Clear cell variant of chondrosarcoma of calcaneum: A case report with review of the literature

Clear cell chondrosarcoma (CCC) is an uncommon variant constituting less than 2% of all chondrosarcomas. CCC arises most commonly in the proximal end of the femur, followed by the humerus, and other small bones. CCC involving the tarsal bone is very rare, and to the best of our knowledge, only one case has been described involving the calcaneum in the English literature to date. In this article, we discuss a case of CCC involving the right calcaneum with complete clinico-immuno-histomorphological features, which is successfully managed by below-knee amputation. We also reviewed the reported cases of chondrosarcomas involving the calcaneum with special reference to clinical features, therapy, morphology, and follow-up data.

Sexual dimorphism: metric measurements based study in human talus bone

 Background: Identification is the act of establishing the identity of an individual. This is a dynamic process and human remains in form of bones can serve as an excellent tool for establishing the sexual identity of the deceased, along with other methods such as DNA, fingerprints, blood group identification etc. Metric analysis of various bones can serve as a viable alternative in cases when morphological analysis is not possible due to damage to the skeletal remains or as an additive analytical tool to establish a positive identity.Methods: Metric analysis of various parameters of randomly selected 100 pairs of human talus bones (50 male and 50 female) as a means of establishing sexual identity from skeletal remains obtained from unidentified and unclaimed dead bodies brought for autopsy.Results: In the present study we found that the values of all the various dimensions measured were higher among the male subjects as compared to that in female samples as was expected. On further analysis, this difference was found to be statistically significant (p<0.001). For the right sided and left sided talus bone, the probable accuracy for various parameters ranged between 83.3% to 100% each, thus indicating strong correlation between sex of the subject and various measurements.Conclusions: The tarsal and their dimensions are highly sexually dimorphic and are useful in determining sex in individuals of this region.

A Case Report Of A Variant Head Of Gastrocnemius

The Gastrocnemius muscle is a fusiform, two-headed, two-joint muscle. The two heads of origin are lateral andmedial head taking origin from medial and lateral condyles of femur. In between the two heads tibial nervepasses. Its other end forms a common tendon with the soleus muscle; this tendon is known as the tendocalcaneusor Achilles tendon which get inserted to posterior surface of calcaneum. The case was reported during routinedissection for undergraduate M.B.B.S. students in Government Medical College and Hospital, Chandigarh. Thesubject was 70-year-old male cadaver of North Indian origin. The accessory head was observed during thedissection of popliteal fossa. The Gastrocnemius muscle was bulky. The inferolateral and inferomedial boundaryof the popliteal fossa were made by medial and lateral head of gastrocnemius. In addition to the normal medialand lateral head an accessory head of gastrocnemius was observed. The accessory head had bipennatearrangement of the muscle fibers. in the left lower limb were observed. All the heads were innervated by branchesfrom tibial nerve. It is possible that this variant muscle could have a compressive effect on the tibial nerve andpopliteal vessels, and the awareness of this may prevent its misinterpretation as a pathological structure byradiologists and surgeons

Patrones radiológicos normales del calcáneo en niños / Aspects radiologiques normaux du calcanéum chez l'enfant / Calcaneus Normal Radiological Patterns in Children

Introducción: en niños es frecuente el dolor en el talón luego de caminar, siendo necesario tener una radiografía convencional. No encontramos en la literatura revisada una descripción del desarrollo radiológico del calcáneo en niños. Frecuentemente se asocia la hiperdensidad y fragmentación de la apófisis posterior con la enfermedad de Sever, sin embargo, estas características se han descrito en niños asintomáticos. Objetivo: describir las características radiológicas del calcáneo en niños, según grupos etarios y especificar aquellas que se relacionan con el desarrollo del núcleo de osificación de la apófisis. Método: estudio observacional descriptivo tipo corte transversal. Población: radiografías de niños entre 5 a 15 años de edad. Se realizó una descripción radiológica y diferentes medidas para comparar entre los subgrupos. Resultados: se obtuvieron 148 radiografías, solo se identificó 1 núcleo de osificación de la apófisis posterior. El proceso de osificación y fusión fue más temprano en niñas que en niños en aproximadamente 2 años, con inicio entre 6 a 8 años y terminación entre 13 a 15 años. El patrón de osificación inició en la mitad inferior del calcáneo y continuó hacia la parte superior. En 26 por ciento de las radiografías se observaron hendiduras y la hiperdensidad fue una característica común en el 89 por ciento de estas. Conclusiones: se describen las características radiológicas normales del calcáneo en niños y la osificación del núcleo de la apófisis posterior, estableciendo diferencias por edad y sexo. El aumento de su densidad y la presencia de hendiduras son características normales y no indican enfermedad(AU)

Introduction: In children, heel pain is frequent after walking, requiring conventional radiograph. The reviewed literature did not provide a description of calcaneus radiological development in children. Hyperdensity and fragmentation of the posterior apophysis are frequently associated with Sever's disease; however, these characteristics have been described in asymptomatic children. Objective: Describe the calcaneus radiological characteristics in children, according to age groups and specify those related to the development of the apophysis ossification nucleus. Method: A descriptive observational cross-sectional study was conducted. Population: X-rays of children between 5 and 15 years of age. A radiological description and different measures were performed to compare the subgroups. Results: 148 radiographs were obtained, only one posterior apophysis ossification nucleus was identified. The ossification and fusion process was earlier in girls than in boys in approximately 2 years, starting between 6 and 8 years and ending between 13 and 15 years. The ossification pattern started in the calcaneus lower half and continued toward the top. Slots were observed in 26 percent of the radiographs and hyperdensity was a common feature in 89 percent. Conclusions: The calcaneus normal radiological characteristics in children and ossification of the nucleus of the posterior apophysis are described, establishing differences by age and sex. Increased density and the presence of clefts are normal features and do not indicate disease(AU)

Introduction: Les enfants se plaignent souvent d'une douleur au talon après la marche, ce qui demande une radiographie conventionnelle. Dans la révision de la littérature, aucune description radiologique du développement du calcanéum chez l'enfant n'a été trouvée. L'hyperdensité et la fragmentation de l'apophyse postérieure du calcanéum sont souvent associées à la maladie de Sever, mais ces caractéristiques sont aussi décrites chez l'enfant asymptomatique. Objectif: Décrire les caractéristiques radiologiques du calcanéum chez l'enfant selon tranches d'âge et définir celles qui sont associées au développement du noyau d'ossification de l'apophyse. Méthode: Étude observationnelle et descriptive type transversal. Population : Enfants âgés de 5 à 15 ans. Une description radiographique et plusieurs mesures ont été réalisées afin de comparer les sous-groupes. Résultats: Sur 148 clichés radiographiques, un seul noyau d'ossification de l'apophyse postérieure a été identifié. D'une durée de 2 ans environ, le processus d'ossification et fusion s'est déclenché plus précocement chez les filles que chez les garçons, avec un début à l'âge de 6 à 8 ans et une fin à l'âge de 13 à 15 ans. L'ossification a débuté au niveau de la partie moyenne inférieure du calcanéum, et s'est étendue vers la partie supérieure. On a trouvé des fissures dans 26 pourcent des clichés radiographiques, et l'hyperdensité a été fréquente dans 89 pourcent des cas. Conclusions: On a réalisé une description des caractéristiques radiologiques normales du calcanéum et de l'ossification du noyau de l'apophyse postérieure chez l'enfant, déterminant les différences par âge et sexe. L'augmentation de la densité et la présence de fissures sont des caractéristiques normales et n'indiquent pas de maladie(AU)

Sinus Tarsi Approach Internal Fixation in the Treatment of Sanders Type Ⅱ and Ⅲ Calcaneum Fracture / 中国微创外科杂志

Objective To explore the efficacy of internal fixation in the treatment of intra-articular calcaneum fractures via the sinus tarsi approach . Methods A retrospective study was made on 55 feet with intra-articular calcaneum fractures in 51 patients treated with open reduction and intemal fixation via sinus tarsi approach from January 2010 to June 2015.According to the Sanders classification, there were 15 feet of type Ⅱfractures and 40 feet of type Ⅲfractures. Results All the patients were followed up for a mean period of 15.7 months (range, 6-33 months).The fractures were completely healed .According to the Maryland Foot Scores , the operative effect was excellent in 43 feet, good in 7 feet, fair in 4 feet, and poor in 1 foot.The excellent and good rate was 90.9%(50/55).The postoperative width of the calcaneum , B?hler angle, and Gissane angle were significantly improved than before operation (P=0.000). Conclusion Open reduction and internal fixation via sinus tarsi approach is a simple and effective method for minimally invasive treatment of Sanders type Ⅱand Ⅲintra-articular calcaneum fractures .

Chronic heel pain: It could be tuberculosis

: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions—if undetected early—may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities.

Pseudoartrosis de calcáneo en contexto de pie catastrófico / Pseudarthrose du calcanéum dans le cadre d'une fracture-luxation de pied / Calcaneal pseduarthrosis in catastrophic foot

La pseudoartrosis de calcáneo es excepcional. La incidencia es del 1,3 por ciento de todas las fracturas intraarticulares. Se relaciona con fracturas intraarticulares tratadas conservadoramente, diabetes mellitus, tabaquismo y fracturas abiertas. Presentamos un caso de pseudoartrosis de calcáneo, secuela de fractura de luxación abierta en el contexto de un pie catastrófico(AU)

Calcaneal pseudoarthrosis is rare and its incidence accounts for 1.3 percent of all the intra-articular fractures. It is associated to intra-articular fractures treated with conservative methods, diabetes mellitus, smoking and open fractures. This is a calcaneal pseudoarthrosis case as a sequel of open dislocation fracture in a catastrophic foot injure(AU)

La pseudarthrose du calcanéum est une affection assez rare. Son incidence est 1.3 pourcent de toutes les fractures interarticulaires. Elle est associée aux fractures interarticulaires traitées de façon conservatrice, au diabète sucré, au tabagisme, et aux fractures ouvertes. Un cas de pseudarthrose de calcanéum, séquelle d'une fracture-luxation ouverte du pied après accident de route, est présenté(AU)

Percutaneous fixation of Calcaneum fractures.

Introduction : Displaced intra-articular calcaneum fractures require reduction and internal fixation for favourable long term results. Open procedures are more prone to complications regarding wound healing. Percutaneous fixation offers a middle pathway in treating simpler variety of displaced calcaneal fractures. Material and Methods : Over a two year period 22 cases of Essex-Lopresti tongue type displaced calcaneum fractures were treated using percutaneous screw fixation following closed reduction techniques were reviewed. Clinical outcome was evaluated by standardized physical examination using AOFAS ankle & hindfoot scores and radiographs of both injured and uninjured feet for comparative purposes. Results : Fall from height was the commonest cause of injury. The average time from injury to operation was 2 days. All patients went on to complete union. There was significant improvement of the Bohler and Gissane angles following reduction as well as maintenance of heel height and breadth. The mean AOFAS score was 84 indicating a good result. There was loss of reduction as evaluated on x-rays in follow-up in14 % patients. The rate of infection was 9% and rate of implant removal was 5%. No cases of peroneal tendon dysfunction were found. Conclusion : For simple displaced intra-articular Essex-Lopresti tongue type fractures of the calcaneum percutaneous fixation techniques give reliable good results without significant complications.

Study of Variations in Pattern of Calcaneal Articular Facets in Human Tali in the Population of Rajasthan (India).

Talus (astragalus) is the second largest tarsal bone. It has no muscular or tendinous attachment. It takes part in the formation of various articulations in the form of talocrural , talocalcaneonavicular or subtalar joints. The prior knowledge of the anatomical set of talus and its various articulations holds significance in operating procedures. Knowing anatomy of talus not only helps in delineating underlying pathology but also helps in treatment. Three hundred dry adult tali (150- right and 150-left) were studied. Each talus was examined for the presence of various patterns of articular facets. They were classified into five groups. Type I was found in 39% cases. Type II in 43.7% cases, Type III in 6% cases, Type IV in 5.3% cases and Type V was in 6% cases; type V has two subtypes. Subtype ‘A’ was found in 5% cases & subtype ‘B’ was found in 1% cases. In the present study, highest incidence of type II tali was 43.7 % and type IV had lowest incidence of 5.3%. These variations and their incidences can be used as an anthropological marker for racial and regional differences in unidentified bones. Further, studies on various other population is indicated using larger sample size to make comparative studies more meaningful.

The types of talar articular facets and morphometric measurements of the human calcaneum bone of Gujarat Region.

Introduction: There are three facets over superior surface of calcaneum which forms Sub talar or talocalcaneal joint: Anterior, middle, and posterior talar facet. Three types of calcaneum that have distinct talar facets Were defined as types A, B and C. Materials and methods A total of 250 calcaneum (130 right, 120 left), with unknown gender, were dried and evaluated. Results In our study type B calcaneum (68.8%) was defined as the most common type, and type A calcaneum (30.8%) was second. By using joint facet differences and bone measurement, we tried to define calcaneum bone. Discussion In many diseases of foot, such as the talocalcaneal arthritis and coalition, intra articular fractures and congenital dysmorphology, flatfoot, valgus deformities, the size and shape of the bones, the relationships of the talus and calcaneum with each other and other bones of the foot must be considered for the internal and external fixation and surgical procedures. Type B calcaneum was defined as the most common Type in Gujarat region and these results correlate with the ones which were performed on bones of American, Indian and African, Turkish race and it was uncorrelated with the results of the Researches performed in Europe.

Benign tumors and tumor-like lesions of the calcaneum: A study of 12 cases.

Benign tumors of the calcaneum are rare. Cystic lesions such as simple bone cysts and aneurysmal bone cysts are commonly seen. Aims and Objectives: To evaluate tumors of the calcaneum, which were seen over a 12-year period. Materials and Methods: We analyzed noninfectious, noninflammatory, benign lesions of the calcaneum seen in the Orthopedic Out Patient Department from 1991 to 2003. Twelve such tumors were encountered. There were 11 males and one female and their ages varied from 18 to 53 years with a median of 31. Data was collected from the histopathology reports, radiographs, and inpatient and outpatient records. One of the coauthors reviewed the histopathologic findings of all the tumors. Results: Twelve benign lesions were seen in 12 patients. In our series, cysts predominated, with three aneurysmal bone cysts and five simple bone cysts. The other benign tumors were: one fibrous dysplasia, one vascular hamartoma, one osteoblastoma, and one chondromyxoid fibroma. The bone cysts were treated by curettage, with or without bone grafting, except for one large aneurysmal bone cyst, which was treated by excision of the calcaneum. The postoperative function in this patient was good, with modified footwear. Conclusion: The calcaneum is an uncommon site for most bone tumors, and in our series, bone cysts were the most common benign lesions. Curettage and bone grafting or the use of bone substitutes can be effectively used in the treatment of symptomatic bone cysts of the calcaneum.

Anatomical study of compartment syndrome of foot after calcanealintar-articular fractures / 中国矫形外科杂志

Objective To study the anatomical character of compartment syndrome of foot after calcaneal intra-articaular by experimental model. MethodSix intact human cadaver lower extremities were used to produce calcaneal intra-articular fracture models, fracture patterns of the model were observed with radiographical technique, and anatomical study was proceeded to observe the fractures and their effects on soft tissues and compartments in foot.ResultAll specimens were sustained calcaneal intra-articular fractures successfully, 4 were joint depression fracture in x-ray, 2 were tongue type; 3 were Sander Ⅱ type and others were Sander Ⅲ type in CT. the primary fracture line coursed from anterolateral to posteromedial, and from anterosuperior to posteroinferior. It damaged all the soft tissue arosed from fractures medially and laterally, included adductor hallucis,quadratus plantae, flexor digitorum brevis and abductor digiti minimi as well.ConclusionFrom anatomical view, soft tissues of many compartments in foot rather than of simple compartmen are injuried when calcaneal intra-articular fractures occur, decompressive fasciotomies should be performed in all compartments involved. The present experimental protocol is useful to reproduce calcaneal intra-articular fractures.