Two cases of insufficiency fracture of the body of the calcaneus are presented to show its clinical presentation and diagnosis. It often is overlooked as a cause of pain in the ankle region. Both patients were elderly women with pain developing at the lateral aspect of the hindfoot in the absence of significant trauma. Physical examination was significant for marked tenderness at the superolateral aspect of the calcaneus. These clinical features suggested the diagnosis, which was confirmed by radionuclide bone scan and magnetic resonance imaging. Magnetic resonance imaging was the diagnostic tool in both cases, after abnormal bone scans and normal plain radiographs. Radiologic alterations were not seen for up to 2 months after the onset of pain. Treatment consisted of rest and protected weightbearing for 8 weeks, with complete resolution of symptoms in both patients. An insufficiency fracture of the body of the calcaneus should be considered in a differential diagnosis of elderly patients with osteoporosis with spontaneous pain in the ankle region.
Study Design. A retrospective cohort study of consecutive patients. Objective. To investigate whether adequate flexion-extension was acquired in standard functional radiographs in lumbar spondylolisthesis. Summary of Background Data. In lumbar spondylolisthesis, flexion-extension radiographs taken in the standing position are most commonly used to evaluate spinal instability. However, these functional radiographs occasionally depend on the patient's effort and cooperation, they can provide different results. Methods. This study included 92 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis. We analyzed the flexion-extension radiographs taken with the patient being led by the hand (LH) and those taken without LH (NLH). Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), and lumbar lordosis (LL) were measured on functional radiographs taken in both tests. Then, ST, SA, PO, detection rate of instability, and LL observed in LH were compared with those observed in NLH. Furthermore, the correlation of the difference was evaluated between ST, lumbar angulation, and LL. Results. A relative value of ST was 9.5% ± 4.3% in LH and 5.6% ± 3.3% in NLH, which differed significantly (P < 0.001). SA and PO were also significantly greater in LH than in NLH. The detection rate of instability was 71.7% in LH and 30.4% in NLH (P < 0.001). LL measurement on flexion showed 17.6° ± 13.5° in LH and 28.2° ± 12.2° in NLH, which differed significantly (P < 0.001). However, no significant difference was found in LL on extension between LH and NLH. There was a moderate correlation between the difference of ST, SA, PO, and LL on flexion. Conclusion. Flexion with physical assistance was useful for the detection of abnormal lumbar mobility. Taking radiation exposure into consideration, physical assistance such as using a table in front of a patient could lead the similar evaluation of the segmental instability. Level of Evidence: 2
Background: Low back pain (LBP) is a major symptom of lumbar spinal stenosis (LSS). To develop better treatment, it is important to assess LBP in patients with LSS. This study aimed to analyze the factors associated with LBP in patients with LSS.Methods: This cross-sectional study included consecutive patients with LSS aged between 51 and 79 years who had symptoms in one or both legs with or without LBP. The participants were classified into two groups: the high group (LBP visual analog scale [VAS] score of 30 mm or more) and the low group (LBP VAS score of less than 30 mm). We performed multiple logistic regression analysis with the high and low groups as dependent variables and a receiver operating characteristic (ROC) analysis.Results: A total of 80 patients with LSS were included (35 men and 45 women; mean age 64.5 years), with 47 and 30 patients in the high and low groups, respectively. Multivariate logistic regression analysis revealed that the sagittal vertical axis (SVA; + 1; odds ratio [OR], 1.029; 95% confidence interval [CI], 1.005−1.052) and pelvic incidence (PI)-lumbar lordosis (LL; + 1; OR, 1.065; 95% CI 1.019–1.168) were significantly associated with LBP. ROC analysis revealed cut-off values of 47.0 mm and 30.5° of PI-LL, respectively.Conclusion: These cut-off values could have a high specificity and positive predictive value for LBP in patients with LSS due to spinopelvic malalignment. However, these cut-off values could also represent with a cause other than LSS due to spinopelvic malalignment.
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