Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.

ObjectiveThe aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities.MethodsSeventy patients (mean age: 49.10; range: 41–58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed.ResultsDegree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = −0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = −0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = −0.943).ConclusionsPlantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis.Level of evidenceLevel III, Therapeutic study.

Closed reduction should not be forced in cases with marked edema, ecchymosis, dimple sign, and absence of radial pulse. The anterior approach is the surgical approach of choice due to direct visualization of neurovascular bundle and availability of neurovascular intervention by extending the same approach.

Introduction Sacral insufficiency fractures (SIF) may cause significant low back pain, limit daily living, and tend to be undetected. Effective pain management and early mobilization are mandatory to prevent complications. Percutaneous sacroplasty for treatment of SIF has gained interest recently. This technique provides safe, rapid, and prolonged pain relief, early mobilization, and functional recovery. Sacral kyphoplasty is percutaneous placement of bone cement into the sacral vertebra using inflatable tamps. Both sacroplasty and sacral kyphoplasty are used for vertical component of the SIF. Highly trabecular pattern of sacral bone and proximity of sacral foramina and sacral canal limit the use of these techniques to sacral ala. We have described a new technique for injection of PMMA into proximal sacral vertebra. Patient and Methods: A 50-year-old patient with SIF at S1–S2 level was selected for this procedure. The patient was placed prone on the operation table. She was sedated using IV midazolam and fentanyl. The fluoroscopy was positioned so that sacral foramina could be clearly visualized on AP and lateral views. A stab incision was made following local anesthesia at the level of sacral hiatus. Bone access needle was introduced into the sacral hiatus above the superior margin of the coccyx under fluoroscopic guidance, similar to epiduroscopy. Epidural space was traversed and the corpus of distal sacral vertebra was reached. Entry point was checked in AP and lateral views. Needle tip was advanced proximal to the fracture line, into the S1. Once the ideal position of the needle was confirmed, guide pin and a working cannula were inserted. Balloon tamp was inserted and was inflated with 1.5 mL contrast dye to no more than 250 psi. Fluoroscopic control was performed to make sure that the inflated balloon did not breach cortices. Bone tamps were deflated and removed. The void was filled with radio opaque bone cement proximal to distal as cannula was slowly pulled back. Migration and extravasation of the cement was checked with fluoroscopy. Results The surgical procedure was completed in 25 minutes. Total fluoroscopy time was 10 minutes. There were no intraoperative or postoperative complications. While in the PACU, the patient declared that her pain had alleviated by half. She could mobilize freely in her room 2 hours after the intervention. No cement extravasation occurred. 24 hours following the surgery, she was completely pain free and was discharged from the hospital. On her last follow-up, she was completely asymptomatic, ambulatory, and could perform her daily activities by herself. Conclusion Sacroplasty and sacral kyphoplasty are generally used for Denis Zone 1 fractures. Proximity of the sacral foramina and sacral canal cause clinicians to avoid cement injection into sacral vertebral bodies. This procedure is very rarely performed. Use of pedicles to reach vertebral corpus restricts surgeon's ability to position cannula and pedicle fracture is another risk. With our long axis technique, bone cement can be injected into the sacral body in a longitudinal fashion with multiple sacral levels being augmented in a single entry.

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