Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire

Miyamura, Satoshi; Ota, Haruka; Okamoto, Michio; Namba, Jiro; Yamamoto, Kōji

doi:10.1053/j.jfas.2015.08.008

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…Hollow nails are minimally invasive, offer easy fixation, and cause limited skin irritation and fewer skin necrosis complications; these properties make them an ideal choice for fracture treatment. [18] Our study has some limitations. First, the calcaneus is complex, and the trabeculae within the cancellous bone are not homogeneous; however, the inner part of the calcaneus is inevitably set as homogeneous for performing loading calculations as required.…”

Section: Discussionmentioning

confidence: 89%

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Hollow screw fixation of type II avulsion fractures of the calcaneal tuberosity using the finite element analysis

Wang

2023

Medicine

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We aimed to establish a model of type II avulsion fractures of the calcaneal tuberosity treated with 2 hollow screws implanted in different directions and to analyze the biomechanical properties of the model using the finite element method. The Dicom data of the calcaneal bone obtained after computed tomography scan were inputted into Mimics 21.0 software and Geomagic Studio software to generate a 3D finite element digital model of the calcaneal bone. The model was then imported into SOLIDWORKS 2020 software. Based on the Beavis theory, the calcaneal bone was cut to build a type II avulsion fracture model of the calcaneal tuberosity; the calcaneal fracture was then simulated by internal fixation using hollow screws. Two screws were used to fix the calcaneal bone from the calcaneal tuberosity in different ways, resulting in 3 different calcaneal models (Model 1 involved 2 screws for fixing the fracture vertically; Model 2 had 2 screws for fixing the fracture cross-wise; and Model 3 had 2 screws for fixing the fracture parallelly). Three internal fixation models were loaded under the same conditions, and lines finite element analysis was then performed to calculate the stress distribution of the generated internal fixation models. Under the same loading conditions, compared with Models 2 and 3, Model 1 exhibited smaller maximum displacement values of the heel bone, maximum equivalent force values of the screws, and more dispersed stresses. Avulsion fractures of the calcaneal tuberosity can be treated using 2 screws to fix the fracture vertically (Model 1), which is more biomechanically relevant.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Hollow screw fixation of type II avulsion fractures of the calcaneal tuberosity using the finite element analysis

Wang

2023

Medicine

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“…One of the potential drawbacks of this technique is the necessity for a second plantar incision, which could potentially lead to skin necrosis or painful plantar scar. However, none of these complications were reported by the authors [ 20 ].…”

Section: Discussionmentioning

confidence: 92%

“…The use of tension band wiring with cannulated lag screws has been recently proposed by Miyamura et al as a better method of fixation for these fractures, avoiding displacement of the reduced fragment after fixation [ 20 ]. The authors used the technique in three elderly patients with extra-articular avulsion fractures of the calcaneal tuberosity.…”

Section: Discussionmentioning

confidence: 99%

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

Giordano

Godoy‐Santos

Souza

et al. 2018

Case Reports in Orthopedics

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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.

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“…As for the patients with large fragments, particularly for those with the fracture line extending to subtalar joint, some researchers adopted conventional lateral calcaneal plate with larger incision 11 . The utilization of cannulated cancellous screws and titanium wire not only provided strong internal xation without any skin or incision problems that may be caused by previous methodologies, but enabled earlier postoperative recovery with range of motion and weightbearing exercises 19 . However, the above approach conducted a posterior Achilles tendon vertical midline curved incision and a small lateral plantar incision, which undoubtedly increased the wound area.…”

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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Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire

Cited by 10 publications

References 8 publications

Hollow screw fixation of type II avulsion fractures of the calcaneal tuberosity using the finite element analysis

Hollow screw fixation of type II avulsion fractures of the calcaneal tuberosity using the finite element analysis

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

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

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