title: Cement Calcaneoplasty: An Innovative Method for Treating Nonunion in Calcaneal Insufficiency Fracture.
abstract: Insufficiency type stress fractures are common in older patients with osteoporosis. Persistent pain after nonunion of these fractures can be disabling, with the management options often limited. We aimed to assess the suitability of fluoroscopic-guided injection of bone cement into a persistently symptomatic nonuniting calcaneal insufficiency fracture. To the best of our knowledge, this technique has not previously been described in the published data. After local subcutaneous anesthesia, the midpoint of the fracture site was accessed by trocar insertion under radiographic guidance, and bone cement was injected directly into the site. A preprocedure visual analog scale pain score of 90 of 100 was recorded. This had improved to 0 of 100 at the 12-month follow-up point after the procedure. The aim of the present case report was to raise awareness of percutaneous calcaneoplasty, which we believe to be a safe and well-tolerated technique for the management of osteoporotic insufficiency fracture of the calcaneus. We propose that this technique be considered when conservative methods aimed at promoting fracture healing have failed.
authors.affiliation: Core Surgical Trainee Year 2, Queen Elizabeth Queen Mother, East Kent Hospitals National Health Services Foundation Trust, Margate, Kent, United Kingdom. Electronic address: Charles.godavitarne@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Godavitarne
authors.affiliation: Orthopaedic Surgeon, Queen Elizabeth Queen Mother, East Kent Hospitals National Health Services Foundation Trust, Margate, Kent, United Kingdom.
authors.forename: Ernest
authors.initials: E
authors.lastname: Fawzy
authors.affiliation: Consultant Radiologist, Queen Elizabeth Queen Mother, East Kent Hospitals National Health Services Foundation Trust, Margate, Kent, United Kingdom.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giancola
authors.affiliation: Consultant Orthopaedic Surgeon, Queen Elizabeth Queen Mother, East Kent Hospitals National Health Services Foundation Trust, Margate, Kent, United Kingdom.
authors.forename: Luc
authors.initials: L
authors.lastname: Louette
mesh_terms: D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries*; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000187:drug effects; D015775:Fractures, Stress / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: bisphosphonate; bone cement; calcaneus; fracture nonunion; osteoporosis