Calcaneus In Children Research Articles

The Treatment of Complex Motorcycle Spoke Injuries in Children.

Motorcycle spoke injuries involving the soft tissue, Achilles tendon, and calcaneal defects are rare in children. Currently, calcaneal defects are very challenging to treat. Multiple methods have been used in clinical practice; however, an effective treatment has yet to be established, especially when Achilles tendon and soft-tissue defects are also present. It is important to address this condition, because the calcaneus plays a key role in standing and gait. Unsatisfactory treatment of calcaneal defects may significantly decrease patients' quality of life (eg, by limiting mobility). In this article, we report the effective treatment of calcaneal defects in four children using distraction osteogenesis with an external fixator framework designed by the authors. From May 2014 to May 2015, four children (age range, 6-11 years) with defects of the Achilles tendon, soft tissue, and calcaneus resulting from a motorcycle accident were treated at our hospital. The Achilles tendon and soft-tissue defects were treated with second-stage reconstruction. In the third-stage surgery, osteotomy of the residual calcaneus was performed. A customized external fixator was used to lengthen the calcaneus at a rate of 1.5 mm/day in the posterior direction and reposition it by 40° in the inferior direction. In all four children, the calcaneus was lengthened by 5 cm. Distraction osteogenesis through external fixation is effective for restoring the length, width, and height of the calcaneus in children.

Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet.

ObjectivesLengthening osteotomies of the calcaneus in children are in general grafted with bone from the iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and precise method for measurements of rigid body movements including the evaluation of joint implant and fracture stability, however, RSA has not previously been used in clinical studies of calcaneal osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal lengthening osteotomy (LCLO).MethodsLCLO was performed in six fixed adult cadaver feet. Tantalum markers were inserted on each side of the osteotomy and in the cuboideum. Lengthening was done with a plexiglas wedge. A total of 24 radiological double examinations were obtained. Two feet were excluded due to loose and poorly dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits.ResultsSystematic bias was generally below 0.10 mm for translations. Precision of migration measurements was below 0.2 mm for translations in the osteotomy.ConclusionRSA is a precise tool for the evaluation of stability in LCLO.Cite this article: Bone Joint Res 2015;4:78–83.

Tuberculosis of the calcaneus in children.

To review 10 children with calcaneal tuberculosis in terms of presentation, healing, and functional outcome. Medical records of 7 boys and 3 girls aged 7 to 12 (mean, 9.8) years who presented with calcaneal tuberculosis were reviewed. The erythrocyte sedimentation rate of all patients was elevated. All patients presented with pain and swelling around the lateral malleolus and a 'heal-up' sign; 7 of them presented with an additional discharging sinus. Three patients had palpable lymph nodes in the right inguinal or left popliteal region. Symptoms had lasted for one month to 1.5 years. Two patients had healed tuberculosis in the lungs; 8 patients had no pulmonary involvement. Seven patients had a single lytic lesion in the calcaneal body (n=1), tuberosity (n=3), and extension to anterior process (n=3). Three patients had multiple lytic lesions in the calcaneum; one of them had bilateral involvement who had lesions in the phalanges, lumbar spine, and ulna. Two patients had subtalar joint involvement. The mean follow-up period was 17 (range, 8-60) months. The erythrocyte sedimentation rate returned to normal after 3 months in 7 patients and after >6 months in 3 patients. The subtalar range of movement was normal in all except for 2 patients. One patient developed subtalar ankylosis. Sinuses healed in a mean of 10 (range, 2-16) weeks. No patient had pain on level walking after treatment. At 3 months, remineralisation of bone was evident in all patients. Sclerosis of cavity margins and sequestra resorption was noted from 6 to 9 months. No patient experienced recurrence. The 'heel up' sign was common in children with calcaneal tuberculosis in this endemic region. The central granuloma-type presentation was the most common. Pathological fractures and involvement of the subtalar joint were not common. Subtalar joint involvement was a poor prognostic factor.

Tuberculosis of the calcaneus in children

Osteoarticular tuberculosis represents 1.7–2% of all tuberculosis (TB). The localization in the foot is rare and accounts for less than 10% of osteoarticular TB.The following report describes the case of a 7-year-old boy who presented with a gradually increasing inflammatory swelling over the lateral aspect of the right ankle. An X-ray of his right ankle showed an osteolytic image at the calcaneus. Diagnosis was confirmed by the presence of a tuberculoid granuloma with caseous necrosis on bone biopsy.

Subacute Haematogenous Osteomyelitis of the Calcaneus in a Child: A Case Report and Review of the Literature

Osteomyelitis is an inflammation of bone caused by a pyogenic organism. Osteomyelitis of the calcaneus in children is an uncommon diagnosis, particularly when haematogenous in nature and not caused by direct inoculation. Historically haematogenous osteomyelitis has been characterized as acute, subacute or chronic with each type based on the time of disease onset. Subacute haematogenous osteomyelitis is characterized by mild localized bony pain and tenderness usually of more than two weeks duration, mild or no systemic manifestations, noncontributory lab data, negative blood cultures, and positive radiological findings. Prior reports and studies have found that children with calcaneal osteomyelitis can be a diagnostic challenge because of the unimpressive signs and symptoms and often marginal lab results. 6 This is made even more difficult when subacute in presentation and associated with a traumatic injury. Therefore we present a case of subacute haematogenous osteomyelitis of the calcaneus with an associated minor traumatic injury, and a review of the literature

Ultrasound Densitometry of the Calcaneus in Children and Adolescents of Ukraine

Ultrasound Densitometry of the Calcaneus in Children and Adolescents of Ukraine

Ultrasound densitometry of the calcaneus in children and adolescents of Ukraine

Ultrasound densitometry of the calcaneus in children and adolescents of Ukraine

An 11-year-old Boy with Ankle Trauma

An 11-year-old Boy with Ankle Trauma

53 Ultrasound Densitometry of the Calcaneus in Children and Adolescents of Ukraine

53 Ultrasound Densitometry of the Calcaneus in Children and Adolescents of Ukraine

Correlation of Body Growth and Bone Mineral Density Measured by Ultrasound Densitometry of the Calcaneus in Children and Adolescents

The assessment of growth, including the developmental change in bone mass, is crucial for child health care. We herein report normative values of bone mineral density (BMD) for calcaneus obtained from a large cross-section sample in Japanese school children. To investigate yearly physical growth from pre-school age to adulthood, we measured height, weight, body mass index (BMI), and BMD in 3,835 school children aged 3 to 18 (1,886 boys and 1,949 girls). Participating institutions included kindergarten, junior high schools, high schools, and a college of technology. The growth pattern (or velocity) of BMD (the ratio of trabecular bone area of the calcaneum) shows 3 phases according to the age rage: 3-10, 11-15, and 16-18 years for boys, and 3-7, 8-15, and 16-18 years for girls, both peaking at age 16 years. Likewise, that of weight shows 3 phases: 3-4, 5-15 and 16-18 years for boys, and 3-4, 5-14 and 15-18 years for girls, while the growth pattern of height shows 2 phases: 3-15 and 16-18 years for boys, and 3-13 and 14-18 years for girls, both sexes peaking at approximately 16 years. Therefore, the physical growth pattern of the school children shows progressive growth until 16 years, at which time growth is generally completed. In children under 16 years old, BMD of the calcaneus is higher in girls than in boys. Boys and girls show a similar growth pattern in body height and weight before peak development; however, the physical growth of boys eventually exceeds that of girls.

Quantitative ultrasound of the calcaneus in children and young adults with severe cerebral palsy

Quantitative ultrasound of the calcaneus in children and young adults with severe cerebral palsy

Concomitant fractures of neck of talus and calcaneus in children

We report two cases of an extremely rare concomitant fractures of the neck of talus and calcaneus in children, sustained by contrasting modes of dorsiplantar and plantidorsal compression, but the same mechanism of axial compressive loading. Dissimilar and diametrically opposite modes of axial compression suggest that axial compression is the primary mechanism of injury in fractures of the neck of talus, which is the common denominator in the two cases. Early recognition of subtle presentations of undisplaced and minimally displaced fractures of the neck of talus in children is of paramount importance to avoid the high risk of avascular necrosis and demands a high index of suspicion. In the combination of fractured neck of talus and calcaneus, displacement of talus is the operative determinant of intervention and outcome.

Quantitative ultrasound of the calcaneus in children and young adults with severe cerebral palsy

Osteopenia is common in children, adolescents, and young adults with severe cerebral palsy (CP; spastic quadriplegia) living in residential care, and frequently results in atraumatic fractures. On clinical grounds 67 patients (34 males, 33 females) with severe CP (gross motor function classification system [GMFCS] levels IV or V) aged 5 to 25 years (median 20 y) were divided into three groups with increasing likelihood of severe impairment of bone quality: (1) patients without fractures and without anticonvulsant medication (n=13); (2) patients without fractures and with anticonvulsant medication (n=45); (3) patients with fractures and with anticonvulsant medication (n=9). Evaluation included measurements of quantitative ultrasound (QUS) of the calcaneus, multiple serum analyses, and determination of urinary bone-resorption markers. Values of the quantitative ultrasound index (QUI) were significantly different (p=0.001): group 1 (median 56.9; interquartile range 43.8-75.3); group 2 (49.9; 40.0-60.0); group 3 (35.6; 30.5-38.5). when comparing values of laboratory serum and urine in the three groups, we found significant differences in values of serum bone alkaline phosphatase (p=0.001), serum parathyroid hormone (PTH; p=0.002), serum albumin (p=0.020), and urinary deoxypyridinoline/creatinine ratio (p=0.004). In multiple regression analysis, no laboratory variable was found to be an independent predictor of QUI. QUS of the calcaneus may be a useful method to assess bone quality and fracture risk in children and young adults with severe cp living in residential care, independent of information from laboratory data.

Treatment of Unicameral Calcaneal Bone Cysts in Children

Nine unicameral bone cysts of the calcaneus in children were managed surgically using the technique of continuous decompression with titanium cannulated cancellous screws. The average age of the patients at surgery was 12.8 years. At follow-up a minimum of 2 years after surgery, eight cysts showed complete healing; one patient showed healing with residuals. Irritation at the screw insertion site necessitated early removal of the screw in one patient; implant-related problems were not observed in the other patients. Patients were allowed to bear weight after surgery. Implant extraction was performed after full consolidation of the cyst and was uneventful in all patients. A review of the literature and the different treatment modalities used for managing calcaneal cysts is also presented.

Treatment of Unicameral Calcaneal Bone Cysts in Children

Nine unicameral bone cysts of the calcaneus in children were managed surgically using the technique of continuous decompression with titanium cannulated cancellous screws. The average age of the patients at surgery was 12.8 years. At follow-up a minimum of 2 years after surgery, eight cysts showed complete healing; one patient showed healing with residuals. Irritation at the screw insertion site necessitated early removal of the screw in one patient; implant-related problems were not observed in the other patients. Patients were allowed to bear weight after surgery. Implant extraction was performed after full consolidation of the cyst and was uneventful in all patients. A review of the literature and the different treatment modalities used for managing calcaneal cysts is also presented.

Hematogenous osteomyelitis of the calcaneus in children.

Fourteen children (average 9 years) with primary hematogenous osteomyelitis of the calcaneus are reported. Four were seen early and 10 late. Clinical presentation was dramatic, with fever, pain, swelling, and fluctuance around the foot and ankle. The diagnosis was missed initially in 8 cases because the patients were treated for septic arthritis of the ankle, cellulitis, and subcutaneous abscess. The 4 patients seen early healed well, with no complications. The 10 patients seen late had chronic osteomyelitis with growth arrest; shortening of the foot; limb length deficiency; fusion of subtalar, calcaneocuboid, and ankle joints; calcaneus and equinus deformity; avascular necrosis of the talus; and phalangeal loss. Hospital stay was prolonged in 4 patients. Total calcanectomy (3 patients) and talectomy (2 patients) with heel pad preservation were useful salvage procedures avoiding ablation of the limb in chronic cases.

Hematogenous Osteomyelitis of the Calcaneus in Children

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A closed extra-articular calcaneal fracture in a nine-year-old child: a case report

Fractures of the calcaneus in children are uncommon. They occur less frequently than in the adult population and tend to be of the extra-articular variety. We present a closed, extra-articular calcaneal fracture in a 9-year-old child. The mechanism and management of the injury is discussed.

Hematogenous osteomyelitis of the calcaneus in children: Surgical treatment and use of implanted antibiotic beads

Hematogenous osteomyelitis is a relatively uncommon disorder that may prove elusive to early diagnosis and treatment. Metaphyseal long bones are commonly involved and the calcaneus is rarely affected. A high index of suspicion should be maintained regarding the pediatric patient with pain out of proportion to a minor injury. Delay in the diagnosis of hematogenous osteomyelitis in the pediatric patient can result in irreversible growth disturbances and devastating sequelae. The authors present a typical case history with an unusual postoperative course and a review of the clinical aspects and surgical treatment of hematogenous calcaneal osteomyelitis in a child.

Unicameral bone cyst of the calcaneus in children.

The calcaneus is an uncommon site for a unicameral bone cyst. However, because of the concentration of forces through the heel, such cysts are usually symptomatic and require treatment. Because of the lack of attention paid to calcaneal unicameral bone cysts, as well as the controversy concerning their appropriate treatment and ultimate outcome, a retrospective study of our experience was undertaken. Over a 15-year period, we treated six children with calcaneal unicameral bone cysts. The diagnosis was confirmed pathologically at the time of treatment for all six. The most common presenting complaint was heel pain upon weight-bearing, secondary to microfracturing of the cyst. Although conservative treatment, which entailed casting and sponge fillers in the shoes, was attempted for most patients, none responded to this form of management. One child had three separate injections of methylprednisolone acetate without any radiographic or clinical change in the cyst, which ultimately required curettage and bone grafting. Bone grafting with either autogenous or allograft bone was successful in eradicating the cyst in all six patients, with no symptoms of recurrence at an average follow-up of 4 years. No resultant treatment complications were encountered. Unicameral bone cysts of the calcaneus, when symptomatic, respond well to curettage and bone grafting, and this type of treatment is recommended.