Avulsion Fracture of the Calcaneal Tuberosity: Classification and Its Characteristics

Abstract

Background Not much is known regarding avulsion fractures of the calcaneal tuberosity. We propose a modified classification scheme that presents the four types of calcaneal avulsion fracture as described by surgical and magnetic resonance imaging (MRI) findings, and evaluation of their specific features. Methods Out of 764 cases of calcaneal fractures, we examined 20 cases (2.6%) that involved the tuberosity of the calcaneus. Each case was classified depending on the avulsed fracture patterns as follows; type I is a 'simple extra-articular avulsion' fracture, type II is the 'beak' fracture, type III is an infrabursal avulsion fracture from the middle third of the posterior tuberosity, and finally in type IV there is the 'beak', but a small triangular fragment is separated from the upper border of the tuberosity. We examined the features of each avulsed type according to several criteria including patient age, gender, anatomical variances of the Achilles tendon, the fibers involved and the mechanism of injury. Results The type I fracture (8/20 cases) was the most common and likely to occur in elderly women. However, in other types, they were more common in relatively younger male patients. Type I were usually caused due to an accidental trip causing a fall by the patient. However, the dominant cause of type II (5/20 cases) fractures a direct blow or hit directly to the bone. Type III (4/20 cases) and IV (3/20 cases) fractures were likely to occur due to falling. All fibers within the Achilles tendon are involved in both type I and II fractures. However, only the superficial fibers are involved in type III fractures, whereas the deep fibers are involved in type IV fractures. Conclusions The avulsion patterns of the calcaneal tuberosity fractures are the result of several factors including the bony density level, the mechanism of injury and the fibers of the Achilles tendon that transmit the force. Accurate diagnosis of type III and IV is dependant on MRI technology to confirm the specific location of the injury and provide proper patient treatment therapeutics.

Comparison of the Outcomes of Two Operational Methods Used for the Fixation of Calcaneal Fracture

“…Wound dehiscence, infection, and pain are the most common post-operative complications of the calcaneal fracture. In case of the plate fixation, a longer incision, exposure of the internal tissue for an increased time, and selection of an improper plate have been indicated as the possible causes of these complications [5,20]. While the prolonged exposure of the wound increases the risk of infection by pathogens, the hindered blood flow due to the use of tourniquet results in weakened barrier to the invading pathogenic bacteria.…”

Avulsion fractures in the foot: telltale radiographic signs to avoid mismanagement

“…If large fragments involve the insertion of the Achilles tendon, tendon lengthening may be required in addition to surgical fixation [38]. Lee et al [43] recommend a cancellous screw for type I fractures associated with osteoporotic insufficiency fractures, emergency reduction for type II fractures to avoid skin necrosis of the posterior heel, suture anchor fixation for small fragments involved in type III fractures, and conservative treatment for type IV fractures.…”

“…Lee et al [43] modified a classification scheme proposed by Beavis et al [44] for calcaneal tuberosity avulsion fractures based on magnetic resonance imaging and surgical findings. Type I is a simple extraarticular fracture.…”

A Novel Technique for Calcaneal Avulsion Fracture: A Case Report

“…A type I fracture is a true avulsion type, called a "sleeve" fracture; a type II fracture is an "open beak" type; and a type III fracture is a type of infrabursal avulsion of the middle third of the tuberosity [3]. Recently, Lee et al modified the classification to include four types [4]. In this classification, the type I, II, and III fractures are the same as the previous classification.…”