Search Results (69)

Background/Objectives: The optimal surgical approach for displaced intra-articular calcaneal fractures (DIACFs) remains controversial. While the extensile lateral approach (ELA) has traditionally been preferred for complex fractures, the sinus tarsi approach (STA) has gained popularity due to its potentially lower soft tissue morbidity. However, comparative data focusing on patient-centered outcomes remain limited. This study aimed to compare clinical, radiological, functional, cosmetic, and complication outcomes between STA and ELA in Sanders type II–IV DIACFs. Methods: A retrospective comparative cohort study was conducted including patients treated with open reduction and internal fixation using either STA or ELA between February 2019 and October 2024. Functional outcomes were assessed using the AOFAS Ankle–Hindfoot Score and VAS. Radiological evaluation included Böhler and Gissane angles measured preoperatively, early postoperatively, and at final follow-up. Patient-centered outcomes included time to full weight bearing, return to work, heel width difference, and changes in shoe size. Complications were recorded throughout follow-up. Results: Baseline demographic and fracture characteristics were comparable between groups. Patients treated with STA demonstrated significantly shorter hospital stay, earlier progression to full weight bearing, and earlier return to work (p < 0.001). Functional outcomes favored STA, with significantly lower VAS scores and higher AOFAS scores at final follow-up (p < 0.05). No significant differences were observed between groups regarding Böhler or Gissane angles at any time point (p > 0.05). Wound-related complications were significantly more frequent in the ELA group (p = 0.018), although overall complication rates were comparable. Conclusions: The sinus tarsi approach was associated with comparable radiological restoration to the extensile lateral approach while demonstrating earlier functional recovery and lower wound-related morbidity. Given the retrospective and non-randomized design, these findings should be interpreted as associations rather than causal effects. STA may represent a safe and effective surgical option in appropriately selected Sanders type II–IV intra-articular calcaneal fractures. Full article

Background: The impact that various methods of calcaneal fracture treatment have on functional outcomes is not thoroughly understood. The purpose of this study was to analyze the impact of calcaneal fractures on the level of physical activity and foot and ankle mobility following various fixation methods. Methods: In our two-center retrospective analysis, we compared treatment outcomes of intra-articular calcaneal fractures in 50 patients treated with the Ilizarov method and 49 patients who underwent internal plate fixation. The following parameters were analyzed: range of motion of the foot and ankle joint; the UCLA Activity Scale, the Saltin–Grimby scale, and the Visual Analog Scale (VAS) of Activity. No multivariable adjustment was performed. Accordingly, between-group comparisons are unadjusted, except where stratified analyses are indicated. Results: Postoperatively, a significant improvement was noted in terms of UCLA Activity parameters and the Saltin–Grimby score in the Ilizarov group. A comparison of post-treatment physical activity levels in the two groups revealed significantly better scores in the Grimby scale and VAS activity in the Ilizarov group than in the internal fixation group. The ranges of motion in the Ilizarov group showed significantly worse mobility in the operated limb than in the intact limb. The ranges of dorsiflexion, foot inversion, and foot eversion in the ORIF group were comparable for the treated and intact limb. A comparison of ranges of motion in the study groups showed significantly lower ranges of motion in the Ilizarov group than in the ORIF group. Conclusions: Calcaneal fracture treatment with the Ilizarov method may be associated with better physical activity levels than internal plate fixation. Foot and ankle mobility following calcaneal fracture treatment is better in patients treated with internal plate fixation. The results should be taken with caution due to the lack of randomization, two-center design and the retrospective nature of the study. Full article

Background: Calcaneus secundarius (CS) is an accessory ossicle located at the anterior aspect of the calcaneus and is typically an incidental and asymptomatic radiographic finding. However, it may become symptomatic following trauma or repetitive mechanical stress and can mimic anterior calcaneal process fracture or tarsal coalition, leading to diagnostic confusion. The presence of multiple independent CS ossicles represents a rare morphological variant and a potential source of diagnostic ambiguity. Methods: We report the case of a 19-year-old male soldier who presented with progressive anterior foot pain following soccer activity without a clearly identifiable traumatic event. Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were performed to evaluate the underlying pathology. Results: CT demonstrated two separate, well-corticated accessory ossicles adjacent to the anterior calcaneal process without bony continuity. MRI revealed focal bone marrow edema (BME) at the calcaneus–ossicle interface, suggesting mechanical irritation at the fibrous connection. Due to persistent symptoms and concordant imaging findings, surgical excision was performed, resulting in immediate pain relief and return to full daily and sports activities without recurrence at the 1-year follow-up. Conclusions: Multiple CS ossicles may produce fragment-like imaging appearances and increase the risk of misdiagnosis. Recognition of characteristic imaging features, particularly well-corticated ossicles and focal BME at the ossicle–calcaneus interface, together with clinical correlation, is essential for accurate diagnosis and appropriate management in patients with persistent anterior foot pain. Full article

Background: Displaced intra-articular calcaneal fractures are difficult to treat due to their complex anatomy and the high risk of soft-tissue complications. Although open reduction and internal fixation (ORIF) enables accurate anatomical reconstruction, it can be associated with substantial wound morbidity. Minimally invasive techniques have been developed to mitigate these risks. This study aims to describe a modified external fixation technique and report its clinical and radiographic outcomes in consecutive cases of patients with displaced intra-articular calcaneal fractures, with a minimum follow-up period of one year. Methods: The surgical technique is described in detail. The technique was evaluated by analyzing the treatment results in a case series of 17 patients. The time from injury to surgery, radiographic parameters (Böhler’s angle and time to union) and clinical outcomes were recorded and analyzed, as were complication rates. The minimum follow-up period was 12 months. Results: Surgical reconstruction was performed at a mean of three days (range 1–6 days; SD 1.5) after injury. Preoperative radiographic parameters showed significant deformity, with calcaneal morphology restored at follow-up. At 12 months, the mean Böhler angle had increased to 27.8°, and all fractures had achieved radiographic union. Functional outcomes improved progressively over time, with increases in both the AOFAS and SF-12 P scores. One complication was observed: K-wire displacement requiring conversion to ORIF in a psychiatric patient. Conclusions: The proposed technique facilitates early surgical treatment and the satisfactory restoration of calcaneal morphology with no soft-tissue complications. It appears to be safe and effective in selected patients. A longer follow-up will provide further insight into long-term outcomes, such as subtalar osteoarthritis. Full article

Surgical fixation techniques for bone fracture healing are well established and effective; however, opportunities remain to improve both functional outcomes and the patient experience. The Biofiligree^® concept integrates medicine, engineering, and design by reimagining conventional osteosynthesis plates as both therapeutic and aesthetic devices. Inspired by traditional Portuguese filigree, these plates allow patient participation through personalized geometries, patterns, or engravings and may later be transformed into wearable jewellery after removal, preserving them as symbolic artefacts of recovery. This study introduces and biomechanically evaluates a novel calcaneal fixation plate incorporating the biofiligree geometry concept. A biofiligree plate was designed for calcaneus fracture fixation and manufactured in stainless steel 306L. Experimental testing was conducted on synthetic composite calcaneus bone models to simulate anatomical conditions and compare the new design with a standard commercial plate. The biofiligree plate, 2 mm thick, was fixed using five screws and two percutaneous screws positioned at 45° to compress the fracture line. Results demonstrated comparable biomechanical performance between both systems, with similar strain distributions and fracture stabilization. The biofiligree plate showed stresses around 430 MPa and fracture displacement below 0.7 mm. Fixation stiffness values were 1445 N/mm for intact calcaneus, 1065 N/mm for the commercial plate, and 725 N/mm for the biofiligree plate, indicating adequate support for bone healing. Full article

Background: Calcaneal fractures are complex injuries frequently associated with significant soft tissue damage and a high risk of post-operative complications, particularly infection. Despite advances in surgical techniques, infectious complications remain a major cause of morbidity and can severely compromise functional outcomes. The aim of this systematic review was to analyze the incidence, management strategies, and clinical impact of infectious complications following surgical treatment of calcaneal fractures. Methods: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science in accordance with PRISMA guidelines, including studies published up to May 2025. Randomized controlled trials and prospective and retrospective cohort studies involving adult patients surgically treated for calcaneal fractures and reporting post-operative infectious outcomes were included. Data extraction focused on patient demographics, fracture characteristics, surgical techniques, infection rates, microbiological findings, management strategies, complications, and functional outcomes. Methodological quality and risk of bias were assessed using the MINORS score. Due to substantial heterogeneity, results were synthesized descriptively. Results: Forty studies met the inclusion criteria, encompassing 5343 patients and 4638 surgically treated calcaneal fractures. Displaced intra-articular fractures predominated, with Sanders type II and III accounting for 79.8% of classified fractures, while Sanders type IV fractures represented 20.2% and were associated with higher complication rates. The overall post-operative infection rate was 9.4%, including 6.3% superficial surgical site infections and 3.0% deep infections. Open fractures accounted for 7.5% of reported cases and demonstrated markedly higher infection rates than closed injuries. Deep infections frequently required implant removal (62%), prolonged intravenous antibiotic therapy (100%), and additional surgical procedures (71%). Staphylococcus aureus, including methicillin-resistant strains, was the most commonly isolated pathogen. Functional outcomes were consistently worse in patients who developed infections. Conclusions: Infectious complications remain a clinically significant problem following surgical treatment of calcaneal fractures, particularly in severe fracture patterns, open injuries, and patients with relevant comorbidities. Deep infections are associated with substantial morbidity and inferior functional outcomes. Optimization of patient-related risk factors, careful surgical planning, and the selective use of minimally invasive approaches may help reduce infection risk. Further high-quality prospective studies with standardized outcome measures are needed to define optimal management strategies. Full article

Background and Objectives: Bone fragility in people living with HIV (PLWH) reflects both reduced bone mineral density (BMD) and impaired microarchitecture, while functional decline may further amplify fracture vulnerability. This study evaluated whether adding a pragmatic sarcopenia screen improves bone fragility characterization beyond DXA-BMD, trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS), and biomarkers, and explored the relationship between tenofovir disoproxil fumarate (TDF) exposure and microarchitectural impairment. Materials and Methods: In this single-center cross-sectional study at Victor Babeș University of Medicine and Pharmacy Timișoara, 98 adults on stable ART underwent DXA (T-scores), lumbar TBS (reported as TBS × 100), calcaneal QUS (SOS/BUA), and bone turnover markers (CTX, P1NP, 25(OH)D). Sarcopenia screening used handgrip strength and 4 m gait speed. Associations were tested using group comparisons, correlations, and multivariable modeling for degraded TBS (TBS × 100 < 124.0). Results: Sarcopenia screen-positive participants (n = 28) had lower TBS (123.8 vs. 127.7, p = 0.02), lower lumbar T-score (−1.7 vs. −1.2, p = 0.014), lower SOS (1523.3 vs. 1548.8 m/s, p = 0.002), and higher CTX (0.6 vs. 0.4 ng/mL, p < 0.001), with less frequent viral suppression (60.7% vs. 85.7%, p = 0.006). With >5 years TDF exposure (n = 28), degraded TBS prevalence was 82.1% vs. 40.0% in never-exposed (p = 0.001), alongside lower TBS (123.1 vs. 129.8, p < 0.001) and higher CTX (0.6 vs. 0.4 ng/mL, p < 0.001). Viral suppression independently reduced odds of degraded TBS (aOR 0.3, 95% CI 0.1–0.9; p = 0.034). Conclusions: In PLWH, prolonged TDF exposure and functional impairment co-occur with worse densitometric and microarchitectural profiles; viral suppression shows an independent protective association with microarchitecture. Full article

Background: The sustentaculum screw plays a crucial role in achieving stable osteosynthesis for intra-articular calcaneal fractures, particularly when using minimally invasive or percutaneous techniques. Accurate placement of the screw within the sustentaculum tali is technically demanding due to the complex anatomy and the limited intraoperative visualization provided by standard fluoroscopic views. Methods: Patients were positioned in a standardized lateral decubitus position. Beginning with a standard lateral fluoroscopic view, the C-arm was tilted approximately 25° to align the central beam with the plane of the lower ankle joint. This adjustment enables clear visualization of the borders of the sustentaculum tali and allows precise definition of the target point for guide-wire insertion. To evaluate whether this technique improves screw positioning, two groups were compared: one using the described fluoroscopic view and a control group using conventional imaging alone. Results: Screw placement accuracy was significantly higher in the group using the dedicated fluoroscopic view compared with the control group. Conclusions: With meticulous preoperative planning, standardized positioning, and the use of a dedicated fluoroscopic setting—referred to as the “sustentaculum view”—accurate and safe screw placement can be achieved with significantly higher accuracy than with conventional imaging alone. Full article

Background and Objectives: People living with HIV (PLWH) have excess osteoporosis and fractures not fully captured by dual-energy X-ray absorptiometry (DXA). We evaluated whether trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS) and bone turnover markers improve vertebral fracture risk assessment beyond areal bone mineral density (BMD) in PLWH. Methods: In this cross-sectional study, 87 antiretroviral-treated adults undergoing DXA had lumbar spine TBS and calcaneal QUS. Morphometric vertebral fractures were identified, correlates of degraded TBS were analyzed using multivariable regression, and sequential logistic models quantified the incremental contribution of TBS and CTX to discriminate for prevalent morphometric vertebral fractures. Results: Low BMD (osteopenia/osteoporosis) was present in 62% of participants, degraded TBS in 37% and morphometric vertebral fractures in 17%. Degraded versus normal TBS was associated with older age (49.1 vs. 39.7 years), longer HIV duration and lower nadir CD4+ count, as well as more frequent tenofovir disoproxil fumarate exposure (66% vs. 52%; all p ≤ 0.04). In multivariable analysis, age (per 10-year increase; adjusted odds ratio [aOR] 1.78; 95% CI 1.13–2.83) and nadir CD4+ < 200 cells/mm³ (aOR 2.29; 95% CI 1.06–4.97) independently predicted degraded TBS. In sequential cross-sectional models for prevalent morphometric vertebral fractures, the area under the curve increased from 0.71 (clinical variables) to 0.79 after adding lumbar spine T-score and to 0.85 after adding TBS; adding CTX yielded 0.87 without a statistically significant incremental gain. Conclusions: In PLWH, TBS captures bone quality deficits and improves vertebral fracture risk discrimination beyond BMD, supporting its integration alongside DXA in routine HIV care. Full article

Background: Covering the defects around the calcaneus is still a largely debatable subject. In the classical view, the defects at the level of the foot can be treated only by a free flap. In a modern approach, it has been observed that for small or moderate foot defects, a local flap can be used. Methodology: In this case series, we have retrospectively selected the patients who were admitted to the orthopedic department for a calcaneal fracture and who presented soft-tissue complications during the treatment. The patients have been selected from the past five years if they have undergone reconstructive surgery with a local or regional flap. Results: By applying the inclusion and exclusion criteria, we found that out of 79 patients who have been admitted to the orthopedic department, only two patients met the criteria. Two flaps have been used to treat the defects that developed at the level of the calcaneus after traumatic injury of the foot. The reverse-flow sural flap, as a tunneled flap, had a good evolution, without vascular suffering of the flap. On the other hand, for defects at the medial level of the calcaneus, we have used the dorsalis pedis flap. The healing was fast, and the patient presented no complications at the level of the donor site. Conclusions: Both flaps presented a good evolution. We try to emphasize through this article that soft tissue defects around the non-weight-bearing area of the heel can also be treated through a non-microsurgical option. These two options can help the ortho-plastic team to manage difficult cases by avoiding a free flap or a split-thickness skin graft. Full article

Background/Objectives: Skeletal impairment has been reported as a common finding in Hyperphenylalaninemia (HPA)/Phenylketonuria (PKU) patients regardless of age and method of diagnosis, both in children and adults. Quantitative Ultrasound (QUS) is a radiation-free and low-cost method for assessing bone quality, used in various chronic conditions. Methods: Bone quality was evaluated using a calcaneal QUS device. Auxological parameters, nutritional intakes, and plasma levels of key bone biomarkers were also registered. The population was divided into four groups: PKU patients under diet therapy and HPA patients on a free diet, both divided into receiving or not receiving single vitamin D supplementation. Results: All HPA/PKU patients had median bone quality index (BQI) Z- and T-score values lower than −1, with slightly better values in HPA children and PKU-supplemented adults. Dietary vitamin D intake in PKU patients was significantly higher than in HPA subjects (p < 0.001), due to protein substitute supplementation. However, plasma 25(OH) vitamin D levels, although increased compared to baseline, were still overlapping among groups (p = 0.845) after supplementation. Approximately a quarter of both pediatric and adult non-supplemented PKU patients had Z-score and T-score levels below −2, and this percentage decreased with vitamin D supplementation in all groups. In PKU-supplemented patients, the Broadband Ultrasound Attenuation (BUA) was significantly higher than in the other groups (p = 0.040). Conclusions: The improvement in BUA may represent preliminary evidence of the effect of vitamin D on bone architecture, which could encourage this supplementation to prevent the worsening of bone structure and reduce the risk of fractures. Full article

Background: The purpose of this study was to evaluate the efficacy and significance of using an independently designed triangular calcaneal distractor in percutaneous poking reduction and internal fixation for treating Sanders type II and III calcaneal fractures. Methods: Forty patients with unilateral closed calcaneal fractures treated at our hospital from May 2021 to May 2022 were selected and randomly divided into a treatment group (20 cases treated with a triangular distractor and closed poking reduction) and a control group (20 cases treated with closed reduction and internal fixation). Standardized postoperative treatment was administered to both groups. The surgical duration, number of fluoroscopic exposures, and postoperative calcaneal height and Böhler’s angle at 3 days and 3 months were recorded. Results: In the treatment group, the Böhler angle and the calcaneal height was measured at 3 days and 3months after the operation. There were no statistically significant differences in the calcaneal height or the Böhler angle between the two groups (P > .05). There were also no statistically significant differences in the calcaneal height or the Böhler angle within each group at different time points (P > .05). The treatment group had a shorter surgical duration and only two to three fluoroscopic exposures compared with the control group. The differences between the groups were statistically significant (P < .05). Conclusions: For Sanders type II and III calcaneal fractures, the triangular distractor enables more precise traction reduction and screw placement during poking reduction treatment, helping to shorten the surgical duration and reduce the number of required intraoperative fluoroscopic exposures (lowering the radiation exposure for surgeons and patients). (J Am Podiatr Med Assoc 115(6), 2025; doi:10.7547/23-207) Full article

Background: There is no consensus on the best treatment method for calcaneal fractures. The topic of lower limb biomechanics following calcaneal fracture treatment with various fixation methods has not been fully explored. The aim of the study was to assess the balance and load distribution of the lower limbs in patients after various methods of stabilization of calcaneal fractures. Methods: In this two-center study, we retrospectively collected data from 19 patients treated with internal plate fixation at a mean age of 46 years and 27 patients treated with Ilizarov external fixation at a mean age of 50 years. Using the Zebris Medical pedobarophragmatic platform, we assessed the percentage distribution of lower limb loads and balance. Results: There were no significant differences in total load distribution for both the operated (p = 0.489) and non-operated limb (p = 0.46), between the Ilizarov method group and the internal plate group. In the Ilizarov fixation group, total load distribution was 46.89% on the treated limb, and 53.11% on the uninjured limb, p = 0.077. In the internal plate fixation group, the mean total load distribution was 41.57% in the treated limb, and 57.89% in the uninjured limb, p = 0.008. The median CoG (center or gravity) sway path length was 132.41 cm and 170.21 cm in the Ilizarov and internal plate group, respectively, p = 0.023. The median CoG sway areas were 0.84 cm² and 7.57 cm² in the Ilizarov method group and internal plate fixation group, respectively, p < 0.001. Conclusions: The Ilizarov method was associated with more symmetrical load distribution and improved balance performance compared to internal plate fixation. Static biomechanical parameters of calcaneal fracture treatment were better in the Ilizarov group compared to patients with internal plate fixation. Full article

Background/Objectives: The calcaneus is the most commonly injured tarsal bone, potentially resulting in long-term functional deficiencies and disability. The type of treatment mainly depends on fracture type and morphology. Treatment of these fractures can be challenging due to a limited soft tissue envelope and is frequently associated with complications. The aim of this study was to classify fracture types and identify factors associated with in-hospital complications. Methods: Patients with calcaneal fractures treated at our level I trauma center between 1997 and 2017 were included. Demographic data, comorbidities, fracture characteristics, type of treatment, complications and revisions, compliance and accompanying injuries were evaluated. Results: A total of 238 patients (m = 163, f = 75) at a mean age of 40 years sustaining either uni- or bilateral calcaneal fracture resulting in a total of 288 calcaneal fractures. Concomitant injuries were present in 103 patients (35.9%). Traumatic spine lesions were present in 21.9%. Complications were recorded in 59 fractures (20.5%). Open fractures were more likely to develop complications (76.0% vs. 15.2%, p < 0.001). Significant complication (33% vs. 14%, p < 0.001) and wound complication rates (29% vs. 10%, p < 0.001) were found in multiple-injured patients. All open fractures were surgically treated on the day of admission. In calcaneal fractures with a Böhler angle below 0 degrees, more complications were seen (33% vs. 17%, p < 0.05). Conclusions: High complication rates following calcaneal fractures were detected, with an increased likelihood in open fractures and in patients with multiple injuries. A negative Böhler angle was associated with worse outcomes. Full article

Background: Most of the studies that have investigated bone quality in inflammatory bowel disease (IBD) have utilized dual-energy X-ray absorptiometry (DXA). We assessed the bone status of IBD adult patients using a comprehensive array of non-invasive techniques. Methods: Fifty IBD patients (30 women) and 50 healthy volunteers—matched for age, gender, and body mass index—were prospectively recruited. Areal bone mineral density (aBMD) at the anteroposterior and lateral spine and the proximal femur was measured by DXA, including vertebral fracture assessment (VFA). Trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS), volumetric bone mineral density (vBMD), and cortical thickness were assessed in the proximal femur with 3D-DXA. A comprehensive laboratory panel of calcium metabolism and bone turnover markers was included. Results: Twenty-nine and 21 patients were diagnosed with ulcerative colitis (UC) and Crohn’s disease (CD), respectively. VFA identified vertebral fractures in two IBD patients and no controls. No statistically significant differences were observed in TBS, aBMD, and vBMD between IBD and healthy controls. After excluding one predefined outlier, broadband ultrasound attenuation (BUA) showed lower values in IBD vs. controls [103.6 ± 14.3 vs. 111.3 ± 19.5 (p = 0.033)]. QUS analysis revealed statistically lower values in the CD group compared to controls. We found a positive correlation between all the QUS parameters with aBMD and vBMD. Conclusions: In our study of IBD subjects, most of whom had mild or quiescent disease, we did not observe significant bone quality deterioration. QUS was the only technique that showed lower values in IBD patients, especially in CD. Full article