Local Random Pattern Flap Coverage for Implant Exposure following Open Reduction Internal Fixation via Extensile Lateral Approach to the Calcaneus

Background Skin necrosis and implant exposure most often appear at the corner of Extensile Lateral Approach for open reduction and internal fixation (ORIF) for displaced intra-articular fracture of the calcaneus. Flap transfer is often used for coverage of this implant exposure. We introduced a new simple local random pattern flap to cover the implant exposure. Methods From March 2017 to March 2020, 12 patients with implant exposure after ORIF for displaced intra-articular fracture of the calcaneus were treated with this procedure. The sizes of the defects ranged from 2 × 2 cm2 to 5 × 2 cm2. A local random pattern flap was designed according to the defect size. The lower edge of the flap was along with the wound upper edge and extended distally. The upper horizontal incision of the flap was made at the lateral malleolus level with a length of 5–7 cm depending on the wound defect. Then the random pattern flap was elevated and transferred to cover the defect area. Results The mean follow-up duration was 6.3 months (ranging 4–13 months). All 12 flaps were uneventfully healed and all patients were able to wear shoes, and no debulking procedures were required. Conclusion The local random pattern flap could be a choice for surgeons when implant exposure at the corner of Extensile Lateral Approach to the Calcaneus occurs.

Bohler's Angle and Critical Angle of Gissane: Morphometry in Adult Indian Population

ABSTRACT Introduction For the quantification of intra-articular fracture of the calcaneus, different types of angles have been mentioned in the literature. Of these, the Bohler's angle (BA) and the critical angle of Gissane (CAG) are used in common practice. However, there is a great paucity of literature conducted on the Indian populace to find out the normal range of BA and CAG. In this article, our objective is to homologate and confirm the normal range of BA and the CAG in the Indian population and compare their values to the published international reference values. Materials and methods It is an observational cross-sectional study done between 2017 and 2019. X-rays were anonymized by hiding the identification data. The BA and CAG were measured together and by two authors simultaneously. Each angle was measured two times. Two-sample T-test was chosen to compare the means of the values and the p value <0.05 was considered significant. Results Three hundred and eighty-four (n = 384) X-rays were studied. The average age of the patients was 41.73 years. The mean (°) of BA was 33.53 ± (SD) 6.78 (max = 46.35, min = 16.23) and the mean (°) of CAG was 115.90 ± (SD) 11.00 (max = 142.88, min = 90.22). Conclusion The distinct apprehension of the normal dispersion of Bohler's angle and the CAG is utmost needed for the clinical practice in a population (racial) group. So, it is praiseworthy to conduct a multicenter study over a large Indian population (considering racial variation) with inter and intra-rater reliability. How to cite this article Mishra PK, Pathak S, Tenguria A. Bohler's Angle and Critical Angle of Gissane: Morphometry in Adult Indian Population. J Foot Ankle Surg (Asia Pacific) 2021;8(2):72–75.

Plantar Medial Avulsion Fracture of the Calcaneus With Acute Tarsal Tunnel: Case Report and Technique Tip

Level of Evidence: Level V, expert opinion.

Surgical treatment of thalamic fractures treated by anatomic plate with survevent

Introduction: Calcaneus fractures are frequent and serious injuries. They represent 65% of tarsal trauma and 2% of all fractures. The thalamic fractures constitute a particular entity by their mechanism of occurrence, by their treatment and by their prognosis much less favorable than the extra-articular fractures.1 Materials and methods: Our series spanning a period of 7 years from January 2011 to November 2018 focused on 12 patients with a thalamic fracture of the calcaneus treated by anatomical plate with bearing, collected in the Orthopedic Trauma Department A of the Hassan II Fez University Hospital. All adult patients with a thalamic calcaneal fracture who had undergone an osteosynthesis using an anatomical plate were included and extra-thalamic fractures and thalamic fractures treated by other therapeutic means or other types of screw plates were excluded. All patients underwent an urgent general systematic examination and a regional examination. On the neurological level, the majority of patients were admitted with a GCS at 15. Results: Our focused on 12 operated patients between the ages of 17 and 53 with an average of 35 years. Our series includes 12 patients including 17 calacneum fractures which are divided into 10 men and 2 women; the male sex represents 83.3%. The preoperative delay was on average 9.25 days with extremes between 03 and 20 days. No thromboembolic complications or algodystrophy were noted in our series. According to Kitaoka's rating, the average score was 73.5%. The functional results were excellent in 47.06% of the cases, good in 23.53% of the cases, average in 23.53% of the cases and poor in 5.88% of the cases. In post-operative the average Bohler angle was 26.5° (15° to 35°) against a pre-operative Bohler angle varying between -7° to 15°. On revision, the average recoil from Bohler's angle finds it to be 21.5°. Conclusion: In the light of all those preceding the surgical treatment of articular fractures of the calcaneus displaced by anatomical plate, despite the risks associated with this technique provides a certain superiority if you are sure you can get a perfect reduction.

Minimally Invasive Surgery for Intra-Articular Calcaneus Fractures: A 9-Year, Single-Center, Retrospective Study of A Standardized Technique Using A 2-Point Distractor

Background: A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative, as in open reduction and internal fixation (ORIF) via different approaches, including a number of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the (xxx institution blinded xxx) over a 9-year period. Methods: All patients with calcaneal fractures treated at the (xxx institution blinded xxx) between 2007 and 2016 were included in this study. The patients’ protocols were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between the accident and the first operative treatment were analyzed. Secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. Results: A minimally invasive 2-point-distractor method was used in 85.8% (n=182) of all operatively managed calcaneal fractures (n=236) in our department. The majority of the operations (88.7%) were performed within two days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n=9) of the subtalar joints in the entire study population. Conclusions: Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. Additionally, our arthrodesis rate was comparable to that in the literature.

Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

Achilles tendon rupture in camel (Camelus dromedarius): Radiographic and Ultrasonographic findings

This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.

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This study describes the clinical presentation of Achilles tendon rupture and evaluates the utility of radiography and ultrasonography in the diagnosis of such disorder in dromedary camels. Seventeen camels were included in this study based on the clinical, radiographic and ultrasonographic evidence of Achilles tendon rupture. The clinical, radiographic and sonographic findings of studied camels differ according to the type, duration, and location of the tendon rupture. Complete and incomplete rupture of the Achilles tendon was precisely diagnosed in five (29.4%) and twelve (70.6%) camels respectively; ruptured deep and superficial parts of the Achilles tendon were recorded in 10 (58.8%) and 2 (11.8%) camels respectively. Clinically, the camels exhibited an acute non-weight-bearing lameness (second to fourth-grade lameness), with swelling in the tendon near the calcaneus. Radiographs revealed swelling of the soft tissues surrounding the Achilles tendon just proximal to the calcaneal tuberosity in most of the camels with the presence of avulsion fracture of the calcaneus in few cases (n=2). Ultrasonographically, the ruptured part was precisely diagnosed as swollen, oedematous, heterogeneous structure with the presence of anechoic or hypoechoic areas (core lesion). In conclusion, lateromedial radiographs and ultrasonography were helpful in diagnosis and differential diagnosis of different types of Achilles tendon rupture and subsequent clinical decision and surgical interference in dromedary camels.