23.00127. [PMID: 38988332 PMCID: PMC11233096 DOI: 10.2106/jbjs.oa.23.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. Therefore, our study aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs. Methods In this multicenter retrospective study, we collected data of patients with CAvFs treated at 9 hospitals from 2012 to 2022. We performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified. Results The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically. The mean age of patients was 68.5 years; 67% of the patients were female. Nineteen percent of the patients had diabetes, and 19% had osteoporosis. The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%. The reoperation rate was 22%. Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases. Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%. CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments. Conclusions CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yu Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuta Asami
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetane Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mihoko Kato
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Flores DV, Goes PK, Damer A, Huang BK. The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment. Radiographics 2024; 44:e230163. [PMID: 38512730 DOI: 10.1148/rg.230163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Paola Kuenzer Goes
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Alameen Damer
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Brady K Huang
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
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Liu Z, Hou G, Zhang W, Lin J, Yin J, Chen H, Huang G, Li A. Calcaneal tuberosity avulsion fractures - A review. Injury 2024; 55:111207. [PMID: 37984015 DOI: 10.1016/j.injury.2023.111207] [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: 03/09/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
Calcaneal tuberosity avulsion fracture, an extra-articular injury, is a rare fracture caused internally by Achilles tendon driven following intense contraction of gastrocnemius-soleus complex, and externally by low-energy (possibly high-energy). Moreover, the risk of injuries of the skin and Achilles tendon around calcaneal tuberosity is closely related to Lee classification and Carnero-Martín de Soto Classification of calcaneal tuberosity avulsion fracture. Although the diagnosis confirmed by X-ray, digital imaging and computed tomography (CT), magnetic resonance imaging (MRI) should also be used to evaluate soft tissue. In recent years, the understanding of this fracture has witnessed the development of different internal fixation devices and surgical procedures. These advances have been further elaborated scientifically in terms of their ability to provide stable fracture reduction ad resistance to Achilles tendon forces. In order to obtain a comprehensive knowledge of the disease, this article reviewed the new understanding of the anatomy, typing, risk factors, and treatment modalities of calcaneal tuberosity avulsion fracture in recent years.
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Affiliation(s)
- Zhiyi Liu
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Guodong Hou
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wencong Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Junyan Lin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinrong Yin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Huan Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guowei Huang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
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Killian M, Wanchu R, Huang D, Walker J, Ganti L. A 75-year-old with left ankle pain. J Am Coll Emerg Physicians Open 2023; 4:e12902. [PMID: 36817081 PMCID: PMC9930736 DOI: 10.1002/emp2.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Morgan Killian
- HCA Florida Ocala HospitalOcalaFLUSA,Department of Emergency MedicineUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Rohan Wanchu
- HCA Florida Ocala HospitalOcalaFLUSA,Department of Emergency MedicineUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Derrick Huang
- HCA Florida Ocala HospitalOcalaFLUSA,Department of Emergency MedicineUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Joshua Walker
- HCA Florida Ocala HospitalOcalaFLUSA,Department of Emergency MedicineUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Latha Ganti
- HCA Florida Ocala HospitalOcalaFLUSA,Department of Emergency MedicineUniversity of Central Florida College of MedicineOrlandoFloridaUSA
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Luo W, Wang Y, Han Q, Wang Z, Jiao J, Gong X, Liu Y, Zhang A, Zhang H, Chen H, Wang J, Wu M. Advanced strategies for constructing interfacial tissues of bone and tendon/ligament. J Tissue Eng 2022; 13:20417314221144714. [PMID: 36582940 PMCID: PMC9793068 DOI: 10.1177/20417314221144714] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/26/2022] [Indexed: 12/25/2022] Open
Abstract
Enthesis, the interfacial tissue between a tendon/ligament and bone, exhibits a complex histological transition from soft to hard tissue, which significantly complicates its repair and regeneration after injury. Because traditional surgical treatments for enthesis injury are not satisfactory, tissue engineering has emerged as a strategy for improving treatment success. Rapid advances in enthesis tissue engineering have led to the development of several strategies for promoting enthesis tissue regeneration, including biological scaffolds, cells, growth factors, and biophysical modulation. In this review, we discuss recent advances in enthesis tissue engineering, particularly the use of biological scaffolds, as well as perspectives on the future directions in enthesis tissue engineering.
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Affiliation(s)
- Wangwang Luo
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Yang Wang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Zhonghan Wang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China,Orthopaedic Research Institute of Jilin
Province, Changchun, China
| | - Jianhang Jiao
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Aobo Zhang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Han Zhang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Hao Chen
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Minfei Wu
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China,Minfei Wu, Department of Orthopedics, The
Second Hospital of Jilin University, 218 Ziqiang Sreet, Changchun 130041, China.
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Choi C, Lee SJ, Choo HJ, Lee IS, Kim SK. Avulsion injuries: an update on radiologic findings. Yeungnam Univ J Med 2021; 38:289-307. [PMID: 34411477 PMCID: PMC8688780 DOI: 10.12701/yujm.2021.01102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.
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Affiliation(s)
- Changwon Choi
- Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Pusan, Korea
| | - Sun Joo Lee
- Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Pusan, Korea
| | - Hye Jung Choo
- Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Pusan, Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Pusan, Korea
- Biomedical Research Institute, Pusan National University School of Medicine, Pusan, Korea
| | - Sung Kwan Kim
- Department of Radiology, Pusan Himchan Hospital, Pusan, Korea
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Pi Y, Hu Y, Jiao C, Ao Y, Guo Q. Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up. Am J Sports Med 2019; 47:2993-3001. [PMID: 31480851 DOI: 10.1177/0363546519869952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. There is a paucity of literature on this problem. PURPOSE To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive case series of 35 patients with acute insertional rupture of the Achilles tendon who received a reattachment procedure between 2011 and 2017 were reviewed. All patients were measured and classified by magnetic resonance imaging (MRI) and surgical findings. Patient-reported outcomes were evaluated using the visual analog scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI), Tegner score, and Ankle Activity Score (AAS). The range of motion and single-legged heel raise test were also conducted for both ankles. RESULTS Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 ± 1.61 preoperatively to 2.07 ± 1.57 postoperatively and from 58.32 ± 18.66 preoperatively to 87.32 ± 7.53 postoperatively, respectively (both P < .001). The mean FFI, AAS, and Tegner scores after the operation were 11.84 ± 1.62, 5.71 ± 2.18, and 4.61 ± 1.31, respectively. Compared with the intact ankle, the mean deficit in dorsiflexion in the involved ankle was 9.54°± 6.25° (range, 0.59°-23.70°; P < .001) and the mean deficit in plantarflexion in the involved ankle was 6.31°± 4.02° (range, 0.24°-14.92°; P < .001). Thirty patients could perform the single-legged heel raise on the operative leg. A larger body mass index was associated with worse postoperative AOFAS and FFI outcomes. Longer follow-up predicted statistically significantly better FFI scores. Better postoperative dorsiflexion was associated with better postoperative FFI, AAS, and Tegner scores, and a statistically significant interaction was found between the VAS score and plantarflexion deficit. Age, preoperative insertional tenderness, Haglund deformity, and MRI classification showed little association with postoperative outcomes. CONCLUSION This study demonstrated that the reattachment procedure for acute avulsion fracture of the Achilles tendon can achieve firm fixation and promising outcomes.
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Affiliation(s)
- Yanbin Pi
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Yuelin Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Chen Jiao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
| | - Qinwei Guo
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injury, Peking University Third Hospital, Beijing, China
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Aparisi Gómez MP, Aparisi F, Bartoloni A, Ferrando Fons MA, Battista G, Guglielmi G, Bazzocchi A. Anatomical variation in the ankle and foot: from incidental finding to inductor of pathology. Part I: ankle and hindfoot. Insights Imaging 2019; 10:74. [PMID: 31363861 PMCID: PMC6667521 DOI: 10.1186/s13244-019-0746-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/02/2019] [Indexed: 12/18/2022] Open
Abstract
Accessory anatomical structures in the ankle and foot usually represent incidental imaging findings; however, they may also eventually represent a source of pathology, such as painful syndromes, degenerative changes, be the subject of overuse and trauma or appear as masses and cause compression syndromes or impingement.This review aims to describe and illustrate the imaging findings related to the presence of accessory ossicles and muscles in the ankle and hindfoot through different techniques, with special attention to those variants that associate factors of clinical relevance or that trigger challenges in the differential diagnosis.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital - Auckland District Health Board (ADHB), 2 Park Road, Grafton, Auckland, 1023, New Zealand
- Department of Radiology, Hospital Vithas Nueve de Octubre, Calle Valle de la Ballestera, 59, 46015, Valencia, Spain
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Calle Valle de la Ballestera, 59, 46015, Valencia, Spain
| | - Alessandra Bartoloni
- Department of Diagnostic Imaging, Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Maria Alejandra Ferrando Fons
- Department of Orthopaedics and Traumatology, Malteser Krankenhaus St. Josefshospital, Kurfürstenstrasse 69, 47829, Krefeld, Germany
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S.Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy.
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Narayanasamy S, Krishna S, Sathiadoss P, Althobaity W, Koujok K, Sheikh AM. Radiographic Review of Avulsion Fractures RadioGraphics Fundamentals | Online Presentation. Radiographics 2018; 38:1496-1497. [PMID: 30207944 DOI: 10.1148/rg.2018180064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sabarish Narayanasamy
- From the Department of Radiology, Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1G 4B5 (S.N., S.K., P.S., W.A., A.M.S.); and Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada (K.K.)
| | - Satheesh Krishna
- From the Department of Radiology, Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1G 4B5 (S.N., S.K., P.S., W.A., A.M.S.); and Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada (K.K.)
| | - Paul Sathiadoss
- From the Department of Radiology, Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1G 4B5 (S.N., S.K., P.S., W.A., A.M.S.); and Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada (K.K.)
| | - Waleed Althobaity
- From the Department of Radiology, Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1G 4B5 (S.N., S.K., P.S., W.A., A.M.S.); and Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada (K.K.)
| | - Khaldoun Koujok
- From the Department of Radiology, Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1G 4B5 (S.N., S.K., P.S., W.A., A.M.S.); and Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada (K.K.)
| | - Adnan M Sheikh
- From the Department of Radiology, Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1G 4B5 (S.N., S.K., P.S., W.A., A.M.S.); and Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Canada (K.K.)
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Not One of the Usual Suspects: MRI Features of Insertional Lateral Cord Plantar Fasciopathy. AJR Am J Roentgenol 2018; 211:W252-W256. [PMID: 30240290 DOI: 10.2214/ajr.17.19218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to report MRI findings of insertional lateral cord plantar fasciopathy and review the presenting symptoms of the condition and suspected diagnoses. CONCLUSION Lateral cord plantar fasciopathy presents with pain and swelling at the lateral midfoot, which are typically clinically suspected to be caused by fifth metatarsal (MT) base stress fracture of peroneal tendon abnormalities. The MRI findings are identical to those seen in association with the more commonly occurring central cord plantar fasciopathy, which has a calcaneal origin, but the findings affect the insertion of the lateral cord onto the plantar lateral base of the fifth MT.
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11
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Rauer T, Twerenbold R, Flückiger R, Neuhaus V. Avulsion Fracture of the Calcaneal Tuberosity: Case Report and Literature Review. J Foot Ankle Surg 2018; 57:191-195. [PMID: 29153287 DOI: 10.1053/j.jfas.2017.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Indexed: 02/03/2023]
Abstract
Avulsion fractures of the calcaneal tuberosity are predominantly seen in patients with poor bone quality, the commonly used lag screw fixation might not be strong enough even with bony fragments of sufficient size. We present a case of a closed displaced avulsion fracture of the calcaneal tuberosity due to blunt trauma to the calf in a 74-year-old female. Open reduction and internal fixation with two 3.5-mm cannulated cortical screws with washers was performed, and anatomic reduction was achieved. Without further trauma, secondary displacement of the fracture occurred on day 3. Revision was performed with a single 3.5-mm cortical screw and transosseous fixation with 2 suture anchors, followed by partial weightbearing for 6 weeks. At 12 weeks postoperative, the fracture had completely healed, and she was doing well at 16 months after the revision surgery. Transosseous suture anchor fixation of an osteoporotic avulsion fracture of the calcaneal tuberosity seems to provide better and stronger fixation than that using lag screws.
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Affiliation(s)
- Thomas Rauer
- Consultant, Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Reto Twerenbold
- Head, Division of Orthopedics & Traumatology, Zuger Kantonsspital, Baar, Switzerland
| | - Roman Flückiger
- Senior Physician, Division of Orthopedics & Traumatology, Zuger Kantonsspital, Baar, Switzerland
| | - Valentin Neuhaus
- Consultant, Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
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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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Choi Y, Kwon YW, Sim YS, Kim T, Song D, Lee S. Achilles tenodesis for calcaneal insufficiency avulsion fractures associated with diabetes mellitus. J Orthop Surg Res 2017; 12:192. [PMID: 29237480 PMCID: PMC5729400 DOI: 10.1186/s13018-017-0695-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/24/2017] [Indexed: 12/26/2022] Open
Abstract
Background Calcaneal insufficiency avulsion (CIA) fractures often present with neuropathic etiology, such as Charcot neuroarthropathy (CN). Under the same surgical procedures, the outcomes of CIA fractures are less desirable, compared to the outcomes of the traumatic calcaneal avulsion fractures. Here, the study suggests Achilles tenodesis technique using suture anchor after resection of the CIA fracture fragments could provide satisfactory clinical results in the cases of surgically indicated CIA fractures. Materials and methods This retrospective study included seven patients of calcaneal avulsion fracture who had underlying diabetes mellitus (DM) and no specific traumatic event. The patients were treated with Achilles tenodesis techniques for their CIA fractures. Achilles tenodesis was performed using suture anchor with removal of the fracture fragments. The patients were evaluated with the Foot and Ankle Outcome Score (FAOS), visual analogue scale (VAS), single-heel rise test, and X-ray images on their final follow-ups. Results Initially, three of the CIA fracture cases treated with traditional open reduction and internal fixation reported pullout failure. Consequently, all patients received Achilles tenodesis using suture anchor after bone fragment resection and had good clinical outcomes. Only one subject with low compliance reported poor outcome. The FAOS of each patient were obtained at a mean of 16.3 months after surgery. The results are as follows: pain 80.6 (SD = 6.2), symptom 83.8 (SD = 4.9), activities of daily living 80.5 (SD = 8.0), sport and recreation function 75.6 (SD = 11.93), and foot- and ankle-related quality of life 77.9 (SD = 6.7). On their final follow-ups, the average VAS was 2.6 (range, 1 to 4). Conclusion Achilles tenodesis using suture anchor after bone fragment resection achieved competent clinical results in the patients with CIA fractures. The study proposes that this surgical procedure could be an appropriate treatment option for patients with CIA fractures. Trial registration The study was approved by the institutional review board (IRB) of our medical center (IRB File No. 2016-07-043), retrospectively registered.
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Affiliation(s)
- Youngrak Choi
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 16, Yatap-ro 65-beon-gil, Bundang-gu,, Sungnam-si, Gyunggi-do, 13497, Republic of Korea
| | - Young-Woo Kwon
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 16, Yatap-ro 65-beon-gil, Bundang-gu,, Sungnam-si, Gyunggi-do, 13497, Republic of Korea
| | - Young-Suk Sim
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 16, Yatap-ro 65-beon-gil, Bundang-gu,, Sungnam-si, Gyunggi-do, 13497, Republic of Korea
| | - Taeho Kim
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 16, Yatap-ro 65-beon-gil, Bundang-gu,, Sungnam-si, Gyunggi-do, 13497, Republic of Korea
| | - Dayoung Song
- School of Medicine, CHA University, 120, Haeryong-ro, Pocheon-si, Gyeonggi-do, Republic of Korea
| | - Soohyun Lee
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 16, Yatap-ro 65-beon-gil, Bundang-gu,, Sungnam-si, Gyunggi-do, 13497, Republic of Korea.
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