Calcaneal apophyseal avulsion fracture

Abstract

Isolated fracture of the calcaneal apophysis is a rare injury in children and adolescents. In this study, we report on a case of a displaced calcaneal apophyseal avulsion fracture in a child treated with open reduction and internal fixation, as well as a review of the literature. A 9-year-old female child presented to the senior surgeon complaining of acute heel pain after a gymnastic injury. She was diagnosed with a displaced, isolated fracture of the proximal calcaneal apophysis for which she underwent open reduction and internal fixation. On the magnetic resonance imaging (MRI) examination, we could diagnose that her injury was not chronic but acute because there was no change of intensity in the metaphyseal area. A combination of bioabsorbable suture tacks and pins was used to anatomically fix the fragment using the tension band wiring technique. At 2 years and 6 months follow-up, she had full range of motion, complete return of strength. We report here on the successful surgical treatment and the first case evaluated by MRI of an avulsion fracture of the calcaneal apophysis in a child.

Bilateral calcaneal epiphysiolysis in a Dobermann puppy presenting for a unilateral femoral fracture

“…8 MRI has become more frequently used as imaging modality for Sever's disease and calcaneal epiphysiolysis in human medicine. 2,9 The radiographic changes in this dog were consistent with bilateral epiphysiolysis and reactive new bone formation indicative of chronic inflammation. Treatment of Sever's disease in children is not surgical and consists of in-shoe orthoses, anti-inflammatory medication, physiotherapy and rest, with a good outcome for return to function.…”

“…Sever's disease, however, is not a fracture separation of the epiphysis and the radiographic changes are subtle and more focused on the ossification centre 8 . MRI has become more frequently used as imaging modality for Sever's disease and calcaneal epiphysiolysis in human medicine 2,9 . The radiographic changes in this dog were consistent with bilateral epiphysiolysis and reactive new bone formation indicative of chronic inflammation.…”

“…Although Sever's disease is fairly common in human medicine, a true epiphysiolysis of the calcanean tuberosity has only been rarely documented. All the cases involved were particularly athletic children and had unilateral presentation 9,13,14 . A study reported fixation of a left calcaneal avulsion fracture with screws and Z‐lengthening plasty of the tendon.…”

“…In another report, a repair with two cancellous screws was performed to fixate the right calcaneal avulsion fracture in a 14‐year old athlete that returned to full activity by 1 year but had no further follow up 14 . Another documented fixation method of a calcaneal avulsion fracture was performed with two bio‐absorbable pins that healed well with no pain or discomfort noted in daily life 2.5 years later 9 . Although avulsion fractures in dogs are seen commonly in the tibial tuberosity 15–17 and reported in various other locations, 18–29 very few case reports in veterinary literature have documented calcaneal epiphysiolysis 30–33 .…”

Demographics of extra-articular calcaneal fractures: including a review of the literature on treatment and outcome

“…The epiphysiolysis, a Salter-Harris type III fracture, occurs in children [2,7,40,52]. It can be mistaken for Severs' disease (apophysitis by repeated stress) if the fracture is not displaced [7].…”