Ilizarov External Fixation Technique for Repair of a Calcaneal Avulsion Fracture and Achilles Tendon Rupture

Ramanujam, Crystal L.; Capobianco, Claire M.; Zgonis, Thomas

doi:10.1177/1938640009350983

Cited by 9 publications

(14 citation statements)

References 15 publications

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“…Kirschner tension band wiring is suitable for the large fracture fragments without Achilles tendon injury, however, the junction of the pin tail and wire is likely to cause intense stimulus to the peroneal tendons and skin. An external fixator is applicable to the poor soft tissue when open reduction and internal fixation are inapplicable. Fracture fragment excision is mainly applicable to small obsolete fracture fragments with obvious symptoms, which are not in the attachment region of the Achilles tendon in calcaneal tuberosity.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management for Avulsion Fracture of the Calcaneal Tuberosity

Pang²,

Yu³

et al. 2013

Orthopaedic Surgery

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To patients with obvious fracture displacement, whose soft tissues are irritated severely, emergency open reduction and internal fixation operation should be offered to prevent the necrosis of the flaps as far as possible. To patients with small fractures, it is advisable to choose open reduction and large diameter screw fixation, while plate and screw fixation may be better for the patients with large fragments, especially for those with the fracture line extending to the subtalar joint.

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Section: Discussionmentioning

confidence: 99%

Surgical Management for Avulsion Fracture of the Calcaneal Tuberosity

Pang²,

Yu³

et al. 2013

Orthopaedic Surgery

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“…Ramanujam CL 20 reported that through using Steinmann pins and Ilizarov external xation, signi cant traumatic calcaneal avulsion fractures with concomitant Achilles tendon ruptures can be successfully reduced. Nevertheless, it must be noted that this technique still has one disadvantageous effect of cutting a second plantar incision, which may potentially cause skin necrosis or irritation 20 . Agni et al applied locking compression hook plate (LCP) to treat avulsion fracture of calcaneal tuberosity 21 .…”

Section: Strong Xation Reduces Recovery Time While Preventing Interna...mentioning

confidence: 99%

Fixation For Calcaneal Tuberosity Fracture (Beak Fracture) Using Preformed "L-shape" Hook Plate

Zhang,

2023

Preprint

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Objectives: Treating calcaneal tuberosity fracture (beak fracture) is considered difficult. The ankle functions of patients may be badly affected by skin flap necrosis and/or implant failure. In this study, we propose a robust, facile, economic and safe internal fixation technique to fix the fracture fragments using preformed "L-shape" hook plate. Methods: A retrospective study is conducted to analyze patients with calcaneal tuberosity fracture who received surgical management from January 2015 to February 2020. According to Beavis classification, all of the patients were categorized into type II with larger fracture fragments, who were treated by internal fixation adopting preformed "L-shape" hook plate. The operation time, complications, and clinical healing time were recorded, Functional assessment is performed according to American Orthopedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and Visual Analog Scale (VAS) pain scores. Results: There were a total of 15 patients of calcaneal tuberosity fracture (beak fracture), who had been treated by internal fixation adopting preformed "L-shape" hook plate. Among them, six patients were female and the rest were male, with their age ranging from 29 to 69 years (average of 52.9±11.2 years). The mean duration of follow-up was 17.1±6.0 months (range: 12 to 36 months). Eleven patients underwent emergency surgery. After the operation, no complications were observed such as poor wound healing, skin flap necrosis, wound dehiscence, hematomas or infections. In addition, none of the following complications were observed, which involved plate exposure, sural nerve injuries, venous thromboembolic events, loss of reduction, and fixation failure. In this study, fifteen cases achieved clinical healing at 8-13 weeks (average 10.5 weeks) postoperatively. For functional evaluation, the preoperative VAS and AOFAS-AH scores were 5.7±0.6 and 24.0±9.9 respectively, whereas the postoperative VAS and AOFAS-AH scores at the last follow-up were 1.3±0.5 and 93.8±5.2 (p<0.001). Conclusions: Emergency open reduction and internal fixation operation should be conducted with respect to patients who have calcaneal avulsion fracture, thereby preventing flap necrosis from happening. For patients with Beavis type II beak fracture, preformed "L-shape" hook plate fixation facilitates better recovery of normal ankle functions. Performing as one of the optional treatments, this study proposes a robust, facile, and safe internal fixation technique for avulsion fractures of calcaneal tuberosity (beak fracture ). A series of follow-up case study have verified the validity and effectiveness of implementing the proposed method, paving way for treating complicated calcaneal avulsion fractures.

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“…This process was cumbersome and required multiple operations. Ramanujam CL [21] reported that signi cant traumatic calcaneal avulsion fractures with concomitant Achilles tendon ruptures can be successfully reduced via the use of Steinmann pins and Ilizarov external xation. Nevertheless, external xation devices may prevent patients from living a normal life [21].…”

Section: Incision Selection and Soft Tissue Protectionmentioning

confidence: 99%

“…Ramanujam CL [21] reported that signi cant traumatic calcaneal avulsion fractures with concomitant Achilles tendon ruptures can be successfully reduced via the use of Steinmann pins and Ilizarov external xation. Nevertheless, external xation devices may prevent patients from living a normal life [21]. Although Agni et al [22] successfully applied LCP hook plate to the avulsion fracture of the calcaneal tuberosity, the plate is too expensive that the nancial burden of patients may be increased.…”

Section: Incision Selection and Soft Tissue Protectionmentioning

confidence: 99%

Calcaneal Tuberosity Fracture (Beak Fracture) Fixation Using a Pre-contoured “L-form” Hook Plate: A Retrospective Study

Zhang¹,

Chan

Wu³

2021

Preprint

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Background: The treatment of calcaneal tuberosity fracture (beak fracture) is very tricky. Patients’ ankle function may be badly affected by skin flap necrosis and internal fixation failure. This study presented a simple, and safe internal fixation technique which is to fix the fracture fragment with a pre-contoured “L-form” hook plate.Methods: A retrospective study was done to analyze patients with calcaneal tuberosity fracture who were treated with pre-contoured “L-form” hook plate fixation from January 2015 to February 2020. When the patients could complete single-legged heel raise tests, and when they achieved clinical healing criteria were reviewed. Functional assessment was performed according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and the Visual Analogue Scale (VAS) was recommended for assessment of pain intensity (PI).Results: There were a total of 15 patients of calcaneal tuberosity fracture (beak fracture) treated with the pre-contoured “L-form” hook plate fixation technique, among which eight patients were female and the others were male, with the age ranging from 35 to 69 years (average of 55.3±9.0 years). And the mean duration of follow-up was 22.53±5.78 months (range: 12 to 36 months). 11 cases underwent emergency surgery. After the operation, there were no complications such as wound dehiscence, poor wound healing, infections, or plate exposure, no sural nerve injuries or venous thromboembolic events. Also, there was no loss of reduction or fixation failure in the follow-up. All 15 cases achieved clinical healing at 8-13 weeks (average 10.5±1.4 weeks) postoperatively. They were able to perform the test on their affected leg after 3.7±0.7 months (3-5 months) on average. The preoperative VAS and AOFAS-AH scores were 5.7±0.6 and 24.0±9.9 respectively, while the postoperative VAS and AOFAS-AH scores at the last follow-up were 1.3±0.5 and 93.8±5.2 (p<0.001).Conclusion: Emergency open reduction and internal fixation should be provided as soon as possible. For patients with Beavis type II beak fractures, the pre-contoured “L-form” hook plate fixation technique helps them restore normal ankle function. This simple, safe, and strong internal fixation technique can be one of the treatment options for avulsion fractures of the calcaneal tuberosity.

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Ilizarov External Fixation Technique for Repair of a Calcaneal Avulsion Fracture and Achilles Tendon Rupture

Cited by 9 publications

References 15 publications

Surgical Management for Avulsion Fracture of the Calcaneal Tuberosity

Surgical Management for Avulsion Fracture of the Calcaneal Tuberosity

Fixation For Calcaneal Tuberosity Fracture (Beak Fracture) Using Preformed "L-shape" Hook Plate

Calcaneal Tuberosity Fracture (Beak Fracture) Fixation Using a Pre-contoured “L-form” Hook Plate: A Retrospective Study

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