Subtalar arthrodesis with correction of deformity after fractures of the os calcis.
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We have reviewed the long-term results of 22 patients (23 fusions) with fractures of the os calcis, who had subtalar arthrodesis with correction of the deformity between 1975 and 1991. The mean follow-up was nine years (5 to 20). All patients were evaluated according to a modified foot score. A radiological assessment was used in which linear and angular variables were measured including the fibulocalcaneal abutment, the height of the heel and fat pad, the angle of the arch and the lateral talocalcaneal and the lateral talar declination angles. The technique used restores the normal relationship between the hindfoot and midfoot and corrects the height of the heel. This leads to better biomechanical balance of the neighbouring joints and gives a favourable clinical outcome. The modified foot score showed a good or excellent result in 51% of the feet. Residual complaints were mostly due to problems with the soft tissues. Subjectively, an excellent or good score was achieved in 78% of the cases. After statistical analysis, except for the height of the heel and the degenerative changes in the calcaneocuboid joint, no significant difference was found in the measured variables between the operated and the contralateral side. (+info)
Medial subtalar dislocation.
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We report a medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game. He was successfully treated with closed reduction and cast immobilization. At one year follow-up he was symptomless. (+info)
Talocalcaneal coalition. Diagnosis with the C-sign on lateral radiographs of the ankle.
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We analysed 42 weight-bearing lateral radiographs of the ankle, 20 of which were from patients with a clinical and plain radiological diagnosis of talocalcaneal coalition (TCC) who subsequently had CT. The remainder were from 22 healthy volunteers with no clinical findings suggestive of hindfoot pathology. Four observers, blinded to the CT findings, independently evaluated the radiographs on two separate occasions. With the 95% confidence interval and using the CT findings as the comparison we calculated the sensitivity, specificity, accuracy, and positive and negative predictive values for the C-sign, and for other signs known to be associated with TCC. Similarly, we also calculated the interobserver and intraobserver reliability for these signs using the kappa statistic. Our results suggest that the C-sign is highly sensitive and specific for TCC. It is an accurate indicator and significantly more reliable than other previously recognised radiological signs of TCC. Features of the C-sign, however, cannot be relied upon to indicate whether the TCC is fibrous or bony. (+info)
Fractures of the tuberosity of the calcaneus.
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We describe 24 fractures of the tuberosity of the calcaneus in 22 patients. Three were similar to the type of avulsion fracture which has been well-defined but the remainder represent a group which has been unrecognised previously. Using CT and operative findings we have defined the different patterns of fracture of the calcaneal tuberosity. Ten fractures extended into the subtalar joint, but did not fit the pattern of the common intra-articular fracture as described classically. We have defined a new pattern which consists of a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semicoronal plane. Non-operative treatment of displaced fractures resulted in a mis-shapen heel and a poor functional outcome. Open reduction and internal fixation with either a plate or compression screw did not give satisfactory fixation. We prefer to use an oblique lateral tension-band wire. This technique gave excellent fixation and we recommend it for the treatment of displaced fractures of the tuberosity of the calcaneus. (+info)
Conservative treatment of subtalar dislocations.
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Forty-five patients who presented between 1983 and 1998 with acute closed dislocation of the subtalar joint were selected for this study. There were 37 medial and eight lateral dislocations. The mean follow-up was 7.5 years (range: 2-17 years). The mean American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS) at follow-up was 84. Subtalar fusion was required in one patient with persistent severe hind-foot instability. There was no significant difference in the AOFAS score between medial and lateral subtalar dislocations. We conclude that pure subtalar dislocation produced by low energy trauma, promptly reduced and immobilised for 4 weeks has a favourable long-term outcome. (+info)
Relation between the occurrence of bony union and outcome for fractures of the lateral process of the talus: a case report and analysis of published reports.
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Fractures of the lateral process of the talus are uncommon, but the incidence has probably risen because of the increased popularity of snowboarding, an increased awareness of doctors, and the ready availability of computed tomography scanning. One case report and a review of the literature are provided. Aggressive management rarely resulted in non-union (7%) and was always associated with a good outcome (100%), even if the fracture fragments were excised initially. The relations between method of treatment, bony union, and outcome were significant (Fisher's exact test, p<0.01). (+info)
Fracture of the lateral process of the talus: computed tomographic scan diagnosis.
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Fracture of the lateral process of the talus is rare but can be mistaken for a simple ankle sprain. A case with normal conventional radiographs is presented to draw attention to this diagnosis in the resistant ankle sprain, and to highlight some of the problems that may be encountered with treatment. (+info)
Misdiagnosed iuxta-articular osteoid osteoma of the calcaneus following an injury.
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The diagnosis of osteoid osteoma, in usual localizations, is generally simple. In iuxta-articular localizations this tumor may be unrecognized and the diagnosis delayed. Injury has been sometimes correlated with the onset of symptoms and this can make the diagnosis even more difficult. We present a case of osteoid osteoma of the calcaneus iuxta-articular to the subtalar joint in a 17-year-old basketball player. He had a history of initial injury, ankle sprain during training, followed by pain and swelling. He was initially treated for lateral ligament lesion of the ankle with unsatisfactory results. After acute trauma the pain changed becoming chronic and mostly nocturnal disappearing when rofecoxib was taken. Standard x-ray didn't show the lesion. Nuclear Magnetic Resonance (NMR) and scintigraphic results were not well interpreted but these clinical changes and Computed Tomography (CT) images supported the diagnosis of osteoid osteoma. The complete resection of the bone lesion resolved all the symptoms and the histological report confirmed the suspected diagnosis. (+info)