Calcaneal fractures

An amorphous calcium phosphate cement retrieved from human biopsies, has indicated an absence of fibrous tissue and partial replacement by new bone. The surface of the cement was surrounded by cells indicative of a bone remodeling process leading to new bone with regular trabecular and osteonal patterns (Sarkar 2001). Patients with complex calcaneal fractures treated with calcium phosphate cement have indicated full weight-bearing as early as three weeks postoperatively (Schildhauer et al. 2000). 

Schildhauer, T. A., Bauer, T. W., Josten, C., and Muhr, G. (2(XX)), Open reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures, /. Orthop. Trauma 14(5) 309-317. 

Routine radiographs for foot trauma are the anteroposterior (AP), oblique and true lateral views. Fractures are more readily identified on the AP or oblique but a true lateral allows full assessment of displacement. Both computerised tomography (CT) and magnetic resonance (MR) imaging have roles to play in foot trauma. CT is useful in comminuted calcaneal fractures to assess joint involvement and to help plan surgical reconstruction, while MR can help diagnose ligament injuries. 

Fig. 16.3a,b. Calcaneal fracture in a 15-year-old boy. The radiograph does not fully detail the fracture. The coronal CT shows the fracture is predominantly on the lateral aspect of the calcaneum (type IIA)... 

Inokuchi S, Usami N, Hiraishi E, Hashimoto T (1998) Calcaneal fractures in children. J Pediatr Orthop 18 469-474 Jones R (1902) Fracture of the base of the fifth metatarsal by indirect violence. Ann Surg 35 697-700 Kay RM, Tang CW (2001) Pediatric foot fractures evaluation and treatment. J Am Acad Orthop Surg. 9 308-319 Logan B, Singh D, Hutchings R (2004) McMinn s colour atlas of foot and ankle anatomy, 3rd edn. Mosby, Elsevier Mora S, Thordarson DB, Zionts CE, Reynolds RA (2001) Pediatric calcaneal fractures. Foot Ankle Int 22 471-477... 

All these products have similar mechanical properties as mentioned before. A porous needle-like structure Caio(P04)e(OH)2 crystals are their typical microstructure (Figure 24.6). These cements have been successfully used in sinus repair, cranioplasty, distal radial and calcaneal fracture. It has also been reported that the calcium phosphate cement has been used for percutanous Vertebroplasty [ 15,26-37]. 

Fig. 4.11.. Subsequent MRI with a sagittal short tau inversion recovery (STIR) sequence demonstrates a calcaneal stress fracture with surrounding bone marrow oedema.

Fig. 7.45. Os trigonum simulating fracture of posterior process of the talus (arrow). The calcaneal apophysis appears sclerotic and fragmented but this is normal...

Fig. 7.49. The unfused calcaneal apophysis simulating a fracture in oblique projection (arrow)...

Fig. 25.8. Volume-rendered multi-detector row CT image of the ankle and hindfoot in a patient following a fall from a height. VR view shows a calcaneal comminuted fracture (arrows) with an involvement of the talo-calcaneal facet (arrowhead).The tendons are well depicted because they are surrounded hy fat...

Boutry N, Vanderhofstadt A, Peetrons P (2006) Ultrasonography of anterosuperior calcaneal process fracture report of 2 cases. J Ultrasound Med 25 381-385 Brigido MK, Fessell DP, Jacobson JA et al (2005) Radiography and US of os peroneum fractures and associated peroneal tendon injuries initial experience. Radiology 237 235-241... 

Redd RA, Peters VJ, Emery SF et al (1989) Morton neuroma sonographic evaluation. Radiology 171 415-417 Reed M, Gooding GA, Kerley SM et al (1991) Sonography of plantar fibromatosis. J Clin Ultrasound 19 578-582 Robbins MI, Wilson MG, Sella EJ (1999) MR imaging of antero-superior calcaneal process fractures. AJR Am J Roentgenol 172 475-479... 

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