Achilles tenodesis for calcaneal insufficiency avulsion fractures associated with diabetes mellitus

Abstract

BackgroundCalcaneal insufficiency avulsion (CIA) fractures often present with neuropathic etiology, such as Charcot neuroarthropathy (CN). Under the same surgical procedures, the outcomes of CIA fractures are less desirable, compared to the outcomes of the traumatic calcaneal avulsion fractures. Here, the study suggests Achilles tenodesis technique using suture anchor after resection of the CIA fracture fragments could provide satisfactory clinical results in the cases of surgically indicated CIA fractures.Materials and methodsThis retrospective study included seven patients of calcaneal avulsion fracture who had underlying diabetes mellitus (DM) and no specific traumatic event. The patients were treated with Achilles tenodesis techniques for their CIA fractures. Achilles tenodesis was performed using suture anchor with removal of the fracture fragments. The patients were evaluated with the Foot and Ankle Outcome Score (FAOS), visual analogue scale (VAS), single-heel rise test, and X-ray images on their final follow-ups.ResultsInitially, three of the CIA fracture cases treated with traditional open reduction and internal fixation reported pullout failure. Consequently, all patients received Achilles tenodesis using suture anchor after bone fragment resection and had good clinical outcomes. Only one subject with low compliance reported poor outcome.The FAOS of each patient were obtained at a mean of 16.3 months after surgery. The results are as follows: pain 80.6 (SD = 6.2), symptom 83.8 (SD = 4.9), activities of daily living 80.5 (SD = 8.0), sport and recreation function 75.6 (SD = 11.93), and foot- and ankle-related quality of life 77.9 (SD = 6.7). On their final follow-ups, the average VAS was 2.6 (range, 1 to 4).ConclusionAchilles tenodesis using suture anchor after bone fragment resection achieved competent clinical results in the patients with CIA fractures. The study proposes that this surgical procedure could be an appropriate treatment option for patients with CIA fractures.Trial registrationThe study was approved by the institutional review board (IRB) of our medical center (IRB File No. 2016-07-043), retrospectively registered.

Outcomes of open reduction and internal fixation of calcaneus fractures: A database study comparing patients with and without diabetes

“…To the best of our knowledge, only one author reported exclusively on surgical treatment in a series of DM calcaneus fractures. Choi et al 12 described treatment of avulsion fractures of the calcaneus and functional outcomes in seven patients. Three of the seven patients (43%) had hardware failure and wound healing problems.…”

The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy

“…Focal tracer uptake conformed to the expected subchondral location of these ligament and tendon insertions and this may reflect abnormal bone turnover at these sites. Calcaneal posterior tuberosity avulsion fractures have been noted previously in diabetes [ 18 ]. The concept of calcaneal avulsion fractures and their association with CN was first introduced in 1991 by Kathol et al [ 19 ].…”

Correction to: Achilles tenodesis for calcaneal insufficiency avulsion fractures associated with diabetes mellitus

“…The original publication of this article [ 1 ] contained the wrong versions of Tables 1 , 2 and 3 . In this correction the updated tables are published.…”