scholarly journals Prevalence of Peroneal Tendon Instability in Calcaneus Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Abduljabbar Alhammoud ◽  
Karim Mahmoud Khamis
Keyword(s):  
English Language ◽  
Lateral Wall ◽  
Calcaneal Fracture ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Distal Fibula ◽  
Calcaneus Fracture ◽  
Orthopedic Surgeons ◽  
Calcaneus Fractures

Category: Trauma Introduction/Purpose: Peroneal tendon instability (PI) associated with intraarticular calcaneal fractures is a significant and commonly missed injury. It has been proposed that the peroneal tendon dislocates with the occurrence of a calcaneal fracture because the axial force transmitted blows out the lateral wall causing either impingement of the peroneal tendon or avulsion of the superficial peroneal retinaculum from the distal fibula, allowing the peroneal tendons to dislocate anteriorly. To date, peroneal tendon instability with a calcaneal fracture has often passed undiagnosed by both radiologists and orthopedic surgeons. The present review aimed to determine the global reported prevalence of peroneal instability associated with calcaneus fractures according to the severity of the calcaneus fracture classification and the significance of a fleck sign as an indicator of PI. Methods: An electronic search of MEDLINE, Scopus, and Google Scholar was conducted until June 2017 without a date restriction and for English-language reports only in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Database searching was augmented by manual searches of common journals in the field (JBS, Foot and Ankle International, Foot and Ankle Surgery, Journal of Orthopedic Trauma). The reference lists from the identified studies were also scrutinized for any additional reports.The studies that reported the prevalence/incidence of peroneal tendon subluxation/ dislocation in association with a calcaneus fracture were included whereas patients with calcaneus fractures combined with other fractures, extraarticular calcaneus fractures, and old calcaneus fractures were excluded.The data analysis was performed using a comprehensive meta-analysis with a random effects model. Results: Of 31 initial studies, 9 were included, contain 1027 patients/1050 calcaneus fractures.Most of the patients were male, with an average age of 42.03 (range 18 to 79) years.Of the 1050 calcaneus fractures, PI was found in association with 305.The pooled odds ratio of the prevalence of PI with calcaneus fractures was 29.3%(95% CI 25.9%-32.9%; p < .001).The prevalence of PI increased with an increased fracture severity using the Sanders classification, with a prevalence of 5.4% with Sanders I,19% with Sanders II, 39.4% in Sanders III, and 49.5% with Sanders IV. The prevalence of PI in the tongue type fracture using the Essex-Lopresti classification was 19%, and for joint depression, was 30.8% (p < .001). The prevalence of the fleck sign as an indicator of PI was 54.7%. Conclusion: The global reported prevalence of peroneal tendon dislocation associated with intraarticular calcaneal fractures was 29.3% and that the prevalence of PI increases with increased severity of the calcaneus fracture. Such a high prevalence should raise suspicions in both radiologists and orthopedic surgeons about this injury. The assessment should begin with a careful review of preoperative radiographs to search for the fleck sign and CT scans for a dislocated tendon, followed later by intraoperative assessment of superior peroneal retinaculum integrity.

scholarly journals Lateral Wall Decompression for Malunited Calcaneal Fractures

2015 ◽  
Vol 2 (2) ◽  
pp. 80-85
Author(s):  
Sanjay Agarwala ◽  
Anshul Shyam Sobti
Keyword(s):  
Treatment Option ◽  
Case Series ◽  
Lateral Wall ◽  
Calcaneal Fracture ◽  
Normal Function ◽  
Asia Pacific ◽  
Type I ◽  
Calcaneal Fractures ◽  
Postoperative Evaluation ◽  
Viable Treatment

ABSTRACT Aim The purpose of this case series is to reintroduce Kashiwagi decompression as a viable treatment option for malunited calcaneal fractures, delineate the operative technique, and discuss its advantages. Materials and methods From August 2004 to May 2013, 18 patients with Sanders type I malunited calcaneal fractures with lateral heel pain and impingement were treated with the lateral wall decompression technique. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results Eleven patients were males and seven were females, with an average age of 48.4 years. Ten patients had left feet fracture and eight had right feet fracture. Among all the 18 patients with a ‘poor’ score at baseline, 2 (11.11%) scored ‘excellent’, 11 (61.11%) scored ‘good’ and 3 (16.67%) scored ‘fair’ during postoperative evaluation. The average time to return to daily activities was 10.2 weeks (8–12.5 weeks). Conclusion Lateral wall osteotomy and decompression effectively addresses the pathology in cases of lateral abutment due to a malunited calcaneal fracture. This technique has advantages of ensuring a reliable resolution with good clinical outcomes and produces fewer postoperative complications. Clinical significance Malunion is a common complication with calcaneal fracture. It affects normal function. In malunited calcaneal fractures, the lateral wall of the calcaneum forms a lateral wall exostosis that causes both subfibular impingement and peroneal tendinopathy or displacement. There is need for a viable treatment option for malunions with lateral wall exostosis after calcaneal fractures. This study describes a surgical technique as a solution for the above. How to cite this article Agarwala S, Sobti AS. Lateral Wall Decompression for Malunited Calcaneal Fractures. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):80-85.

scholarly journals Steinmann pin retractor-assisted reduction with circle plate fixation via sinus tarsi approach for intra-articular calcaneal fractures: a retrospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Bin Zhao ◽  
Wenqian Zhao ◽  
Isaac Assan
Keyword(s):  
Plate Fixation ◽  
Lateral Wall ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Anatomic Reduction ◽  
Sinus Tarsi Approach ◽  
American Orthopaedic ◽  
Calcaneus Fractures ◽  
Steinmann Pin

Abstract Background Sinus tarsi approach and mini-calc plate have been used for intra-articular calcaneal fractures. However, the sinus tarsi approach has limited exposure to the lateral wall, which makes it challenging to obtain an excellent anatomic reduction of the calcaneal body. What is more! To restore the width of the calcaneal body entirely and prevent the heel varus simultaneously with mini-calc plate was tough as well. Aimed to solve the aforementioned problems, our study focused on using the Steinmann pin retractor for reduction and the circle plate for fixation via the sinus tarsi approach. Methods From March 2017 to January 2019, 15 patients with closed calcaneal fractures were treated with the method of Steinmann pin retractor-assisted reduction and circle plate fixation via the sinus tarsi approach. All these patients received a positive postoperative clinical and radiological evaluation. Results A postoperative follow-up was done for each of the 15 patients, and the following scores and parameters were observed: value of visual analogue scale (VAS) was 1.44 ± 0.63, and The American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot score was 84.31 ± 5.03 at the last follow-up. The Böhler angle (30.81 ± 3.56°), width (37.83 ± 4.87 mm), length (87.4 ± 3.33 mm), and height (86.23 ± 5.36 mm) of the calcaneus were improved significantly in comparison with preoperative values (− 0.94 ± 10.06°, 45.67 ± 5.68 mm, 82.72 ± 5.54 mm, 76.32 ± 7.98 mm), and these parameters were maintained excellently after 6–19 months’ follow-up. Conclusion Our present study suggested that Steinmann pin retractor-assisted reduction with circle plate fixation via the sinus tarsi approach may serve as a safe and effective method for Sanders type II and type III calcaneus fractures. The Böhler angle, height, length, and body of the calcaneus were excellently restored postoperatively and maintained at last follow-up and rare postoperative complications. Trial registration This study has been registered. The unique identifying number is research registry 5092.

scholarly journals Social Media Use Among Foot and Ankle Orthopedic Surgeons

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142098192
Author(s):  
Garret Garofolo-Gonzalez ◽  
Cesar R. Iturriaga ◽  
Jordan B. Pasternack ◽  
Adam Bitterman ◽  
Gregory P. Guyton
Keyword(s):  
Social Media ◽  
Clinical Practice ◽  
Media Use ◽  
The United States ◽  
Foot And Ankle ◽  
Social Media Use ◽  
Social Media Platform ◽  
Orthopedic Surgeons ◽  
Media Platform ◽  
Social Media Presence

Background: Digital media is an effective tool to enhance brand recognition and is currently referenced by more than 40% of orthopedic patients when selecting a physician. The purpose of this study was to evaluate the use of social media among foot and ankle (F&A) orthopedic surgeons, and the impact of that social media presence on scores of a physician-rated website (PRW). Methods: Randomly selected F&A orthopedic surgeons from all major geographical locations across the United States were identified using the AAOS.org website. Internet searches were then performed using the physician’s name and the respective social media platform. A comprehensive social media use index (SMI) was created for each surgeon using a scoring system based on social media platform use. The use of individual platforms and SMI was compared to the F&A surgeon’s Healthgrades scores. Descriptive statistics, unpaired Student t tests, and linear regression were used to assess the effect of social media on the PRW scores. Results: A total of 123 board-certified F&A orthopedic surgeons were included in our study demonstrating varying social media use: Facebook (48.8%), Twitter (15.4%), YouTube (23.6%), LinkedIn (47.9%), personal website (24.4%), group website (52.9%), and Instagram (0%). The mean SMI was 2.4 ± 1.6 (range 0-7). Surgeons who used a Facebook page were older, whereas those using a group website were younger ( P < .05). F&A orthopedic surgeons with a YouTube page had statistically higher Healthgrades scores compared to those without ( P < .05). Conclusion: F&A orthopedic surgeons underused social media platforms in their clinical practice. Among all the platforms studied, a YouTube page was the most impactful social media platform on Healthgrades scores for F&A orthopedic surgeons. Given these findings, we recommend that physicians closely monitor their digital identity and maintain a diverse social media presence including a YouTube page to promote their clinical practice. Level of Evidence: Level IV.

Foot and Ankle Injections in Athletes

2021 ◽  
pp. 194173812110036
Author(s):  
Jonathan K. Ochoa ◽  
Christopher E. Gross ◽  
Robert B. Anderson ◽  
Andrew R. Hsu
Keyword(s):  
English Language ◽  
Platelet Rich Plasma ◽  
Empirical Studies ◽  
Autologous Blood ◽  
Case Series ◽  
Placental Tissue ◽  
Ankle Injuries ◽  
Extensive Literature ◽  
Foot And Ankle ◽  
Level Of Evidence

Context: Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. Evidence Acquisition: An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. Study Design: Clinical review. Level of Evidence: Level 4. Results: Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. Conclusions: Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.

Peroneal Tendon Pathology Associated with Calcaneus Fractures

2020 ◽  
pp. 373-379
Author(s):  
Rull James Toussaint ◽  
Nicholas P. Fethiere ◽  
Dominic Montas
Keyword(s):  
Peroneal Tendon ◽  
Tendon Pathology ◽  
Calcaneus Fractures

scholarly journals Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

2020 ◽  
Author(s):  
Chenggong Wang ◽  
Can Xu ◽  
Mingqing Li ◽  
Hui Li ◽  
Han Xiao ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Subtalar Joint ◽  
Calcaneal Fracture ◽  
Patient Specific ◽  
Calcaneal Fractures ◽  
Intraoperative Fluoroscopy ◽  
Joint Width ◽  
Preoperative Plan ◽  
Overlap Ratio ◽  
Minimally Invasive Internal Fixation

Abstract Background: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.Methods: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.Results: Mean intraoperative fluoroscopy time was 3.95±1.78 h; IFAU in 16 patients (16 feet) was the same as the preoperative plan; mean surgery time was 28.16±10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2%±2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.Conclusions: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

scholarly journals An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

2021 ◽  
Vol 9 ◽  
pp. 205031212110409
Author(s):  
Ali Varol ◽  
Yunus Oc ◽  
Bekir Eray Kilinc
Keyword(s):  
Bone Grafting ◽  
Plate Osteosynthesis ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Type Iii ◽  
Heel Height ◽  
The Mean ◽  
American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

scholarly journals Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

2020 ◽  
Author(s):  
Zihua Li ◽  
Xinbo Wu ◽  
Haichao Zhou ◽  
Shaochen Xu ◽  
Fajiao Xiao ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Internal Fixation ◽  
Incremental Cost ◽  
Lateral Approach ◽  
Type Ii ◽  
Calcaneus Fracture ◽  
Sinus Tarsi Approach ◽  
Significant Difference ◽  
Extensile Lateral Approach ◽  
Calcaneus Fractures

Abstract Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons. And comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of CUA about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life-years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results 109 patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory and radiographic evaluation expense, surgery, anesthesia and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group ( P <.001, P =.008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days ( P <.001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8±2835.2/QALY and $7914.9 ± 1822.0/QALY respectively and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.

scholarly journals Functional assessment of foot and ankle tendinopathies treated with tendoscopy

2021 ◽  
Vol 15 (2) ◽  
pp. 128-132
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Renato Morelli Berg
Keyword(s):  
Functional Assessment ◽  
Descriptive Analysis ◽  
Case Series ◽  
P Value ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Treatment Results ◽  
Duration Of Treatment ◽  
Aofas Score ◽  
Level Of Evidence

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot & Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was <0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

scholarly journals Three-Dimensional CT Mapping of Intra-articular Calcaneal Fractures

2021 ◽  
Author(s):  
Haichao Zhou ◽  
Wenbao He ◽  
Zhendong Li ◽  
Shaochen Xu ◽  
Fajiao Xiao ◽  
...  
Keyword(s):  
Articular Surface ◽  
Compression Fracture ◽  
3D Models ◽  
Calcaneal Fracture ◽  
Fracture Line ◽  
X Rays ◽  
Calcaneal Fractures ◽  
Secondary Fracture ◽  
Fracture Group ◽  
Primary Fracture

Abstract Background: Intra-articular calcaneal fracture is a challenge for surgeons, which must be understood to provide optimal treatment. The aim of this study was to define the distribution of the primary fracture line and the secondary fracture line of intra-articular calcaneal fractures. Methods: All X-rays and CT scans of intra-articular calcaneal fractures were collected from January 2014 to July 2020. According to the classification of Essex-Lopresti, these fractures were divided into tongue-fracture group and compression-fracture group. Construct 3D models of intra-articular calcaneal fractures in all patients, and record the location of all fracture lines, which were marked and integrated on the 3D model of intact calcaneus after virtual reduction. Heat mapping were created based on the occurrence frequency of fracture lines. Results: A total of 171 patients with intra-articular calcaneal fractures were included in this study, 4 of whom were bilateral. There were 87 cases in the tongue-fracture group, 37 cases (42.5%) involved 4 anterior articular surface, 16 cases (18.4%) involved middle articular surface, and 52 cases (59.8%) involved calcanecuboid articular surface. There were 88 cases in the compression-fracture group, including 43 cases (48.9%) involving anterior articular surface, 21 cases (23.9%) involving middle articular surface, and 63 cases (71.6%) involving calcanecuboid articular surface. Conclusion: The distribution of the primary fracture line and the secondary fracture line of intra-articular calcaneal fractures has a certain rule and correlation. Whether in tongue-fracture group or compression-fracture group, the fracture line is most often involves the calcanecuboid articular surface, followed by anterior articular surface, at least involves middlearticular surface. This study provides a theoretical basis for further exploration of calcaneal injury mechanism, construction of biomechanical model, and choice of surgical approach.

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