Essex-Lopresti type II joint depression calcaneal fracture from a fall of eighteen inches.

A brief review of calcaneal fractures is presented with a case report of an Essex-Lopresti type II joint depression fracture sustained from a vertical fall of 18 inches.

Steroid injection of a unicameral bone cyst of the calcaneus: literature review and two case reports.

Two interesting cases are presented, describing the diagnosis and treatment of unicameral bone cysts of the calcaneus. The first case report presents a patient who had a 5-month history of a painful right heel. The pain had been getting progressively worse and was aggravated by prolonged walking and physical activity. The second case report presents a patient whose unicameral bone cyst was discovered as a relatively incidental finding on radiographs; however, the patient later admitted that he had mild tenderness upon the plantar-lateral aspect of his right calcaneus with weightbearing. The authors reviewed the literature concerning the etiology and treatment of unicameral bone cysts. Attention is directed to the use of injectable steroid as an alternative means to open surgical intervention. Certain potential problems exist, in spite of the various surgical approaches utilized, including infection, postoperative fracture, recurrence, immobilization, and prolonged hospitalization.

Unusual osteochondroma of the foot and ankle.

Osteochondroma, also known as osteocartilaginous exostosis, is by far the most commonly occurring benign bone neoplasm. Its occurrence is the most frequent of all osseous tumors found in the foot. A basic review is discussed along with two case reports. The first case describes an osteochondroma of the third metatarsal shaft that became symptomatic during boot camp. The second case presents an atypical osteochondroma arising from the posterior aspect of the talus.

Sesamoid pain secondary to a plantar neuroma.

Two cases are presented in which the necessity of a plantar incision for removal of a fibular sesamoid led to the incidental finding of an undiagnosed plantar neuroma and bursal sac. The first case presented a hypertrophic fibular sesamoid fused to the plantar aspect of the first metatarsal head. The second case presented a dystrophic fibular sesamoid consistent with a healing fracture or avascular necrosis. Plantar neuromas are a known cause of pain in the forefoot. The authors review the literature concerning plantar neuromas and provide a discussion of their etiology, clinical findings, and surgical treatment. Attention is directed to the use of a plantar incision as a viable alternative to the dorsal approach for excision of a fibular sesamoid and associated soft tissue masses.

A serum C3-activating factor: its characterization and its presence in glomerular deposits.

A non-IgG C3 activating factor (C3AF) isolated from the serum and plasma of a patient with membranoproliferative glomerulonephritis with subendothelial and subepithelial deposits (type III) was studied to define its molecular structure, functional characteristics, and presence in renal biopsies. Alternative complement pathway (ACP) activation of C3 was comparable to that of zymosan, but significantly less than that of IgG C3 nephritic factor (C3NeF). Functionally active isolate contained beta 1H globulin (beta 1H) and the C3AF protein, which had a gamma-electrophoretic migration. beta 1H present in the isolate exhibited an altered gamma-beta electrophoretic mobility. The function of this complex is heat labile. Time/temperature studies demonstrated that inactivated preparations of this isolate show a return to the normal beta migration of beta 1H followed by the development of an alpha 2 electrophoretic migration of the previously gamma-migrating material of functionally active isolate. Normal human serums contain an alpha 2 protein that shows complete antigenic identity with the gamma protein of C3AF, but this alpha 2 protein lacks C3 activating function. On polyacrylamide gel electrophoresis, the C3AF isolate contains a high m.w. protein of 500,000 to 590,000 that is composed of 2 major subunits. Carbohydrate is not demonstrable, and the protein is antigenically distinct from plasma fibronectin. Immunofluorescence studies of renal biopsies of patients with types I and III MPGN revealed the presence of C3AF antigen in granular deposits in 10 of 16 cases. The presence of this antigen in glomerular deposits was associated with C3 and beta 1H, but was independent of Ig. These studies suggest that the mechanism of ACP activation by C3AF results from interference with beta 1H function. The presence of this material in renal biopsies from some MPGN patients further suggests a pathogenetic role in mediating glomerular pathology.