Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To evaluate the need for reoperation of geriatric intertrochanteric hip fractures treated with 10-mm cephalomedullary nails versus those treated with nails larger than 10 mm. Design:Retrospective review at a single institution.Setting: Level I trauma center.Patients/Participants: All patients age 60 and over treated with cephalomedullary fixation for an intertrochanteric femur fracture at a single institution.Intervention: Cephalomedullary fixation with variable nail diameters.Main Outcome Measurements: Reoperation rates of geriatric intertrochanteric fractures treated with a size 10-mm diameter cephalomedullary nail compared with patients treated with nails larger than 10 mm.Results: There were no significant differences in reoperation rates when the 10-mm cohort was compared with an aggregate cohort of all nails larger than 10 mm (P = 0.99). This result was true for both allcause reoperation and noninfectious reoperation. There was no difference between cohorts in regards to age, gender, or fracture pattern.Conclusions: A 10-mm cephalomedullary nail can be used in lieu of a larger diameter fixation in patients age 60 and older with intertrochanteric femur fractures while still maintaining a comparable rate of reoperation.

Objective: To characterize the presentation and outcomes of calcaneal avulsion fractures. Design: Case series. Setting: Two ACS Level I trauma centers. Patients/Participants: Forty-seven calcaneal avulsion fractures isolated from a cohort of 1365 calcaneus fractures treated over a 17-year period. Main Outcome Measurements: We collected instances of soft-tissue compromise at presentation, evidence of implant failure or fracture displacement after fixation, and reoperation. Results: Forty-one patients were treated operatively, and 6 were treated without surgery. Twenty-one patients (44.7%) had either soft-tissue compromise or an open fracture necessitating urgent treatment at the time of presentation. Of those patients treated operatively with 3-month follow-up (n = 39), 28.2% of patients (11/39) had evidence of implant failure or fracture displacement. Age was the only predictor of catastrophic fixation failure (P = 0.01). The use of washer(s), suture anchor(s), or addition of soft-tissue procedures (eg, Strayer) did not have a significant effect on failure rate. Neither the number of screws used nor size of screw impacted the failure rate. Fourteen patients (35.9%) underwent a secondary operation. Discussion: Avulsion fractures of the calcaneus commonly present with soft-tissue compromise and have a significant rate of treatment failure and reoperation. This injury should be identified early and approached thoughtfully, acknowledging that risks are high. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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