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1.
BMC Musculoskelet Disord ; 22(1): 374, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888108

RESUMO

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.


Assuntos
Calcâneo , Fraturas Ósseas , Futebol , Calcâneo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
2.
Medicina (Kaunas) ; 57(3)2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33800136

RESUMO

Background and Objectives: Previous studies have demonstrated that risk of hip fracture is at least partly heritable. The aim of this study was to determine the magnitude of the genetic component of bone mineral density (BMD), using both X-ray and ultrasound assessment at multiple sites. Materials and Methods: 216 adult, healthy Hungarian twins (124 monozygotic, MZ, 92 dizygotic, DZ; mean age 54.2 ± 14.3 years), recruited from the Hungarian Twin Registry with no history of oncologic disease underwent cross-sectional BMD studies. We measured BMD, T- and Z-scores with dual energy X-ray absorptiometry (DEXA) at multiple sites (lumbar spine, femoral neck, total hip and radius). Quantitative bone ultrasound (QUS) was also performed, resulting in a calculated value of estimated bone mineral density (eBMD) in the heel bone. Heritability was calculated using the univariate ACE model. Results: Bone density had a strong genetic component at all sites with estimates of heritability ranging from 0.613 to 0.838 in the total sample. Lumbar BMD and calcaneus eBMD had major genetic components with estimates of 0.828 and 0.838 respectively, and least heritable (0.653) at the total hip. BMD of the radius had also a strong genetic component with an estimate of 0.806. No common environmental effect was found. The remaining variance was influenced by unique environment (0.162 to 0.387). In females only, slightly higher additive genetic estimates were found, especially in the case of the femoral neck and total hip. Conclusion: Bone mineral density is strongly heritable, especially in females at all locations using both DEXA and QUS, which may explain the importance of family history as a risk factor for bone fractures. Unshared environmental effects account for the rest of the variance with slight differences in magnitude across various bone regions, supporting the role of lifestyle in preventing osteoporotic fractures with various efficacy in different bone regions.


Assuntos
Densidade Óssea , Calcâneo , Absorciometria de Fóton , Adulto , Idoso , Densidade Óssea/genética , Calcâneo/diagnóstico por imagem , Estudos Transversais , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Ultrassonografia
3.
Artigo em Inglês | MEDLINE | ID: mdl-33799691

RESUMO

PURPOSE: The aim of the study was to establish the relationship between the shape of the calcaneal tuberosity (flat, stepped, rounded, normal) and the probability that retrocalcaneal bursitis among people who train running regularly. METHODS: The study included a group of 30 runners who suffered from retrocalcaneal bursitis in the past, and 30 people who never had symptoms of this disease. The study was based on a diagnostic survey, as well as on clinical examination. The surface of the calcaneal tuberosity and the slope of the calcaneus were assessed using X-rays. The mobility of the bursa, its surface size, the thickness of the Achilles tendon and its attachment rate were established during an ultrasound examination. RESULTS: Flat surface of the calcaneal tuberosity increases fourfold the risk of suffering from retrocalcaneal bursitis (OR = 4.3). The people whose calcaneus slope is above 25° are at increased risk of suffering from such an inflammation compared with the people whose calcaneus bone is more horizontal (OR = 2.8). The analysis shows that the thickness of the Achilles tendon (p = 0.001), the surface size of the bursa (p = 0.009), as well as the flat surface of the calcaneal tuberosity (p = 0.008) are strongly associated with the occurrence of retrocalcaneal bursitis. CONCLUSIONS: The flat shape of the calcaneal tuberosity increases the risk of bursitis. The risk of inflammation is higher when the Achilles tendon is thicker and the surface of the bursa is smaller than normal.


Assuntos
Tendão do Calcâneo , Bursite , Calcâneo , Tendão do Calcâneo/diagnóstico por imagem , Bolsa Sinovial , Bursite/diagnóstico por imagem , Bursite/epidemiologia , Calcâneo/diagnóstico por imagem , Humanos , Ultrassonografia
4.
Sensors (Basel) ; 21(8)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33917016

RESUMO

The study of the foot is relevant in kinematic analyses of gait. Images captured through a lens can be subjected to various aberrations or distortions that affect the measurements. An in vitro study was performed with a rearfoot simulator to compare the apparent degrees (photographed) with the real ones (placed in the simulator) in the plane of the rearfoot's orientation, according to variations in the capture angle in other planes of space (the sagittal plane and transverse plane-the latter determined by the foot progression angle). The following regression formula was calculated to correct the distortion of the image: real frontal plane = 0.045 + (1.014 × apparent frontal plane) - (0.018 × sagittal plane × foot progression angle). Considering the results of this study, and already knowing its angle in the transverse and sagittal planes, it is possible to determine the angle of a simulated calcaneus with respect to the ground in the frontal plane, in spite of distortions caused by perspective and the lack of perpendicularity, by applying the above regression formula. The results show that the angular measurements of a body segment made on frames can produce erroneous data due to the variation in the perspective from which the image is taken. This distortion must be considered when determining the real values of the measurements.


Assuntos
Calcâneo , Fenômenos Biomecânicos , Calcâneo/diagnóstico por imagem , Pé/diagnóstico por imagem , Marcha , Humanos , Técnicas In Vitro
5.
Nutrients ; 13(2)2021 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-33669942

RESUMO

Scientific evidence suggests that a vegan diet might be associated with impaired bone health. Therefore, a cross-sectional study (n = 36 vegans, n = 36 omnivores) was used to investigate the associations of veganism with calcaneal quantitative ultrasound (QUS) measurements, along with the investigation of differences in the concentrations of nutrition- and bone-related biomarkers between vegans and omnivores. This study revealed lower levels in the QUS parameters in vegans compared to omnivores, e.g., broadband ultrasound attenuation (vegans: 111.8 ± 10.7 dB/MHz, omnivores: 118.0 ± 10.8 dB/MHz, p = 0.02). Vegans had lower levels of vitamin A, B2, lysine, zinc, selenoprotein P, n-3 fatty acids, urinary iodine, and calcium levels, while the concentrations of vitamin K1, folate, and glutamine were higher in vegans compared to omnivores. Applying a reduced rank regression, 12 out of the 28 biomarkers were identified to contribute most to bone health, i.e., lysine, urinary iodine, thyroid-stimulating hormone, selenoprotein P, vitamin A, leucine, α-klotho, n-3 fatty acids, urinary calcium/magnesium, vitamin B6, and FGF23. All QUS parameters increased across the tertiles of the pattern score. The study provides evidence of lower bone health in vegans compared to omnivores, additionally revealing a combination of nutrition-related biomarkers, which may contribute to bone health. Further studies are needed to confirm these findings.


Assuntos
Densidade Óssea , Dieta Vegana/efeitos adversos , Estado Nutricional/fisiologia , Adulto , Biomarcadores/análise , Índice de Massa Corporal , Calcâneo/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia
6.
BMC Musculoskelet Disord ; 22(1): 234, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648468

RESUMO

BACKGROUND: The aim of this retrospective monocentric study was to investigate the outcomes of surgically treated intra-articular calcaneus fractures in a maximum care trauma center. METHODS: One hundred forty patients who had undergone surgery for intra-articular calcaneal fractures between 2002 and 2013 were included. One hundred fourteen cases with 129 fractures were eligible to participate in the study of which 80 were available for a clinical and radiological follow-up. 34 patients were followed up by telephone interview only. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form 36 Health Status Survey (SF-36), complications, and subsequent surgeries. RESULTS: Mean follow-up was 91 months (range 12-183). The overall complication rate was 29% (37/129 ft). Disturbed wound healing (11%) and infection (5%) occurred most commonly. Non-union (4%) only occurred in smokers (p = 0.02). A high rate of posttraumatic subtalar arthritis (77%) and need for subsequent subtalar fusion (18%) without independent risk factors for subsequent subtalar fusion was found. The revision rate was high (60%) after primary fusion. Mean AOFAS-hindfoot score was 74 (Sanders I: 99, Sanders II: 74, Sanders III: 77, Sanders IV: 70). The postoperative Boehler angle improved significantly in all subgroups (p < 0.01). Patients with a decreased Boehler angle between postoperative images and the follow-up had significantly lower AOFAS hindfoot scores (p < 0.01). CONCLUSIONS: Our data can aid decision-making in the treatment of calcaneal fractures. We advocate to use primary subtalar fusion with caution due to the high revision rate. Smoking status should always be considered. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Estudos Retrospectivos , Centros de Traumatologia , Resultado do Tratamento
7.
J Int Med Res ; 49(3): 300060521992959, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33682490

RESUMO

OBJECTIVE: To analyse the imaging changes in bone marrow oedema of the calcaneal prominence, retrocalcaneal bursa and degenerative Achilles tendon after the surgical treatment of insertional Achilles tendinopathy (IAT). METHODS: This retrospective study analysed patients with IAT and retrocalcaneal bursitis that were diagnosed based on their symptoms and radiographic and magnetic resonance imaging (MRI) examinations. For patients that had received 3 months of conservative treatment but still presented with symptoms, arthroscopic debridement of the retrocalcaneal bursa and resection of calcaneal prominence were undertaken. Patients with degeneration of the Achilles tendon underwent debridement of Achilles tendon calcification with an open incision. The last follow-up included radiographic and MRI imaging, Visual Analogue Scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS)-Ankle and Hindfoot scores. RESULTS: Thirty patients were included (mean ± SD follow-up, 3.1 ± 0.5 years). The VAS pain and AOFAS-Ankle and Hindfoot scores were significantly improved after surgery. MRI showed that bone marrow oedema of the calcaneal prominence and the retrocalcaneal bursa was significantly reduced compared with preoperative values. There was no significant change in the high signal area of the IAT. CONCLUSION: Surgical treatment of IAT and retrocalcaneal bursitis effectively alleviated local pain and restored function.


Assuntos
Tendão do Calcâneo , Bursite , Calcâneo , Tendinopatia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Bursite/diagnóstico por imagem , Bursite/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Seguimentos , Humanos , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Tendinopatia/cirurgia
8.
BMC Musculoskelet Disord ; 22(1): 285, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33736625

RESUMO

BACKGROUND: A simple, non-quantitative, and cost-effective diagnostic tool would enable the diagnosis of flatfoot without need for specialized training. A simple footprint assessment board that investigates which toe the cord passes through from the centre point of the heel to the most lateral point of the medial contour of the footprint has been developed to assess flatfoot. The purpose of this study was to verify the validity of a simple footprint assessment board for flatfoot. METHODS: Thirty-five consecutive patients with foot pain, foot injury, or any associated symptoms who underwent computed tomography (CT) were analysed prospectively. At the time of the CT scan, a footprint analysis using a simple footprint assessment board was performed. The navicular index, tibiocalcaneal angle, and calcaneal inclination angle were evaluated by CT to assess flat feet. These three criteria were compared to those evaluated with the simple footprint assessment board by regression analysis. In addition, the same analysis was conducted separately for young, middle-aged, and older patients in order to investigate each age group. RESULTS: The navicular index and tibiocalcaneal angle generally decreased as the score of the simple footprint assessment board increased. Calcaneal inclination angle generally increased as the score of the simple footprint assessment board increased. As the scores of the simple footprint assessment board decreased by approaching the great toe, the navicular index and tibiocalcaneal angle were higher and calcaneal inclination angle was lower, which is indicative of a higher likelihood of flatfoot. The scores derived from the simple footprint assessment board was correlated with these three criteria measured by CT, not only when the result of simple footprint assessment board was set as a non-continuous variable but also when the result was set as a continuous variable. The results of the age-stratified survey were similar for all groups. CONCLUSIONS: The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Calcâneo , Pé Chato , Ossos do Tarso , Calcâneo/diagnóstico por imagem , Pé Chato/diagnóstico por imagem , Pé/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Medicina (Kaunas) ; 57(2)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33530595

RESUMO

Background: Calcaneal bone cysts rarely occur and most of them are known to be benign. Among them, simple bone cysts (SBCs) third most commonly occur in the calcaneus and of the many surgical treatment options, endoscopic curettage is recently gaining popularity among surgeons due to its advantages of minimal invasiveness and optimal visualization. As for portal placement for endoscopy, two lateral portals are considered a standard technique, but no rationale has been established for SBCs with abnormal geometry. This case report suggests an SBC with secondary aneurysmal change located outside the Ward's triangle, as well as an appropriate endoscopic approach. Case Presentation: An 18-year-old male high school student presented with a main complaint of pain at the hind foot level for the past one year, without significant improvement from conservative treatment. An endoscopic curettage through the lesion specific two posterior portals and bone graft using allogeneic cancellous bone were performed. SBC with a secondary aneurysmal bone cyst was diagnosed on pathology. At a one-year follow-up, the patient was painless and had returned to his regular activities. Physical and radiographic examinations revealed that the lesion was completely healed without any evidence of recurrence. Conclusion: For calcaneal bone cysts located at the posterior aspect of the calcaneus, eccentrically medial and abnormally long anterior-posteriorly, we suggest an endoscopic procedure using lesion specific portals such as two posterior portals.


Assuntos
Cistos Ósseos , Calcâneo , Adolescente , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Curetagem , Endoscopia , Humanos , Masculino , Recidiva Local de Neoplasia
10.
Int Orthop ; 45(3): 731-741, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33517475

RESUMO

PURPOSE: Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs). METHODS: Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes. RESULTS: VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively). CONCLUSION: Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term results.


Assuntos
Calcâneo , Fraturas Ósseas , Fraturas Intra-Articulares , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(2): e24261, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466211

RESUMO

BACKGROUND: Calcaneal fractures are a prevalent form of injury caused by high-energy trauma. This study aimed at investigating whether bone graft and non-bone graft are essential for the internal fixation of calcaneal fractures. A meta-analysis of relevant clinical studies evaluated radiographic parameters, functional outcomes, and complications that offer practical recommendations on the suitability of bone grafts for the management of Calcaneal fractures. METHODS AND ANALYSIS: This study performed a comprehensive search on PubMed, EMBASE, and Cochrane electronic to retrieve related clinical studies. The studies incorporated in our meta-analysis were identified after doing a preliminarily screening, reading of the full-text articles, and eliminating repeated studies. After quality assessment and data extraction, the standardized mean difference and risk ratio were selected as effect sizes. The data on Böhler angle, Gissane angle, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland Foot Evaluation, and rate of wound infection were analyzed using Revman 5.3 software (Cochrane Collaboration). RESULTS AND CONCLUSIONS: This study did not reveal any significant differences (P < .05) in both Böhler and Gissane angles, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland foot evaluation, and rate of wound infection between the 2 groups. Due to the lack of a large sample of comparative studies, the use of bone grafting for the management of calcaneal fractures requires additional substantiation.


Assuntos
Transplante Ósseo/métodos , Calcâneo/lesões , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Estudos de Coortes , Pesquisa Comparativa da Efetividade , Feminino , Traumatismos do Pé/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Resultado do Tratamento
12.
Niger J Clin Pract ; 24(1): 110-114, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33473035

RESUMO

Background: Böhler's angle (BA) and the crucial angle of Gissane (CAG) are the most frequently used objective measurements for the follow-up of fixation following calcaneus fracture surgery. However, the measurements of these angles by different people can affect the results and cause conflicting interpretations of different results obtained. This has caused confusion in the literature. Aims: The aim of this study was to investigate the reliability and disagreement of BA and the CAG, and to interrogate the veracity of angular changes in the postoperative period of calcaneal fractures. Methods: In the first round, a total of 82 postoperative lateral radiographs were investigated to assess the inter-tester reliability and disagreement. Second round; all radiographs were re-evaluated by two testers 15 days after the first measurement. These values were used to assess the intra and inter-tester reliability, disagreement and false negative/positive angular change. All measurements were performed separately by a radiologist and an orthopedic surgeon. Results: Inter- and intra-tester reliability was found low to high in BA (ICC: 0.465 to 0.837), and moderate to very high in CAG (ICC: 0.661 to 0.926). The mean inter-tester disagreement of BA was 4.19° and 6.07°. These values were 4.76° and 7.22° for CAG. The mean intra-tester disagreement of BA was 4.09° for the orthopedic surgeon and 3.97° for the radiologist. These values were 4.96° and 4.39° for CAG respectively. The false negative angular difference was found for BA in 51 (62.2%) cases for the orthopedic surgeon and 46 (56.1%) cases for the radiologist. The mean values were -3.87° and -4.21°, respectively. For the CAG, the false positive angular difference was found in 43 (52.4%) cases for both the orthopedic surgeon and the radiologist. The mean values were +5.01° and +4.72°, respectively. Conclusion: These angles alone should not be considered to be of guidance in the postoperative period. If any angular change is determined on the lateral radiographs, this could arise from a disagreement or false angular change.


Assuntos
Calcâneo , Fraturas Ósseas , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Período Pós-Operatório , Reprodutibilidade dos Testes , Resultado do Tratamento
13.
Arch Osteoporos ; 16(1): 13, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33447939

RESUMO

This study investigated the potential role of quantitative ultrasound (QUS) to assess low bone mass in anorexia nervosa patients (AN). Bone parameters from QUS and DXA were positively correlated and significantly reduced in AN compared with controls, suggesting that QUS is a pertinent technique to assess low bone mass in these patients. PURPOSE: The aim of this study was to investigate the potential role of an alternative technique, quantitative ultrasound (QUS), to assess low bone mass in patients with anorexia nervosa (AN). METHODS: Two hundred seven young women (134 patients with AN and 73 healthy controls) with ages ranging from 14.4 to 38.4 years participated in this observational cross-sectional study. Bone mass was concomitantly evaluated by DXA to determine areal bone mineral density (aBMD; g/cm2) at hip, lumbar spine, and radius and by QUS to determine broadband ultrasound attenuation (BUA; dB/MHz) at the heel. RESULTS: BUA (66.5 ± 4.6 dB/MHz vs 61.0 ± 5.0 dB/MHz) and aBMD at the hip (0.916 ± 0.013 g/cm2 vs 0.806 ± 0.010 g/cm2), lumbar spine (0.966 ± 0.012 g/cm2 vs 0.886 ± 0.010 g/cm2), and radius (0.545 ± 0.005 g/cm2 vs 0.526 ± 0.04 g/cm2) were significantly decreased (p < 0.01) in patients with AN compared with controls. When patient and control data were pooled, BUA was significantly correlated with aBMD at the hip (r = 0.60, p < 0.001), lumbar spine (r = 0.48, p < 0.001), and radius (r = 0.40, p<0.001). In patients with AN, BUA and aBMD were mainly and positively correlated with weight, lean tissue mass, body mass index (BMI), and minimal BMI life and negatively with the duration of both disease and amenorrhea. Better concordance between the two techniques was obtained when absolute BUA and aBMD values were used according to the WHO T score classification. CONCLUSION: BUA measurement at the heel by QUS appears to be a pertinent nonionizing technique to assess low bone mass in patients with AN.


Assuntos
Anorexia Nervosa , Calcâneo , Absorciometria de Fóton , Adolescente , Adulto , Anorexia Nervosa/diagnóstico por imagem , Densidade Óssea , Osso e Ossos , Calcâneo/diagnóstico por imagem , Feminino , Humanos , Ultrassonografia , Adulto Jovem
14.
Am J Phys Anthropol ; 174(1): 49-65, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871028

RESUMO

OBJECTIVES: The primate foot has been extensively investigated because of its role in weight-bearing; however, the calcaneus has been relatively understudied. Here we examine entire gorilla calcaneal external shape to understand its relationship with locomotor behavior. MATERIALS AND METHODS: Calcanei of Gorilla gorilla gorilla (n = 43), Gorilla beringei graueri (n = 20), and Gorilla beringei beringei (n = 15) were surface or micro-CT scanned. External shape was analyzed through a three-dimensional geometric morphometric sliding semilandmark analysis. Semilandmarks were slid relative to an updated Procrustes average in order to minimize the bending energy of the thin plate spline interpolation function. Shape variation was summarized using principal components analysis of shape coordinates. Procrustes distances between taxa averages were calculated and resampling statistics run to test pairwise differences. Linear measures were collected and regressed against estimated body mass. RESULTS: All three taxa exhibit statistically different morphologies (p < .001 for pairwise comparisons). G. g. gorilla demonstrates an anteroposteriorly elongated calcaneus with a deeper cuboid pivot region and mediolaterally flatter posterior talar facet. G. b. beringei possesses the flattest cuboid and most medially-angled posterior talar facets. G. b. graueri demonstrates intermediate articular facet morphology, a medially-angled tuberosity, and an elongated peroneal trochlea. DISCUSSION: Articular facet differences separate gorillas along a locomotor gradient. G. g. gorilla is adapted for arboreality with greater joint mobility, while G. b. beringei is adapted for more stereotypical loads associated with terrestriality. G. b. graueri's unique posterolateral morphology may be due to a secondary transition to greater arboreality from a more terrestrial ancestor.


Assuntos
Variação Anatômica/fisiologia , Calcâneo/anatomia & histologia , Gorilla gorilla/anatomia & histologia , Gorilla gorilla/fisiologia , Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/diagnóstico por imagem , Animais , Antropologia Física , Comportamento Animal/fisiologia , Calcâneo/diagnóstico por imagem , Calcâneo/fisiologia , Feminino , Hominidae/anatomia & histologia , Hominidae/fisiologia , Masculino , Caracteres Sexuais
15.
Maturitas ; 144: 68-73, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33358211

RESUMO

OBJECTIVES: Gestational diabetes mellitus (GDM) is a common pregnancy complication. This study aims to investigate the association between a history of GDM and bone mineral density (BMD), fractures, and falls in later life. STUDY DESIGN: We used data from the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) where BMD at calcaneum was measured at second health check (1997-2000) using broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 7,515 women. Fractures and falls were documented from hospital admissions data via linkage with ENCORE (East Norfolk Commission Record) and history of GDM from health questionnaires at baseline. We examined the relationship between GDM and BUA/VOS using linear regression. Cox regression was used to estimate hazard ratios (HRs) for incident fractures and falls, controlling for age, BMI, smoking status, physical activity, area deprivation, self-reported stroke, use of diuretics, calcium and vitamin D supplements, social class and education, statin and total blood cholesterol, prevalent diabetes, hormone therapy and menopausal status. RESULTS: History of GDM (n = 183) was not statistically significantly associated with BUA/VOS in fully adjusted linear regression models with unstandardised beta coefficients (standard error): -0.37 (1.40) and -5.41 (3.48). GDM was significantly (p < 0.05) associated with risk of hip and all fractures, fully adjusted HRs(95 %CI) 2.46(1.54-3.92) and 1.60(1.09-2.35), respectively. Median follow-up from first live birth to date of admission was 53 and 52 years, respectively. CONCLUSION: There was an association between history of GDM and risk of any fracture as well as hip fracture specifically. Further research is required to confirm this.


Assuntos
Densidade Óssea , Diabetes Gestacional/epidemiologia , Fraturas Ósseas/epidemiologia , Acidentes por Quedas , Adulto , Idoso , Calcâneo/diagnóstico por imagem , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Ultrassonografia
16.
Clin Nucl Med ; 46(1): 45-46, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33086279

RESUMO

Haglund syndrome-the combination of Haglund's deformity, retrocalcaneal bursitis, and achilles tendinopathy-is a common cause of hind foot pain in adults; however, diagnosis on planar scintigraphy can be challenging. We present a case of Haglund syndrome and show the key role that SPECT/CT can play in its diagnosis.


Assuntos
Ossos do Pé/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tendão do Calcâneo/diagnóstico por imagem , Adulto , Bursite/complicações , Calcâneo/diagnóstico por imagem , Feminino , Doenças do Pé/complicações , Humanos , Masculino , Tendinopatia/complicações
17.
Orthopade ; 49(11): 976-984, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33025037

RESUMO

BACKGROUND: Adult acquired flatfoot deformity is characterized by a progressive functional deficit of the foot that leads to an eversion of the subtalar joint complex with heel valgus, abduction of the forefoot and collapse of the medial arch. In the case of a flexible deformity, a joint-preserving operative reconstruction is advisable, which should correct all elements of the deformity. A calcaneal lengthening osteotomy can correct excessive abduction of the forefoot, which can be measured by the amount of talar head uncoverage visible on AP weight-bearing x­rays of the foot. THERAPY: Any calcaneal lengthening osteotomy leads to an incongruence between talar and calcaneal joint surfaces of the subtalar joint, which is a risk factor for secondary degenerative changes. It is, therefore, advisable to limit the amount of lengthening to the necessary minimum. A residual heel valgus can be corrected by an additional medial displacement osteotomy as adjunct to the calcaneal lengthening. Calcaneal osteotomies are usually part of a complex reconstruction of advanced but still flexible adult flatfoot deformities. In addition to the correction of the hindfoot deformity, persistent forefoot supination needs to be corrected. In cases of midfoot instability, which is frequently located in the naviculo-cuneiforme joint line, a corrective arthrodesis is recommended. Without midfoot instability forefoot a Cotton osteotomy is able to reduce forefoot supination and add to reconstruction of the medial arch of the foot. All bony corrections should be combined with soft tissue reconstruction, i.e. spring ligament repair, Flexor tendon transfer and, in cases of gastrocnemius shortening, a gastroc recession.


Assuntos
Calcâneo/cirurgia , Pé Chato/cirurgia , Deformidades Adquiridas do Pé , Ligamentos/cirurgia , Osteotomia/métodos , Adulto , Alongamento Ósseo/métodos , Calcâneo/diagnóstico por imagem , Pé Chato/diagnóstico por imagem , , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/cirurgia , Humanos , Complicações Pós-Operatórias , Transferência Tendinosa , Tendões/fisiopatologia , Tendões/cirurgia , Resultado do Tratamento
18.
Orthopade ; 49(11): 962-967, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32990760

RESUMO

Minimally invasive medializing calcaneal osteotomy, the implantation of a tarsi spacer and the tendoscopy of the posterior tibial tendon have been established as treatment options for tibialis posterior insufficiency grade II. The minimally invasive medializing calcaneal osteotomy allows a correction of the hindfoot valgus like an open procedure with a significantly lower risk of wound healing problems. It has gained increasing popularity within recent years. There is also good evidence for arthroereisis, with the use of the sinus tarsi spacer being primarily an addition to calcaneus sliding osteotomy. The possibilities for tendoscopy of the posterior tibial tendon are limited to debridement and synovectomy. Various papers report minimally invasive alternatives to the strayer procedure for a shortened gastrocnemius muscle. The proximal lengthening of the medial head of the gastrocnemius muscle is particularly popular as a soft tissue-sparing, less traumatic procedure. So far, no reports of a minimally invasive cotton osteotomy have been found in the literature.


Assuntos
Tendão do Calcâneo/cirurgia , Calcâneo/cirurgia , Pé Chato , Osteotomia/métodos , Disfunção do Tendão Tibial Posterior/cirurgia , Adulto , Calcâneo/diagnóstico por imagem , , Calcanhar , Humanos , Resultado do Tratamento
19.
PLoS Med ; 17(7): e1003152, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32614825

RESUMO

BACKGROUND: Since screening programs identify only a small proportion of the population as eligible for an intervention, genomic prediction of heritable risk factors could decrease the number needing to be screened by removing individuals at low genetic risk. We therefore tested whether a polygenic risk score for heel quantitative ultrasound speed of sound (SOS)-a heritable risk factor for osteoporotic fracture-can identify low-risk individuals who can safely be excluded from a fracture risk screening program. METHODS AND FINDINGS: A polygenic risk score for SOS was trained and selected in 2 separate subsets of UK Biobank (comprising 341,449 and 5,335 individuals). The top-performing prediction model was termed "gSOS", and its utility in fracture risk screening was tested in 5 validation cohorts using the National Osteoporosis Guideline Group clinical guidelines (N = 10,522 eligible participants). All individuals were genome-wide genotyped and had measured fracture risk factors. Across the 5 cohorts, the average age ranged from 57 to 75 years, and 54% of studied individuals were women. The main outcomes were the sensitivity and specificity to correctly identify individuals requiring treatment with and without genetic prescreening. The reference standard was a bone mineral density (BMD)-based Fracture Risk Assessment Tool (FRAX) score. The secondary outcomes were the proportions of the screened population requiring clinical-risk-factor-based FRAX (CRF-FRAX) screening and BMD-based FRAX (BMD-FRAX) screening. gSOS was strongly correlated with measured SOS (r2 = 23.2%, 95% CI 22.7% to 23.7%). Without genetic prescreening, guideline recommendations achieved a sensitivity and specificity for correct treatment assignment of 99.6% and 97.1%, respectively, in the validation cohorts. However, 81% of the population required CRF-FRAX tests, and 37% required BMD-FRAX tests to achieve this accuracy. Using gSOS in prescreening and limiting further assessment to those with a low gSOS resulted in small changes to the sensitivity and specificity (93.4% and 98.5%, respectively), but the proportions of individuals requiring CRF-FRAX tests and BMD-FRAX tests were reduced by 37% and 41%, respectively. Study limitations include a reliance on cohorts of predominantly European ethnicity and use of a proxy of fracture risk. CONCLUSIONS: Our results suggest that the use of a polygenic risk score in fracture risk screening could decrease the number of individuals requiring screening tests, including BMD measurement, while maintaining a high sensitivity and specificity to identify individuals who should be recommended an intervention.


Assuntos
Programas de Rastreamento/métodos , Herança Multifatorial , Fraturas por Osteoporose/genética , Fraturas por Osteoporose/prevenção & controle , Medição de Risco/métodos , Idoso , Densidade Óssea , Calcâneo/diagnóstico por imagem , Estudos de Coortes , Bases de Dados Genéticas , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Calcanhar/diagnóstico por imagem , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Osteoporose/genética , Fatores de Risco , Ultrassonografia , Reino Unido
20.
Acta Orthop Traumatol Turc ; 54(3): 255-261, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544061

RESUMO

OBJECTIVE: The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal arthrodesis using a retrograde nail. METHODS: A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)] who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery was massive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfoot derangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by their American Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed. RESULTS: The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able to walk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing. The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points; p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of the surgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patients had deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed after the treatment but never recovered full weight bearing and the other one died from other complications. These two deep infections occurred after 23 months of follow-up. CONCLUSION: Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfoot disorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated, it is a safe procedure with good clinical outcomes and low risk of below-knee amputation. LEVEL OF EVIDENCE: Level IV, Therapeutic study.


Assuntos
Artrodese , Calcâneo/cirurgia , Diabetes Mellitus/epidemiologia , Fixação Intramedular de Fraturas/métodos , Artropatias , Complicações Pós-Operatórias , Reoperação , Tíbia/cirurgia , Artrodese/efeitos adversos , Artrodese/métodos , Artrodese/reabilitação , Artrodese/estatística & dados numéricos , Calcâneo/diagnóstico por imagem , Comorbidade , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/epidemiologia , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Recuperação de Função Fisiológica , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tíbia/diagnóstico por imagem
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