Fracture of the Heel Bone (Calcaneus)

Fractures of the calcaneus can be debilitating injuries. Usually these fractures occur when tremendous forces impact the foot and damage the heel. Examples are falls from heights or motor vehicle accidents. Imagine standing on an orange and seeing it widen and squash flat. This is essentially what happens to the calcaneus. 
The joint between the calcaneus and the talus is called the subtalar joint. This joint is responsible for the inward and outward movements of the foot, otherwise called inversion and eversion. When the calcaneus is fractured the movement of inversion and eversion is commonly decreased or lost completely. The upward and downward movement of the ankle (dorsiflexion and plantarflexion) is not usually affected by fractures of the calcaneus.

There are numerous problems associated with fractures of the calcaneus. One is the widening and deformity of the bone itself. Another is irregularity of the subtalar joint that leads to arthritis. Fractures to the calcaneus may also cause injuries to the heel cushion (the heel pad) and to the nerves and tendons surrounding the heel. 

The ideal goal of treatment is to restore the dimensions of the heel as accurately as possible. This is always difficult because of the multiple fragments of bone that are commonly present. It is almost like trying to piece together a jigsaw puzzle.

For the majority of patients, surgery is the correct form of treatment. The goal of surgery is to restore the correct size and structure of the heel. This is done by performing what is called an open reduction and internal fixation of the fracture. The open reduction and internal fixation procedure is performed through an incision on the outside of the heel. The bone is put together and held in place with a metal plate and multiple screws. This procedure decreases the likelihood of arthritis developing and maximizes the potential for inward and outward movement of the foot.

There are times, however, when the bone is so severely smashed and fractured that, in addition to the open reduction and internal fixation, the heel joint (the subtalar joint) needs to be fused. This is done to decrease the chances of developing painful arthritis. Although the inversion and eversion movement of the foot is lost after a subtalar fusion, there is a more rapid return to activities and functions after this type of surgery. 


The ideal time to perform surgery is when there is minimal swelling of the skin. The Doctor will often use a foot pump device applied to the foot for a few days to decrease the swelling. This allows him to perform the surgery as soon as possible.

Following surgery, no walking on the foot is permitted for approximately 3 months. A bandage is applied to the leg after surgery. After the stitches are removed, movement exercises and therapy are started to try to maximize the function of the foot. It typically takes approximately six months to recover from this type of injury.

Link: http://www.mdmercy.com/footandankle/conditions/trauma/fracture_heelbone.html

POSTED BY RENE GARCIA:
- Some of our clients have suffered Calcaneus fractures due to a serious accident. The Garcia Law Firm, P.C. was able to successfully handle these types of cases. For a free consultation please call us at 1-866- SCAFFOLD or 212-725-1313.

Medical Breakthrough: Paraplegic Man Stands Up

http://healthland.time.com/2011/05/20/medical-breakthrough-paraplegic-ma...

After being struck by a car in 2006, Rob Summers was given a grim prognosis: paralysis from the chest down and the possibility of never walking again. But five years later, he is able to stand on his own two feet unaided — thanks to an experimental treatment, whose success is giving hope to millions of patients with spinal-cord injuries.

Summers, 25, is the first paralysis patient to undergo a combination of electrical stimulation to the spinal cord — delivered through a surgically implanted stimulation device — combined with intense rehabilitation. As part of a research project at the University of Louisville, Summers first underwent 26 months of intense motor training, in which therapists helped him practice trying to move his legs, before receiving the implant. The Wall Street Journal reports:

Mr. Summers then had surgery to implant a device with 16 electrodes placed on key parts of the spinal cord. With the device delivering constant electrical stimulation, Mr. Summers has been able to stand up using his own leg muscles while holding on to bars for support. He can remain standing, bearing his own weight for up to four minutes at a stretch, and take steps on a treadmill with assistance, according to the researchers.
"I didn't move a toe for four years," said Mr. Summers. "I stood up on the third day they turned the stimulator on," he said. "There are not enough words to describe how I felt."

Although he hasn't regained the full ability to walk — and although the researchers working with him remain cautious, given that his is the only such success in the world — spine-injury experts call the results groundbreaking.

With the stimulators on, doctors helped Summers to practice standing and moving his legs. Now he can pull himself up to standing position on his own, not to mention move his toes, ankles, knees and hips while being stimulated. He has also regained control of his bowels and bladder, and sexual function.

Experts say it's too soon to tell whether the same combination stimulation-rehabilitation program will be able to help other patients (there are four others currently planned to receive it), or whether it will work in patients whose spinal cords have been completely severed. Summers' spine was not. The stimulation from the implanted device (adapted from a device originally FDA-approved to control pain) excites the neurons in his spine, which allows them, even without getting input from the brain, to receive and respond to sensory information from the legs.

Researchers still need to design a more sophisticated stimulation device specifically for spinal-cord injury, and the current findings need to be replicated in other patients. But experts say the results — if they hold up — may offer new treatment avenues for paralyzed patients. "It opens a whole new set of possibilities for patients, not just those recently injured but those who have been injured for months and years," said study author Susan Harkema of the University of Louisville, at a press conference to announce the results.

The research was supported by the Christopher and Dana Reeve Foundation and is outlined in the journal Lancet.

POSTED BY RENE G. GARCIA - ATTORNEY
The spinal chord stimulator is giving hope to many accident victims. It can often be performed by a Pain Management specialist. Several of our clients have undergone this procedure with remarkable results.

Bionic Legs Allow Paraplegics to Get Up and Walk.

http://healthland.time.com/2010/10/11/bionic-legs-allow%C2%A0paraplegics-to-get-up-and-walk/

A robotic exoskeleton called eLEGS enables people who have been paralyzed below the waist to walk again. The technology, developed by Berkeley Bionics, is geared toward consumers — the 6 million Americans who are paralyzed, many of whom use wheelchairs.
For so many sufferers of paralysis — many of whom may have been active and athletic before an injury damaged their spinal cord — being able to move their bodies independently will no doubt be an emotional, gratifying experience. Watch for yourself:

"The most exciting possibility for the eLEGS for me is to take it out into the real world," said Amanda Boxtel, who was paralyzed from the waist down during a ski accident in 1993 and now works as a motivational speaker. "I'm not meant to be in my wheelchair, sitting down and rolling. I want to be tall in my body."

eLEGS is the latest in a line of "human augmentation robotics systems" that Berkeley Bionics has created with the Robotics and Human Engineering Laboratory at the University of California, Berkeley. It was based on another system called HULC, for the Human Universal Load Carrier, a robotics system licensed to Lockheed Martin that was made for the military to help soldiers carry heavy packs across extreme terrain without risking injury.

The eLEGS device consists of a backpack that holds the battery, and metal leg casings that are secured around a person's clothed body with velcro straps. A mixture of sensors and robotics creates a natural-seeming gait that can speed up to an excess of 2 miles per hour.  More from Berkeley Bionics:

The device is battery-powered and employs a gesture-based human-machine interface which — utilizing sensors — observes the gestures the user makes to determine their intentions and then acts accordingly. A real-time computer draws on sensors and input devices to orchestrate every aspect of a single stride.

Boxtel points out that the technology may be of help to those who are newly injured, since they may still retain muscle memory and their muscles will not have atrophy significantly yet. Such early assistance in getting patients back on their feet may further aid a host of minor health concerns associated with being in a wheelchair — from digestive issues to poor circulation.

Dr. Graham Creasey, chief of spinal chord injury service at the Palo Alto VA Medical Center, has great hopes for the eLEGS as well: "For the first time in history, we can start to think about giving movement back," he said.


POSTED BY: RENE G. GARCIA - ATTORNEY

Brain injury raises dementia risk, US study finds

http://m.apnews.com/ap/db_16026/contentdetail.htm?contentguid=Fi7lPF95

PARIS (AP) - A large study in older veterans raises fresh concern about mild brain injuries that hundreds of thousands of troops have suffered from explosions in recent wars. Even concussions seem to raise the risk of developing Alzheimer's disease or other dementia later in life, researchers found.
Closed-head, traumatic brain injuries are a legacy of the Afghanistan and Iraq wars. Body armor is helping troops survive bomb blasts, but the long-term effects of their head injuries are unknown.
Other research found a possibly high rate of mild cognitive impairment, or "pre-Alzheimer's," in some retired pro-football players, who take many hits to the head in their careers.
The studies, reported Monday at the Alzheimer's Association International Conference in France, challenge the current view that only moderate or severe brain injuries predispose people to dementia.
"Even a concussion or a mild brain injury can put you at risk," said Laurie Ryan, a neuropsychiatrist who used to work at Walter Reed Army Medical Center and now oversees Alzheimer's grants at the U.S. National Institute on Aging.
Don't panic - this doesn't mean that every soldier or student athlete who has had a concussion is in danger. Pro-football players and boxers "are almost a different species from us" in terms of the repeated blows they take to the head, said William Thies, the Alzheimer's Association's scientific director.
It does mean you should try to avoid one, by fall-proofing your home and wearing helmets and seat belts, he said. About 1.7 million brain injuries occur each year in the U.S.
Troops also need to prevent any further harm, said Dr. David Cifu, national director of physical medicine and rehabilitation for the Veterans Health Administration.
"What the people who have had a head injury and read this should do is to exercise and eat right and take their medicines and take their aspirin and do meditation to reduce stress - reduce risk factors that are modifiable," he said. The new study is "a great start," but limitations in its methods mean that it can't prove a brain injury-dementia link, he said. More definitive studies are starting now but will take many years to give results.
The veterans study was led by Dr. Kristine Yaffe, a University of California professor and director of the Memory Disorders Clinic at the San Francisco VA Medical Center. The Department of Defense and the National Institutes of Health paid for the work.
"It's by far the largest" study of brain injury and dementia risk, she said. "It's never been looked at in veterans specifically."
Researchers reviewed medical records on 281,540 veterans who got care at Veterans Health Administration hospitals from 1997 to 2000 and had at least one follow-up visit from 2001-2007. All were at least 55 and none had been diagnosed with dementia when the study began. This older group was chosen because dementia grows more common with age, and researchers needed enough cases to compare those with and without brain injuries.
Records showed that 4,902 of the veterans had suffered a traumatic brain injury, or TBI, ranging from concussions to skull fractures. Researchers don't know how long ago the injuries occurred. Many participants were Vietnam War vets and their injuries were during active duty. None were due to strokes - those cases were weeded out.
Over the next seven years, more than 15 percent of those who had suffered a brain injury were diagnosed with dementia versus only 7 percent of the others - a more than doubled risk. Severity of the injury made no difference in the odds of developing dementia.
"It's not just one kind of TBI or super-severe TBI" that poses a danger, Yaffe said.
That worries Ryan Lamke, 26, a medically retired Marine who lives in suburban Washington, D.C. He suffered a traumatic brain injury from multiple blast exposures in 2005 in Iraq. "I'm diagnosed as a moderate (brain injury) but it feels like a mild," said Lamke, who relies on electronic calendars and other gadgets to stay organized. He's a student at Georgetown University and works part-time as a government relations intern for a private firm.
"I have to read for twice as long as my classmates" to accomplish what's needed, he said. "I've not found a doctor so far who can give me a true understanding of what's going to happen 20 or 30 years down the road."
Troops will need close monitoring in the years ahead and treatment for post-traumatic stress, depression and other conditions that can lead to cognitive problems, experts said.
"While we don't want people frightened to think they're going to be permanently impaired, a mild traumatic brain injury does not necessarily mean" no long-term problems, said Dr. Gregory O'Shanick, a psychiatrist and chairman of the board of the advocacy group Brain Injury Association of America.
The other study is follow-up work on nearly 4,000 retired National Football League players surveyed in 2001. New surveys were sent in 2008 to 905 of them who were over 50. Of those who responded, 513 had spouses who could complete the part assessing the players' memory.
"We were surprised that 35 percent of them appeared to have significant cognitive problems," said lead researcher Dr. Christopher Randolph of Loyola University Medical Center in Chicago.
Researchers sent 41 of them to the Center for the Study of Retired Athletes at the University of North Carolina in Chapel Hill. Tests showed they had mild cognitive impairment that resembled a comparison group of much older patients from the general population.
The results are preliminary, and suggest the players have higher rates of impairment than would be expected for their age, but they also have more dementia risk factors, such as obesity, high blood pressure and diabetes, Randolph said.

POSTED BY: RENE GARCIA - ATTORNEY
Many of our clients have expressed concerns over the long term effects of Traumatic Brain injury and Post Concussion Syndrome. Unfortunately, this current study does not paint a bright picture for the victims of these injuries.