Fractures of the calcaneal tuberosity are relatively uncommon and are seen most frequently in elderly and diabetic patients. These injuries are typically avulsion fractures caused by concentric contraction of the gastrocnemius-soleus muscle complex. Displacement of these fractures can compromise the skin over the posterior aspect of the heel; therefore, early recognition and management are imperative. Surgical management of calcaneal tuberosity fractures requires reduction and stable fixation of the displaced fragment. When the patient has preexisting tightness of the gastrocnemius-soleus complex, successful management must also address this pathology to improve outcome.
The prognosis for patients with the onset of Legg-Calvé-Perthes disease before the age of six years is favorable, with 80% having a good result. Only children between the ages of four years and five years and eleven months with a B/C or C lateral pillar classification of involvement have a less favorable prognosis. Treatment was not found to influence outcome. Simultaneous bilateral disease, which had a more favorable prognosis, may represent a unique disorder.
Fractures of the calcaneal tuberosity, although rare, present a challenge for the treating surgeon. The goal of treatment is restoration of function of the gastrocnemius-soleus complex and the Achilles tendon. These fractures often occur in diabetics and elderly osteoporotic patients and therefore fixation of the displaced fragment is difficult. Displaced fractures, if not recognized and promptly reduced, often result in secondary soft tissue compromise. Often, the fragment is a small shell of osteoporotic bone, which is less than optimal for bony fixation. We present our technique for surgical fixation of calcaneal tuberosity fractures using a suture placed through bone tunnels in the calcaneal body. This technique is used by itself for smaller fragments or supplemented with screw fixation for larger fragments.
one of the follow up visits when asked directly by the examiner, SUI in the bladder diary, or evidence of SUI on the supine stress test.RESULTS: Between 2009 and 2015 134 women underwent RSC. 52 patients complained of urinary incontinence pre operatively (38.5%). As BMI increased, the number of pads recorded on preoperative bladder diary also increased, however, following concomitant mid urethral sling there was no difference in number of patients reporting incontinence or pad use at the last postoperative visit (Table 1) over 21.3 months follow up. The denovo rate of urinary incontinence did not increase as the BMI increased and failed to meet statistical significance, with normal BMI having a de-novo SUI rate of 26%, overweight 17%, obese 23%, and extreme obesity 25%, p>0.05.CONCLUSIONS: Obese patients undergoing RSC have increased preoperative pad use and SUI rates but have similar SUI cure rates and denovo SUI rates compared with nonobese patients.
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