Calcaneal Research Articles

Percutaneous hallux fusion with calcaneus bone autograft: a retrospective cohort study of clinical and radiographic outcomes.

In the case of end-stage hallux rigidus, first metatarsophalangeal (MTP) joint arthrodesis is the gold-standard and is traditionally performed via an open approach. However, complications such as nonunion have been reported to be as high as 30%. Recently, there have been reports demonstrating a percutaneous approach to be effective and safe. Forty-nine patients with end-stage hallux rigidus underwent percutaneous first MTP joint arthrodesis with calcaneus autograft performed by a single surgeon. Each patient underwent a minimum of 24 month clinical and radiographic follow up, including 3 month post operative computed tomography scans. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI) preoperatively and at final follow-up. Mean follow-up was 27.3 months. Bone union was observed in 46 patients (93.9%). Mean time to union was 3.1 months. Nonunion rate was 6.1%. Overall complication rate was 12.2%. Mean pre- and postoperative VAS scores were 7.5 and 0.2, respectively (P < .0001). Mean pre- and postoperative total FFI values were 56.3 and 15.7 (P < .0001), respectively. Patient satisfaction after the procedure was 93.9%. Observed union rate is comparable to the average fusion rate previously reported for open and minimally invasive procedure union rates. Mean time to union was observed to be comparable to open procedures union time. Observed overall complication rate is similar to those reported for open techniques as well. Patient reported outcomes demonstrated a significant reduction in postoperative VAS and FFI for the percutaneous metatarsophalangeal arthrodesis with calcaneus bone autograft. Patient satisfaction rates compared favorably to those reported following open surgery.

Isolated Tuberculous Osteomyelitis of Calcaneus in an Immune-Competent Adult Patient With Literature Review: A Case Report.

We present a case of isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient with a 5-year follow-up. The diagnosis was established by core needle aspiration and biopsy. He was treated with antituberculous chemotherapy and immobilization. The lesion healed with collapse of the calcaneal tuberosity that clinically resulted in shortening and heel valgus. A literature review is also presented. Isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient is rare. It may pose diagnostic dilemma, and orthopaedist should work through the differential diagnosis.

The effectiveness of laser therapy combined with concentric exercises on pain and functional ability in patients with Haglund’s deformity – utilizing PainChek AI software and AOFAS scoring

Introduction. Haglund’s deformity, characterized by inflammation of the bursa situated in the posterior aspect of the calcaneus (heel bone), poses a significant challenge in orthopedic treatment. This study examines the effectiveness of laser therapy combined with concentric exercises on pain and functional ability in patients with Haglund’s deformity, pain and discomfort in the heel caused by the bony enlargement in it. Aim of the study. The aim of this study was to evaluate the effectiveness of concentric exercises and laser therapy in lowering pain and enhancing functionality in people with Haglund’s deformity. Materials and Methods. A study was conducted involving 40 subjects diagnosed with Haglund’s deformity, aged between 20 to 35 years and of both genders, randomly selected and divided equally into two groups: Group A (experimental) and Group B (traditional). Exclusion criteria encompassed foot fracture history, hindfoot open wounds, or non-cooperative behavior. Pre-test assessments utilizing the American Orthopaedic Foot &amp; Ankle Society (AOFAS) scale and PainChek AI software were administered to both groups. Treatment intervention for both groups involved three weeks of exercises, comprising 3 sets per session, 15 repetitions per set, and 5 days a week. Post-treatment evaluations were conducted to compare the effectiveness of the interventions using AOFAS and PainChek scores, alongside monitoring for any adverse effects or complications arising from the treatments. Results. The post-treatment mean PainChek value for Group A was 5.10, whereas it was 6.45 for Group B. Group A’s post-treatment mean AOFAS score was 79.50, whereas Group B was 61.50. It was discovered that Group A was beneficial in lowering discomfort and enhancing function in those with Haglund’s deformity. Conclusion. The results of this study suggest that among individuals with Haglund’s deformity, the utilization of laser therapy alongside concentric exercises in the experimental group proved to be more effective in reducing discomfort and enhancing functionality compared to employing stretching exercises in the conventional group.

Comparison of Primal Reflex Release Technique and Positional Release Therapy on Pain, Functional Ability and Ankle Range in patients with Plantar Fasciitis: An Experimental Study

Background: Plantar fasciitis (PF) is characterized by inflammation, fibrosis and structural deterioration of foot and there is pain over heel and plantar fascia. Plantar fasciitis pain is gradual in onset, sharp and diffusely located initially which later localizes to medial calcaneal tuberosity. Typically, pain is most severe in the morning which lessens with movement but intensifies with long-standing weight bearing. Plantar fasciitis has been experienced by 10% of the non-athletic population and most typically observed in weight-bearing activities. So, the aim was to study the effects of primal reflex release technique and positional release therapy on pain, functional ability and ankle range in patients with plantar fasciitis. Method: Total 36 patients were recruited for the study as per the selection criteria and were divided into two groups (18 in each group). Group A was treated with primal reflex release technique (PRRT) along with conventional therapy and Group B was treated with positional release therapy (PRT) along with conventional therapy for 7 consecutive days. Intergroup analysis by independent t-test showed statistically significant improvement in pain and functional ability (P value ≤ 0.001). Conclusion: Primal reflex release technique along with conventional therapy was found to be more predominant in improving pain and functional ability than positional release therapy along with conventional therapy. Also, Primal reflex release technique along with conventional therapy and positional release therapy along with conventional therapy were equally effective in improving ankle range of motion.

AN ANATOMICAL VARIATION OF THE PERONEUS QUARTUS MUSCLE: A CASE STUDY

The peroneus quartus (PQ), an extraneous assessory muscle of the ankle, is found in the lateral compartment of the leg. It is the most frequent source of genesis and its insertion is along the peroneus brevis muscle into the calcaneo retrotrochlear prominence. We noticed a peculiar variation of the muscle that arises from the lateral surface of the fibula in between the two peroneal muscles. A lateral malleolus that was protruding from the skin was crammed with tendons. The muscle was discovered to be attached to the peroneal trochlea. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. It is rarely involved in pathologic processes of the foot and ankle. Only a few reports exist in the literature involving peroneus quartus in a “retro malleolar conflict” (lateral ankle stenosis), sometimes in association with longitudinal attrition and tears of the peroneus brevis. The presence of this muscle in individuals can complain of ankle pain with throbbing and tingling sensation along with swelling. It could include the ankle weakness along with ankle instability.1

Short- and Mid-Term Results Using a 448 Kilohertz Radiofrequency Stimulation on the Elasticity Plantar Fascia Measured by Quantitative Ultrasound Elastography on Active Healthy Subjects: An Open Controlled Clinical Trial with Three Months of Follow-Up.

Background: This study is an open clinical trial that included 3 months of follow-up. Methods: This study aimed to show the changes that occur in the viscoelastic properties of the PF measured by SEL after the six applications of a 448 kHz capacitive resistive monopolar radiofrequency (CRMR) in active, healthy subjects, immediately before the CRMR intervention (T0), during the two-week CRMR intervention program (T1), after the CRMR intervention program (T2), two weeks after the CRMR intervention program (T3), one month after the CRMR intervention program (T4), and three months after the CRMR intervention program (T5). Results: Our results showed that the effects of CRMR on the plantar fascia elasticity may last up to one month in a healthy population after a 3-week treatment program when compared to controls, specifically following the medial process of the calcaneal tuberosity (points 1 and 2). However, there were no changes when analyzing points 3 and 4. These findings are a first step towards understanding the duration of the CRMR effects in the elastic properties of the tissue and therefore how long the benefit may last. Conclusions: This study showed that changes in the plantar fascia elasticity measured by SEL have been found after a CRMR intervention protocol, similarly to other structures reported in the literature, such as the patellar tendon or supraspinatus tendon.

Effect of genetically predicted sclerostin on cardiovascular biomarkers, risk factors, and disease outcomes

Sclerostin inhibitors protect against osteoporotic fractures, but their cardiovascular safety remains unclear. We conducted a cis-Mendelian randomisation analysis to estimate the causal effect of sclerostin levels on cardiovascular risk factors. We meta-analysed three GWAS of sclerostin levels including 49,568 Europeans and selected 2 SNPs to be used as instruments. We included heel bone mineral density and hip fracture risk as positive control outcomes. Public GWAS and UK Biobank patient-level data were used for the study outcomes, which include cardiovascular events, risk factors, and biomarkers. Lower sclerostin levels were associated with higher bone mineral density and 85% reduction in hip fracture risk. However, genetically predicted lower sclerostin levels led to 25–85% excess coronary artery disease risk, 40% to 60% increased risk of type 2 diabetes, and worse cardiovascular biomarkers values, including higher triglycerides, and decreased HDL cholesterol levels. Results also suggest a potential (but borderline) association with increased risk of myocardial infarction. Our study provides genetic evidence of a causal relationship between reduced levels of sclerostin and improved bone health and fracture protection, but increased risk of cardiovascular events and risk factors.

Effect of additional free sustentaculum tali screw fixation through modified sinus tarsi approach on intra-articular calcaneal fractures

BackgroundCalcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs).MethodsThis study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery.ResultsFunctional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group.ConclusionCompared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy.

Functional Outcomes Following Partial Osteotomy of the Calcaneal Tuberosity for Haglund's Syndrome.

Background Haglund's syndrome, a common cause of pain in the posterior heel that consists of painful swelling of the local soft tissues and prominence of the posterosuperior calcaneal projection, presents significant challenges in treatment, particularly when conservative management fails. This study evaluates the functional outcomes following oblique partial excision of the posterosuperior portion (calcaneal tuberosity osteotomy) of the calcaneus for Haglund's syndrome. Methods A cohort of 30 patients, aged 18 years and older, with persistent heel pain unresponsive to conservative treatments, underwent partial osteotomy using a medial or lateral approach. Patients were assessed pre-operatively and post-operatively at six weeks, three months, and six months using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Data were analyzed using descriptive statistics and the Friedman test to evaluate changes in AOFAS scores over time. Results The mean AOFAS score improved significantly from 55.17 pre-operatively to 79.27 at six months post-operatively. At six months, 16 (53.3%) participants had AOFAS scores between 80-89, indicating good functional outcomes, while 14 (46.7%) had scores between 70-79. The improvement in functional outcomes was statistically significant (p < 0.001). The study also found both lateral and medial surgical approaches yielded similar results. Conclusion Partial osteotomy of the calcaneal tuberosity is a safe and effective surgical intervention for Haglund's syndrome, leading to significant functional improvements. The use of AOFAS scoring provides a reliable assessment of outcomes, confirming the procedure's efficacy.

The Micromechanical Environment of the Impinged Achilles Tendon.

Although tendon predominantly experiences longitudinal tensile forces, transverse forces due to impingement from bone are implicated in both physiological and pathophysiological processes. However, prior studies have not characterized the micromechanical strain environment in the context of tendon impingement. To address this knowledge gap, mouse hindlimb explants are imaged on a multiphoton microscope, and image stacks of the same population of tendon cells are obtained in the Achilles tendon before and after dorsiflexion-induced impingement by the heel bone. Based on the acquired images, multiaxial strains are measured at the extracellular matrix (ECM), pericellular matrix (PCM), and cell scales. Impingement generated substantial transverse compression at the matrix-scale, which led to longitudinal stretching of cells, increased cell aspect ratio, and enormous volumetric compression of the PCM. These experimental results are corroborated by a finite elementmodel, which further demonstrated that impingement produces high cell surface stresses and strains that greatly exceed those brought about by longitudinal tension. Moreover, in both experiments and simulations, impingement-generated microscale stresses and strains are highly dependent on initial cell-cell gap spacing. Identifying factors that influence the microscale strain environment generated by impingement could contribute to a more mechanistic understanding of impingement-induced tendinopathies.

Impact of dorsal closing wedge calcaneal osteotomy on hindfoot alignment and biomechanics of patients with insertional achilles tendinopathy; A weightbearing CT-based simulation study

PurposeDorsal closing wedge calcaneal osteotomy (DCWCO) is purported to enhance both the biological and mechanical aspects of insertional Achilles tendinopathy (IAT) by altering its insertional anatomy. The biomechanical impacts of shifting the Achilles insertion, however, are not fully understood. This study aimed to analyze the effect of DCWCO on hindfoot alignment and gastrocnemius-soleus (G-S) power. MethodsSix weightbearing ankle CTs of patients diagnosed with IAT were segmented and standardized planes were used to conduct DCWCOs with six variations, resulting in a total of 42-foot models including the 6 preoperative original model. Two distinct representations of plantar osteotomy starting points were defined. One was 1 cm anterior to plantar calcaneal tubercle (posterior osteotomy) and the other was 2 cm anterior (anterior osteotomy). The osteotomies were extended to 1 cm anterior of posterosuperior calcaneal tuberosity with 6-, 10-, or 14-mm dorsal wedges. Pre-defined Achilles insertion points were used to create computational Achilles tendon models. Multiple automated measurements were performed to calculate the change in foot alignment and biomechanics. ResultsBoth anterior and posterior osteotomy locations resulted in decreased lateral talocalcaneal and calcaneal pitch angles, more substantially so with the anterior osteotomy (p = 0.028). Distance change between Achilles and Haglund was much greater with posterior osteotomy using 6- and 10-mm wedges as compared to the anterior alternative (p = 0.028). Anterior osteotomy caused a significant decrease in the Böhler angle (p < 0.001). The subtalar joint orientation was observed to change up to 3.8° in anterior osteotomy and the decrease in G-S power was found to be a maximum of 2–3 %. ConclusionA posteriorly placed starting point can provide more Achilles decompression while an anteriorly placed starting point can affect foot alignment more significantly. DCWCO can change the subtalar joint orientation predisposing the joint to increased loads. Decrease in G-S power was low and will presumably not have clinical impact.

Applications of artificial intelligence in age estimation: a review

Age estimation is a legally significant issue, particularly in underdeveloped and developing countries, due to factors such as inadequate civil registration systems and irregular migration. While various techniques are employed for age estimation using traditional methods, it is known that factors including age, gender, chronic illness, race, and geographical region can result in discrepancies between skeletal age and chronological age. This complicates the process of achieving accurate age estimation. This review aims to discuss recent research on artificial intelligence applications in light of current literature. Artificial intelligence and machine learning have enabled machines to acquire human-like capabilities in thinking, learning, problem solving, and decision making, leading to significant progress in achieving faster and accurate results. In the field of forensic medicine, methods such as linear discriminant analysis, K-Nearest Neighbors, support vector machines, random forests, and artificial neural networks have been employed to classify data and conduct studies on age estimation. Research has focused on five regions: the carpal bones, ossification centers, the middle phalanx of the hand, the third metacarpal, and the radius and ulna. Additionally, facial angles and width obtained through tomographic examinations, as well as measurements of the calcaneus and cuboid bones, panoramic dental radiographs, volumetric analysis of teeth and pulp using Cone Beam Computed Tomography, and analysis of bloodstains on microRNAs, have been analyzed for their distribution across different age. The results demonstrate that artificial intelligence applications can be utilized in age estimation with a high accuracy rate (85-95%). Age estimation using artificial intelligence enhances data-driven decision-making processes, improves the quality of services, and contributes to societal benefit. Therefore, we believe that incorporating artificial intelligence applications alongside traditional methods in age estimation will yield more meaningful outcomes.

Proteome-wide Mendelian randomization provides novel insights into the pathogenesis and druggable targets of osteoporosis.

With the aging population, the prevalence and impact of osteoporosis are expected to rise, and existing anti-osteoporosis agents have limitations due to adverse events. This study aims to discover novel drug targets for osteoporosis. The protein data were obtained from the latest proteome-wide association studies (PWAS) including 54, 219 participants. The osteoporosis data were extracted from a GWAS meta-analysis, characterized by heel bone mineral density (HBMD) comprising 426,824 individuals. Mendelian randomization (MR) was the primary approach used to establish genetic causality between specific traits. Summary-data-based MR (SMR), colocalization analysis, heterogeneity test, and external validation were applied to ensure the findings were reliable. The underlying mechanisms behind these causal associations were investigated by additional analyses. Finally, the druggability of the identified proteins was assessed. After Bonferroni correction, a total of 84 proteins were found to have a genetic association with osteoporosis. With strong colocalization evidence, proteins such as ACHE, HS6ST1, LRIG1, and LRRC37A2 were found to negatively influence HBMD, whereas CELSR2, CPE, FN1, FOXO1, and FSHB exhibited a positive association with HBMD. No significant heterogeneity was found. Additionally, CELSR2, FN1, FSHB, HS6ST1, LRIG1, and LRRC37A2 were replicated in the external validation. The effect of FSHB on HBMD was more pronounced in females compared to males. Interestingly, ACHE, LRIG1, FN1, and FOXO1 were observed to partially act on HBMD through BMI. Phewas analysis indicated that CPE and FOXO1 did not have genetic associations with any phenotypes other than osteoporosis. FN1 was highlighted as the most significant protein by protein-protein interaction network analysis. In conclusion, this study offers valuable insights into the role of specific proteins in the development of osteoporosis, and underscores potential therapeutic targets. Future studies should emphasize exploring these causal relationships and elucidating their underlying mechanisms.

Anatomy of the Achilles tendon-Apictorial review.

The Achilles tendon (AT) is the strongest tendon of the human body. The knowledge of AT anatomy is abasic prerequisite for the successful treatment of acute and chronic lesions. The structure of the AT results from acomplicated fusion of three parts: the tendons of the medial and lateral gastrocnemius and the soleus muscles. From proximal to distal, the tendon fibers twist in along spiral into aroughly 90° internal rotation. The tendon is narrowest approximately 5-7 cm above its calcaneal insertion and from there it expands again. The topography of the footprints of the individual AT components reflects the tendon origins. The anterior (deep) AT fibers insert into the middle third of the posterior aspect of the calcaneal tuberosity, the posterior (superficial) fibers pass over the calcaneal tuberosity and fuse with the plantar aponeurosis. Adeep calcaneal bursa is interposed between the calcaneal tuberosity and the AT anterior surface. The AT has no synovial sheath but is covered along its entire length with asliding connective tissue, the paratenon which is, however, absent on its anterior surface. The AT is supplied by the posterior tibial artery (PTA) and the peroneal artery (PA). Motor innervation of the triceps surae muscle is provided by fibers of the tibial nerve which also gives off sensitive fibers for the AT. Sensitive innervation is also provided via the sural nerve. The sural nerve crosses the AT approximately 11 cm proximal to the calcaneal tuberosity. The forces acting on the AT during exercise may be up to 12 times the body weight. Physiological stretching of AT collagen fibers ranges between 2% and 4% of its length. Stretching of the tendon over 4% results in microscopic failure and stretching beyond 8% in macroscopic failure.

Morphological characteristics of talocalcaneal coalitions: Anatomical observation, finite element analysis and clinical application

BackgroundThe intricate anatomical structure of talocalcaneal coalitions (TCCs) presents significant challenges for clinicians in both diagnosis and treatment. This study aimed to investigate the anatomy, imaging characteristics, and biomechanical properties of TCCs, providing essential references for contemporary clinical diagnosis, treatment, scientific research, and education regarding TCCs. MethodsThe morphologies of TCCs were examined and classified in intact dry osseous specimens from 131 Asian adults. The imaging characteristics of TCCs were summarized by carefully observing the X-rays and CT scans. Additionally, finite element models of TCCs were established and validated, allowing for the simulation and analysis of stress and strain. ResultsThe TCCs were primarily located in the region between the posterior end of sustentaculum tali (ST), the medial port of the tarsal canal, and the medial edge of the posterior talar articular surface (PTF). In comparison to specimens with cartilage and ligament connections, the medial tubercle of osseous connections exhibited significant inward and downward protrusion, while the ST was longer and thicker. Statistically significant differences were noted in the widths of the calcaneus and talus, as well as in the thickness and length of the ST (P < 0.05). CT imaging provided an accurate determination of TCCs’ locations, while X-rays revealed the presence of the “C sign” and “duck beak sign” in all osseous connection specimens. Finite element model analysis indicated that stress was primarily concentrated at the osseous connection, which also reduced displacement of the subtalar joint. ConclusionsThe comprehension of the precise location, anatomical morphological characteristics, imaging features and finite element mechanical properties of TCCs is instrumental in enhancing the diagnosis and treatment of TCCs.

Creation of a Custom 3D Algorithm for Proper Alignment of Straight Nails in Tibiotalocalcaneal Arthrodesis

Category: Hindfoot; Ankle Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a complex procedure for severe ankle and hindfoot pathologies like end-stage osteoarthritis or avascular necrosis of the talus. Proper calcaneal fixation with the talus and tibia is crucial for postoperative stability and neurovascular protection in intramedullary nailing. A cadaveric study by Hyer et al. showed that a wire placed anterograde through the tibial shaft may miss the calcaneus medially. Methodologic limitations included a limited number of cadavers, non-loaded specimens, and a lack of critical examination of hindfoot alignment. This study aims to determine the feasibility of using weightbearing computed tomography (WBCT) and 3D segmentation software to ascertain an optimal entry point for a straight intramedullary nail in TTC arthrodesis in weightbearing patients. Methods: A total of 100 normal ankles (48 left, 52 right) from 52 patients (Age: 39.9 ± 16.7 years; Gender: 68% F; BMI: 28.1 ± 5.8 kg/m^2) with WBCT scans were obtained and subsequently segmented for inclusion in the study. A novel mathematical algorithm was developed to determine the 3D intersection of the distal tibial central axis extension at the inferior calcaneus. The algorithm approximates the central axis by mapping the center point of the tibial medulla at each CT slice, from the shaft to the tibiotalar joint using 3D surface contours in the axial plane. Then, the central axis is extended through the talus and calcaneus to approximate its exit point on the inferior surface of the calcaneus for each individual ankle (Figure 1a). A 2D linear transformation (affine transformation) was applied to obtain a heat map of all intersection points on the inferior surface of the calcaneus. Results: The mean (SD) polar angle of the central axis with respect to the ground was 84.9 ± 2.3 degrees. The root mean (SD) square error of the affine transformation was 1.62 ± 1.02 mm, demonstrating the validity of mapping. The exit points of the central axis across all patients fall predominantly along the sustentaculum tali (Figure 1b). Conclusion: A straight nail passing through the sustentaculum tali places surrounding neurovascular structures at risk and can also compromise the biomechanical stability of the implant. Our novel 3D algorithm shows that intraoperative adjustment of the starting point lateral to the central tibial axis is required to obtain optimal alignment of the hindfoot nail. Additionally, the novel algorithm can also be used preoperatively to estimate the required calcaneal medialization and ensure precise implant positioning. Proper nail alignment may potentially improve the success of TTC arthrodesis and decrease the risk of postoperative complications, including implant failure.

Finite Element Analyses of Three Minimally Invasive Fixation Techniques for Treating Sanders Type II Intra‑Articular Calcaneal Fractures

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods: A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results: After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was &lt; 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress. Conclusion: All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques.

Assessment of the Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures in a Cadaveric Model

Category: Trauma; Hindfoot Introduction/Purpose: Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures. Methods: SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step1), superficial deltoid ligament disruption (step2) and deep deltoid ligament disruption (step3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and x-rays of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT). Results: The COF (5.3mm, p=0.030) and the CA (-188.4 mm2, p=0.015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2,3mm, p=0.059; CA -121mm2, p=0.133). PP were found to not change significantly in either varus or valgus (varus:-4.9N, p=0.132;valgus:-4N, p =0.464). The MCS demonstrated widening in step 3 compared to step 2 (0.7mm, p=0.020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8°, p=0.020) compared to step 0. Conclusion: SERIV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER IV fractures with varus hindfoot alignment. Based on this cadaver modelling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation. Results of the measurements of COF (center of force), CA (contact area), PP (peak contact pressure) MCS (medical clear space) in mm, TT (talar tilt) in degree in varus and valgus hindfoot alignment in the different steps. It shows the mean and (standard deviation)

Exploring the Link Between Calcaneal Apophysis Maturation and Heel Pain in Youth Baseball Players.

Calcaneal apophysitis is the most common cause of heel pain in children and adolescents. However, the relationship between skeletal maturity and heel pain in the specific youth cohort is unclear. To clarify the relationship between the maturity stages of the calcaneal apophysis and heel pain in youth baseball players. Cross-sectional study; Level of evidence, 3. A total of 336 youth male baseball players participated in this study. Ultrasound scanning of the calcaneal apophysis was performed along the longitudinal line connecting the middle of the Achilles tendon, the middle of the calcaneus, and the second toe, between the proximal calcaneal edge and the medial calcaneal tubercle. The authors classified the maturity of the calcaneal apophysis into 5 stages, from nonpresence of the apophysis (stage 1) to complete fusion (stage 5). The diagnosis of heel pain was based on subjective report of feeling pain on the squeeze test. The relationship between the maturity stages and physical characteristics was investigated using 1-way analysis of variance or the Kruskal-Wallis test, and the relationship between the maturity stages and heel pain was investigated using the chi-square test. Of the 336 players, 49 had heel pain, for a prevalence of 14.6%. Eighteen (5.4%) players had unilateral heel pain, and 31 (9.2%) players had bilateral heel pain. There were no significant differences in the maturity stages of the calcaneal apophysis between the players with no heel pain and those with heel pain. However, no players had heel pain during stage 5, when the calcaneus had completed its maturation. The prevalence of heel pain was 14.6% in Japanese youth male baseball players. There was no relationship between the maturity stages of the calcaneal apophysis and heel pain. Heel pain that could be associated with calcaneal apophysitis did not occur during stage 5, when maturation of the calcaneal apophysis was complete.

Effects of FGF21 overexpression in osteoporosis and bone mineral density: a two-sample, mediating Mendelian analysis.

Fibroblast growth factor 21 (FGF21) is a secreted protein that regulates body metabolism. In recent years, many observational studies have found that FGF21 is closely related to bone mineral density and osteoporosis, but the causal relationship between them is still unclear. Therefore, this study used two-sample, mediated Mendelian randomization (MR) analysis to explore the causal relationship between FGF21 and osteoporosis and bone mineral density. We conducted a two-sample, mediator MR Analysis using genetic data from publicly available genome-wide association studies (GWAS) that included genetic variants in the inflammatory cytokine FGF21, and Total body bone mineral density, Heel bone mineral density, Forearm bone mineral density, Femoral neck bone mineral density, osteoporosis. The main analysis method used was inverse variance weighting (IVW) to investigate the causal relationship between exposure and outcome. In addition, weighted median, simple median method, weighted median method and MR-Egger regression were used to supplement the explanation, and sensitivity analysis was performed to evaluate the reliability of the results. MR Results showed that FGF21 overexpression reduced bone mineral density: Total body bone mineral density (OR=0.920, 95%CI: 0.876-0.966), P=0.001), Heel bone mineral density (OR=0.971, 95%CI (0.949-0.993); P=0.01), Forearm bone mineral density (OR=0.882, 95%CI(0.799-0.973); P=0.012), Femoral neck bone mineral density (OR=0.952, 95%CI(0.908-0.998), P=0.039); In addition, it also increased the risk of osteoporosis (OR=1.003, 95%CI (1.001-1.005), P=0.004). Sensitivity analysis supported the reliability of these results. The effect of FGF21 overexpression on osteoporosis may be mediated by type 2 diabetes mellitus and basal metabolic rate, with mediating effects of 14.96% and 12.21%, respectively. Our study suggests that the overexpression of FGF21 may lead to a decrease in bone mineral density and increase the risk of osteoporosis, and the effect of FGF21 on osteoporosis may be mediated through type 2 diabetes and basal metabolic rate. This study can provide a reference for analyzing the potential mechanism of osteoporosis and is of great significance for the prevention and treatment of osteoporosis.