Calcaneal tuberosity avulsion fracture
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At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosuresAt the time the article was last revised Mostafa Elfeky had no financial relationships to ineligible companies to disclose.
View Mostafa Elfeky's current disclosures- Calcaneal tuberosity avulsion fractures
Avulsion fractures of the calcaneal tuberosity are rare, accounting for only 3% of all calcaneal fractures.
Pathology
There are three mechanisms of action 4:
- fall during plantarflexion
- ankle hyperextension
- feet fixed on the ground with sudden muscular contraction
Associations
There is a strong association with diabetes, where they may occur spontaneously and are thought to be due to peripheral neuropathy. They also occur in patients with osteoporosis, renal osteodystrophy and hyperparathyroidism.
Classification
According to Lee et al, this injury can be classified into four types (modification of the original classification system proposed by Beavis et al) 4,5:
- type I: simple extra-articular avulsion fracture
- type II: "beak" fracture with oblique fracture line running posteriorly from just behind Bohler's angle
- type III: infrabursal avulsed fracture by superficial fibers from the middle third of the posterior tuberosity
- type IV: "beak" fracture but with a small triangular fragment separated by deep fibers only from the upper border of the tuberosity
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Treatment and prognosis
Typically, treatment is with open reduction - internal fixation (ORIF), although minimally displaced fractures may be treated with closed reduction. They have a higher rate of malunion/non-union 4.
References
- 1. Rijal L, Sagar G, Adhikari D et-al. Calcaneal tuberosity avulsion fracture: an unusual variant. J Foot Ankle Surg. 2012;51 (5): 666-8. doi:10.1053/j.jfas.2012.05.004 - Pubmed citation
- 2. Banerjee R, Chao JC, Taylor R et-al. Management of calcaneal tuberosity fractures. J Am Acad Orthop Surg. 2012;20 (4): 253-8. J Am Acad Orthop Surg (full text) - doi:10.5435/JAAOS-20-04-253 - Pubmed citation
- 3. Beavis RC, Rourke K, Court-Brown C. Avulsion fracture of the calcaneal tuberosity: a case report and literature review. Foot Ankle Int. 2008;29 (8): 863-6. doi:10.3113/FAI.2008.0000 - Pubmed citation
- 4. Narayanasamy S, Krishna S, Sathiadoss P, Althobaity W, Koujok K, Sheikh AM. Radiographic Review of Avulsion Fractures RadioGraphics Fundamentals | Online Presentation. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1496-1497. doi:10.1148/rg.2018180064 - Pubmed
- 5. Lee SM, Huh SW, Chung JW, Kim DW, Kim YJ, Rhee SK. Avulsion fracture of the calcaneal tuberosity: classification and its characteristics. (2012) Clinics in orthopedic surgery. 4 (2): 134-8. doi:10.4055/cios.2012.4.2.134 - Pubmed
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