Primary tumours of the calcaneus

3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy

BACKGROUND

The use of 3D-printed endoprosthesis has been proposed as a viable limb-salvage procedure following total calcanectomy in patients with calcaneal malignancy. However, certain drawbacks persist concerning the prosthetic design. In this case series, we designed a modular endoprosthesis incorporating a novel drainage system, aiming to improve the functional outcomes and to promote wound healing.

METHODS

We retrospectively analyzed patients with calcaneal malignancy who underwent 3D-printed modular endoprosthesis reconstruction. Clinically, we evaluated functional outcomes using the 10-cm visual analog scale (VAS) score, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications were also recorded.

RESULTS

Five male patients met the final inclusion criteria. The median age was 20 years (range 13-47 years). The median follow-up time was 28 months (range, 13-65 months). Median postoperative functional MSTS-93, VAS, and AOFAS scores were 27 points (range, 25-29), 0 points (range, 0-1), and 86 points (range, 83-93), respectively. Wound healing was observed in all patients, and there were no complications related to the endoprosthesis at the last follow-up.

CONCLUSION

The use of 3D-printed modular endoprosthesis was associated with satisfactory short-term outcomes in patients undergoing calcaneal reconstruction. The incorporation of a novel design featuring an integrated draining system has the potential to enhance wound healing and expedite functional recovery.

LEVEL OF EVIDENCE

Level IV, case series.

A radiological diagnostic approach to tumours and tumour-like lesions of the calcaneus

OBJECTIVE

The calcaneus is a rare location for the development of primary bone tumours. The purpose of the study is to review the imaging findings in a cohort of patients presenting with tumours and tumour-like lesions of the calcaneus and to develop a more structured approach to the diagnosis of calcaneal lesions.

METHODS

A retrospective study with a collection of 167 cases of calcaneal tumours and tumour-like lesions from our tertiary orthopaedic oncology institution over a period of 13 years. Cases were reviewed by two consultant musculoskeletal radiologists and the location of the lesion within the calcaneus and demographics of the patient were noted for each case. A diagnostic algorithm, which is based on patient age and tumour location, was then extrapolated.

RESULTS

Out of the 167 cases, we identified 24 different calcaneal pathologies which included both tumours and tumour-like lesions. The most common being simple bone cysts (18.3% of cases) and intra-osseous lipoma (15% of cases) sited in the diaphyseal equivalent of the calcaneus. A diagnostic algorithm was formulated, which describes the most common location of the different pathologies including both benign and malignant pathologies, subdivided by age.

CONCLUSION

Our algorithm should help the radiologist narrow down the differential diagnosis when evaluating calcaneal lesions.

ADVANCES IN KNOWLEDGE

This article provides a radiological approach to calcaneal lesions.

Efficacy of Lesion Specific Portals in Endoscopic Treatment of Calcaneal Bone Cyst: A Case Report and Literature Review

Background: Calcaneal bone cysts rarely occur and most of them are known to be benign. Among them, simple bone cysts (SBCs) third most commonly occur in the calcaneus and of the many surgical treatment options, endoscopic curettage is recently gaining popularity among surgeons due to its advantages of minimal invasiveness and optimal visualization. As for portal placement for endoscopy, two lateral portals are considered a standard technique, but no rationale has been established for SBCs with abnormal geometry. This case report suggests an SBC with secondary aneurysmal change located outside the Ward’s triangle, as well as an appropriate endoscopic approach. Case Presentation: An 18-year-old male high school student presented with a main complaint of pain at the hind foot level for the past one year, without significant improvement from conservative treatment. An endoscopic curettage through the lesion specific two posterior portals and bone graft using allogeneic cancellous bone were performed. SBC with a secondary aneurysmal bone cyst was diagnosed on pathology. At a one-year follow-up, the patient was painless and had returned to his regular activities. Physical and radiographic examinations revealed that the lesion was completely healed without any evidence of recurrence. Conclusion: For calcaneal bone cysts located at the posterior aspect of the calcaneus, eccentrically medial and abnormally long anterior-posteriorly, we suggest an endoscopic procedure using lesion specific portals such as two posterior portals.

Giant Cell Tumor of the Calcaneus

A 17-year-old female presented to us with pain and swelling in the right heel. Examination revealed the swelling to be tender, hard and fixed to the calcaneus. Radiographs showed an expansile, lytic lesion of the calcaneus with well-defined margins and no extraosseus spread. A core biopsy was done which showed multinucleated giant cells in a sea of mononuclear stromal cells, suggestive of a giant cell tumour (GCT). Curettage and filling up of the defect with bone cement was done under anaesthesia. The patient was fully ambulatory three months after the surgery. At two-year follow-up, the patient continued to be asymptomatic and radiographs revealed no signs of recurrence. It is important to note that GCT can occur in these rare sites and unusual age groups, and hence requires a good level of awareness of the surgeon and adequate preoperative workup, including biopsy, before proceeding to the definitive treatment of the lesion. Considering its potential local aggressiveness, early intervention is necessary. The patient should be kept under regular follow-up to detect any recurrence or metastasis in early stage.