Calcaneal Avulsion Fractures: An Often Forgotten Diagnosis

Abstract

The mechanisms of injuries include overuse and neuropathic conditions, although most cases are related to trauma.

Avulsion Fracture of the Calcaneal Tuberosity: Case Report and Literature Review

“…The calcaneus is the largest bone of the foot and serves as the primary weightbearing structure in the heel (11). AFCTs are rare and usually present in a frail population (5,7).…”

“…The anatomy and forces acting at the calcaneus need to be reviewed to understand the reason for this treatment failure. The Achilles tendon (AT) is the strongest tendon in the body, with an average length of about 15 cm from the junction of the triceps surae muscle group to its insertion on the calcaneus (11,13). At the distal part, the surface of the AT is anteriorly concave and posteriorly convex, tapering to its enthesis at the middle third of the calcaneal tuberosity (11).…”

The Fate of Fracture Fragment in Diabetic Calcaneal Insufficiency Avulsion Fracture

“…The neuropathic avulsion fractures of the calcaneal tuberosity were recognized as an insufficiency fracture, and often appeared in a patient with long-term diabetes mellitus [5]. In these patients, calcaneal insufficiency avulsion (CIA) fracture occurred without a history of significant trauma or overuse activities [3].…”

“…Traditionally, diabetic CIA fractures have commonly been surgically treated with open reduction and internal fixation, in the same method as the traumatic calcaneal avulsion fractures. However, poor surgical outcomes and surgical failures were reported in these cases, due to the low healing potential related diabetes [4,5]. For these reasons, some authors have recently proposed the surgical technique with calcaneal tenodesis after excision of fracture fragment through revision surgery after experiencing the fixation failure [6].…”

“…have higher incidence of complications, such as loss of reduction, nonunion, mal-union and soft tissue problems (delayed wound healing or skin necrosis, wound infection, and skin irritation) than traumatic calcaneal avulsion fractures [5]. Thus, the proper surgical treatment for diabetic CIA fracture was still controversy.…”