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Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description

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Abstract

Purpose

A fracture or a pseudarthrosis of the processus anterior calcanei (PAC) as well as a traumatized Os calcaneus secundarius (OCS) is often overlooked. A clinical or conventional radiological differentiation of these is uncertain. Therefore, a CT scan is recommended. The aim of the study was to identify CT morphological differentiators between OCS and pathologies of PAC.

Methods

All CT scans at our trauma center level I from 2010 to 2014, which imaged the entire foot, performed after acute trauma or postoperative control were retrospectively re-examined for OCS, other accessory ossicles (oAOS), fracture or pseudarthrosis of PAC and analyzed for specifiers.

Results

In 611 CT examinations, 14 (2.3%) accessory ossicles (AOS) at the PAC were detected. 12 (86%) were identified as typical OCS and 2 (14%) as oAOS. 56 (9.2%) pathologies were detected. Of these, 44 (79%) were declared as fractures and 12 (21%) as pseudarthrosis. 7 OCS (58%) and 25 (46%) of the pathologies were not mentioned in the initial CT reports. The main differentiators of OCS to fracture of PAC were the anteromedial localization into a concave notch at the calcaneal facet at PAC and the continuous corticalization. With increasing size, radiological osteoarthritic signs at the OCS were frequent (p ≤ 0.05).

Conclusions

The study confirms that AOS or pathologies at the PAC often are not exactly described in CT report. In the context of foot trauma, attention should be paid to this region. Based on the presented differentiation criteria, a precise distinction can be made with the help of a CT.

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Acknowledgements

We thank the radiological technicians for their help in identifying the necessary CT examinations.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany

    Robert Hennings, Christoph Josten & Annette B. Ahrberg

  2. Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany

    Peter Voigt & Thomas Kahn

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  1. Robert Hennings
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  2. Peter Voigt
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  4. Christoph Josten
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Contributions

RH and ABA: contributed significantly to the idea, planning and data collection of this paper. Furthermore, he contributed significantly to the preparation of the manuscript, literature research, radiological analysis, analysis and interpretation of the data; PV: made a significant contribution to the planning and radiological analysis of the present work. Furthermore, he contributed significantly to the preparation of the manuscript and interpretation of the data; TK and CJ: contributed to the realization and final control of the manuscript.

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Correspondence to Robert Hennings.

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Hennings, R., Voigt, P., Kahn, T. et al. Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat 41, 1425–1432 (2019). https://doi.org/10.1007/s00276-019-02348-y

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