Clinical observation of biomimetic mineralized collagen artificial bone putty for bone reconstruction of calcaneus fracture

This study investigated clinical outcomes of biomimetic mineralized collagen artificial bone putty for bone reconstruction in the treatment of calcaneus fracture.Sixty cases of calcaneal fractures surgically treated with open reduction and internal fixation in our hospital from June 2014–2015 were chosen and randomly divided into two groups,including 30 cases treated with biomimetic mineralized collagen artificial bone putty as treatment group,and 30 cases treated with autogenous ilia as control group.The average follow-up time was 17.263.0 months.The results showed that the surgery duration and postoperative drainage volume of treatment group were significantly lower than control group;there were no statistically significant differences in the fracture healing time,American Orthopaedic Foot and Ankle Society scores at 3 and 12 months after surgery,Bo¨hler’s angle,Gissane’s angle and height of calcaneus between the two groups.There were no significant differences in wound complication and reject reaction between the two groups,while significant difference in donor site complication.As a conclusion,the implantation of biomimetic mineralized collagen artificial bone putty in the open reduction of calcaneal fracture resulted in reliable effect and less complications,which is suitable for clinical applications in the treatment of bone defect in calcaneal fractures.

Application of medial column classification in treatment of intraarticular calcaneal fractures

BACKGROUND There are many types of treatments for calcaneal fractures,including conservative treatment,conventional surgical treatment,and minimally invasive surgery.The choice of specific treatment options is still controversial.Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic.A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus;however,many studies have reported a high incidence of postoperative incision complications.Although there are many methods for the classification of intra-articular calcaneal fractures,it is generally believed that the computed tomography(CT)classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures.However,this method has no clear guiding significance for the choice of surgical incision and surgical plan.AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.METHODS From July 2017 to July 2018,91 patients,including 60 males and 31 females aged 27 to 60 years,were enrolled.All participants had closed intra-articular calcaneal fracture,and their surgical options were selected under the guidance of medial column classification.The patients'fractures were classified according to the Sanders classification:Type II,35 cases;Type III,33 cases;and Type IV,23 cases.Among them,53 patients had medial column displacement(shortened varus)and underwent open reduction and internal fixation with L-lateral incision of the calcaneus;38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision.The calcaneus Bohler angle,Gissane angle,length,width,height,and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up.Foot function recovery was assessed by the Maryland foot scoring criteria.RESULTS All patients were followed for 5 to 14 mo,with an average of 10.5±2.9 mo.The fractures of all patients healed,and the healing time was 10 to 19 wk,with an average of 10.8±1.5 wk.One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection.The patient's fracture healed 5 mo after surgery.One patient developed a sural nerve injury,and the symptoms disappeared 3 mo after surgery.The patients were assessed according to the Maryland foot scoring system:Excellent in 77 cases,good in 10,and fair in 4.The excellent and good rate was 95.6%.CONCLUSION Medial column classification can effectively guide the surgical selection for intraarticular fractures of the calcaneus.

Subtalar dislocation without associated fractures: Case report and review of literature

Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.

Footfall patterns of a runner with an Achilles tendon rupture

Purpose: This study aims to compare the load and the length of previously ruptured and healthy Achilles tendon(AT) of a recreational runner who used different footfall patterns on each limb during running.Methods: A 41-year-old recreational athlete with a ruptured AT participated in this report. Two force plates and a high-speed motion capture system were used to collect ground reaction force and kinematic data in shod and barefoot running conditions. AT length was measured using ultrasonography and an infrared camera system. AT force was estimated as the active plantar flexion moment divided by AT moment arm during stance phase.Results: The participant used a rearfoot pattern on the affected limb and a forefoot/midfoot pattern on the unaffected limb during shod running,and a forefoot/midfoot pattern during barefoot running. There was no difference between the length of the affected and the unaffected AT. During shod running, the maximal AT force and loading rate were lower in the affected AT versus the unaffected AT. During barefoot running, the affected maximal AT force and loading rate were greater than the unaffected AT.Conclusion: Footfall patterns can be an adaptation to reduce the loading on a previously injured AT. It appears that runners may consider using a rearfoot footfall pattern during running to reduce the stress on the AT.

Os calcis lipoma: To graft or not to graft?——A case report and literature review

BACKGROUND Intraosseous lipoma is a rare benign lesion, commonly affecting the os calcis. Its pathogenesis and natural history are not fully understood, and its management remains controversial.CASE SUMMARY A 56-year-old male complaining of heel pain was diagnosed with an os calcis lipoma. The lesion was treated with curettage and it was filled with impacted allograft and demineralized bone matrix. Histological examination confirmed the above diagnosis. Six months postoperatively, the patient returned to recreational long-distance running. Repeated computed tomography scanning, up to five years postoperatively, showed almost complete resorption of the graft over time.CONCLUSION The treatment of an os calcis lipoma should be individualized, depending on the symptoms, the location and size of the lesion. Surgeons, electing to proceed with bone grafting, should consider the probability of bone graft resorption.

Stress fractures in uncommon location:Six case reports and review of the literature

BACKGROUND Individuals’interest in sports activities has been increasing,contributing to more stress fracture occurrences in uncommon locations on the skeleton.In this study,several cases of stress fractures in atypical locations are presented,and the possibility of combining diagnostic methods to make accurate and quick diagnoses is explored.Additionally,different causes of stress fractures,as well as various modalities of treatment,are highlighted.Other potential factors of stress fractures were identified by a literature review.CASE SUMMARY Six cases of stress fractures in the calcaneus,intermediate cuneiform bone,sacrum,tibia(bilateral),navicular bone and femoral neck are presented,with different types of diagnostic imaging and treatments.All of the cases were associated with an aspect of mobility because all of the patients were physically active in various sport disciplines.CONCLUSION The type of therapeutic procedure selected should depend on the specific clinical case,i.e.,the patient’s condition and level of physical activity.

Heel pain caused by os subcalcis:A case report

BACKGROUND The accessory bones are common bone variations around the feet and ankles,which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass,and most of them remain asymptomatic.Os subcalcis is an accessory bone at the plantar aspect of the calcaneus,which is located just posterior to the insertion of the plantar fascia.Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported.CASE SUMMARY A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years.X-ray,computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus,located at the insertion of the plantar fascia.He underwent surgical excision of the lesion.Microscopically the bony trabeculae were intermingled with fat and covered with cartilage.CONCLUSION This is a rare case with accessory os subcalcis leading to heel pain.It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.

Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long-Term Follow-Up

There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcaneal fractures who were treated surgically. In these patients open reduction and internal fixation were performed using a calcaneal reconstruction plate. The functional outcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the satisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.

Ilizarov reconstruction of chronic bilateral calcaneovalgus deform让ies

Calcaneovalgus foot deformities are present in up to 35% of patients with lumbar spina bifida. Resultant heel weight bearing causes complications include those associated w让h pressure ulcers. Early surgical reconstruction is advocated to prevent deformity progression and rigidity. Several surgical techniques in paediatric populations have been described, but there remains a paucity of literature regarding reconstruction of chronic calcaneovalgus feet in adults. This case report describes our experience using the Ilizarov technique in the reconstruction of an adult presenting with chro nic calcaneovalgus feet. This is a 34-year-old lady with myelomeningocoele spina bifida of lumbar level 5 who presented with a history of multiple admissions for cellulitis and infections of bilateral heel pressure sores. Rigid calcaneovalgus deformities of both feet (45° on the right, 40° on the left) were noted on clinical examination and radiological investigations. Reconstruction with an Ilizarov frame allowed for gradual correction of both soft tissue and bone, correcting heel weight bearing ambulation, with the aim of preventing further complications from infected heel ulcers. While the correction of bony deformities is crucial, management of chronically contracted soft tissue must not be overlooked. An Ilizarov frame requires both an experienced surgeon and a motivated patient, but it allows for accurate reconstruction of bony deferm让ies, while allowing management of surrounding chronic soft tissue contractures with good functional outcome.