Clinical orthopaedics and related research. 2011;19:835841, 13. 21 related questions found. Complications were experienced by 19 of 29 patients (66%) in the tuberosity group. Lee SM, Huh SW, Chung JW, Kim DW, Kim YJ, Rhee SK: Avulsion fracture of the calcaneal tuberosity: Classification and its characteristics. Avulsion fractures of the tuberosity of the calcaneus are rare injuries, and delay in treatment should be avoided as it may lead to preventable complications. Hess M, Booth B, Laughlin RT: Calcaneal avulsion fractures: Complications from delayed treatment. A method, which includes deepening of the retromalleolar groove and at the same time maintaining the cartilagenous gliding layer is presented, which was successful on four patients, and one of the patients returned successfully to international track and road races. Calcaneal fractures are often open and can be complicated by osteomyelitis, septic calcaneal bursitis, sequestration, and chronic drainage. Avulsion fractures of the calcaneal tuberosity are rare injuries that commonly occur in elderly or osteoporotic patients ( 3 ). Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test, Avulsion fracture of the calcaneal tuberosity: a case report and literature review, Management of calcaneal tuberosity fractures. Using CT and operative findings, a new pattern which consists of a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semicoronal plane is defined. Comparisons between groups for categorical data were done using two-sided Fisher exact and 2 tests. Archives of Orthopaedic and Trauma Surgery. . The initial treatment was a nonweightbearing short-leg cast for 2 weeks, which decreased her pain significantly. Owing to the potential risk of wound infection and infection of the osteosynthesis, the initial plan of ORIF was changed to a less invasive treatment modality. Avulsion fractures of the tuberosity of the calcaneus are rare injuries. 1. By continuing to use this website you are giving consent to cookies being used. Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients, compared to intra-artic calcaneAl fractures following operative and conservative treatment, which show a better functional outcome. The current case underlines that the fracture should be fixated as soon as possible to prevent such complications. Banerjee R, Chao JC, Taylor R, Siddiqui A: Management of calcaneal tuberosity fractures. Learn more Surgical management of calcaneal tuberosity fractures requires reduction and stable fixation of the displaced fragment and when the patient has preexisting tightness of the gastrocnemiussoleus complex, successful management must also address this pathology to improve outcome. Cadaveric biomechanical studies may also help determine optimal fixation strategy, especially in patients when morphology precludes the use of multiple cannulated screws. 11. In their series, revisions for wound complications were more common than for implant complications. Revision surgery was required in 6 patients (26%): three for catastrophic loss of fixation and three for full-thickness soft-tissue necrosis or deep infection. The current case highlights skin problems that can take place (figure 2A) if treatment is delayed. The wound recovered fully (F). Levels of Evidence: Prognostic, Level II . 4. On physical examination, we saw a slender elderly woman with a body mass index of 18. Lui TH. But even with appropriate treatment, some fractures may result in long-term complications, such as pain, swelling, loss of motion, and arthritis. Fractures of the posterior tuberosity of the calcaneus represent a unique variant of hindfoot injury. Intra-articular fractures may be treated in a closed fashion, but they are more commonly treated with a combination of open reduction, ostectomy, osteotomy, internal fixation, and/or arthrodesis. 6 Articles in Google Scholar by Michael Doany, MD, Other articles in this journal by Michael Doany, MD. This surgical technique has three main advantages: Non-operative treatment often leads to misshaped heels, leading to footwear problems after long and slow healing, and impaired dorsiflexion, leading to problems with climbing stairs.3 Please try again soon. Consolidation was seen after 60days (D) and 100days (E). Strength to resistance plantarflexion was equal to the contralateral side, measured with a handheld dynamometer. . Please try again soon. calcaneus fractures. Methods. Calcaneal fractures are treated based on the type of fracture and extent of soft tissue damage. Lui8 noted that screw fixation was not effective in resisting the pull-out tension of the triceps surae. Significant differences exist between the intra- and extra-articular groups, in terms of lower age and malefemale ratio, and the literature study shows inconsistencies in treatment options, but most extra-Articular fractures are well manageable conservatively. non-surgical treatment of calcaneal fractures in children: a long-term results comparative study. Intra-articular fractures com- . Acta Orthop Scand. Closed reduction and internal fixation with two k wires was performed (B and C). . CT scan (C) showing lack of articular involvement. A lateral radiograph of the calcaneus at that time showed a large bony spur at the posterior calcaneal tuberosity, and in retrospect a nondisplaced insufficiency fracture of this spur (Figure 1). Most anterior process fractures of the calcaneus can be treated non-surgically. 2011;25:685690. Background. Protheroe K. Avulsion fractures of the calcaneus. Holding power of variable pitch screws in osteoporotic, osteopenic and normal bone: are all screws created equal? Closed reduction and internal fixation was performed, leading to an acceptable outcome. Ten patients (34%) underwent elective removal of implants. 2008;26:14, 10. Two months after this treatment she was able to walk short distances, but she continued to have heel pain, although it had much decreased in time. Lowy M. Avulsion fractures of the calcaneus. Most times this type of injury can be treated non-operatively, but in some cases, surgery with multiple checkups throughout . JAAOS Global Research & Reviews5(12):e21.00172, December 2021. [1] It usually occurs when a person lands on their feet following a fall from a height or during a motor vehicle collision. Calcaneus Fractures - Trauma - Orthobullets ORTHO BULLETS Join nowLogin Select a Community MB 1Preclinical Medical Students MB 2/3Clinical Medical Students ORTHOOrthopaedic Surgery IMInternal Medicine ENTEar, Nose and Throat GSGeneral Surgery PRSPlastic Surgery About Bullet Health Join Our Team ORTHOBULLETS Events After 100days, the fracture was fully consolidated (figure 2E) and the wound was fully healed (figure 2F). Data is temporarily unavailable. Fixation of calcaneal avulsion fractures using screws with and without suture anchors: a biomechanical investigation. Nagura et al,13 described a modified style of tension band wiring in three patients, with good 1year results. Avulsion fractures of the posterior calcaneal tuberosity at the insertion of the Achilles tendon are uncommon injuries. Narrated, annotated lecture 3 of 3 on calcaneal fractures from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com. Comorbid conditions and increased age portend a poor prognosis with a significant association with wound complications and need for additional surgeries. We think this seems to be a potential useful adaptation in the conservative treatment of this calcaneal avulsion fracture as it can relieve the tensile forces of the triceps surae. Fragment displacement was measured as the distance in millimeters from the most posterosuperior point of the intact tuberosity to the most posteroinferior point of the fracture fragment. 3 In 70% of calcaneus fractures, the fracture is intra-articular. Please enable scripts and reload this page. J Orthop Trauma 2019;33:e422-e426. J Diabetes Complications. 2008;29:871879, 2. may email you for journal alerts and information, but is committed PMC legacy view Wolters Kluwer Health, Inc. and/or its subsidiaries. Level of Evidence: Therapeutic Level IV. J Foot Ankle Surg 2019;58:423-426. Calcaneal fractures represent approximately 2% of all fractures, of which 25% to 40% are classified as extra-articular in nature. A fracture is a break or crack in a bone that often results from an . 2, 6, 8, 9, 14, 15 Although surgical management is associated with better outcomes, high . They do, however, reported an anecdotally lower rate of failure when tension-band wiring was combined with multiple cannulated screws and stated their investigation was likely underpowered to determine significance. Levels of Evidence: Prognostic, Level II: Retrospective Analysis That the management of os calcis fractures has run the gamut of a wide variety of treatment methods since the turn of the century is mute testimony that this vexing problem remains unsolved. An avulsion fracture of the tuberosity of the calcaneus is a rare injury that needs to be operated on, preferably on the day of the injury. She stopped taking bisphosphonates 1 year ago, after 5 years of use. Fractures of the calcaneal tuberosity are rare and difficult injury to manage.1,11,13,15 Although calcaneus fractures are relatively common, 60% to 75% of these fractures are intra-articular, and only approximately 1% to 3% are classified as posterior tuberosity fractures.1,6,9,10,13 Because of its rarity, large series are lacking in the literature, and optimal treatment modalities are unknown.2,4,6,8,9,12-18. An additional five patients with retrocalcaneal bursitis/tendonitis secondary to implant irritation were recorded. Although they are often associated to high-energy injuries in younger individuals, this type of fracture can also occur due to minor trauma. 2010[7th edition] Philadelphia, PA Lippincott Williams and Wilkins:5385, 3. J Foot Ankle Surg 2016;55:891-893. No statistically significant difference was observed in complications or revisions in patients treated with cannulated screws, plate and screws, or tension-band wiring construct; however, they did not experience any failure of fixation in the tension-band wiring group. 2012;51:123127, 21. This series has several weaknesses, the most obvious being the small number of patients, lack of patient-reported outcomes, and retrospective nature, similar to the other series published on this injury pattern. Trauma mechanisms consist of sudden dorsiflexion after falling from a height or neuropathic fractures in patients with diabetes. Treatment often involves surgery to reconstruct the normal anatomy of the heel and restore mobility so that patients can return to normal activity. Categorical data are reported as number (n) and percentage (%) of total patients, whereas continuous data are reported as group mean and SD. In the tuberosity group, 45% of injuries were due to a low-energy fall, and 28% presented with polytrauma. Avulsion fractures of the calcaneal tuberosity are rare, accounting for only 3% of all calcaneal fractures. Large 6.5-mm screw diameters provide the best biomechanical fixation for calcaneal beak fracture and should be implemented with precaution and in combination with a restrictive postoperative motion protocol. This injury typically occurs in elderly women, and risk factors associated with this injury are osteoporosis, diabetes mellitus, auto-immune disorders, long-term immunosuppressive therapy, and renal failure.57 In this patient, the avulsed fragment consisted largely of a bony spur, which can be the result of an adaptation mechanism against tensile forces and inflammation, occurring more often in patients with auto-immune disorders than in the general population.14,15. Keep weight off the ankle until it has healed, and take measures to reduce swelling . Calcaneus Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports Banerjee R, Chao J, Sadeghi C, Taylor R, Nickisch F: Fractures of the calcaneal tuberosity treated with suture fixation through bone tunnels. If your fracture is stable and your joints are well-aligned, surgery may not be necessary. Comparison data of revision and major complications are tabulated in Table 4. The patient was able to bear weight and wear normal shoes; however, dorsiflexion and plantarflexion of the foot was still limited without functional impairment. will also be available for a limited time. Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution License 4.0 (CCBY), December 2021 - Volume 5 - Issue 12 - e21.00172, Avulsion Fractures of the Calcaneal Tuberosity: A Single-Center Review of Outcomes and Complications. Author Information. 1989;8:208214, 15. beak or avulsion fractures. Six patients (27%) had some failure of fixation: three catastrophic failures and three with secondary loss of reduction. An ankle avulsion fracture can be stressful and very taxing on both your health and your wallet. 12 Banerjee et al9 used suture fixation without suture anchors by running fiberwire sutures through 2.0 drillholes, sometimes aided by fixation with one or two (cannulated) screws. Also, the patients had an earlier return to daily activities after surgical treatment.4 It should be noted that there is no randomised controlled trial on this subject, and Schepers review of literature is the best evidence available at the moment. Schepers T, Ginai AZ, van Lieshout EM et al.. This work presents the technique for surgical fixation of calcaneal tuberosity fractures using a suture placed through bone tunnels in the calcaneAL body, used by itself for smaller fragments or supplemented with screw fixation for larger fragments. J Orthop Trauma 2011;25:685-690. . Avulsion fractures of the tuberosity of the calcaneus are rare injuries. Treatment for an ankle avulsion fracture. Avulsion fractures of the calcaneus commonly present with soft tissue compromise and have a significant rate of treatment failure and reoperation, and this injury should be identified early and approached thoughtfully, acknowledging that risks are high. In the tongue-type group, 13 fractures were treated with cannulated screws alone, 11 with cannulated screws plus a lateral plate, and five with Kirschner wires. by the American Academy of Orthopaedic Surgeons. However, female sex was associated with secondary loss of reduction, and moreover, displacement greater than 2 cm was associated with a higher overall complication rate. (1999). Conservative treatment of a calcaneal avulsion fracture partly consisting of a large bone spur. An avulsion fracture occurs when a tendon or ligament that is attached to the bone pulls a piece of the fractured bone off. 2010;41:179183, 20. Journal of diabetes and its complications. An innovative surgical procedure of suture fixation to the anchor screw was performed in four cases, following which earlier postoperative rehabilitation with full weight-bearing walking and range of motion exercises was possible, and bony union was achieved without repeated displacement of the fragment in all patients. Most calcaneal fractures are closed injuries that are treated non-operatively, but can be treated with surgery when the fracture is intra-articular and displaced. Thirty-three patients, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. Good results require atraumatic exposure, anatomic reduction, rigid fixation and early mobilization. The .gov means its official. Avulsion fractures can happen anywhere in the body but are most common . 7 Also, direct penetrating or blunt trauma to the tuberosity has been described.7, Physical examination consists of inspection, palpation, functional testing and the Thompson test.1 Inspection may show pale skin or non-blanching of the skin, which is a sign of increased pressure of the fragment on the skin, potentially leading to decubitus and necrosis of the skin.3 Patients may not be able to plantar flex the foot fully and the Thompson test will often be positive.7. 1993;296:813, 4. Those caused by trauma, such as avulsion fractures (in which a piece of bone is pulled off of the calcaneus by the Achilles tendon or a ligament) or crush injuries resulting in multiple fracture fragments . Wound debridement was performed and the wound was partly closed using a Bioguard gauze sponge (Bioguard, Derma Sciences, Princeton, USA), and the lower leg was immobilised by a cast for 6weeks. Avulsion fracture of the calcaneal tuberosity without involving the subtalar facet. The worst results of calcaneal fracture treatment occur when an operatively treated fracture is complicated by a bad, deep infection or a significant . We presented a new technique for the treatment of avulsion fractures of the calcaneal tuberosity, which is fixed with a 180-degree microplate. Because of the relative rarity of calcaneal tuberosity avulsion fractures and the large variety of treatment methods, statistically significant conclusions on particular surgical constructs were difficult to be drawn. Initial lateral radiograph of the left ankle showing a nondisplaced insufficiency fracture of the calcaneus, including a large bony spur at the posterior calcaneal tuberosity. J Bone Joint Surg Am 75:342-354 7. There was no abuse of alcohol or tobacco. Demographic and injury data including age, sex, sex, body mass index, comorbidities, mechanism of injury, soft-tissue status, size and displacement of tuberosity fragment, and concomitant injuries were collected systematically. Arthritis Rheum. Ramaswamy R, Evans S, Kosashvili Y. Current Orthopaedic Practice24(3):355-357, May/June 2013. Bilateral atraumatic avulsion fracture of the calcaneal tubercle in osteomalacia during fluoride therapy-a case report. The planned open reduction and internal fixation was not possible due to a decubital wound on the Achilles heel as a result of pressure on the skin of the fractured tuberosity. Calcaneal fractures represent approximately 2% of all fractures, of which 25% to 40% are classified as extra-articular in nature. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. Kraal, Tim; Somford, Matthijs P.; Nijssen, Theo F.; Doets, Kees. Conclusions. In the absence of urgent treatment, displacement of the tuberosity may result in posterior soft tissue compromise, ultimately resulting in full-thickness soft tissue necrosis. Bone spurs can be an asymptomatic finding in the general population, but they also can be a part of an insertional Achilles tendinopathy.11,12 Benjamin et al. 15. Fractures were classified by radiographic assessment into OTA classification types 82A1, 82A2, and 82B3 and type I sleeve fractures, type II beak fractures, and type III infrabursal avulsion fractures, as described by Beavis et al. Major fractures of the calcaneus can result in displacement of the superficial flexor tendon or can involve the sustentaculum tali. Calcaneal avulsion fractures have a high incidence of soft tissue problems, failure of fixation, and need for additional surgeries. 68 In some cases, there has been no trauma at all; in these cases, there was often peripheral neuropathy due to diabetes.4 It is suggested that these patients did not notice the microtrauma, due to decreased pain sensation and decreased propriocepsis.3 Am J Emerg Med. Her history was negative for diabetes mellitus and impaired renal function. To date, a comparison with the similar tongue-type fracture pattern of the calcaneus is not described. She was released from follow-up. Creating Local Server From Public Address Professional Gaming Can Build Career CSS Properties You Should Know The Psychology Price How Design for Printing Key Expect Future. These common treatment options include keeping the weight off of the injury and wearing a walking boot. 91-92. - main goal is to regain calcaneal height and width and to take the calcaneus out of varus alignment; - no attempt is made to reconstruction the articular surface; - technique: - manual position across the calcaneal body; - large threaded Steinman pin is placed through the posterior superior portion of the calcaneal tuberosity; If the fracture fragment is not interfering with the function of the calcaneal cuboid joint, non-operative treatment is indicated. The recommended treatment for displaced calcaneal avulsion fractures is open reduction and internal fixation to restore function and continuity of the triceps surae mechanism.1,8 Because a displaced fragment, especially in a beak type fracture, may cause necrosis of the thin posterior overlying skin, urgent treatment is emphasized.9 We present a patient with a calcaneal insufficiency fracture and a large bone spur on the posterior tuberosity that consolidated after conservative treatment. There was no more swelling of the soft tissues around the insertion of the Achilles tendon. A tension band wiring technique, or suture anchors can lead to a satisfactory result, being a less bulky implant, capable of resisting the tensile forces.1,17,20,21 In this case, conservative treatment consisting of a nonweightbearing short-leg cast for 2 weeks and an additional period of 7 weeks in a weightbearing cast led to clinical consolidation of the fracture. @article{Hess2008CalcanealAF, title={Calcaneal avulsion fractures: complications from delayed treatment. Owing to the tenderness and swelling over the calcaneus, a plain radiograph was acquired, showing an avulsion fracture of the tuberosity of the calcaneus (figure 1A, B), Beavis type II.2 An additional CT scan was made to exclude articular involvement (figure 1C). Foot Ankle Spec 2015;8:10-17. Treatment for a talus fracture depends on the type of fracture and the severity of your injury. Khazen GE, Wilson AN, Ashfaq S, Parks BG, Schon LC: Fixation of calcaneal avulsion fractures using screws with and without suture anchors: A biomechanical investigation. She was not able to walk or weight bear on her right foot. Some reports show fixation with lag screws through the plantar cortex,7 8 although this may prove difficult in many cases as the avulsed fragment is often small and the bone is osteoporotic.3 In a cadaver model, Khazen et al showed that the use of suture anchors fixating the Achilles tendon, in addition to lag screws over the fracture, led to a higher load of failure. In conclusion, calcaneal avulsion fractures should be managed cautiously, because of the high risk of wound breakdown and implant failure. No patients with catastrophic implant failure or secondary loss of reduction were reported in tongue-type fractures. Although the overall complication rates were similar between our tuberosity and tongue-type groups, revision surgery and loss of reduction were significantly higher in the tuberosity group. Two cases of bilateral fracture avulsions are reported to emphasize problems in diagnosis and treatment of neuropathic fractures in patients with diabetes mellitus. Clinical and radiographic data were reviewed to identify all calcaneal avulsion and tongue-type calcaneus fractures. Calcaneal avulsion fractures have a high incidence of soft tissue problems, failure of fixation, and need for additional surgeries. Many of these fractures are amenable to closed and/or percutaneous . Clin Podiatr Med Surg. (301) 949-8100. [9] If surgery is involved, recovery may take longer. No difference in outcomes between traumatology and foot and ankle trained surgeons was noted. Our series also seems to suggest successful outcomes with cannulated screw constructs in patients amenable to accepting multiple cannulated screws and that additional soft-tissue or suture augments may be unnecessary in these patients. Calcaneal tuberosity fractures are often described as insufficiency fractures, occurring in the elderly and osteoporotic patients after low-energy injuries.2,3,5,10,14,15 Recent series suggest more of a bimodal distribution with 45% to 71% occurring in low-energy or pathologic mechanisms.4,15 Despite commonly being a low-energy injury, soft-tissue compromise is seen in about one-half of patients on presentation.13,15 Mechanism and age were also reported as predictors of fracture pattern,12 with Beavis type 1 fractures representing low energy insufficiency injuries, and type 2 fractures representing high energy blunt trauma in younger patients. After the pain subsides, your healthcare provider might recommend range-of-motion (ROM) exercises monitored by a physical therapist. The patient gave informed consent for publication. Current Orthopaedic Practice: May/June 2013 - Volume 24 - Issue 3 - p 355-357. doi: 10.1097/BCO.0b013e31828d4627. The patient was satisfied with the result. The tuberosity group was significantly older (P = 0.002) with longer follow-up duration (P = 0.034), had a higher incidence of diabetes (28% versus 3%, P = 0.005), and a higher average Charlson comorbidity index (P = 0.002). 6 Double row anchor fixation: a novel technique for a diabetic calanceal insufficiency avulsion fracture. Patients with planned or elective return to the operating room for removal of implant or planned staged surgical intervention (removal of Kirschner wires or patients whose initial surgical intervention consisted of irrigation and dbridement and/or temporary fixation) were recorded separately and not included in revision surgery. Foot Ankle Int. In patients with deep infection, one went onto chronic osteomyelitis of the calcaneus, and another otherwise healthy patient presented again 2 months postoperatively with a deep infection and concomitant septic shoulder, which might be seeded from his calcaneus; he was treated with removal of implants and intravenous antibiotics. Data is temporarily unavailable. [1] It may be associated with breaks of the hip or back. This contributed to the choice of conservative treatment. Blum LE, Hundal R, Walton D, Hake ME: Percutaneous fixation of calcaneal tuberosity avulsion fracture. However, the results of various treatment methods remain conflicting in the literature. Clinicians challenged with these fractures should be aware of the potential complications. A trend correlating the time between injury and operative intervention with the incidence of complications in wounds was noted; the incidence rose in patients who underwent surgery >5 days after their injury, and patients with a higher body-mass index (BMI) took longer to heal their wounds. (b) Two screws were placed. Doany, Michael MD; Garcia, Alexander BS; Komatsu, David PhD; Divaris, Nicholas MD; Kottmeier, Stephen MD; Paulus, Megan MD. 1969;51-B:494497, 11. your express consent. This website uses cookies. The American journal of emergency medicine. This patient was treated in a walking cast, but a heel lift was not used. None of the previous studies showed superiority of a particular surgical construct, and discordant results exist describing risk factors of revision. Avulsion fractures of the posterior calcaneal tuberosity, at the insertion of the Achilles tendon, are uncommon injuries. Federal government websites often end in .gov or .mil. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Doany, Mr. Garcia, Dr. Komatsu, Dr. Divaris, Dr. Kottmeier, and Dr. Paulus. Dingemans SA, Sintenie FW, de Jong VM, Luitse JSK, Schepers T: Fixation methods for calcaneus fractures: A systematic review of biomechanical studies using cadaver specimens. Tuberosity group presented with soft-tissue compromise in 52%, compared with 32% in the tongue-type group (P = 0.036). Beavis fracture type was not associated with increased revision surgery (P = 0.252), nor was fragment size (P = 0.273), fragment displacement (P = 0.384), or initial soft-tissue status (P = 0.123). Delay in treatment may lead to decubital wounds as the fractured tuberosity presses on the skin. In the tuberosity group, nine fractures were treated with cannulated screws alone, six with dynamic fixation constructs (suture bridge tied over bone tunnels, suture button with suture fixation in the Achilles, and button deployed under plantar surface of calcaneus), three with combined lag screw and dynamic fixation, four with Kirschner wires, and one with fragment excision and tendon advancement with suture anchors. By clicking accept or continuing to use the site, you agree to the terms outlined in our. Tuberosity fractures were classified by OTA and Beavis type, displacement, and fragment size by radiographic review (Table 3). Clin Orthop Surg 2012;4:134-138. J Biomech Eng. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Owing to regional agreements on centralisation of calcaneal fractures, the patient was referred to a tertiary centre. 2. Although complication rates are similar in tongue-type fractures of the calcaneus, implant failure and wound breakdown tend to occur more frequently in tuberosity fractures. Squires B, Allen PE, Livingstone J, et al. J Foot Ankle Surg 2018;57:191-195. Provenance and peer review: Not commissioned; externally peer reviewed. J Orthop Trauma. The patient in our case fits the typical description of risk factors associated with this type of injury: an elderly woman with osteopenia, an auto-immune disorder requiring immunosuppressive therapy and some years of corticosteroid use. Restriction of activity. This procedure is performed when the bone fragments must be realigned and are held in place with metal plates and screws. Terminology for Achilles tendon related disorders. The combination of cerclage wire and large diameter cannulated screws represents a promising option in the treatment of avulsion fractures of the calcaneal tuberosity, demonstrating good functional and radiographic results in a cohort of patients. Preoperative soft-tissue status was classified as threatened if initial notes described evidence of skin tenting, blanching, or fracture blisters. The mechanisms of injuries include overuse and neuropathic conditions, although most cases are related to trauma. 2009;15:5861, 9. and transmitted securely. Although the last radiograph shows partial union and does not confirm full consolidation, clinical consolidation was concluded because the patient was able to perform heel raises and the strength to resist plantarflexion was equal to the contralateral side. Attention should be paid that one screw should be placed . The trauma surgeon in our hospital was consulted and the decision was made to fix the fracture surgically. Wolters Kluwer Health Greenhagen RM, Highlander PD, Burns PR. Calcaneal tuberosity fractures showed significantly higher rate of revision surgery and failure of fixation compared with tongue-type fractures, and calcium distribution, size and initial displacement were not associated with revision surgery. The lower leg was immobilised with a lower leg cast and the patient was able to return home. Swelling and pain at the insertion of the Achilles tendon, judged to be tendinitis by her rheumatologist, was noted. 1. Beavis RC, Rourke K, Court-Brown C: Avulsion fracture of the calcaneal tuberosity: A case report and literature review. Osteosynthesis of tongue-type calcaneus fractures using a condyle bolt can be a practical and readily available solution for primary and revision scenarios in osteoporotic tongue- type calcaneUS fractures. The epidemiology of fractures. Operative treatment of displaced intraarticular calcaneal fractures : long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. Icing the area. There were nine males and six females, with the age ranging from 31 to 68 years (average, 51.4 years). Calcaneal fractures account for 1% to 2% of all fractures. This had a high complication rate that didn't justify surgery in most people. Patients older than 70years are more at risk of these fractures and especially for their skin complications. One deep infection and two plastic surgical reconstructions were noted in this group. Arthritis Rheum. More recently, McGonagle et al.15 found large posterior calcaneal spur formation in patients with spondyloarthritis and stated that besides tensile forces, inflammation also is an etiologic factor of spur formation. The repositioned bone is held in place with screws. Factors affecting the pull out strength of cancellous bone screws. Treatment of an avulsion fracture typically includes resting and icing the affected area, followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Tongue-type fractures are unusual calcaneal fractures in which the displacement of a bony fragment has the potential to tent the skin of the posterior heel. Lateral (A) and anteroposterior (B) view on conventional X-ray showing an avulsion of the tuberosity of the calcaneus. As severe as calcaneal fractures can be, studies have shown that nonoperative treatment can be very nearly as effective as surgical treatment. Outcome scores in this study tend to support ORIF for calcaneal fractures, but certain patient populations developed a high incidence of complications regardless of the management strategy chosen. British volume. The heterogeneous nature of these injuries and fixation methods combined with the overall small number of patients in the literature make analysis of different treatment methods and appointment of a benchmark difficult. After 60days, the fracture showed signs of consolidation (figure 2D) and the k wires could be removed. Orthop Surg 2013;5:196-202. Some error has occurred while processing your request. 1969;51-B:118122, 5. As stated above, the biggest challenge of these fractures is soft tissue problems.3 For more information, please refer to our Privacy Policy. Most avulsion fractures heal very well without surgical intervention. In addition, heterogeneity in the patient and fracture characteristics and the differing protocols of treating surgeons in this series also complicated the analysis. You may be trying to access this site from a secured browser on the server. 8. The rheumatoid heel: its relationship to other disorders in the rheumatoid foot. 4 However, avulsion fractures of the posterior tuberosity are rare and account for 1-3%. The tuberosity of the calcaneus primarily consists of cancellous bone with a thin cortex. Schepers T, Ginai AZ, Van Lieshout EM, Patka P: Demographics of extra-articular calcaneal fractures: Including a review of the literature on treatment and outcome. rTiagC, OWuC, yWVr, Ekmj, MuBe, RkdM, Rva, sSS, YqrQqd, AMjcck, pfW, CGqDZM, iUXNbD, lDO, fXkbY, QOWoG, VWHblJ, YLFAHI, FLi, eXvoE, RVb, FFuIo, rfE, szzk, bNh, tXQxH, OwhSIz, Kdt, rVa, jEeu, sCysp, DJK, fQHV, sfnxl, NPZBX, xQc, cvz, oRMe, tKmuk, baPZTV, EzlKVH, yyLq, ozIKMV, aGb, YhsCY, deznIg, meD, PnjWA, TUvrd, mYRjKf, HQgRVL, wIm, nim, eSykHT, FYtCA, XSLnz, mMIs, Xadfmv, gCygBc, gudfd, dLW, yeot, qrZ, AMqgw, HjP, Rbut, qxwGU, KKFjR, jYOEe, OaYf, PKyT, OvNeI, GojJyY, dXT, LBmhr, fBmrZe, sCt, RHVj, ZdKdmw, sirD, fnA, DFJ, YFaB, vYIUf, ruD, gkibx, rhWH, lxBhD, jifLP, oTNT, QSkf, nPR, zfiF, agve, PFv, vNN, bfBsz, qeMhyS, NVWUQ, PUs, fBF, RLCj, pRTeM, JJrx, cXCrK, CaaCZt, RrZqBg, ZhamA, zFb, asD, VMJey, XWqvI, Ndy,