Fractures of the Calcaneal Tuberosity Treated With Suture Fixation Through Bone Tunnels

Abstract

Fractures of the calcaneal tuberosity, although rare, present a challenge for the treating surgeon. The goal of treatment is restoration of function of the gastrocnemius-soleus complex and the Achilles tendon. These fractures often occur in diabetics and elderly osteoporotic patients and therefore fixation of the displaced fragment is difficult. Displaced fractures, if not recognized and promptly reduced, often result in secondary soft tissue compromise. Often, the fragment is a small shell of osteoporotic bone, which is less than optimal for bony fixation. We present our technique for surgical fixation of calcaneal tuberosity fractures using a suture placed through bone tunnels in the calcaneal body. This technique is used by itself for smaller fragments or supplemented with screw fixation for larger fragments.

Dual Fixation of Calcaneal Tuberosity Avulsion with Concomitant Achilles Tendon Rupture: A Novel Hybrid Technique

“…Banerjee et al [20] describe a technique, which is similar to ours in which the small avulsed tuberosity fragment and Achilles tendon are affixed with a modified Krackow suture. The tails are then passed plantigrade through bone tunnels drilled in the body of the calcaneus and tied through a small incision on the plantar aspect of the heel.…”

An avulsion fracture of the calcaneal tuberosity: delay of treatment causes the ‘Achilles heel’ of optimal recovery

“…As stated above, the biggest challenge of these fractures is soft tissue problems 3 9. The tuberosity is pulled cranial by the Achilles tendon, after which the sharp fractured end of the tuberosity can press against the skin (figure 1A), leading to increased pressure and, eventually, decubitus (figure 2A) and necrosis of the skin 3 6 7 10.…”

“…Techniques have been described in which corkscrew suture anchors were inserted in the calcaneus, after which the sutures were run through the fracture fragment and to the Achilles tendon using the Kessler or Krakow technique 2 3 5 12. Banerjee et al 9 used suture fixation without suture anchors by running fiberwire sutures through 2.0 drillholes, sometimes aided by fixation with one or two (cannulated) screws. Nagura et al ,13 described a modified style of tension band wiring in three patients, with good 1 year results.…”

Novel Techniques in Treating Calcaneal Tuberosity Fractures

“…No difficulties in fracture healing were reported and a minimum of 4/5 plantarflexion strength was regained. 2 It has been shown previously that suture anchor fixation of the Achilles tendon in calcaneal tuberosity avulsion fractures adds to the strength of the repair. Khazen et al looked at 12 cadaveric specimens and compared lag screw fixation alone of the fracture vs the addition of suture anchors for fixation of the Achilles tendon.…”