Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures.

OBJECTIVE: Managing displaced intra-articular calcaneal fractures remains controversial. The purpose of this study is to compare and identify the surgical technique with the best outcomes for the treatment of intra-articular calcaneal fractures. MATERIALS AND METHODS: This is a retrospective multicentric study conducted between February 2000 and June 2014 in 206 patients with intra-articular calcaneal fractures presenting to the outpatient or emergency department of three different orthopaedic departments. The patients were treated with one of the following techniques: 1. Open reduction and internal fixation with screws and plate; 2. Percutaneous reduction and monolateral external fixation; and 3. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation. RESULTS: Patients treated with open reduction and internal fixation using an extensive lateral approach had a mean AOFAS score of 71 points; those treated through a minimal incision and reduction and fixation with an external fixator had a mean score of 83.1 points; and those treated with the balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation had a mean score of 78.75 points. No statistically difference was found comparing the three types of treatment. CONCLUSION: Displaced intra-articular calcaneal fractures are still technically demanding injuries to manage. The results of this study suggest that in comparison to open reduction, a percutaneous reduction and fixation leads to higher but not statistical functional scores minimizing the wound-healing complications.

Hip fracture in a patient affected by transient osteoporosis of the femoral head during the last trimester of pregnancy.

Few cases of hip fracture in pregnant women affected by transient osteoporosis of the femoral head have been reported in the literature, but its real incidence seems to be underestimated. During pregnancy, osteoporosis manifests itself with an insidious onset of hip pain and limp without any trauma or infective episode in clinical history. Its clinical course is characterized by spontaneous recovery a few weeks to several months after delivery. This article describes the case of a 35-year-old woman with a sudden onset of bilateral hip pain during the last trimester of her first pregnancy; she had neither history of steroid therapy nor alcohol abuse; her body temperature and serological parameters were normal. Bilateral transient osteoporosis of the femoral heads was suspected and confirmed by magnetic resonance imaging. Fifteen days postpartum, she was admitted to our clinic with a displaced femoral neck fracture. A cementless total hip arthroplasty was performed to quickly begin a rehabilitative program. She underwent antiresorptive therapy with alendronic acid 70 mg/week and vitamin D for 3 months. Three months after the fracture, a dual-energy x-ray absorptiometry scan showed osteopenia (T-score, -1.5). Risedronic acid 35 mg/week and vitamin D were then prescribed. The last physical examination at 3 months postoperatively revealed a gradual recovery of the autonomy in activities of daily life.

Extensor deficiency: first cause of childhood flexible flat foot.

Childhood flexible flat foot is the most common paramorphism of the lower limb. The cause is not a bony malformation of the foot but a functional deficiency of the anatomic structures supporting the plantar arch. These structures, working as active tie rods (the tibialis anterior and posterior muscles) or passive factors of support (flexor hallucis longus and flexor digitorum longus muscles) act together to maintain the plantar arch. Their deficiency is responsible for childhood flexible flat foot, characterized by a flattening of the plantar arch and calcaneus pronation (heel valgus) and manifested in the characteristic "duck walking" in children. Hypothesizing poor extensor activity of the tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles during the heel contact phase of the gait cycle, we began a preliminary study to evaluate, through superficial electromyography (sEMG), the activation of muscle groups involved in the pathogenesis of childhood flexible flat foot, in particular the tibialis anterior and extensor hallucis longus muscles, to plan a rehabilitative program addressing the strengthening of insufficient muscles. The therapeutic program should also include the use of a medial elastic push orthosis. Data obtained by sEMG highlight a reduced activation of muscles related to the grade of flat foot, emphasizing the concept that a reduced activation of extensor muscles may be involved in determining flexible flat foot.