Tarsal coalition is an often unrecognised cause of foot and ankle pain and represents a congenital osseous, cartilaginous or fibrous connection between two or more tarsal bones. fractures in combination with tarsal coalitions are rarely described in the literature. We report the case of a 43-year-old male patient with a taloCalcaneal coalition who sustained an open comminuted Calcaneal fracture and a closed transverse cuboid fracture. Due to the asymptomatic tarsal coalition and the already firmly fixed subtalar joint, the patient was treated with open reduction and internal fixation (ORIF) with satisfactory outcomes instead of ORIF in combination with subtalar arthrodesis. Ten months after the trauma, the patient was satisfactory and could return to his regular work. There is currently no evidence for the gold standard treatment of Calcaneal fractures with combined tarsal coalitions. Due to the satisfactory results of this case, authors conclude that in case with prior asymptomatic coalitions, singular ORIF without subtalar arthrodesis may be performed.

Background: Open reduction and internal fixation is the standard surgical treatment of Calcaneal fractures. However, it is associated with a high rate of wound problems. Objectives: In this study, we evaluated the clinical and radiologic outcomes, as well as the wound complication rates of sinus tarsi minimally-invasive approach in the treatment of intraarticular calcaneus fracture. Methods: In a retrospective study, 62 patients who were referred with an intra-articular calcaneus fracture and treated with a minimally-invasive sinus tarsi approach were included. The radiographic evaluations included the assessment of Bohler and Gissane angles before and after the surgery, as well as the height and length of the calcaneus. The clinical outcome was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire. Results: The Mean± SD age of the patients was 41. 8± 12. 7 years. The Mean± SD follow-up of the patients was 21. 3± 10 months. After 6 months, in 43 patients (69. 3%) both Bohler’ s and Gissane’ s angles were significantly improved after the surgery (P=0. 003 and P<0. 001, respectively). The calcaneus height was significantly improved after the surgery (P=0. 009), as well. The Mean± SD AOFAS score of the patients was found 79. 6± 7. Wound infection was seen in only 1 case (1. 6%). Delayed wound healing occurred in 4 cases (6. 4%). No other wound complication such as dehiscence and skin necrosis was recorded. Conclusion: Minimally-invasive sinus tarsi approach is an efficacious procedure for the treatment of intra-articular calcaneus fracture with a minimized rate of wound complications.

Introduction: Criteria for starting weight-bearing on the heel with a symptomatic Calcaneal insufficiency fracture have not yet been reported. Case Presentation: We describe a rare case of a 52-year-old woman with a Calcaneal insufficiency fracture who sustained a second ipsilateral Calcaneal insufficiency fracture within a short time span. The initial fracture was not evident radiographically, but was detected using magnetic resonance imaging (MRI). The patient rejected our advice to avoid weight-bearing on the heel, instead opting to use a silicone heel orthosis. Although there were no abnormal local findings, the stand on heel test was positive at each subsequent visit until 2 months after her first medical examination. At this time, radiographs showed a sclerotic line; however, a second round of MRI showed a new Calcaneal insufficiency fracture anterior to the initial Calcaneal insufficiency fracture. The patient then agreed to stop weight-bearing on the heel. Three months after the initial visit, radiographs showed two sclerotic lines, and the standon heel test became negative for the first time; hence, weight-bearing was permitted. There was radiographic evidence of fracture healing and complete resolution of symptoms 4 months after the initial visit. Conclusions: The callus formation seen on radiographs is helpful in determining when to start weight-bearing; however, fresh insufficiency fractures of the ipsilateral calcaneus may not be detected by radiography. Since local findings such as tenderness, swelling, and heat are subjective, the criteria for starting weight-bearing on the affected heel with an insufficiency fracture should be based on not only radiographs but also objective clinical findings such as the stand on heel test.

Background & Objectives: Anatomical reconstruction of articular surface and restoration of walking ability without pain are the main goals of displaced intra-articular Calcaneal fracture management, but treatment results are not always satisfied. This paper focused on comparison between open reduction and internal fixation using: A) auto graft B) bone cement, in patients with displaced intra-articular Calcaneal fracture.Methods: This prospective comparative study of 44 patients with displaced intra-articular Calcaneal fractures. Patients had been divided into 2 groups and then, they were operated by the standard protocol, including lateral approach, open reduction and internal fixation with reconstruction plate. Posterior facet was supported by autogenous bone graft in the first group (BG) and it was strengthened by bone cement in the second group (BC). Patients were followed up from the point of view of following surgical complications: 1- superficial infection, 2- wound dehiscence, 3- incisional site skin necrosis, 4- Sural nerve paresthesia, 5- osteomyelitis. Functional outcome were evaluated using Calcaneal fracture scoring system and ankle-hind foot scaling system of AOFAS. The gathered data was analyzed in SPSS 16 software.Results: Of 44 included patients, 36 were male (81.8%) and eight were female (18.2%). The mean of age was 44.25±11.34 (range: 16-69 yrs.), and the mean of follow-up duration was 13.27±2.71 months (range: 9-18 months). The mean of operation time in second group (BC) (41.82 min) was significantly lower than first group (BG), (p<0.001). Five patients (23%) from first group (BG) and only one patient (5%) from the second group (BC) showed surgical complications (p=0.079). There was no significant difference between the average score evaluated by Calcaneal fracture scoring system and the average scale indicated by ankle-hind foot scaling system.Conclusion: Instead of autogenous bone graft, the use of bone cement decreases the duration of operation time and it seems to lead in less complications.

Background: Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of Calcaneal fractures are intra-articular fractures with displacement. The majority of Calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economic damages.Objectives: In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular Calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. Patients and Methods: A total of 140 patients with intra-articular Calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group.Results: In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one.Conclusions: Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular Calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur.

Statement of Problem: In a previous study it was reported that a durable resin-ceramic tensile bond could be obtained by an appropriate silane application without the need for HF acid etching the ceramic surface. Evaluation of the appropriate application of silane by other test methods seems to be necessary.Purpose: The purpose of this study was to compare the interfacial fracture toughness of smooth and roughened ceramic surfaces bonded with a luting resin.Materials and Methods: Ceramic discs of 10 mm in diameter and 2 mm in thickness were prepared.Four different surface preparations (n=10) were carried out consisting of (1) ceramic surface polished to a 1µm finish, (2) gritblasted with 50µm alumina, (3) etched with 10% HF for 2 min, and (4) gritblasted and etched. The ceramic discs were then embedded in PMMA resin. For the adhesive area, the discs were masked with Teflon tapes. A circular hole with diameter of 3 mm and chevron-shaped with a 90° angle was punched into a piece of Teflon tape. The exposed ceramic surfaces were treated by an optimised silane treatment followed by an unfilled resin and then a luting resin cylinder of 4mm in diameter and 11 mm in length was built. Specimens were stored in two different storage conditions: (A): Distilled water at 37°C for 24 hours and (B): Distilled water at 37°C for 30 days. The interfacial fracture toughness (GIC) was measured at a cross-head speed of 1 mm/min. The mode of failure was examined under a stereo-zoom microscope and fracture surfaces were examined under Scanning Electron Microscope.Results: The mean interfacial fracture toughness values were; Group A: 1) 317.1±114.8, 2) 304.5±109.2, 3) 364.5±169.8, and 4) 379.4±127.8 J/m2±SD. Group B: 1) 255.6±134.4, 2) 648.0±185.1, 3) 629.3±182.6 and 4) 639.9 ±489.0 J/m2±SD. One way Analysis of Variance showed that there was no statistically significant difference in the mean interfacial fracture toughness for groups A1-A4 (P>0.05). However, the mean interfacial fracture toughness for group B1 was significantly different from that for groups B2, B3 and B4 (P<0.05). Independent-ٍٍٍSamples T-Test results showed that there was a significant increase in the GIC mean value for groups B2 and B3 after 30 days water storage (P<0.05). The modes of failure were predominantly interfacial or cohesive within the resin.Conclusions: The fracture toughness test method used in this study would be appropriate for analysis of the adhesive zone of resin-ceramic systems. From the results, it can be concluded that micro-mechanical retention by gritblasting the ceramic surfaces could be sufficient with no need for HF acid etching the ceramic surfaces when an appropriate silane application procedure is used.

Objective: Ultrasonography (US) is not the method of choice for the diagnosis of Calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29. 4 ± 15. 7 years (85. 5% male). fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of Calcaneal fractures were 83. 6%, (confidence interval (CI), 69. 7 – 92. 2) and 100% (95% CI, 96. 7 – 100), while the sensitivity and specificity of X-ray were 87. 7% (95% CI, 74. 5 – 94. 9) and 100% (95% CI, 96. 7 – 100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of Calcaneal fracture in ED.

Osteosarcoma of the foot is rare and, when presents, commonly observed in adults. We report a case of osteosarcoma of the calcaneus in an 11-year-old girl who was presented with a 4-month history of pain and swelling on her left ankle and inability to walk in her left lower extremity. On examination, there was a diffuse swelling involving her left ankle joint and foot. The radiograph showed soft tissue with calcification and ossification that involved the calcaneus with cortical bone destruction. Histologically, the tumor was consisted of variable foci of lacy osteoid formation and spindle pleomorphic stroma with typical osteoblasts. This rare location, histologic characteristics, and differential diagnostic points are discussed.