Morphometric Analysis of the Calcaneus in a Southeast Asian Population.

Introduction The calcaneus is the most commonly fractured tarsal bone, accounting for up to 60% of tarsal bone fractures and 2% of all fractures in the body. With the calcaneus playing an important role in maintaining a stable and efficient bipedal gait, the sequelae of these injuries have also been associated with potential long-term disability or discomfort, especially if improperly managed. Incorrectly sized implants similarly cause their own set of complications, such as poor fixation, impingement, or implant prominence. This potentially increases the need for revision surgery or implant removal, with increased morbidity for the patient. As such, a thorough understanding of calcaneal morphology is vital to ensure optimal conservative and surgical management of calcaneal pathology. CT imaging has become an indispensable tool in the evaluation of such a complex three-dimensional structure and allows us to accurately map out calcaneal morphology. This study aims to evaluate calcaneal morphology in the Southeast Asian population using CT imaging and to determine if morphological differences exist between male and female patients. Methods Calcaneus measurements were taken from CT scans of 100 patients with intact calcanei, consisting of 34 female and 66 male patients. Patients who have had fractures or previous calcaneus surgery were excluded. IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA) was used for statistical calculations. Mean values were calculated, and t-tests were performed to establish any significant differences between measurements taken from male and female patients. Results were deemed to have a significant difference if the p-value was less than 0.05. Results Males had larger calcanei measurements than females in all parameters included. Calcaneal length in females measured on CT axial views was 66.2 mm, compared to 75.2 mm in males (p < 0.001). Calcaneal height, measured at the medial wall, was 28.2 mm in females and 33.9 mm in males (p < 0.001). Calcaneal height measured at the lateral wall was 33.3 mm and 38.1 mm in females and males, respectively (p > 0.001). Calcaneal width was 33.0 mm in females and 36.9 mm in males (p < 0.001). The mean dimensions measured in the total sample were an axial length of 72.1 mm, a medial wall height of 32.0 mm, a lateral wall height of 36.4 mm, and a width of 35.6 mm. Conclusion There is a significant difference in calcaneal morphology on CT imaging between male and female patients in the Southeast Asian population, which is an important consideration for surgical planning and the selection of appropriately sized implants.

Branchiooculofacial syndrome and bilateral ectopic thymus: report of a family.

Branchiooculofacial syndrome (BOFS) is a rare autosomal-dominant condition characterized by branchial cleft sinus and ophthalmologic and craniofacial abnormalities that can range from mild to severe forms. Ectopic thymus, an uncommon condition with just over 100 cases reported in the literature, is seen in BOFS. We report a family with BOFS affecting the mother and two daughters, showing the dominant inheritance and variable phenotypical expression of BOFS.

Mechanical thromboprophylaxis for patients undergoing hip fracture surgery.

PURPOSE: To evaluate the rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients receiving mechanical thromboprophylaxis. METHODS: 123 men and 311 women (mean age, 76 years) admitted to our institution with hip fractures were included. 95% of patient received mechanical prophylaxis using pneumatic calf pumps intermittently for 20 hours or less per day before and after surgery. At the surgeon's discretion, 161 (37%) of them received concomitant chemical prophylaxis in the form of subcutaneous low-molecular-weight heparin (enoxaparin). Signs and symptoms of DVT and PE were monitored daily, as were calf and thigh circumference. Diagnoses were confirmed by duplex ultrasonography of the lower limbs and/or spiral computed tomography scan of the thorax. RESULTS: 13 patients developed symptomatic venous thromboembolism (VTE); 11 were DVT and 2 were PE. Among DVT patients, 2 had proximal and 9 had distal DVT. All these patients underwent anticoagulation and were discharged without any complications. No patients developed complications from pneumatic calf pumps (foot drop, skin abrasions or stasis). Eight patients developed bleeding tendencies during hospitalisation. No patient developed surgical wound infections. 12 patients died during hospitalisation; 8 of them from acute myocardial infarction or pneumonia, and none from PE. The median length of hospital stay was significantly longer in patients with VTE. CONCLUSION: Routine use of mechanical thromboprophylaxis is recommended in patients undergoing hip fracture surgery.

Meyerson phenomenon.

BACKGROUND: Meyerson phenomenon is an uncommon clinical condition that is characterized by an eczematous halo surrounding a preexisting melanocytic nevus and numerous other lesions. The etiology of this condition is unknown. We suggest that the mechanism is due to the interaction between CD4 T lymphocytes and increased expression of intercellular cell adhesion molecule 1 (ICAM-1). OBJECTIVE: This article provides a concise overview of Meyerson phenomenon. METHODS AND RESULTS: We present the case of a 37-year-old female with an inflamed nevus located on her thigh from no evident cause. Her condition resolved with surgical excision of the nevus. Histopathology of the specimen demonstrated spongiosis and lymphocytic infiltrate with eosinophils, which confirmed the diagnosis of Meyerson phenomenon. CONCLUSION: Meyerson phenomenon can resolve spontaneously or with treatment of either topical steroids or surgical excision. The main concern with benign lesions presenting with inflammation is malignant transformation; thus, clinicians need to be more aware of Meyerson phenomenon.

Second metatarsophalangeal joint: biomechanics and reconstruction potential.

A damaged distal radioulnar joint results in instability, pain, and loss of motion. This amounts to function loss. Of the many proposed reconstructive procedures, only a vascularized joint transfer offers growth potential in children and durability. The well-studied vascular anatomy and minimal donor morbidity of the second metatarsophalangeal joint makes it a potentially useful source. The authors evaluated various biomechanical aspects of the second metatarsophalangeal joint, which included the mediolateral arc of movement of the second metatarsophalangeal joint in hyperextension when subjected to lateral stress loading; the different patterns of disruption at peak load; and the flexion and extension range of movement. Twenty-six cadaveric specimens were tested with a customized jig. The results showed that the mediolateral arc of movement of 114 degrees approximates that of the flexion and extension range of movement of 114.2 degrees. However, it differed in that it was equal in both directions, compared with an extension arc that was greater than a flexion arc. The peak load was approximately 100 N, and this resulted in fracture, avulsion, and ligament tear. These biomechanical results may be useful to reconstructive surgeons.