Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures

Abstract

Avulsion fractures of the calcaneal tuberosity represent a rare injury pattern that is caused by a powerful tension force from the Achilles tendon and is usually seen following minor trauma, especially in elderly patients. The objective of this study is to describe a surgical technique using cerclage wiring through cannulated screws in the treatment of extra- and intra-articular avulsion fractures of the calcaneal tuberosity and to present our results in a small patient's cohort. Through a 5.0 cm longitudinal skin incision over the posterolateral aspect of the calcaneus, after adequate debridement of the fracture fragments and while keeping the ankle in plantarflexion, the calcaneal tuberosity is anatomically reduced with the help of a periarticular reduction clamp and an accessory plantar longitudinal approach. Provisionally fixation is performed with K-wires. Definitive fixation is achieved with two parallel partially threaded 7.0 cannulated screws, which are positioned from the superior and posterior aspect of the tuberosity to the inferior and anterior aspect of the plantar surface of the calcaneus, and 1.5 mm cerclage wires that are pulled epiperiosteally to the plantar aspect of the calcaneus to avoid damage to local soft tissues. Alternatively, for smaller fracture fragments, two 3.5 mm partially threaded cannulated screws and 1.25 mm cerclage wires can be used. We also report the results of the procedure in a small cohort of four patients. All fractures healed in an anatomic position. There was no failure of fixation, loss of reduction, or need for secondary surgery, including hardware removal. At final follow-up, all patients had regained full plantar flexion range of motion and strength, with no gait or weight-bearing restrictions. In conclusion, 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 our cohort of patients.

A Biomechanical Study of Calcaneal Tuberosity Avulsion Fracture: A Comparison Between Three-Screw Versus Two-Screw Fixation Strength

“…Cannulated screw fixation with the titanium wiring technique was reported to be successful in three elderly patients [ 19 ]. Similar cannulated screw fixation with the cerclage wire technique was reported to be successful in four patients, and the authors suggested that a bigger screw diameter of 7.0 mm could be used for bigger fragments or a screw diameter of 3.5 mm was preferred for smaller fragments [ 20 ]. The Tightrope® technique was reported for a calcaneal sleeve fracture, and this technique could be used for tongue-type fractures as well [ 21 ].…”

Outcomes of U-shaped internal fixation in the treatment of avulsion fracture of calcaneal tubercle

“…The surgical treatment of calcaneal tubercle fracture includes screw fixation, plate fixation, Kirschner wire fixation, anchor fixation, external fixation and fracture fragment resection [23][24][25]. Giordano et al [26] reported that calcaneal tuberosity fractures were more common in osteoporotic patients, such as the elderly, diabetes and autoimmune diseases. Osteoporosis makes fixation more difficult.…”