Calcaneal stress fracture: an adverse event following total hip and total knee arthroplasty: a report of five cases.

BACKGROUND: Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the English-language literature. Most orthopaedic surgeons are not familiar with calcaneal stress fractures that may occur in elderly patients after a total knee or total hip arthroplasty. METHODS: We retrospectively reviewed the clinical features, imaging findings, and bone mineral content of the proximal part of the femur and the distal end of the radius in five patients who had a calcaneal stress fracture after a total knee or total hip arthroplasty. RESULTS: All patients were women with a mean age of 76.8 years. All fractures occurred in the calcaneus on the same side as the arthroplasty. The fracture appeared at a mean of 10.2 weeks postoperatively. All patients reported heel pain on walking. Swelling and local heat were found in four and three patients, respectively. Pain was elicited by squeezing the calcaneus in all patients. Early radiographs had normal findings in two patients, and an irregular sclerotic line appeared later in the radiographs of all patients. All fractures were treated conservatively. Four fractures healed uneventfully, but one fracture displaced. All patients had osteoporosis. CONCLUSIONS: Calcaneal stress fractures during the postoperative period following total knee or total hip arthroplasty may not be as rare as previously thought. Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. Magnetic resonance imaging or repeated radiographs may be necessary to make the correct diagnosis when no abnormality is apparent on the initial radiograph.

Deposition of micrometer particles in pulmonary airways during inhalation and breath holding.

We investigated how breath holding increases the deposition of micrometer particles in pulmonary airways, compared with the deposition during inhalation period. A subject-specific airway model with up to thirteenth generation airways was constructed from multi-slice CT images. Airflow and particle transport were simulated by using GPU computing. Results indicate that breath holding effectively increases the deposition of 5µm particles for third to sixth generation (G3-G6) airways. After 10s of breath holding, the particle deposition fraction increased more than 5 times for 5µm particles. Due to a small terminal velocity, 1µm particles only showed a 50% increase in the most efficient case. On the other hand, 10µm particles showed almost complete deposition due to high inertia and high terminal velocity, leading to an increase of 2 times for G3-G6 airways. An effective breath holding time for 5µm particle deposition in G3-G6 airways was estimated to be 4-6s, for which the deposition amount reached 75% of the final deposition amount after 10s of breath holding.

Automated segmentation and morphometric analysis of the human airway tree from multidetector CT images.

Remarkable advances in computed tomography (CT) technology geared our research toward investigating the integrative function of the lung and the development of a database of the airway tree incorporating anatomical and functional data with computational models. As part of this project, we are developing the algorithm to construct an anatomically realistic geometric model of airways from CT images. The basic concept of the algorithm is to segment as many airway trees as possible from CT images and later correct quantified parameters based on CT values. CT images are acquired with a 64-channel multidetector CT, and the airway is then extracted from them by the region-growing method while maintaining connectivity. Using this method, we extracted 428 airways up to the 14th branching generation. Although the airway diameters up to the 4th generation showed good agreement with those reported in an autopsy study, those in later generations were all greater than the reported values because of the limited resolution of the CT images. We corrected the errors in diameters by assessing the relationship between the diameter and median value of Hounsfield unit (HU) intensity of each airway; consequently, the diameters up to generation 8 agreed well with the reported values. Based on these results, we conclude that the use of HU-based correction algorithm combined with rough segmentation can be another way to improve data accuracy in the morphometric analysis of airways from CTs.