Morphological differences in the calcaneus among extant great apes investigated by three-dimensional geometric morphometrics

Investigating the morphological differences of the calcaneus in humans and great apes is crucial for reconstructing locomotor repertories of fossil hominins. However, morphological variations in the calcaneus of the great apes (chimpanzees, gorillas, and orangutans) have not been sufficiently studied. This study aims to clarify variations in calcaneal morphology among great apes based on three-dimensional geometric morphometrics. A total of 556 landmarks and semilandmarks were placed on the calcaneal surface to calculate the principal components of shape variations among specimens. Clear interspecific differences in calcaneal morphology were extracted, corresponding to the degree of arboreality of the three species. The most arboreal orangutans possessed comparatively more slender calcaneal tuberosity and deeper pivot region of the cuboid articular surface than chimpanzees and gorillas. However, the most terrestrial gorillas exhibited longer lever arm of the triceps surae muscle, larger peroneal trochlea, more concave plantar surface, more inverted calcaneal tuberosity, more everted cuboid articular surface, and more prominent plantar process than the orangutans and chimpanzees. These interspecific differences possibly reflect the functional adaptation of the calcaneus to locomotor behavior in great apes. Such information might be useful for inferring foot functions and reconstructing the locomotion of fossil hominoids and hominids.

Calcaneal Tuberosity Fracture (Beak Fracture) Fixation Using a Pre-contoured “L-form” Hook Plate: A Retrospective Study

Background: The treatment of calcaneal tuberosity fracture (beak fracture) is very tricky. Patients’ ankle function may be badly affected by skin flap necrosis and internal fixation failure. This study presented a simple, and safe internal fixation technique which is to fix the fracture fragment with a pre-contoured “L-form” hook plate.Methods: A retrospective study was done to analyze patients with calcaneal tuberosity fracture who were treated with pre-contoured “L-form” hook plate fixation from January 2015 to February 2020. When the patients could complete single-legged heel raise tests, and when they achieved clinical healing criteria were reviewed. Functional assessment was performed according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and the Visual Analogue Scale (VAS) was recommended for assessment of pain intensity (PI).Results: There were a total of 15 patients of calcaneal tuberosity fracture (beak fracture) treated with the pre-contoured “L-form” hook plate fixation technique, among which eight patients were female and the others were male, with the age ranging from 35 to 69 years (average of 55.3±9.0 years). And the mean duration of follow-up was 22.53±5.78 months (range: 12 to 36 months). 11 cases underwent emergency surgery. After the operation, there were no complications such as wound dehiscence, poor wound healing, infections, or plate exposure, no sural nerve injuries or venous thromboembolic events. Also, there was no loss of reduction or fixation failure in the follow-up. All 15 cases achieved clinical healing at 8-13 weeks (average 10.5±1.4 weeks) postoperatively. They were able to perform the test on their affected leg after 3.7±0.7 months (3-5 months) on average. The preoperative VAS and AOFAS-AH scores were 5.7±0.6 and 24.0±9.9 respectively, while the postoperative VAS and AOFAS-AH scores at the last follow-up were 1.3±0.5 and 93.8±5.2 (p<0.001).Conclusion: Emergency open reduction and internal fixation should be provided as soon as possible. For patients with Beavis type II beak fractures, the pre-contoured “L-form” hook plate fixation technique helps them restore normal ankle function. This simple, safe, and strong internal fixation technique can be one of the treatment options for avulsion fractures of the calcaneal tuberosity.

Low Donor Site Morbidity Associated With Tricortical Calcaneal Bone Graft

Background: Autologous grafting is widely used in orthopedic surgery because of its high osteogenic capacity, immunologic compatibility, for the absence of risk of disease transmission, and for not requiring a bone bank. The posterior-superior calcaneal tuberosity is an option for obtaining a cortical and cancellous structural bone. This study aims to describe the operative technique and complications observed at the donor site of the posterior-superior calcaneal tuberosity. Methods: Patients who underwent graft harvesting from the posterior-superior calcaneal tuberosity were retrospectively evaluated by pain outcomes, imaging tests, and intra- and postoperative complications. Results: Twenty patients with a median age of 69 years (range 48-77) and follow-up of 16 months (12-26) were assessed. Median postoperative pain at the donor site was 0 (0-6), with 2 patients reporting persistent local pain. No case of Achilles tendon rupture or intra- or postoperative calcaneal fracture were identified. One patient developed a superficial infection that was quickly resolved using oral antibiotic therapy. Conclusion: The posterior-superior calcaneal tuberosity is an alternative source of autologous graft with low donor site morbidity. Level of Evidence Level IV, case series.

Surface Shape of the Calcaneal Tuberosity and the Occurrence of Retrocalcaneal Bursitis among Runners

Purpose: The aim of the study was to establish the relationship between the shape of the calcaneal tuberosity (flat, stepped, rounded, normal) and the probability that retrocalcaneal bursitis among people who train running regularly. Methods: The study included a group of 30 runners who suffered from retrocalcaneal bursitis in the past, and 30 people who never had symptoms of this disease. The study was based on a diagnostic survey, as well as on clinical examination. The surface of the calcaneal tuberosity and the slope of the calcaneus were assessed using X-rays. The mobility of the bursa, its surface size, the thickness of the Achilles tendon and its attachment rate were established during an ultrasound examination. Results: Flat surface of the calcaneal tuberosity increases fourfold the risk of suffering from retrocalcaneal bursitis (OR = 4.3). The people whose calcaneus slope is above 25° are at increased risk of suffering from such an inflammation compared with the people whose calcaneus bone is more horizontal (OR = 2.8). The analysis shows that the thickness of the Achilles tendon (p = 0.001), the surface size of the bursa (p = 0.009), as well as the flat surface of the calcaneal tuberosity (p = 0.008) are strongly associated with the occurrence of retrocalcaneal bursitis. Conclusions: The flat shape of the calcaneal tuberosity increases the risk of bursitis. The risk of inflammation is higher when the Achilles tendon is thicker and the surface of the bursa is smaller than normal.

Pediatric Calcaneal Tuberosity Avulsion Fracture: A Case Report and Literature Review

Introduction: Calcaneus fractures are rare in the pediatric population, and avulsion fracture of the calcaneal tuberosity is even less common. In adults, those fractures are usually associated with poor bone quality, however, this is not the case in children. It is a fracture that requires emergent intervention to prevent devastating skin and soft-tissue-related complications. Case Report: We report a case of a 9-year-old female who had a displaced calcaneal tuberosity fracture with heel skin impending compromise, after a fall at an indoor gymnastic facility. The child had a history of acute lymphoblastic leukemia, diagnosed at age 4, she was in remission at the time of injury. In the present report, besides reporting a rare injury among the pediatric population, we also describe the operative management, the post-operative course, and we review the literature. Conclusion: Pediatric calcaneal tuberosity fractures, although rare, can lead to devastating complications if not addressed promptly, and should be treated in an expedited fashion. Keywords: Pediatric, calcaneal tuberosity, skin compromise.

Duckbill Calcaneum fracture

Introduction: The avulsion fractures of the calcaneal tuberosity represent a rare model of injury that is caused by a powerful tension force of the Achilles tendon associated or not to direct shock to the calcaneusCase report: We report a case of direct trauma to the heel on the edge of the swimming pool at the sport stroke of swimming.Percutaneous reduction by bone reduction forceps under fluoroscopy fluoroscopy with osteosynthesis by two percutaneous cannula screws on Kirchner wires. Equine cast immobilization after removal of the threads. Good clinical and functional radiological evolution.Conclusion: The percutaneous screw under fluoroscopy is the best technique with good results anatomical and functional and aesthetic.