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Sobota JKB, Kienapfel H, Werner M, Vogt DM. Intraosseous myolipoma of the calcaneus. BMJ Case Rep 2024; 17:e259743. [PMID: 38508597 PMCID: PMC10952934 DOI: 10.1136/bcr-2024-259743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
A man in his 40s presented with an incidental finding of an osteolytic bone lesion. He sustained an ankle injury while inline skating, fracturing his lateral malleolus. Besides the fracture, radiographic imaging on the day of the injury incidentally revealed a well-defined solitary osteolytic lesion with a sclerotic rim within the right calcaneus. MRI showed an intraosseous, fat-containing lesion with focal contrast enhancement, assessed as an intraosseous lipoma with central necrosis. In the pathological analysis of a sample of the lesion an intraosseous myolipoma of the calcaneus was found-an unexpected and extraordinary finding. To prevent pathological fracturing, curettage and bone grafting were performed using autologous iliac crest bone in combination with allogenous bone chips.
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Affiliation(s)
- Jana Kerstin Betty Sobota
- Zentrum für Operative Medizin Klinik und Poliklinik für Unfallchirurgie und Orthopädie, UKE, Hamburg, Hamburg, Germany
| | | | - Mathias Werner
- Vivantes Hospital in Friedrichshain Landsberger Allee, Berlin, Berlin, Germany
| | - Dominik Maximilian Vogt
- Klinik für Orthopädie und Unfallchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lubeck, Lübeck, Germany
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2
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Sessions JW, Brust K. Calcaneal Bone Biopsy Inconsistency between Specimens Obtained From Trephine and Fine Needle Biopsy Techniques. J Foot Ankle Surg 2024; 63:241-244. [PMID: 38043599 DOI: 10.1053/j.jfas.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/11/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
Standardized methods for osteomyelitis (OM) diagnosis of the lower extremity have proven to be difficult. Preoperative probability of foot osteomyelitis necessitates a combination of clinical, laboratory, imaging evidence (i.e., X-ray, CT, MRI), and bone biopsy to guide diagnosis and treatment. In the recent past, the relative weight that clinicians give to these collections of data to advise potential surgical intervention has been challenged, particularly with histologic evaluation of bone biopsy-traditionally considered "gold standard" in OM diagnosis. This study seeks to further expand this dialogue by retrospectively comparing calcaneal bone biopsies performed by direct visualization trephine approach (performed by Surgeons) vs fine needle biopsy with fluoroscopy guidance (performed by Interventional Radiologists). Results obtained from 57 patients with suspected calcaneal osteomyelitis demonstrate that Trephine obtained samples are significantly more likely to produce histopathologic evidence of OM (p-value: .013), microbiologic evidence of OM (p-value: <.001) and have better histopathologic and microbiologic concordance (p-value: <.001) than calcaneal bone biopsies obtained from Fine Needle Biopsy with fluoroscopy guidance.
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Affiliation(s)
| | - Karen Brust
- Internal Medicine - Infectious Disease, University of Iowa, Iowa City, IA
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Tsuha Y, Oshiro H, Mizuta K, Aoki Y, Tamaki T, Wada N, Tome Y, Nishida K. Intraoperative cone-beam computed tomography-guided curettage for osteoid osteoma. Medicine (Baltimore) 2023; 102:e36747. [PMID: 38134085 PMCID: PMC10735135 DOI: 10.1097/md.0000000000036747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Recently, cone-beam computed tomography (CBCT)-guided surgeries have been developed for bone and soft tissue tumors. The present study aimed to evaluate the efficacy of CBCT-guided curettage for osteoid osteoma. Our study population included 13 patients who underwent primary curettage for osteoid osteoma using intraoperative CBCT in a hybrid operating room between April 2019 and November 2022. We collected the following data: sex, age, follow-up period, symptom onset to time of surgery, tumor size and location, length of skin incision, operating time, radiation dose, recurrence, postoperative complications, and visual analog scale for pain during the last follow-up. There were 10 male and 3 female patients, and the mean age was 25.0 years (range, 9-49 years). The mean follow-up period was 10.6 months (range, 0.4-24.0 months). The locations of the tumors were the proximal femur in 6 patients, the acetabular region in 2 patients, and the ilium, tibial shaft, calcaneus, cuboid, and talus in 1 patient each. The mean time of symptoms onset to surgery was 18.7 months (range, 2.3-69.9 months). The mean maximum diameter of the tumor was 5.9 mm (range, 3.5-10.0 mm). The mean length of the skin incision was 2.2 cm (range, 1.5-3.5 cm). The mean operating time was 96.9 minutes (range, 64-157 minutes). The mean dose of radiation was 193.2 mGy (range, 16.3-484.0 mGy). No recurrences, postoperative complications, and reoperation were observed in this study. All the patients reported 0 mm on the visual analogue scale for pain on the last follow-up. CBCT-guided curettage for osteoid osteoma was minimally invasive and reliable. This procedure can be effective for the treatment of lesions found in deep locations such as the pelvic bone and proximal femur or an invisible lesion that cannot be detected by regular fluoroscopy.
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Affiliation(s)
- Yuichi Tsuha
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiromichi Oshiro
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kohei Mizuta
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Aoki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Melly V, Ortved KF, Manzi TJ, Richardson DW, Stefanovski D, Wulster KB. Identification of a previously unreported site of subchondral bone injury in the dorsodistolateral calcaneus in Thoroughbred racehorses. Equine Vet J 2023; 55:1029-1037. [PMID: 36716290 DOI: 10.1111/evj.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasing accessibility and advancements in computed tomographic (CT) imaging improve understanding of the contributors to poor performance in the Thoroughbred racehorse. OBJECTIVES To characterise an unreported site of tarsal subchondral bone injury (SBI) in Thoroughbred racehorses. STUDY DESIGN Retrospective, cross-sectional analytical study. METHODS Tarsal CT scans of 108 horses were reviewed for evidence of SBI in the dorsodistolateral calcaneus (DDLC). Signalment, including age, breed, sex, and discipline of horses, was recorded. The association of DDLC SBI with Thoroughbred racehorse compared to other breeds/disciplines was calculated. Nuclear scintigraphic scans of the hindlimbs of Thoroughbreds between 2007 and 2022 were also reviewed for increased radiopharmaceutical uptake (IRU) suggestive of DDLC SBI. RESULTS Tarsal CT scans of 108 horses were analysed and lesion location and type were recorded. DDLC SBI was identified in 8/108 (7.3%) horses. All lesions were found in racing Thoroughbreds (Fischer's exact test p = 0.002) and in 20% (8/40) of racing Thoroughbreds that underwent tarsal CT. DDLC SBI was determined to be the primary cause of lameness in 3/8. Third tarsal bone fracture was considered the primary cause of lameness in 3/8 horses. A total of 1663 nuclear scintigraphic scans of 1603 Thoroughbred horses were reviewed. Increased IRU in the DDLC was present in 13 horses (0.9%). MAIN LIMITATIONS Study limitations include the retrospective nature of the study, incomplete medical records, lack of sensitivity/specificity data for lesion identification on various imaging modalities or comparison to histopathology, and limited substantive follow-up information. CONCLUSIONS The DDLC is a previously unreported site of SBI in the Thoroughbred racehorse. The lesion can be the primary source of lameness but may also be found in horses with other clinically relevant osseous injuries. This lesion may be underestimated in the Thoroughbred population. Further investigation is required to determine the true prevalence, clinical relevance, and prognosis in Thoroughbred racehorses with this injury.
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Affiliation(s)
- Virginia Melly
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Kyla F Ortved
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Timothy J Manzi
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Dean W Richardson
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Kathryn B Wulster
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
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Kaya O, Gok M, Mirioglu A, Yeldir N. Calcaneus as a Rare Location of Solitary Osteochondromas: Two Case Reports. J Am Podiatr Med Assoc 2023; 113:21-041. [PMID: 37715972 DOI: 10.7547/21-041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Osteochondromas are the most common benign bone tumors, with an incidence of 36% to 41% among benign bone tumors. They can be caused by genetics, trauma, and growth defects. The incidence of all osteochondromas in the hands and feet is approximately 10%, and they are extremely rare in the calcaneus. They generally arise from the metaphysis and metaphyseal-diaphyseal region of the long bones. Osteochondromas, which are generally painless, are noted with signs of inflammation in the bursa, vascular and nerve compression, pain caused by joint deterioration, swelling in the subcutaneous tissue, or gait disturbance. The incidence of malignant transformation of solitary osteochondromas is 1%. We present two cases, an 11-year-old male patient and a 32-year-old male patient, diagnosed with osteochondroma in the calcaneus.
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Affiliation(s)
- Onur Kaya
- *Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | - Murat Gok
- *Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | - Akif Mirioglu
- †Cukurova University Medicine Faculty, Adana, Turkey
| | - Nese Yeldir
- ‡Sivas Cumhuriyet University Medicine Faculty, Sivas, Turkey
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Wang J, Yu X, Zheng K, Xu M. Limb salvage surgery for calcaneal chondrosarcoma: A case report. Medicine (Baltimore) 2022; 101:e31578. [PMID: 36595783 PMCID: PMC9794288 DOI: 10.1097/md.0000000000031578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Limb salvage surgery for calcaneal sarcomas remains challenging due to its poor compartmentalization. While below-knee amputation is still the standard choice of operative treatment, total calcanectomy with or without reconstruction was advocated. This report aims to analyze the clinical outcome of calcaneal reconstruction with cement and replantation in situ after the inactivation of tumor. METHODS We describe a 73-year-old male patient who suffered chronic pain and increasingly larger neoplasm in the left foot for about 3 years. Based on the results of percutaneous biopsy, a diagnosis of chondrosarcoma was made. RESULTS The patient underwent total calcanectomy, inactivation of calcaneus tumor, and reconstruction with cement. The Achilles tendon was detached through a Cincinnati incision. No adverse events occurred both during and after the surgery. At the last follow-up of 29 months, the patient claimed no pain, no evident limp, or any limitation of daily activities. Image examination, weight-bearing test, and MSTS score revealed a satisfactory result. CONCLUSION Calcaneal reconstruction with bone cement after total calcanectomy, inactivation of calcaneus tumor, and replantation in situ is likely to provide a feasible surgical choice and a satisfactory clinical outcome.
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Affiliation(s)
- Jingming Wang
- Department of Orthopaedics, The 960th Hospital of Chinese People’s Liberation Army, Jinan, China
| | - Xiuchun Yu
- Department of Orthopaedics, The 960th Hospital of Chinese People’s Liberation Army, Jinan, China
- * Correspondence: Xiuchun Yu, Department of Orthopaedics, The 960th Hospital of Chinese People’s Liberation Army, Jinan, China (e-mail: )
| | - Kai Zheng
- Department of Orthopaedics, The 960th Hospital of Chinese People’s Liberation Army, Jinan, China
| | - Ming Xu
- Department of Orthopaedics, The 960th Hospital of Chinese People’s Liberation Army, Jinan, China
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Mattioli D, Vinicola V, Aragona M, Montuori M, Tarantino U, Capuani S. Behavior during aging of bone-marrow fatty-acids profile in women's calcaneus to search for early potential osteoporotic biomarkers: a 1H-MR Spectroscopy study. Bone 2022; 164:116514. [PMID: 35952974 DOI: 10.1016/j.bone.2022.116514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022]
Abstract
AIM Identify new potential biomarkers of osteoporosis at an early stage, by magnetic resonance spectroscopy (MRS), studying early changes in the metabolic profile of bone-marrow fatty acids in women's calcanei during healthy aging and osteoporosis status. METHODS Single voxel MRS was performed by using a point resolved spectroscopy (PRESS) sequence at 3T. Thirty-four Caucasian women (age range: 22-59 years) were recruited to investigate calcaneus bone marrow. The cohort was constituted of four groups according to age, menopausal status, and T-score evaluated after a DXA examination on the femoral neck. Women were classified in young control (n = 11, mean age = 26.5 ± 3.8 y, age range: 22-34 years), perimenopausal groups (n = 11, mean age = 42.0 ± 3.6 y, age range: 37-47 years), postmenopausal group (n = 9, mean age = 55.4 ± 2.9 y, age range: 50-59 years, mean T-score = -1.70 ± 0.50) and osteoporotic group (n = 6, mean age = 53.0 ± 2.8 y, age range: 50-58 years, mean T-score = -2.54 ± 0.10). The total lipid content (TL), the Unsaturation Index (UI), and the fraction of unsaturated/polyunsaturated fatty acid (fUFA and fPUFA) were calculated. RESULTS TL was significantly correlated with age (r = 0.73, p < 0.001). TL increases linearly with age in the young + perimenopausal population (r = 0.92, p < 0.001) but this trend is not significant in the postmenopausal subject (r = 0.48, p = 0.07). No significant correlation was found between T-Score and TL in postmenopausal and osteoporotic women, whereas a significant correlation was found between TL and time interval (tp) between the age at menopause and the age of the subject at the MRS examination. Conversely, no correlation was found between T-score and tp. The unsaturation index (UI) does not significantly discriminate between osteoporotic, peri- and postmenopausal women. On the other hand, fUFA is significantly different in peri-menopausal and osteoporotic subjects (p = 0.02), while fPUFA is significantly different both between peri- and postmenopausal women (p = 0.05) and postmenopausal and osteoporotic subjects (p = 0.03). Both fUFA and fPUFA did not correlate with subjects' age. CONCLUSION In the female calcaneus, fUFA and fPUFA are promising measurable quantities for the characterization of bone marrow's composition potentially correlated with the development of osteoporosis, whereas UI does not differentiate between subjects of varying osteoporotic status. The fact that the TL in the calcaneus is correlated with tp, indicates that active metabolic changes are still occurring in these subjects, giving complementary information to the DXA about the changes in bone marrow's composition which may affect the whole bone health.
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Affiliation(s)
| | - Vincenzo Vinicola
- Center for Prevention, Diagnosis and Treatment of Osteoporosis, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Michele Aragona
- National Research Council, Institute for Complex Systems CNR-ISC, Rome, Italy
| | - Marco Montuori
- National Research Council, Institute for Complex Systems CNR-ISC, Rome, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy; Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133 Rome, Italy
| | - Silvia Capuani
- National Research Council, Institute for Complex Systems CNR-ISC, Rome, Italy; Santa Lucia Foundation, IRCCS, Rome, Italy.
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Schuh A, Koehl P, Sesselmann S, Goyal T, Benditz A. INCIDENTAL INTRAOSSEOUS CALCANEAL LIPOMA IN A PATIENT SUFFERING FROM PLANTARFASZIITIS. Georgian Med News 2022:37-39. [PMID: 36427838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intraosseous calcaneal lipoma is a rare benign bone tumor. The incidence of intraosseous lipoma involving the calcaneus has been noted to account for fewer than 8-15% of all intraosseous lipoma. The etiology of the lesion is unknown. A post-traumatic secondary bone reaction, healing bone infarct, and benign neoplasm have been discussed. The symptoms can be nonspecific, varying from dull, intermittent pain to activity-related plantar pain. This pain can predictably be misdiagnosed as plantar fasciitis. We present the case of a 49-year-old male patient suffering from plantar fasciitis for three months and incidental asymptomatic intraosseous calcaneal lipoma, which was diagnosed by x-ray and CT scan. As the patient was out of complaints, the typical CT findings we saw no indication for biopsy but recommended regular CT and MRI controls.;
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Affiliation(s)
- A Schuh
- 1Hospital of trauma surgery, Department of musculoskeletal research, Marktredwitz Hospital, Germany
| | - P Koehl
- 2Hospital of trauma surgery, Marktredwitz Hospital, Germany
| | - S Sesselmann
- 3Institute for Medical Engineering, OTH Technical University of Applied Sciences Amberg-Weiden, Germany
| | - T Goyal
- 4Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - A Benditz
- 5Hospital of trauma surgery, Department of orthopedics. Marktredwitz Hospital, Germany
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Wiratnaya IGE, Subawa IW, Astawa P, Nugraha HK. Arthroscopic Management of Giant Cell Tumor of the Calcaneus. Foot Ankle Spec 2022; 15:266-271. [PMID: 34259061 DOI: 10.1177/19386400211029120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Giant cell tumor of the calcaneal bone is a very rare entity and generally seen in the 30 to 40 years age group. We report a case of a 17-year-old male with giant cell tumor of the calcaneus, presented with left heel pain without another obvious physical abnormality. Radiographs showed a lobulated, well-defined, lytic lesion of the calcaneus with narrow transitional zone without periosteal reaction, no extraosseal spread, and no lung metastases. Arthroscopic procedure was done directly for both diagnostic and curative procedures. All soft, grayish lesions were completely removed arthroscopically using direct lateral portals and the suspected reactive zones debrided using high-speed burr and injected with corticosteroid. Histopathology confirmed the suspected diagnosis. The postoperative clinical course was uneventful with immediate pain relief and full weight bearing and movement allowed soon. The patient had no recurrent pain as well as recurrent radiographic lesions, and normal joint mobility 9 months postoperatively. Considering the accessibility of the lesion, giant cell tumor of the calcaneal bone can be successfully treated arthroscopically using direct lateral approach.Levels of Evidence: Therapeutic, Level IV: Retrospective, case report.
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Affiliation(s)
- I Gede Eka Wiratnaya
- Department of Orthopaedic and Traumatology, Sanglah Hospital; Faculty of Medicine, University of Udayana, Bali, Indonesia
| | - I Wayan Subawa
- Department of Orthopaedic and Traumatology, Sanglah Hospital; Faculty of Medicine, University of Udayana, Bali, Indonesia
| | - Putu Astawa
- Department of Orthopaedic and Traumatology, Sanglah Hospital; Faculty of Medicine, University of Udayana, Bali, Indonesia
| | - Hans Kristian Nugraha
- Department of Orthopaedic and Traumatology, Sanglah Hospital; Faculty of Medicine, University of Udayana, Bali, Indonesia
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Futani H, Takaki H, Sawai T, Taniguchi J, Kako Y, Ide YH, Yamakado K, Tachibana T. Long-term survival following radiofrequency ablation of lung metastases in an elderly patient with calcaneal osteosarcoma: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e26681. [PMID: 34449453 PMCID: PMC8389876 DOI: 10.1097/md.0000000000026681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Recently, the number of osteosarcomas has been increasing in elderly patients due to human longevity. Lung metastases are the primary cause of death from osteosarcomas. Complete resection of lung metastases can prolong the survival. However, complete resection in elderly patients is often difficult due to high risk of operative complications. Computed tomography (CT) guided radiofrequency ablation (RFA) is a minimally invasive technique to destroy tumor nodules using heat. In this report, we present the first case older than 65 years applying RFA for lung metastases due to osteosarcoma. PATIENT CONCERNS A 74-year-old male presented with 1-year history of heel pain. A conventional high-grade osteosarcoma in his calcaneus was diagnosed. Below-knee amputation was performed. However, lung metastases were found in both lungs 1 year after amputation. CT-guided lung RFA was chosen since surgical intervention for lung metastases was abandoned because of tumor multiplicity and medical comorbidities. A total of 18 lung metastases were treated by CT-guided RFA. The most frequent complication was pneumothoraxes in 4 of 8 (50%) procedures and chest tube drainage was required in 2 of these (2 of 8 (25%) procedures). DIAGNOSES Six lung metastases of osteosaroma were found in both lungs at 1 year after surgery. INTERVENTIONS CT-guided lung RFA was performed. A total of 18 lung metastases were treated in 8 lung RF procedures. OUTCOMES The patient has been alive with disease for 5.5 years after the initial surgery. LESSONS CT-guided lung RFA is effective for elderly patients with osteosarcoma lung metastases in spite of discouragement of lung metastasectomy due to multiplicity of metastases and medical-comorbidities.
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Affiliation(s)
- Hiroyuki Futani
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Haruyuki Takaki
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tatsuo Sawai
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Junichi Taniguchi
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yasukazu Kako
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshi-Hiro Ide
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Özbek EA, Başarır K, Yıldız HY. Brodie's abscess of the calcaneus in an adult patient. Acta Orthop Traumatol Turc 2020; 54:344-347. [PMID: 32442124 DOI: 10.5152/j.aott.2020.03.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Brodie's abscess of the calcaneus is an uncommon benign lesion that has rarely been reported in the literature. This study presents a rare case of a Brodie's abscess of the calcaneus caused by Staphylococcus aureus in an adult patient. A 46-year-old immunocompetent man had undergone nonsurgical treatment since childhood owing to the diagnosis of a heel spur. Radiological evaluation revealed a benign radiolucent cystic lesion of the calcaneus surrounded by a sclerotic rim. This condition was accompanied by perilesional bone marrow edema. Thereafter, surgical treatment was planned. During surgery, the content of the lesion was observed to be purulent. Meticulous intralesional debridement was performed, and antibiotic-loaded bone cement beads were placed. Subsequent to microbiological and pathological examinations, the cystic lesion was confirmed to be a Brodie abscess; however, direct clinical evidence of an intraosseous infection was lacking. The patient was followed up for 14 months with no complications until recovery. A Brodie abscess may mimic bone tumors. The onset of a Brodie abscess is insidious, and the clinical findings of such lesions may be obscure. A Brodie abscess of the calcaneus should be considered in the differential diagnosis of patients with chronic heel pain when suspicious radiological findings are evident.
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Affiliation(s)
- Emre Anıl Özbek
- Department of Orthopedic Surgery and Traumatology Yozgat City Hospital, Yozgat, Turkey
| | - Kerem Başarır
- Department of Orthopedic Surgery and Traumatology, İbn-i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
| | - Hüseyin Yusuf Yıldız
- Department of Orthopedic Surgery and Traumatology, İbn-i Sina Training and Research Hospital, Ankara University, School of Medicine, Ankara, Turkey
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Jafri L, Majid H, Ahmed S, Naureen G, Khan AH. Calcaneal Ultrasound and Its Relation to Dietary and Lifestyle Factors, Anthropometry, and Vitamin D Deficiency in Young Medical Students. Front Endocrinol (Lausanne) 2020; 11:601562. [PMID: 33551995 PMCID: PMC7859491 DOI: 10.3389/fendo.2020.601562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/26/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bone quality and peak bone mass are greatly affected by lifestyle factors. The objective of the study was to investigate the relationships between anthropometry, dietary and caloric intake, body composition measurements, physical activity, and vitamin D status with quantitative ultrasound-based bone parameters among medical students. METHODS Both male and female medical college students were included in this study. A detailed questionnaire was administered, collecting clinical, dietary, physical activity information, physical examination details, including body mass index (BMI). Body composition (total body fat, total body water, muscle mass, mean visceral fat mass, basal metabolic rate, bone mass using a bioelectrical impedance analyzer) and calcaneal heel ultrasound parameters were measured using an Osteosys Sonost-3000, Ultrasound Bone Densitometer were measured, respectively. RESULTS In this cross-sectional study, 211 healthy students with a mean age of 20.1 ± 1.1 years, 51.7% (n = 109) were males. Majority (79.4%) of the young adults had vitamin D deficiency. The mean BMI, calcium intake, and vitamin D levels were 22.35 ± 3.43 kg/m2, 788.7 ± 364.8 mg/day, and 15.02 ± 8.63 ng/ml, respectively. Female subjects compared to males had statistically significantly lower daily energy intake, muscle mass, visceral fat mass, calcium intake, and vitamin D levels. In addition the median Z-scores in females [-1.40 (-0.57 to -1.82)] was significantly poorer than the male [-0.50 (0.20 to -1.3)] counterparts, p-value <0.001. Multiple regression analysis showed that overall body fat percent (p-value 0.016) and visceral fat percent (p-value 0.029) were the only significant negative predictors to the calcaneal bone quality index (BQI) values. CONCLUSION Adolescent lifestyle patterns can influence young adult bone strength. The young Pakistani females exhibited significantly lower dietary intakes and more inadequate bone parameters compared to males. Our data suggest that total body and visceral fat percent are the predominant negatively associated determinant of bone strength for this cohort. Calcaneal ultrasound can be utilized for mass screening of young adults for identification of low BMD.
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Affiliation(s)
- Lena Jafri
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- *Correspondence: Lena Jafri,
| | - Hafsa Majid
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sibtain Ahmed
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Ghazala Naureen
- Department of Medicine - Western Health, The University of Melbourne and Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, St Albans, VIC, Australia
| | - Aysha Habib Khan
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Poudyal S, Shrestha S. Solitary Plasmacytoma of the Calcaneum: A Case Report. JNMA J Nepal Med Assoc 2019. [PMID: 32329469 PMCID: PMC7580439 DOI: 10.31729/jnma.4566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Solitary Plasmacytoma is characterized by a mass of neoplastic monoclonal plasma cells in either bone or soft tissue without evidence of systemic disease attributing to myeloma. Solitary bony plasmacytoma commonly presents in the axial skeleton. The occurrence of solitary bony plasmacytoma in young individuals is exceedingly rare but has been reported sporadically. We report a case of Solitary bony plasmacytoma involving the calcaneum (appendicular skeleton) in a 26-year-old male with a prior history of trauma at the same site. To our knowledge, this is one of the few cases of solitary bony plasmacytoma in the calcaneum being reported. Our patient presents with some unusual features like the unusual site of the lesion (calcaneum), presentation at a young age and the disease being symptomatic following trauma.
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Affiliation(s)
- Saugat Poudyal
- Department of Clinical Oncology, National Academy of Medical Sciences, Mahaboudha, Kathmandu, Nepal
- Correspondence: Dr. Saugat Poudyal, Department of Clinical Oncology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal. , Phone: +977-9841876901
| | - Shailendra Shrestha
- Department of Orthopaedics, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal
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Berger E, Yang L, Ye W. Foot binding in a Ming dynasty cemetery near Xi'an, China. Int J Paleopathol 2019; 24:79-88. [PMID: 30300764 DOI: 10.1016/j.ijpp.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/07/2018] [Accepted: 09/17/2018] [Indexed: 06/08/2023]
Abstract
This paper describes the morphology of the feet of a population of elite women from the Ming dynasty (1368-1644 CE) in Shaanxi province. This is a social stratum, time, and place in which foot binding was practiced. Among a group of 31 skeletons exhumed from the cemetery, eight were women with well-preserved foot bones. Macroscopic examination revealed that half these women (4/8) had clearly altered foot bones: the metatarsal bones, and the few observable phalanges, were gracile and small, while the tarsal bones exhibited a slight reduction in size but no dramatic change in morphology. The other half of the women (4/8) had apparently unmodified metatarsal bones. T-tests comparing linear measurements of the foot bones between the two groups revealed that metatarsal bones were the most affected by binding, and among the tarsal bones, the talar trochlea and calcaneal dimensions were most impacted. This small group of skeletons reveals that some elite women in Shaanxi apparently still did not practice foot binding in the late Ming dynasty, or practiced a much milder form of foot binding, and that there was considerable variation even among those who did practice it.
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Affiliation(s)
- Elizabeth Berger
- Lieberthal-Rogel Center for Chinese Studies, University of Michigan, United States.
| | | | - Wa Ye
- Cotsen Institute of Archaeology, University of California Los Angeles, United States
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Abstract
Os calcaneus secundarius is an accessory ossicle resulting from a secondary ossification center of the anterior facet of the calcaneus. It may cause chronic pain and limitation in inversion motion after inversion ankle sprain. Excision of the ossicle is indicated if the symptoms do not resolve with conservative treatment. A case of symptomatic os calcaneus secundarius, which was successfully resected endoscopically, is presented.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region.
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Drampalos E, Mohammad HR, Kosmidis C, Balal M, Wong J, Pillai A. Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: The Silo technique. Foot (Edinb) 2018; 34:40-44. [PMID: 29278835 DOI: 10.1016/j.foot.2017.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/26/2017] [Accepted: 11/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. METHODS The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabetic patients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny-Mader (C-M) Class B hosts). The mean age was 68 years (range 50-85). A retrospective review of radiographs and electronic medical records was conducted. RESULTS Patients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12-18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures. CONCLUSIONS The Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation. LEVEL OF EVIDENCE Level IV- case series.
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Affiliation(s)
- Efstathios Drampalos
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Hasan Raza Mohammad
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Chris Kosmidis
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Moez Balal
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Jason Wong
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Anand Pillai
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom.
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Kao EF, Lu CY, Wang CY, Yeh WC, Hsia PK. Fully automated determination of arch angle on weight-bearing foot radiograph. Comput Methods Programs Biomed 2018; 154:79-88. [PMID: 29249349 DOI: 10.1016/j.cmpb.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/29/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Flatfeet can be evaluated by measuring the calcaneal-fifth metatarsal angle on a weight-bearing lateral foot radiograph. This study aimed to develop an automated method for determining the calcaneal-fifth metatarsal angle on weight-bearing lateral foot radiograph. METHOD The proposed method comprises four processing steps: (1) identification of the regions including the calcaneus and fifth metatarsal bones in a foot image; (2) delineation of the contours of the calcaneus and the fifth metatarsal; (3) determination of the tangential lines of the two bones from the contours; and (4) determination of the calcaneal-fifth metatarsal angle between the two tangential lines as arch angle. RESULTS The proposed method was evaluated using 300 weight-bearing lateral foot radiographs. The arch angles determined by the proposed method were compared with those measured by a radiologist, and the errors between the automatically and manually determined angles were used to evaluate the precision of the method. The average error in the proposed method was found to be 1.12° ± 1.57° In the study, in 73.33% of the cases, the arch angles could be determined automatically without redrawing any tangential lines; in 23.00% of the cases, the angles would be correctly determined by redrawing one of the tangential lines; further, in only 3.67% of the cases, both the calcaneal and fifth metatarsal tangential lines needed to be redrawn to determine the arch angles. CONCLUSION The results revealed that the proposed method has potential for assisting doctors in measuring the arch angles on weight-bearing lateral foot radiographs more efficiently.
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Affiliation(s)
- E-Fong Kao
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chiao-Yi Lu
- Department of Radiology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chi-Yuan Wang
- Department of Radiology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Wei-Chen Yeh
- Department of Medical Imaging, Nantou Hospital of Ministry of Health and Welfare, Nantou, Taiwan
| | - Pang-Kai Hsia
- Department of Medical Imaging, Nantou Hospital of Ministry of Health and Welfare, Nantou, Taiwan
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Paša L, Kužma J, Herůfek R, Prokeš J, Šprláková-Puková A. [Arthroscopic Treatment of Chronic Retrocalcaneal Bursitis - Endoscopic Calcaneoplasty]. Acta Chir Orthop Traumatol Cech 2018; 85:209-215. [PMID: 30257781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The authors evaluate the results of endoscopic treatment and analyse the causes of persisting difficulties in retrocalcaneal bursitis unresponsive to conservative treatment. Stated as one of the causes is the possible chronic irritation of minor/partial tears of anterior parts of the distal portion of the Achilles tendon, which have no chance to heal due to continued overload and impingement syndrome of the superior prominence of the calcaneal tubercle. MATERIAL AND METHODS The authors evaluate the group of 24 patients (10 women and 14 men) diagnosed with retrocalcaneal bursitis, who reported more than 12 months of difficulties and in whom the conservative therapy options have already been exhausted. The decision to perform a revision arthroscopy was made by the authors based on chronic long-lasting difficulties, clinical examination, calcaneus radiograph, ultrasound examination and negative response to the performed conservative treatment. The MRI scan was obtained in 4 patients. In 11 patients during arthroscopy the Achilles tendon was intact, in 13 patients (54.2%) minor tears were detected on the anterior aspect of the distal Achilles tendon, not diagnosed preoperatively (by ultrasound examination). In all the patients, resection of the prominence of the calcaneal tubercle was performed, whereas in patients with affected Achilles tendon also the loose tendon fragments were resected. RESULTS A total of 23 patients reported an improvement of their condition, the pain subsided at 21-43 days. Altogether 21 patients returned to activities carried out before the onset of pain. The AOFAS score values measured preoperatively in patients with an intact tendon were 59.5 ± 15.0, in patients with an injured tendon it was 45.57 ± 9.6, while 6 months after the surgery the values were 95.7 ± 6.2, or 88.71 ± 7.8 respectively. In 1 female patient, with one prior surgery, diagnosed with a partial tear of the Achilles tendon, the effect of the surgery was unsatisfactory. After six months the patient underwent an open revision surgery and the Achilles tendon reinsertion. No intraoperative or postoperative complications were observed. DISCUSSION The endoscopic technique facilitates a more visible bone resection, with better control of resection, which is less invasive than the open technique. The source of irritation can be removed, which is not always only the prominence of the calcaneal tubercle, but another cause of persisting problems can also be a microtrauma affecting the anterior portion of the Achilles tendon, with a reactive hyperaemia in bursal tissue. Compared to literature and also based on the results of the authors of this retrospective study, the endoscopic calcaneoplasty is less invasive than the open surgery. It is always necessary to properly diagnose the causes of difficulties and to timely respond to persisting symptoms in patients, not responding satisfactorily to conservative therapy. CONCLUSIONS The findings presented by the authors provide a new perspective on the causes of chronic problems such as the "posterior heel pain" and tend to give preference to the active endoscopic approach in patients with persisting problems, not responding to conservative treatment, predisposed based on the radiological examination and with a positive finding on ultrasound or MRI scan. Key words:retrocalcaneal bursitis, endoscopic calcaneoplasty, arthroscopy.
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Affiliation(s)
- L Paša
- Klinika traumatologie Lékařské fakulty Masarykovy univerzity Brno
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19
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Manoli A. Remodeling of the Calcaneocuboid Joint in the Acquired Flatfoot. J Surg Orthop Adv 2018; 27:237-245. [PMID: 30489250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There has been debate recently as to whether the lateral column is actually short in the acquired flatfoot. Doubters argue that it is not possible for the lateral column to change in length and actually shorten, especially in the acquired type. In this series of 21 consecutive patients operated on for an acquired flatfoot, the calcaneocuboid joint (CC) had remodeled in all, resulting in the calcaneal side being short, facing laterally and dorsally. These findings give evidence to the rationale for performing a lateral column lengthening (LCL) proximal to the CC joint to treat the acquired flatfoot. When performing a LCL, one should attempt to restore length to the calcaneal side of the joint and to redirect it medially and plantarward. (Journal of Surgical Orthopaedic Advances 27(3):237-245, 2018).
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Affiliation(s)
- Arthur Manoli
- Michigan International Foot and Ankle Center, St. Joseph Mercy Hospital - Oakland, Pontiac, Michigan; Departments of Orthopaedic Surgery, Wayne State University, Detroit, Michigan, and Michigan State University College of Osteopathic Medicine, East Lansing, Michigan; e-mail:
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Sinacore DR, Hastings MK, Bohnert KL, Strube MJ, Gutekunst DJ, Johnson JE. Immobilization-induced osteolysis and recovery in neuropathic foot impairments. Bone 2017; 105:237-244. [PMID: 28942120 PMCID: PMC5650927 DOI: 10.1016/j.bone.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/22/2017] [Accepted: 09/16/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. OBJECTIVE To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33-53weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). METHODS Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. RESULTS Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p<0.01); BMD in NPU immobilized feet averaged 486±136mg/cm2, and CNA immobilized feet averaged 456±138mg/cm2, p>0.05). After immobilization, index NPU feet lost 27mg/cm2; CNA feet lost 47mg/cm2 of BMD, p<0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. CONCLUSIONS There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.
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Affiliation(s)
- David R Sinacore
- Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States.
| | - Mary K Hastings
- Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States.
| | - Kathryn L Bohnert
- Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States.
| | - Michael J Strube
- Dept of Psychology, Campus Box 1125, Washington University, Saint Louis, MO, United States.
| | - David J Gutekunst
- Musculoskeletal Biomechanics Laboratory, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, United States.
| | - Jeffrey E Johnson
- Dept Orthopaedic Surgery, Campus Box 8233, Foot & Ankle Service, Washington University School of Medicine, Saint Louis, MO, United States.
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Chiu YC, Yang SC, Wu CH, Chuang HW, Tu YK, Ma CH. Mycobacterium abscessus Osteomyelitis of the Calcaneus Presenting as Tumor-Mimicking Lesions: A Case Report. JBJS Case Connect 2017; 7:e56. [PMID: 29252886 DOI: 10.2106/jbjs.cc.16.00273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present the case of a 51-year-old immunocompetent man with refractory heel pain who initially had been treated for plantar fasciitis. However, the pain was proven to be caused by a Mycobacterium abscessus infection of the calcaneus. The process of diagnosis and treatment is described. CONCLUSION Although rare, chronic heel pain can be caused by an atypical mycobacterial infection of the calcaneus. Because of its indolent clinical course, misdiagnosis is not uncommon with calcaneal osteomyelitis. Physicians should note that this rare infection should be considered in patients with refractory heel pain.
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Affiliation(s)
- Yen-Chun Chiu
- Departments of Orthopaedic Surgery (Y.-C.C., S.-C.Y., C.-H.W., Y.-K.T., and C.-H.M.) and Pathology (H.-W.C.), E-Da Hospital, I-Shou University, Taiwan, Republic of China
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Smith MO, Nicosia CE. A rare probable chondroblastoma of the calcaneus in a pre-Columbian subadult from Illinois. Int J Paleopathol 2017; 16:14-21. [PMID: 28290305 DOI: 10.1016/j.ijpp.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 06/06/2023]
Abstract
Discrete cystic or tumorous intraosseous lesions can arise from a variety of benign and malignant conditions as well as trauma and infection. They are clinically rarely observed in the calcaneus. A fourteen-to-seventeen-year-old subadult recovered from a Late Woodland (∼AD 800-1100) period mortuary context in the Mississippi River Valley of central Illinois presents with a single lytic intraosseous lesion on the posterior right calcaneus that bilaterally perforates the cortex. The lesion, although primarily anterior to the epiphyseal plate, does breach it. There is also a small perforation of the outer cortex of the epiphysis above the insertion of the Achilles' tendon. The lesion is well-defined with a primarily spongy cancellous interior margin. On the body of the calcaneus, there is periostosis and a slightly expansive endosteal reaction. Comparative radiographic assessments undertaken to differentially diagnose the lesion indicate that it was likely not malignant. Based on the posterior location, the radiographic signature, the bilateral cortical perforation and the breach of the epiphysis, the lesion is best interpreted as a chondroblastoma.
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Affiliation(s)
- Maria Ostendorf Smith
- Department of Sociology and Anthropology, Illinois State University, Normal, IL, United States.
| | - Christopher E Nicosia
- Department of Sociology and Anthropology, Illinois State University, Normal, IL, United States.
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Stoica IC, Pop DM, Grosu F. Unicameral bone cyst of the calcaneus - minimally invasive endoscopic surgical treatment. Case report. Rom J Morphol Embryol 2017; 58:689-693. [PMID: 28730263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The role of arthroscopic surgery for the treatment of various orthopedic pathologies has greatly improved during the last years. Recent publications showed that benign bone lesion may benefit from this minimally invasive surgical method, in order to minimize the invasiveness and the period of immobilization and to increase visualization. Unicameral bone cysts may be adequately treated by minimally invasive endoscopic surgery. The purpose of the current paper is to present the case report of a patient with a unicameral bone cyst of the calcaneus that underwent endoscopically assisted treatment with curettage and bone grafting with allograft from a bone bank, with emphasis on the surgical technique. Unicameral bone cyst is a benign bone lesion, which can be adequately treated by endoscopic curettage and percutaneous injection of morselized bone allograft in symptomatic patients.
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Affiliation(s)
- Ioan Cristian Stoica
- Department of Orthopedics and Trauma, "Carol Davila" University of Medicine and Pharmacy, "Foisor" Orthopedics Hospital, Bucharest, Romania;
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Quatman CE, Alexander JH, Wakely PE, Mayerson JL. Transformation of Benign Giant Cell Tumor of Bone Into Epithelioid Angiosarcoma. Am J Orthop (Belle Mead NJ) 2017; 46:E463-E467. [PMID: 29309463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we report a case of transformation of a benign giant cell tumor (GCT) of the calcaneus into an epithelioid angiosarcoma. The patient presented to our service in 2003 and was followed until 2014. Transformation occurred 11 years after curettage, cryotherapy, cementation, and a well-documented disease-free interval. Longitudinal radiographs, magnetic resonance imaging, and histopathology were evaluated by the same medical team. There are only a few case reports and case series of malignancy associated with GCT of bone. To our knowledge, this case report is the first to describe an assessment of the transformation of a benign GCT of bone into an epithelioid angiosarcoma. Orthopedic surgeons, radiologists, oncologists, and pathologists should be aware of the potential for transformation of benign GCTs to high-grade sarcomas after a long disease-free interval.
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Affiliation(s)
| | | | | | - Joel L Mayerson
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, OH.
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Restuccia G, Lippi A, Casella F, Evangelisti G, Citarelli C, Benifei M. Peroneal Tubercle Hypertrophy: A Case Report. Surg Technol Int 2016; 29:270-272. [PMID: 27608743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The peroneal tubercle is an osseous prominence present on the calcaneus bone at the junction between the middle and the anterior third of its lateral surface. It is a bony septum which divides the tendons of the peroneus brevis and the peroneus longus and offers insertion to the inferior peroneal retinaculum. A hypertrophy of this prominence causes pain in the lateral and the posterior part of the foot while wearing shoes, rarely peroneal tenosynovitis can even cause it to break. In the following pages, we will describe a case of peroneal tubercle hypertrophy, visible even at clinical examination, in a 26-year-old male patient without apparent causes nor previous trauma.
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Davison MJ, David-West SK, Duncan R. Careful assessment the key to diagnosing adolescent heel pain. Practitioner 2016; 260:30-3. [PMID: 27382917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The most common cause of adolescent heel pain is calcaneal apophysitis also known as Sever's disease. The condition may occur in adolescent athletes, particularly those involved in running or jumping activities, during the pubertal growth spurt. The mean age of presentation in Sever's disease is ten, (range 7-15). It presents with posterior heel pain that is worse with activity and relieved by rest in most cases. Sever's disease, Osgood Schlatter's disease (tibial tuberosity) and Sinding-Larsen Johansson syndrome (distal patella) are all overuse syndromes brought about by repetitive submaximal loading and microtrauma. They are, however, entirely self-limiting and resolve at skeletal maturity or earlier. Careful assessment is required to differentiate them from other rare pathologies. Achilles tendinitis is rare under the age of 14. As in Sever's disease, it may occur in jumping athletes, those who suddenly increase their sporting activities and in individuals with relative gastrosoleus tightness. It may also occur in those with inflammatory arthropathies and merit rheumatological investigation if there are other suggestive signs or symptoms. Benign and malignant tumours of the adolescent calcaneus are extremely rare In a unilateral case, atypical features such as night pain or absence of a precipitating activity should raise the index of suspicion. There may be localised swelling and bony expansion.
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Terzi R, Özer T. A tuber calcanei avulsion fracture developed on the basis of idiopathic osteoporosis in a young male: a case report. Osteoporos Int 2015; 26:2381-4. [PMID: 25851698 DOI: 10.1007/s00198-015-3111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
Calcaneus fractures constitute 1.2 % of all fractures. Tuber calcanei avulsion fractures constitute 1.3-2.7 % of calcaneus fractures. Osteoporosis, osteomalacia, and diabetes mellitus have been reported to increase the risk of development of these fractures. It has been reported that tuber calcanei avulsion fractures in elderly females might develop due to osteoporosis. As far as we know, no tuber calcanei avulsion fracture developing on the basis of osteoporosis without presence of a trauma has been reported in young males in the literature. In the current case report, a 41-year-old male patient who was admitted with complaints of pain in the left heel and diagnosed with calcaneal avulsion fracture that developed on the basis of idiopathic osteoporosis and who was treated with conservative methods was presented.
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Affiliation(s)
- R Terzi
- Department of Physical Medicine and Rehabilitation, Kocaeli Derince Education and Research Hospital, Derince, Kocaeli, Turkey,
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Sohl E, de Jongh RT, Swart KMA, Enneman AW, van Wijngaarden JP, van Dijk SC, Ham AC, van der Zwaluw NL, Brouwer-Brolsma EM, van der Velde N, de Groot CPGM, te Velde SJ, Lips P, van Schoor NM. The association between vitamin D status and parameters for bone density and quality is modified by body mass index. Calcif Tissue Int 2015; 96:113-22. [PMID: 25539856 DOI: 10.1007/s00223-014-9943-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/12/2014] [Indexed: 11/25/2022]
Abstract
The association of vitamin D status with bone mineral density (BMD) and Quantitative Ultrasound measurements (QUS) has been inconsistent in previous studies, probably caused by moderating effects. This study explored (1) the association of vitamin D status with QUS and BMD, and (2) whether these associations were modified by body mass index (BMI), age, gender, or physical activity. Two-independent cohorts of the Longitudinal Aging Study Amsterdam (LASA-I, 1995/1996, aged ≥65; LASA-II, 2008/2009, aged 61-71) and baseline measurement of the B-vitamins for the prevention of osteoporotic fractures (B-PROOF) study (2008-2011, aged 65+) were used. QUS measurements [broadband ultrasound attenuation (BUA) and speed of sound (SOS)] were performed at the calcaneus in all three cohorts (N = 1,235, N = 365, N = 1319); BMD was measured by Dual X-ray absorptiometry (DXA) in B-PROOF (N = 1,162 and 1,192 for specific sites) and LASA-I (N = 492 and 503). The associations of vitamin D status with BUA and BMD were modified by BMI. Only in persons with low-to-normal BMI (<25 kg/m(2)) and serum 25(OH)D <25 nmol/L was associated with lower BUA as compared to the reference group (≥50 nmol/L) in LASA-I and B-PROOF. Furthermore, in LASA-I, these individuals had lower BMD at the hip and lumbar spine. In LASA-II, no associations with BUA were observed. Vitamin D status was not associated with SOS, and these associations were not modified by the effect modifiers tested. The association between vitamin D status and BUA and BMD was modified by BMI in the older-aged cohorts: there was only an association in individuals with BMI <25 kg/m(2).
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Affiliation(s)
- E Sohl
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Room A517, 1081 BT, Amsterdam, The Netherlands
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Prischl C, Bendtsen MM, Laursen M. [Shewanella algae infection after surgical treatment of Haglund's heel and rupture of the Achilles tendon]. Ugeskr Laeger 2014; 176:V05140271. [PMID: 25353681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a case report of soft tissue infection with the marine bacterium Shewanella algae that is rare in Denmark. The patient was a 43-year-old male and he was treated surgically for Haglund's heel, a bony protrusion at the calcaneus. After clinical healing the patient suffered a rupture of the Achilles tendon, which was treated surgically as well. The post-operative healing process proved to be protracted with a number of surgical wound revisions being necessary. A microbiology culture showed the presence of S. algae and after proper antibiotic treatment the patient recovered quickly.
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Affiliation(s)
- Clemens Prischl
- Kirurgisk Afdeling, Dronning Ingrids Hospital, Postboks 3333, 3900 Nuuk.
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Abstract
The peroneal tubercle is an osseous structure on the lateral side of the calcaneus present in 90% of individuals. Hypertrophy of the peroneal tubercle resulting in stenosing peroneal tenosynovitis has been well described in the literature. Repair of this condition involves operative treatment to remove the hypertrophied peroneal tubercle and repair any resulting tendon pathology. The authors report a unique case of a hypertrophied peroneal tubercle with an associated tarsal coalition, resulting in complete bony encasement of the peroneal tendons. In this case, a 50-year-old white man presented with worsening bilateral foot and ankle pain for several years. On examination, he had fixed hindfoot varus and bilateral equinocavovarus feet. Magnetic resonance imaging and weight-bearing radiographs showed a calcaneonavicular coalition. Intraoperatively, the authors discovered complete bony encasement of the peroneal longus and brevis tendons. On examination, the peroneal longus and brevis were severely stenotic, with the peroneal brevis to the point of near laceration. This painful condition was repaired by takedown of the calcaneonavicular coalition, the peroneal tubercle was resected, and the peroneal tendons were freed from their bony encasement. Tenodesis of the peroneus brevis to longus was performed and the hindfoot varus was corrected with wedge osteotomy of the calcaneus. The patient reported excellent postoperative results. At 3 months postoperatively, he was pain-free and his calcaneal osteotomy was well healed. This case appears to be the first of its type to be reported in the literature. The details of the case are presented along with a review of the relevant literature.
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Okano K, Aoyagi K, Enomoto H, Osaki M, Chiba K, Yamaguchi K. Bone mineral density in patients with destructive arthrosis of the hip joint. J Bone Miner Metab 2014; 32:312-6. [PMID: 23921834 DOI: 10.1007/s00774-013-0501-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/07/2013] [Indexed: 11/28/2022]
Abstract
Recent reports have shown the existence of subchondral insufficiency fracture in rapidly destructive arthrosis of the hip joint (RDA), and the findings suggest that osteopenia is related to the pathogenesis of the rapid progression of this disease. Therefore, we measured bone mineral density (BMD) in RDA patients. We measured BMD of the lumbar spine, radius, and calcaneus using dual-energy X-ray absorptiometry in 19 patients with RDA and 75 with osteoarthritis of the hip (OA) and compared BMD at different skeletal sites between RDA and OA patients. No significant differences were observed in BMD of the lumbar spine, ultradistal radius, mid-radius, and calcaneous between the RDA and OA groups. Our data suggest that RDA is not accompanied by generalized osteoporosis. Factors other than generalized bone status, for example, BMD around the affected hip joint before destruction, need to be analyzed to elucidate the pathophysiological mechanism of RDA.
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Affiliation(s)
- Kunihiko Okano
- Department of Orthopedic Surgery, Nagasaki Prefectural Center of Medicine and Welfare for Children, 24-3 Eishohigashimachi, Isahaya, 854-0071, Japan,
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Apóstol-González S, Herrera J, Herrera I. [Calcaneus fractures as a complication of the percutaneous treatment of plantar fasciitis. Case report]. Acta Ortop Mex 2014; 28:134-136. [PMID: 26040157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Plantar fasciitis, a self-limiting pathologic entity, is a common cause of heel pain in adult patients. Surgical treatment is indicated when the patient does not improve after receiving conservative treatment for 4-6 months with proper surveillance. The complications of percutaneous techniques include: infection, persistent pain, and neurologic injuries, among others. We report the case of a patient with calcaneus fracture following percutaneous plantar fasciotomy and resection of a calcaneal spur. We conducted a review and discussion of the literature.
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Muramatsu K, Tominaga Y, Hashimoto T, Taguchi T. Symptomatic intraosseous lipoma in the calcaneus. Anticancer Res 2014; 34:963-966. [PMID: 24511040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Intraosseous lipoma remains a poorly-characterized tumor. In paticular, the natural course of intracalcaneus lipoma after conservative treatment and the appropriate surgical modalities are still quite controversial. PATIENTS AND METHODS We reviewed six symptomatic patients who underwent curettage of intracalcaneus lipoma followed by grafting of α- or β-tricalcium phosphate. An endoscopically-assisted technique was used in one case. RESULTS All patients experienced heel pain that increased acutely after minor trauma. Heel pain disappeared soon after surgery in five cases. One patient experienced short-term mild chronic regional pain syndrome for short term. β-tricalcium phosphate was completely resorbed and remodeled after transplantation. CONCLUSION Surgical treatment is indicated for cases that are: i) symptomatic, ii) larger than the critical size, and iii) prone to pathological fracture. Curettage of intracalcaneus lipoma involving an endoscopically-assisted technique and filling of the defect with β-tricalcium phosphate is a feasible method and is minimally-invasive for the patient.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Rebuzzi M, Vinicola V, Taggi F, Sabatini U, Wehrli FW, Capuani S. Potential diagnostic role of the MRI-derived internal magnetic field gradient in calcaneus cancellous bone for evaluating postmenopausal osteoporosis at 3T. Bone 2013; 57:155-63. [PMID: 23899635 DOI: 10.1016/j.bone.2013.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/01/2013] [Accepted: 07/18/2013] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Bone mineral density (BMD) result has a low predictive value on patients' risk for future fractures. Thus, new approaches for examining patients at risk for developing osteoporosis would be desirable. Magnetic resonance (MR) investigations in cancellous bone have been shown to yield useful quantitative information on both trabecular-bone microstructure and bone marrow composition. This work was undertaken to address the hypothesis that the effective internal magnetic field gradient (IMFG), a new MR parameter, discriminates between healthy, osteopenic and osteoporotic postmenopausal women, classified on the basis of bone mineral density (BMD) criteria. The work builds on preliminary results indicating that IMFG, measured in trabecular-bone pores and quantified by spin-echo decay and water diffusion MR near the bone-bone marrow interface depends on both the bone marrow water rate of diffusion and the magnetic susceptibility difference (ΔX) between water and bone. MATERIALS AND METHODS MR relaxometry, MR spectroscopy and diffusion-weighted MR imaging of the heel was performed in fifty-five women (mean age, 62.9±6.6years) at 3T. Moreover, in order to study the reproducibility of IMFG measurement, five young women (mean age 31.0±3.2years; age range, 28-36years) were scanned and rescanned. The study protocol was approved by the local Ethics Committee. Quantitative Computer Tomography (QCT) of the L1-L3 vertebral segments was performed to classify the postmenopausal women into three groups according to QCT BMD: healthy (n=8); osteopenic (n=25); and osteoporotic (n=22). In all subjects, BMD T-scores, marrow fat content (Mfc), T2*, apparent diffusion coefficient (ADC) and IMFG (estimated from the additional spin-echo decay due to diffusion of water in local magnetic field gradients), were assessed in the whole calcaneus as well as in three calcaneal subregions: subtalar, tuber calcaneus, and cavum calcaneus. Between-group comparisons to assess group differences and Pearson correlation analysis were performed. Short and long-term coefficients of variation (CVS and CVL, respectively) were evaluated in young subjects. RESULTS Reproducibility of the IMFG measurement was satisfactory. No significant difference was found in the IMFG measurement performed in both calcaneus and subtalar calcaneal region between the two separate sessions comprised of five young women. Mfc did not significantly differ between groups. The IMFG in the subtalar region was significantly different between all three groups (P<0.01), being greatest in healthy women, intermediate in those with osteopenia, and lowest in osteoporotic subjects. Conversely neither T2* nor ADC is able to discriminate healthy subjects from those with osteopenia and osteoporosis. Increased inter-trabecular space, as it typically occurs in patients with osteoporosis, modifies water diffusion, conferring higher ADC values, thereby lowering the IMFG. CONCLUSION The IMFG measured in the calcaneal subtalar region shows a high ability in identifying healthy subjects. The new quantitative MR method based on measurement of the IMFG may provide a new means for assessing patients with osteoporosis.
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Affiliation(s)
- Mauro Rebuzzi
- Physics Department, Sapienza University of Rome, Italy; Radiology Department, IRCCS Santa Lucia Foundation, Rome, Italy
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Rafiqi K, Yousri B, Arihi M, Bjitro C, Aboumaarouf M, El Andaloussi M. Unusual locations of osteoarticular tuberculosis in children: a report of 12 cases. Orthop Traumatol Surg Res 2013; 99:347-51. [PMID: 23562710 DOI: 10.1016/j.otsr.2012.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 09/20/2012] [Accepted: 10/15/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Unusual locations of osteoarticular tuberculosis (OA-TB) raise diagnostic issues due to their untypical and non-suggestive clinical and radiological presentation. OBJECTIVES The present retrospective study analyzed the various clinical, radiological and therapeutic aspects. PATIENTS AND METHODS A retrospective series included 12 children (mean age, 7 years 4 months; sex-ratio, 0.7), treated in our department between 1980 and 2010. Knee, hip and spine locations were excluded. RESULTS Mean time to diagnosis was 32 months. Active TB infection was identified in 42% of cases. Pain was the presenting symptom in 83% of cases, with a preponderance of osteitis. Bone loss was the main radiological sign. Phemister's triad was found in two cases of combined articular and bone infection. Diagnosis was confirmed on histology in 92% of cases. All patients were managed according to the Moroccan national TB protocol. Surgery was indicated in five cases, comprising abscess drainage with or without bone surgery (notably for joint dislocation). Four patients showed orthopedic sequelae, including two with associated spinal locations. DISCUSSION Rare osteoarticular tuberculosis locations often cause diagnostic problems. Any chronic clinical presentation or suspected atypical bone lesion should suggest a diagnosis of osteoarticular tuberculosis. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- K Rafiqi
- Traumatology and Pediatric Orthopedics Department, Abderrahim Harouchi Children's Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.
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Mallard F, Bouvard B, Mercier P, Bizot P, Cronier P, Chappard D. Trabecular microarchitecture in established osteoporosis: relationship between vertebrae, distal radius and calcaneus by X-ray imaging texture analysis. Orthop Traumatol Surg Res 2013; 99:52-9. [PMID: 23260368 DOI: 10.1016/j.otsr.2012.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/24/2012] [Accepted: 08/01/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoporosis is an alteration of bone mass and microarchitecture leading to an increased risk of fractures. A radiograph is a 2D projection of the 3D bone network exposing a texture, that can be assessed by texture analysis. We compared the trabecular microarchitecture of the spine, radius and calcaneus in a series of osteoporotic cadavers. MATERIALS AND METHODS Thirty-four cadavers (11 men, 23 women), mean age 85.2±2.1years, were radiographed from T4 to L5 to identify those with vertebral fractures (FV). Non-fractured vertebrae (NFV), radius and calcaneus were taken and analyzed by densitometry, radiography and texture analysis under run-length, skeletonization of the trabeculae, and fractal geometry. RESULTS Six subjects (five women, one man) were selected, mean age 82.5±5.5years. Twelve calcanei and 10 radii were taken. Two radii were excluded. The texture of NFV was significantly correlated (P<0.01) with that of the radius for horizontal run-lengths. No relationship between the texture of NFV and calcaneus was found. DISCUSSION In the horizontal direction (perpendicular to the stress lines), the microarchitecture of NFV and radius showed a disappearance of the transverse rods anchoring the plates. Due to its particular microarchitecture, the calcaneus is not representative of the vertebral status. CONCLUSION Bone densitometry provides no information about microarchitecture. Texture analysis of X-ray images of the radius would be a minimally invasive tool, providing an early detection of microarchitectural alterations. LEVEL OF EVIDENCE IV retrospective study.
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Affiliation(s)
- F Mallard
- LUNAM, Angers University, Bone remodeling and biomaterials study group GEROM-LHEA, IRIS-IBS Biology Institute of Health, Angers Universitary Hospital Center, 49933 Angers Cedex, France
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Del Buono A, Chan O, Maffulli N. Achilles tendon: functional anatomy and novel emerging models of imaging classification. Int Orthop 2012; 37:715-21. [PMID: 23254856 DOI: 10.1007/s00264-012-1743-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 11/28/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Ideally, a classification should have some prognostic value, and should therefore include precise information upon extent and location of the Achilles tendon disorders. We propose a new imaging and anatomical system to classify Achilles tendon disorders at imaging using US and MRI. APPROACH We consider the non-insertional region as the tendon mid-portion, and distinguish the insertional component into a pre-insertion site, located about two centimetres above the calcaneum, and a calcaneal insertion, where the tendon is attached to the bone. On sagittal scans, we introduced a new classification which considers two main portions: "musculotendinous" and "insertional". In the context of the muscolotendinous portion, it is possible to find muscle fibres proximally, and the free tendon distally. This latter is made up of proximal, middle and distal portions. We also propose a 5 grade Doppler classification system to quantify blood flow, in which Grades I and II are respectively characterised by the presence of one and two vessels within the tendon; in Grades III, IV and V, the neovascularisation respectively involves less than 50 %, from 50 to 90 %, and more than 90 % of the tendon tissue. These proposed systems will require validation and possible modification to be applied to different tendons.
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Affiliation(s)
- Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy
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Czeczuk A, Huk-Wieliczuk E, Michalska A, Bylina D, Sołtan J, Zofia D. The effect of menopause on bone tissue in former swimmers and in non-athletes. ADV CLIN EXP MED 2012; 21:645-652. [PMID: 23356202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND An increased loss of bone density during the first years after menopause induces osteoporosis. OBJECTIVES The aim of the research presented in this paper was to ascertain the difference in the rate of involutional changes in bone tissue in former athletes and in non-athletes of the same age. MATERIAL AND METHODS The research involved 18 former swimmers and 18 females of similar age who had never practiced sports. The subjects were subdivided into two subgroups: Subgroup I had been post-menopausal for < or = 5 years, and Subgroup II for > 5 years; this was done to assess bone mineral content relative to the length of the postmenopausal time period. Bone mineral content (BMC) and bone mineral density (BMD) were measured in lumbar vertebrae by dual-emission X-ray absorptiometry (DXA). Bone strength was measured in the heel using the bone stiffness index. Each subject was examined twice, with a one-year period in between. A diagnostic questionnaire was used to compile date on the subjects' physical activity and their gonad functioning. Dietary habits (calcium intake) were established by three interviews and the Dieta 4.0 computer program. Results. Anthropometric features did not differentiate the subjects in the subgroups. Former athletes in both subgroups spent off-work time on physical activities significantly more frequently. In both groups, calcium intake was sufficient and did not exceed 3/4 of the daily norm. A higher calcium intake was found in former athletes compared to non-athletes. The subjects in Subgroup I had significantly greater BMC and BMD than those in Subgroup II. In Subgroup I, the second examination showed somewhat lower reductions in BMC and BMD among the former athletes than among the non-athletes. In Subgroup II, BMC and BMD increased somewhat among the former athletes, while non-significant reductions were observed in the BMC and BMD of the non-athletes. All the subjects undertook pharmacologic treatment after the first examination, which caused improvement of bone parameters in the second examination. CONCLUSIONS The rate of bone mass loss in former athletes proved to be consistent with the involutional process and similar to that of non-athletes. The reduced BMD in the lumbar vertebrae of 22% of the women in the study demonstrates the need for regular densitometric examinations in postmenopausal females.
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Affiliation(s)
- Anna Czeczuk
- Physical Education Department, Faculty of Physical Education in Biala Podlaska, Poland.
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Tequabo Y, Admasie D, Gebeyaw A, Yusuf N. Aneurysmal bone cyst of the calcaneus. Ethiop Med J 2012; 50:271-273. [PMID: 23409411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aneurysmal bone cyst (ABC) is a benign solitary bone lesion of unknown etiology. ABCs mainly occur in the long bones but only rarely in the bones of the feet. Few cases of ABC involving the calcaneum have been reported. We present a rare case of an ABC of the calcaneum in 18 year old Ethiopian female.
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Affiliation(s)
- Yodit Tequabo
- Department of Radiology, Addis Ababa University, Medical Facility, Addis Ababa, Ethiopia
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Vanhoenacker FM, Eyselbergs M, De Schepper AM, Verstraete KL. Proceedings of the Joint Meeting RBRS Bone Section and Nederlandse Vereniging Voor Skeletaradiologie, Leiden, The Netherlands, 25.0.3.2011-Part II. Tumors and tumorlike conditions of the calcaneous: the usual and the unusual. JBR-BTR 2012; 95:184-188. [PMID: 22880535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The calcaneus is an uncommon site for involvement by tumors or tumorlike conditions of bone, although any lesion may involve the calcaneus. The purpose of this paper is to highlight the imaging features of common and uncommon tumors and tumorlike conditions occurring in the calcaneus. Typical case studies will illustrate the imaging findings on different imaging modalities.
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Affiliation(s)
- F M Vanhoenacker
- Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, Belgium
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Abstract
A 30-year-old woman presented with a 6-month history of pain and swelling over the sole of her right foot. Plain radiograph showed a calcified mass in the heel pad, which appeared to be arising from the spur on inferior aspect of calcaneum. Magnetic resonance imaging showed a lesion, hypointense on T1-weighted and hyperintense on T2-weighted images over the plantar aspect of the foot. Open biopsy of the mass was indicative of periosteal osteosarcoma, the variety that has never been reported in calcaneum. Below-knee amputation was done with no recurrence or distance metastasis seen at 24 months of follow up.
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Affiliation(s)
- Daljit Singh
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Lo AB, Chow AHL, Wong WCW, Hui JPK, Yuen MK. Osteoid osteoma of the calcaneum: a small painful lesion causing confusing symptoms. Hong Kong Med J 2012; 18:70-72. [PMID: 22302918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Archie B Lo
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong.
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Sierra-Solís A, Romero-López AI, Martín-Rodrigo JL. [Haglund syndrome]. Semergen 2012; 38:64-65. [PMID: 24847544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Van Gool AR, Pepels WRJ. [A jogger with painful heels]. Ned Tijdschr Geneeskd 2012; 156:A3346. [PMID: 22551752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 54-year-old man had chronic pain of his left heel region, which was initially diagnosed as 'tendinopathy'. An X-ray of the ankle joint showed a Haglund deformity. After successful surgery, he developed pain on his right heel, where again a Haglund deformity was diagnosed.
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Affiliation(s)
- Arthur R Van Gool
- Yulius Academie, Yulius Geestelijke Gezondheid, Rotterdam, the Netherlands.
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Abstract
Rheumatoid arthritis (RA) leads to a progressive weakening of the skeleton which may result in bone fractures. However, spontaneous fractures (exclusive of stress fractures, vertebral collapse, and superficial articular fragmentation) in patients with rheumatoid arthritis have been only occasionally reported in the medical literature. A case of spontaneous talar and calcaneal fracture in rheumatoid arthritis is described. Bone lesions were identified on radiographs, MR images and scintigraphy in a patient with right ankle pain. The absence of episodes of acute trauma, and the presence of acute clinical manifestations should guide the clinical suspicion.
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Affiliation(s)
- Antonio Spina
- Department of Radiology, Ferrara University, Ferrara, Italy.
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Khasabova IA, Chandiramani A, Harding-Rose C, Simone DA, Seybold VS. Increasing 2-arachidonoyl glycerol signaling in the periphery attenuates mechanical hyperalgesia in a model of bone cancer pain. Pharmacol Res 2011; 64:60-7. [PMID: 21440630 DOI: 10.1016/j.phrs.2011.03.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 01/01/2023]
Abstract
Metastatic and primary bone cancers are usually accompanied by severe pain that is difficult to manage. In light of the adverse side effects of opioids, manipulation of the endocannabinoid system may provide an effective alternative for the treatment of cancer pain. The present study determined that a local, peripheral increase in the endocannabinoid 2-arachidonoyl glycerol (2-AG) reduced mechanical hyperalgesia evoked by the growth of a fibrosarcoma tumor in and around the calcaneous bone. Intraplantar (ipl) injection of 2-AG attenuated hyperalgesia (ED(50) of 8.2 μg) by activation of peripheral CB2 but not CB1 receptors and had an efficacy comparable to that of morphine. JZL184 (10 μg, ipl), an inhibitor of 2-AG degradation, increased the local level of 2-AG and mimicked the anti-hyperalgesic effect of 2-AG, also through a CB2 receptor-dependent mechanism. These effects were accompanied by an increase in CB2 receptor protein in plantar skin of the tumor-bearing paw as well as an increase in the level of 2-AG. In naïve mice, intraplantar administration of the CB2 receptor antagonist AM630 did not alter responses to mechanical stimuli demonstrating that peripheral CB2 receptor tone does not modulate mechanical sensitivity. These data extend our previous findings with anandamide in the same model and suggest that the peripheral endocannabinoid system is a promising target for the management of cancer pain.
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Affiliation(s)
- Iryna A Khasabova
- Department of Diagnostic and Biological Sciences, Dental School, University of Minnesota, Minneapolis, MN 55455, United States
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Bacchetta J, Boutroy S, Vilayphiou N, Fouque-Aubert A, Delmas PD, Lespessailles E, Fouque D, Chapurlat R. Assessment of bone microarchitecture in chronic kidney disease: a comparison of 2D bone texture analysis and high-resolution peripheral quantitative computed tomography at the radius and tibia. Calcif Tissue Int 2010; 87:385-91. [PMID: 20711834 DOI: 10.1007/s00223-010-9402-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/24/2010] [Indexed: 11/26/2022]
Abstract
Bone microarchitecture can be studied noninvasively using high-resolution peripheral quantitative computed tomography (HR-pQCT). However, this technique is not widely available, so more simple techniques may be useful. BMA is a new 2D high-resolution digital X-ray device, allowing for bone texture analysis with a fractal parameter (H(mean)). The aims of this study were (1) to evaluate the reproducibility of BMA at two novel sites (radius and tibia) in addition to the conventional site (calcaneus), (2) to compare the results obtained with BMA at all of those sites, and (3) to study the relationship between H(mean) and trabecular microarchitecture measured with an in vivo 3D device (HR-pQCT) at the distal tibia and radius. BMA measurements were performed at three sites (calcaneus, distal tibia, and radius) in 14 healthy volunteers to measure the short-term reproducibility and in a group of 77 patients with chronic kidney disease to compare BMA results to HR-pQCT results. The coefficient of variation of H(mean) was 1.2, 2.1, and 4.7% at the calcaneus, radius, and tibia, respectively. We found significant associations between trabecular volumetric bone mineral density and microarchitectural variables measured by HR-pQCT and H(mean) at the three sites (e.g., Pearson correlation between radial trabecular number and radial H(mean) r = 0.472, P < 0.001). This study demonstrated a significant but moderate relationship between 2D bone texture and 3D trabecular microarchitecture. BMA is a new reproducible technique with few technical constraints. Thus, it may represent an interesting tool for evaluating bone structure, in association with biological parameters and DXA.
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Affiliation(s)
- Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatrique, Hôpital Femme Mère Enfant, Bron, France.
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Yu GR, Li B, Yang YF, Zhou JQ, Zhu XZ, Huang YG, Yuan F. [Surgical treatment of flatfoot resulting from calcaneal fractures malunion]. Zhonghua Yi Xue Za Zhi 2010; 90:2308-2312. [PMID: 21092486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore the operative approach and efficacy of flatfoot after calcaneal fractures malunion. METHODS A total of 116 flatfoot patients after old calcaneal fractures were treated from January 1998 to January 2008. There were 94 males and 22 females with an average age of 33.5 years old (range: 16 - 46). They included unilateral flatfoot after old calcaneal fractures (n = 110) and bilateral flatfoot after old calcaneal fractures (n = 6). The surgical treatments included open reduction, calcaneal osteotomy without subtalar fusion or a reconstruction of calcaneal thalamus and subtalar arthrodesis. RESULTS A total of 101 patients were followed up for an average of 14 months (range: 12 - 24). No wound healing problem or infection was observed. Solid union was obtained without redislocation in all patients. The mean time of bone union was 12 weeks (range: 10 - 14). The mean time of complete weight loading was 13 weeks (range: 11 - 15 weeks). The height of foot arch increased from 4.2 mm ± 1.7 mm to 14.1 mm ± 4.1 mm (P < 0.05). Calcaneal inclination angle increased from 11.2° ± 2.5° to 19.1° ± 4.4° (P < 0.05). Bohler angle increased from 5.4° ± 3.5° to 25.8° ± 5.2° (P < 0.05). Meary angle recovered from 22.2° ± 4.4° to 5.1° ± 3.2° (P < 0.05). The mean AOFAS Ankle and Hindfoot score increased from 33.4 (range: 27 - 43) to 85.8 (range: 78 - 98). CONCLUSION As to flatfoot after old calcaneal fractures, surgical treatment has a favorable efficacy. A customized operative approach may achieve a satisfactory outcome.
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Affiliation(s)
- Guang-rong Yu
- Department of Orthopedics, Tongji University, Shanghai 200065, China.
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Brand RA. 50 Years ago in CORR: Resection of major portion of the calcaneus L. L. Wiltse MD, J. Gordon Batemen MD, and Sidney Kase MD CORR 1959;13:271-278. Clin Orthop Relat Res 2010; 468:2295-6. [PMID: 20387019 PMCID: PMC2895856 DOI: 10.1007/s11999-010-1343-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Richard A Brand
- Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19103, USA.
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Mancarella L, Battaglia M, Addimanda O, Pelotti P, Galletti S, Meliconi R. Successful adalimumab treatment of HLA B27 negative heel enthesitis documented with MRI and US. Clin Exp Rheumatol 2010; 28:443-444. [PMID: 20576232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/10/2009] [Indexed: 05/29/2023]
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