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Cockerill SJ, Arnay-de-la-Rosa M, González-Reimers E. An atlas of anatomical variants of the human calcaneus. J Morphol 2024; 285:e21706. [PMID: 38704702 DOI: 10.1002/jmor.21706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
The usefulness of anatomical variation is determined by the knowledge of why nonmetric traits appear. Clear descriptions of the traits are a necessary task, due to the risk of confusing anatomical variants and evidence of trauma. Numerous interpretations of the appearance of calcaneal anatomical variants add to the need of an anatomical atlas of calcaneal nonmetric traits. We have analyzed a total of 886 calcanei; 559 belong to different modern and pre-Hispanic samples, and 327 bones were studied from a reference collection from Athens. In this study, we present the anatomical variations that exist on the calcaneus bone, some of which have rarely been mentioned in previous research. The standardization of methods proposed may be useful to experts working in human anatomy, physical anthropology as well as comparative morphology, due to usefulness of this information during surgery, and bioanthropology to observe and study the lifestyle of past populations.
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Affiliation(s)
- Samuel James Cockerill
- Departamento Geografía e Historia, Facultad de Humanidades, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Matilde Arnay-de-la-Rosa
- Departamento Geografía e Historia, Facultad de Humanidades, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Emilio González-Reimers
- Dpto. de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
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A case of an injured calcaneus secundarius in a professional soccer player. BMC Musculoskelet Disord 2021; 22:374. [PMID: 33888108 PMCID: PMC8063446 DOI: 10.1186/s12891-021-04246-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background The calcaneus secundarius (CS) is an accessory ossicle of the anterior facet of the calcaneus and is usually asymptomatic. This accessory bone can be frequently mistaken for a fracture of the anterior process of the calcaneus. Few reports of symptomatic CS have been published, and physicians need to be familiar with imaging strategies when encountering chronic ankle pain or in case of suspicion of fracture of the anterior process of the calcaneus. Case presentation We describe the case of symptomatic CS in a professional soccer player injured during a match. First, computed tomography showed a large CS. Second, magnetic resonance imaging (MRI) demonstrated synchondrosis between the CS and the calcaneus, as well as edema (high MR T2 signal) within it, corresponding to posttraumatic edema. The patient was successfully treated with nonsteroidal anti-inflammatory drugs and physiotherapy; no surgical management was necessary. At the 4-week follow-up, he was pain-free and returned to activity. Conclusion This case illustrates the role of imaging for the diagnosis of CS in cases of acute pain of the foot. CT, as well as MRI, helped to confirm the diagnosis of CS traumatized synchondrosis, which can be mistaken for a fracture.
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Fractures of the anterior process of the calcaneum: A review and proposed treatment algorithm. Foot Ankle Surg 2019; 25:849-851. [PMID: 30502223 DOI: 10.1016/j.fas.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
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Hennings R, Voigt P, Kahn T, Josten C, Ahrberg AB. Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat 2019; 41:1425-1432. [PMID: 31563970 DOI: 10.1007/s00276-019-02348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE A fracture or a pseudarthrosis of the processus anterior calcanei (PAC) as well as a traumatized Os calcaneus secundarius (OCS) is often overlooked. A clinical or conventional radiological differentiation of these is uncertain. Therefore, a CT scan is recommended. The aim of the study was to identify CT morphological differentiators between OCS and pathologies of PAC. METHODS All CT scans at our trauma center level I from 2010 to 2014, which imaged the entire foot, performed after acute trauma or postoperative control were retrospectively re-examined for OCS, other accessory ossicles (oAOS), fracture or pseudarthrosis of PAC and analyzed for specifiers. RESULTS In 611 CT examinations, 14 (2.3%) accessory ossicles (AOS) at the PAC were detected. 12 (86%) were identified as typical OCS and 2 (14%) as oAOS. 56 (9.2%) pathologies were detected. Of these, 44 (79%) were declared as fractures and 12 (21%) as pseudarthrosis. 7 OCS (58%) and 25 (46%) of the pathologies were not mentioned in the initial CT reports. The main differentiators of OCS to fracture of PAC were the anteromedial localization into a concave notch at the calcaneal facet at PAC and the continuous corticalization. With increasing size, radiological osteoarthritic signs at the OCS were frequent (p ≤ 0.05). CONCLUSIONS The study confirms that AOS or pathologies at the PAC often are not exactly described in CT report. In the context of foot trauma, attention should be paid to this region. Based on the presented differentiation criteria, a precise distinction can be made with the help of a CT.
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Affiliation(s)
- Robert Hennings
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany.
| | - Peter Voigt
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Christoph Josten
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Annette B Ahrberg
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
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Aparisi Gómez MP, Aparisi F, Bartoloni A, Ferrando Fons MA, Battista G, Guglielmi G, Bazzocchi A. Anatomical variation in the ankle and foot: from incidental finding to inductor of pathology. Part I: ankle and hindfoot. Insights Imaging 2019; 10:74. [PMID: 31363861 PMCID: PMC6667521 DOI: 10.1186/s13244-019-0746-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/02/2019] [Indexed: 12/18/2022] Open
Abstract
Accessory anatomical structures in the ankle and foot usually represent incidental imaging findings; however, they may also eventually represent a source of pathology, such as painful syndromes, degenerative changes, be the subject of overuse and trauma or appear as masses and cause compression syndromes or impingement.This review aims to describe and illustrate the imaging findings related to the presence of accessory ossicles and muscles in the ankle and hindfoot through different techniques, with special attention to those variants that associate factors of clinical relevance or that trigger challenges in the differential diagnosis.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital - Auckland District Health Board (ADHB), 2 Park Road, Grafton, Auckland, 1023, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, Calle Valle de la Ballestera, 59, 46015, Valencia, Spain
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Calle Valle de la Ballestera, 59, 46015, Valencia, Spain
| | - Alessandra Bartoloni
- Department of Diagnostic Imaging, Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Maria Alejandra Ferrando Fons
- Department of Orthopaedics and Traumatology, Malteser Krankenhaus St. Josefshospital, Kurfürstenstrasse 69, 47829, Krefeld, Germany
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S.Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy.
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Dhinsa BS, Latif A, Walker R, Abbasian A, Back D, Singh S. Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm. Foot Ankle Surg 2019; 25:258-263. [PMID: 30321973 DOI: 10.1016/j.fas.2018.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 02/01/2018] [Accepted: 02/03/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND There remains a lack of recognition of these fractures, which leads to a delay in diagnosis and appropriate management. METHODS A comprehensive literature search was performed. Following inclusion and exclusion criteria, 23 studies were available for analysis. RESULTS Delay in diagnosis is common and has a negative impact on outcome. If an APC fracture is suspected; anteroposterior, lateral and oblique plain radiographs should be requested. Further investigation with computed tomography or magnetic resonance imaging is indicated if plain radiographs are inconclusive and patient remains symptomatic. Non-operative measures are usually adequate for most undisplaced fractures, however surgical intervention maybe required for large, intra-articular fractures in the acute setting and for non-union. CONCLUSIONS A treatment algorithm is suggested that may help with the diagnosis and management of these injuries. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Baljinder S Dhinsa
- William Harvey Hospital, Kennington Road, Willesborough, Ashford TN24 0LZ, United Kingdom.
| | - Ahmed Latif
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Roland Walker
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Ali Abbasian
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Diane Back
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Sam Singh
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
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Guo S, Yan YY, Lee SSY, Tan TJ. Accessory ossicles of the foot-an imaging conundrum. Emerg Radiol 2019; 26:465-478. [PMID: 30963314 DOI: 10.1007/s10140-019-01688-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
Various anatomical variations can be found in the foot and ankle, including sesamoid bones and accessory ossicles. These are usually incidental findings and remain asymptomatic; however, they may cause complications resulting in painful syndromes or degenerative changes secondary to overuse or trauma. They can also lead to fractures or simulate fractures. These complications are challenging to diagnose on radiographs. Advanced imaging with US, CT, MRI, or Tc-99m bone scan is useful for definitive diagnosis. This study aims to illustrate how imaging modalities can be used to diagnose complications of common sesamoids and accessory ossicles of the ankle and foot (hallux sesamoids, os trigonum, accessory navicular, os supranaviculare, os peroneum, os intermetatarseum, and os calcaneus secundarius) and demonstrate the imaging differences between fractures and their mimics.
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Affiliation(s)
- Shuyi Guo
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Yet Yen Yan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Sonia Shu Yi Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
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Lui TH. Endoscopic resection of symptomatic os calcaneus secundarius. Foot (Edinb) 2018; 37:101-104. [PMID: 30336402 DOI: 10.1016/j.foot.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 02/04/2023]
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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Multiple abnormalities in the feet and associated changes elsewhere in the skeleton: The case of 3A-7 from a Capsian Site in Algeria. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:199-212. [PMID: 28549622 DOI: 10.1016/j.jchb.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/03/2017] [Indexed: 11/22/2022]
Abstract
A skeleton with a number of abnormalities is described involving full discussion of alternative diagnoses. In this complex case, the primary diagnosis is of avulsion of the stem of the bifurcate ligament causing a fracture of the anterior process of the calcaneus. The bilateral fracture identified in Skeleton 3A-7 from Site 12, a Capsian site in Algeria, is a result of the feet being inverted and plantar flexed: the fracture is prone to non-union, which is asymmetrical here. There is also a separate anatomical variation of the feet, 3rd cuneiform and 3rd metatarsal coalition, which was not the cause of trauma. The bifurcate ligament is a major stabilizer of the lateral transverse talar joint, and the trauma could lead to further issues: however, multiple other traumatic changes in 3A-7 most likely occurred at the same time, rather than as the result of pre-existing foot trauma. The asymmetry of the calcaneal condition and asymmetry of the sequelae of the original trauma led to long bone asymmetry, the result of locomotor difficulties.
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Krapf D, Krapf S, Wyss C. Calcaneus secundarius--a relevant differential diagnosis in ankle pain: a case report and review of the literature. J Med Case Rep 2015; 9:127. [PMID: 26033079 PMCID: PMC4456698 DOI: 10.1186/s13256-015-0595-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/21/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Accessory ossicles of the foot are a common finding. Although mostly asymptomatic, they can gain clinical relevance by trauma or stress on the complex biomechanical system of the foot. There are few reports on the entity of symptomatic calcaneus secundarius. Furthermore, the current literature does not address the need for awareness of calcaneus secundarius as a differential diagnosis in cases of persistent posttraumatic ankle pain. Case presentation We present the case of a 51-year-old Indo-European man with a medical history of persistent load-dependent ankle pain over 3 decades. At presentation after an acute ankle sprain, we diagnosed a traumatized calcaneus secundarius. Surgical excision led to a complete recovery. More than 1 year postoperative he is still asymptomatic. Conclusions With the presented case and review of the literature we demonstrate the clinical relevance of calcaneus secundarius. Depending on size and alignment, calcaneus secundarius can alter the biomechanics in the subtalar region generating pain at the ankle. If a patient has persistent sinus tarsi syndrome, a painful limited subtalar range of motion or repetitive ankle sprains, then calcaneus secundarius should be considered in differential diagnosis. Likewise when a fracture of the anterior process of the calcaneus or a calcaneonavicular coalition is suspected, calcaneus secundarius should be considered a possible diagnosis by all clinicians confronted with foot and ankle pain.
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Affiliation(s)
- Daniel Krapf
- Kantonsspital Aarau, Fusszentrum, Tellstrastrasse, CH-5001, Aarau, Switzerland.
| | - Sebastian Krapf
- Universitäts-Kinderspital beider Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland.
| | - Christian Wyss
- Universitäts-Kinderspital beider Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland.
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Bulut MD, Yavuz A, Bora A, Gökalp MA, Özkaçmaz S, Batur A. Three-Dimensional CT Findings of Os Calcaneus Secundarius Mimicking a Fracture. Case Rep Radiol 2014; 2014:537062. [PMID: 25610694 PMCID: PMC4283419 DOI: 10.1155/2014/537062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022] Open
Abstract
Os calcaneus secundarius is one of several accessory ossicles of the foot that have been identified as normal variants of skeletal development. It may cause ankle pain and may mimic an avulsion fracture of the anterior calcaneal process. A twenty-year-old male was admitted to our institution with right ankle pain following an inversion injury. An axial CT image of the patient's right ankle revealed a shape with smooth and sharp margins, identified as a well-corticated bone fragment in the subtalar region. A diagnosis of an accessory ossicle, os calcaneus secundarius, was made based on radiographic findings. As a result of this case, it is recommended that potential locations of the accessory bones should be well understood in order to prevent misdiagnosis and inappropriate surgical procedures. Os calcaneus secundarius must be considered when an apparent bone fragment or a suspicious fracture line at the anterior region of os calcaneus is demonstrated.
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Affiliation(s)
- Mehmet Deniz Bulut
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Dursun Odabaş Medical Center, 65100 Van, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Dursun Odabaş Medical Center, 65100 Van, Turkey
| | - Aydın Bora
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Dursun Odabaş Medical Center, 65100 Van, Turkey
| | - Mehmet Ata Gökalp
- Department of Orthopedics, School of Medicine, Yuzuncu Yil University, 65100 Van, Turkey
| | - Sercan Özkaçmaz
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Dursun Odabaş Medical Center, 65100 Van, Turkey
| | - Abdussamet Batur
- Department of Radiology, School of Medicine, Yuzuncu Yil University, Dursun Odabaş Medical Center, 65100 Van, Turkey
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Avulsion fractures in the foot: telltale radiographic signs to avoid mismanagement. Clin Imaging 2014; 39:374-9. [PMID: 25482353 DOI: 10.1016/j.clinimag.2014.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/12/2014] [Accepted: 11/15/2014] [Indexed: 11/22/2022]
Abstract
Due to similar clinical presentations, avulsion fractures are frequently missed on initial exam and categorically treated as "sprain" not otherwise specified. However, delays in appropriate diagnosis and treatment can result in further injury and long-term disability. This article will review multiple foot avulsion fractures, their respective mechanisms of injury, the clinical and radiographic presentations, and the most appropriate courses of treatment.
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Aykanat F, Kose O. Chronic Ankle Pain After An Initial 'Twisting' Injury To The Ankle. Turk J Emerg Med 2014; 14:46. [PMID: 27331168 PMCID: PMC4909873 DOI: 10.5505/1304.7361.2014.02069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/04/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Faruk Aykanat
- Department of Orthoapedics and Traumatology, Islahiye State Hospital, Gaziantep
| | - Ozkan Kose
- Department of Orthoapedics and Traumatology, Antalya Education and Research Hospital, Antalya
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Frakturen des Processus anterior calcanei. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:579-91. [DOI: 10.1007/s00064-013-0248-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 01/28/2023]
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Abstract
UNLABELLED Stress fracture of the anterior process of the calcaneus is rare. We present a case of a 14-year-old female basketball player who suffered a stress fracture of the anterior process of the calcaneus that was not associated with a calcaneonavicular coalition. After conservative treatment failed, drilling of the fracture site was required to facilitate healing. A possible cause of this rare type of stress fracture seemed to be a long anterior process of the calcaneus. LEVEL OF EVIDENCE Therapeutic, Level IV: Case study.
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Affiliation(s)
- Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (ST)
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Green D, Green HD, New DI, Kalra PA. The clinical significance of hyperkalaemia-associated repolarization abnormalities in end-stage renal disease. Nephrol Dial Transplant 2012; 28:99-105. [DOI: 10.1093/ndt/gfs129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lui TH. Endoscopic excision of symptomatic nonunion of anterior calcaneal process. J Foot Ankle Surg 2011; 50:476-9. [PMID: 21601485 DOI: 10.1053/j.jfas.2011.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Indexed: 02/03/2023]
Abstract
Most fractures of the anterior process of the calcaneus are successfully treated with cast immobilization. Large fragments might be amenable to open reduction and internal fixation. The correct initial diagnosis and treatment are important, particularly if the fracture fragment is large. An improper initial diagnosis will lead to painful nonunion requiring surgical intervention. We present a case of symptomatic nonunion of the anterior calcaneal process that was successfully treated by endoscopic resection of the fragment. The adjacent structures can be examined arthroscopically for concomitant lesions and treated accordingly.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China.
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19
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Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S. Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol 2011; 18:211-25. [DOI: 10.1007/s10140-011-0945-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/21/2011] [Indexed: 12/26/2022]
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20
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Van der Wall H, Lee A, Magee M, Frater C, Wijesinghe H, Kannangara S. Radionuclide Bone Scintigraphy in Sports Injuries. Semin Nucl Med 2010; 40:16-30. [DOI: 10.1053/j.semnuclmed.2009.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Demographics of extra-articular calcaneal fractures: including a review of the literature on treatment and outcome. Arch Orthop Trauma Surg 2008; 128:1099-106. [PMID: 18094984 DOI: 10.1007/s00402-007-0517-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Extra-articular calcaneal fractures represent 25-40% of all calcaneal fractures and an even higher percentage of up to 60% is seen in children. A disproportionately small part of the literature on calcaneal fractures involves the extra-articular type. The aim of this study was to investigate the incidence of extra-articular calcaneal fractures in a Level 1 trauma centre, define the distribution of the various types of fractures and compare patient demographics between extra- and intra-articular calcaneal fractures. In addition the literature was reviewed for the most common types of extra-articular calcaneal fractures with regard to incidence, treatment and clinical outcome. METHODS The radiological records between 2003 and 2005 were reviewed for intra- and extra-articular calcaneal fractures. Patient gender-distribution and age were compared. A literature search was conducted for the treatment of extra-articular calcaneal fractures. RESULTS In this 3-year study period a total of 49 patients with 50 extra-articular calcaneal fractures and 91 patients with 101 intra-articular fractures were identified. The median age for the first group was 32.7 years, and for the second group 40.3 years; P = 0.04. Male predominance was significantly less pronounced for extra-articular (63%) compared with intra-articular fractures (79%; P = 0.04). CONCLUSION One-third of all calcaneal fractures are extra-articular. Significant differences exist between the intra- and extra-articular groups, in terms of lower age and male-female ratio. The literature study shows inconsistencies in treatment options, but most extra-articular fractures are well manageable conservatively.
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Wünschel M, Wülker N, Kluba T. Progressive pes adductus caused by an accessory calcaneus: a case report. Foot Ankle Int 2007; 28:838-40. [PMID: 17666178 DOI: 10.3113/fai.2006.0838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Markus Wünschel
- Department of Orthopaedics, University Hospital, Tübingen, Germany
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Ouellette H, Salamipour H, Thomas BJ, Kassarjian A, Torriani M. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms. Skeletal Radiol 2006; 35:833-7. [PMID: 16724199 DOI: 10.1007/s00256-006-0154-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 04/18/2006] [Accepted: 04/20/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence, appearances and associated injuries of fractures affecting the anterior process of calcaneus from a general population with foot and ankle symptoms. DESIGN AND PATIENTS A retrospective review of foot and ankle MR imaging procedures was performed for detection of cases with a fracture affecting the anterior process of calcaneus over a four year period. Radiographs, MR imaging studies, radiology reports, medical records, and operative notes were reviewed. Imaging analysis included fracture pattern, displacement, associated fractures, and presence of tendon and ligamentous injuries. RESULTS The incidence of anterior process of calcaneus fracture on MR imaging was 0.5% (14/2577). Fractures were more common in female subjects (71%, 10/14). Fracture orientation was predominantly vertical (93%, 13/14). No comminuted fractures were seen and only three fractures were displaced. Three of the eight MR imaging evident fractures of anterior process of calcaneus were seen on radiographs. Associated fractures of the talus (n=5), navicular bone (n=3), cuboid (n=2), and calcaneal body (n=1) were noted. Associated injuries to the anterior talofibular ligament (n=3) and tears of the peroneus brevis (n=3) and peroneus longus (n=1) tendons were present. All fractures were treated non-operatively. Two patients had subtalar joint steroid injection for symptomatic relief. CONCLUSIONS Fractures of the anterior process of the calcaneus are uncommon in MR examinations of a general population of patients with foot and ankle symptoms. Although anterior process of calcaneus fractures are rare, there was a moderately high incidence of associated bone and soft-tissue injuries.
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Affiliation(s)
- Hugue Ouellette
- Division of Musculoskeletal Radiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6046, Boston, MA 02114, USA.
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24
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Boutry N, Vanderhofstadt A, Peetrons P. Ultrasonography of anterosuperior calcaneal process fracture: report of 2 cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:381-5. [PMID: 16495499 DOI: 10.7863/jum.2006.25.3.381] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The purpose of this series is to describe the ultrasonographic findings of anterosuperior calcaneal process (ASCP) fracture. METHODS Two patients with ASCP fractures were examined with ultrasonography. Both of them had pain over the lateral aspect of the ankle 10 to 13 months after an injury. Initial radiographs had shown no evidence of bone fracture or bone avulsion. RESULTS In both cases, ultrasonography revealed the presence of a bone fragment adjacent to the ASCP suggestive of a misdiagnosed fracture. The latter was confirmed by radiographs. In 1 case, a hypoechoic thickening of the calcaneocuboid component of the bifurcate ligament was also identified on ultrasonographic scans. CONCLUSIONS Ultrasonography is potentially valuable in detecting clinically or radiographically occult ASCP fractures.
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Affiliation(s)
- Nathalie Boutry
- Department of Musculoskeletal Radiology, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Boulevard du Prof J. Leclercq, 59037 Lille Cedex, France.
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25
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Ceroni D, De Coulon G, Spadola L, De Rosa V, Kaelin A. Calcaneus secundarius presenting as calcaneonavicular coalition: a case report. J Foot Ankle Surg 2006; 45:25-7. [PMID: 16399555 DOI: 10.1053/j.jfas.2005.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Calcaneus secundarius is an accessory ossicle of the anterior calcaneal facet identified in up to 5% of the population. Calcaneus secundarius rarely leads to symptoms, but its presence may generate pain around the ankle. The purpose of this case report is to describe this atypical accessory ossicle, which can mimic a calcaneonavicular coalition, and to explain the clinical approach to reach a diagnosis and determine treatment. The authors report the case of a 13-year-old girl who sustained several lateral sprains of the right ankle and had local chronic pain. Clinical findings were consistent with calcaneonavicular coalition but radiographic examinations revealed a calcaneus secundarius. The location of this ossicle may limit the range of motion of the subtalar joint, mimicking a calcaneonavicular coalition. Surgical excision of this bulky accessory ossicle was performed, and this treatment fully resolved the pain and improved subtalar motion.
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Affiliation(s)
- Dimitri Ceroni
- Service d'Orthopédie et de Traumatologie Pédiatrique, Hôpital des Enfants, Geneva, Switzerland.
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26
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Abstract
Ankle injuries are among the most common musculoskeletal complaints a physician will see. A thorough understanding of the bony, ligamentous, and musculotendinous anatomy and an appreciation of the biomechanics of the ankle and mechanisms of injury are important to the accurate assessment of ankle injuries.
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Affiliation(s)
- Kimberly G Harmon
- Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Box 354410, Seattle, WA 98195-4410, USA.
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27
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Frey C, Wallis D, Feder KS, Hohl W. Arthroscopic resection of an anterior calcaneal fracture: a case report. Foot Ankle Int 2005; 26:409-11. [PMID: 15913528 DOI: 10.1177/107110070502600513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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28
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Germann CA, Perron AD, Miller MD, Powell SM, Brady WJ. Orthopedic pitfalls in the ED: Calcaneal fractures. Am J Emerg Med 2004; 22:607-11. [PMID: 15666272 DOI: 10.1016/j.ajem.2004.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fractures of the calcaneus are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Due to distracting injury and variations in clinical findings, calcaneal fractures may be initially missed or misdiagnosed. This review article examines the clinical presentation, diagnostic techniques, and management of calcaneal fractures applicable to the emergency practitioner.
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Affiliation(s)
- Carl A Germann
- Department of Emergency Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA
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29
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Mellado JM, Ramos A, Salvadó E, Camins A, Danús M, Saurí A. Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis. Eur Radiol 2003; 13 Suppl 6:L164-77. [PMID: 16440220 DOI: 10.1007/s00330-003-2011-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2002] [Revised: 05/12/2003] [Accepted: 07/02/2003] [Indexed: 12/15/2022]
Abstract
Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures.
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Affiliation(s)
- J M Mellado
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Tarragona Joan XXIII, Carrer Doctor Mallafrè Guasch 4, 43007, Tarragona, Spain.
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