Diagnosis is made radiographically with foot radiographs with CT scan often being required for surgical planning. Skin compromise at presentation was significantly associated with soft tissue complication (P = .036) and failure of fixation (P = .046). 10:896790. doi: 10.3389/fbioe.2022.896790. A beak fracture was simulated in synthetic bones and assigned to five different groups of fixation: A) In type I fractures, a shell of bone avulses from the posterior tuberosity. (A), Characteristics of the avulsion fracture. 2015 Feb 5;20:106. doi: 10.11604/pamj.2015.20.106.5709. Outcome measures were peak-to-peak displacement, total displacement, plastic deformation, stiffness, visual-fracture-line displacement, and mode of implant failure. Br. As mentioned previously, our results raise concerns about the fixation of beak-type fractures using plate osteosynthesis. Although suture anchors were not included in the test protocol, they may also be used to augment screw fixation for bony fragments (Khazen et al., 2007; Yoshida et al., 2016). For the load level of 100N, means were 0.1 0.1mm in Group A, 0.3 0.2mm in Group B, and 0.2 0.1mm in Group C. There was no significant difference. 2013 Nov;44(11):1483-5. doi: 10.1016/j.injury.2013.01.033. Of the 22 that underwent surgery, 6 (27%) had failure of fixation. eCollection 2018. Foot Ankle Surg. This site needs JavaScript to work properly. Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. RM: manuscript revision, clinical input, and data interpretation. Methods: (B) X-ray after urgent reduction and screw fixation. (2008) described three different fracture types based on the extent to which the tendon insertion is affected at the tuber calcanei. HHS Vulnerability Disclosure, Help This method may also reduce the necessity of implant removal. Type II or beak fractures are uncommon. -Ant. Neuropathic calcaneal tuberosity avulsion fractures. Epub 2021 Aug 13. Calcaneal fractures The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Type V fractures are comminuted fractures with a centrally depressed fragment. Foot Calcaneus. Epub 2020 Sep 5. Dec 416, 2022. Cement-augmented Screw Fixation for Calcaneal Fracture Treatment: a Biomechanical Study Comparing Two Injectable Bone Substitutes. As anticipated, large 6.5-mm screw diameters provide the best biomechanical fixation. 3) In general, 2.3-mm or 2.8-mm bend plates cannot be recommended. One specimen failed by fracture at the level of the caudal screw. (A) Fixation device for synthetic bone specimens to the material testing machine. Bone Substitute First or Screws First? The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The joint depression is notorious for the degree of joint involvement and displacement. doi:10.1111/os.12058, Keywords: foot, ankle, Achilles, tendon, fracture, Citation: Jordan MC, Hufnagel L, McDonogh M, Paul MM, Schmalzl J, Kupczyk E, Jansen H, Heilig P, Meffert RH and Hoelscher-Doht S (2022) Surgical Fixation of Calcaneal Beak FracturesBiomechanical Analysis of Different Osteosynthesis Techniques. 2022 Lineage Medical, Inc. The site is secure. (A) In type III fracture, only the superficial fibers are involved with the avulsed fracture fragment (. sharing sensitive information, make sure youre on a federal Executive Editors. FOIA (2015). The horizontal column represents the groups tested (AE). Sci. Bhlers angleA decrease in Bhlers angle demonstrates the severity of joint injury and displacement (depression) as measured on the lateral x-ray. MeSH J. Orthop. Plate fixation should be implemented with precaution and in combination with a restrictive postoperative motion protocol. Biotechnol. Foot Ankle Int. Department of Orthopedics, Balgrist University Hospital, Switzerland. This fracture occurs as a result of the Achilles tendon, which is extremely strong, avulsing a posterior fragment which may be either intra- or extraarticular. In calcaneal beak fractures, the skin and soft tissue cover over the heel is at risk and should be handled with great caution (Banerjee et al., 2012; Gitajn et al., 2015; Mitchell et al., 2019). Foot Ankle Surg. This unusual displaced calcaneal fracture can be intra- or extraarticular. 1979;134:214-6. Reposition was achieved by a pointed reduction clamp and temporarily fixed by k-wires. The most important feature of this Finally, clinical cases about the surgical application and recovery are included. In case 3 complicated by the skin ulcer, the skin behind the bone fragment was pressed by a large piece of the beak fracture (Beavis type II) for 1 week until the operation. A power analysis was performed in previous tests using a power of 80% and a significance level of 5%, which showed that the sample size was adequate. This CT shows a normal foot and an axial cut of a patient with a beak fracture, showing the double line of the articular surface which demonstrates the articular split. Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures. FIGURE 6. Type 3. Orthop. Group B was stabilized with two cannulated 4.0mm partially threaded screws and washers (length 44mm, REF 407.644, DePuy Synthes). doi:10.1302/0301-620x.35b1.33, Yoshida, K., Kasama, K., and Akahane, T. (2016). Two subjects required below knee amputation. 2 Classification for calcaneal avulsion fractures. This classification was first published in 1951-52*. Detailed step by step desription of ORIF - screw fixation for Extreme tongue-type (beak) fracture of the calcaneus body located in our module on Foot Calcaneus The involved fibers of the Achilles tendon according to the fracture type. Test set-up and fixation in the material testing machine. type B: fracture of the mid calcaneus, trochlear process, and sustentaculum tali Calcaneal fractures are best assessed with a calcaneal series of radiographs, though are often identified on a lateral ankle radiograph if the presentation does not lead the requesting of calcaneal views specifically. 2021 Jan-Feb;60(1):218-220. doi: 10.1053/j.jfas.2020.09.001. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Federal government websites often end in .gov or .mil. Results: The Achilles tendon was simulated by a braided synthetic band (kwb Germany GMBH, LC 1500daN, Art.-Nr. Description of Extreme tongue-type (beak) fracture of the calcaneus body. Parameters measured were peak-to-peak displacement for 100, 200, and 300N in mm, stiffness (N/mm) and plastic deformation (mm), total displacement (mm), load-to-failure (N), and mode of failure (anterior fracture, caudal screw cut-out and cranial screw pull-out, caudal screw cut-out, caudal and cranial screw pull-out, pull-out of the fracture-fragment from the caudal screw, pull-out of the fracture fragment from both screws, fracture of the fracture-fragment at the caudal screw, fracture of the fracture fragment at the site of the cranial screws, and plastic deformation of the plate). Type I is a sleeve fracture in which the shell of the cortical bone is avulsed from the posterior tuberosity. Type II fracture is the classical beak fracture, and type III fracture is the infrabursal avulsion fracture from the middle third of the posterior tuberosity. Epub 2013 Mar 4. Methods: FIGURE 9. Clin. (D) Revision performed using a combination of screw and plate osteosynthesis. Type 1 is simple avulsion with variable sized bone fragment, type 2 is beak fracture with horizontal fracture extending into posterior body, type 3 is avulsion by superficial fibers of middle third of Achilles tendon, and type 4 is small beak fracture avulsed from deep fibers of tendon. (C) 5.0 headless cannulated compression screw. 95144. Foot Ankle Int. Fractures of the Calcaneum. AO Davos Courses 2022. Am. Calcaneus - Extreme tongue-type (beak) fracture AuthorsAuthors Beak fracture This unusual displaced calcaneal fracture can be intra- or extraarticular. Foot Ankle Surg. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. Breakout of the fragment happens when plates are used. doi:10.5435/JAAOS-20-04-253, Beavis, R. C., Rourke, K., and Court-Brown, C. (2008). Type III (20%) are oblique fractures. Fractures of the calcaneus are common and account for approximately 60% of tarsal injuries. Federal government websites often end in .gov or .mil. -. The distinction lies in that the avulsion fracture pulls the entire Achilles tendon from its insertion. Surprisingly, the 5.0-mm headless cannulated compression screws yield reliable stability despite the absent screw head and washer. FIGURE 2. Plate fixation was found to be significantly weaker. In each group, ten synthetic bone specimens of the calcaneus were used. 1), S44S45. To our knowledge, no biomechanical study has been conducted regarding the use of 2.3- or. Physical Therapy Management [edit | edit source] There are many similarities between nonoperative and operative physical therapy management of calcaneal fractures. Beavis and colleagues describe a modified classification for calcaneal tuberosity avulsions. Pan Afr Med J. The fracture healed completely, and the clinical function was excellent after 6months (Figure 8). Connect with peers, learn from experts. Two-thirds of the bone specimen was embedded in the fixation device using calcium sulfate Ca [SO4] 2H2O, leaving the tuber calcanei free. Copyright 2022 Elsevier B.V. or its licensors or contributors. The integrated software (Correlate Professional, 2018; GOM) captured marker displacement. A total of 50 synthetic bone specimens of the calcaneus (LD 9118; Synbone, Zizers, Switzerland) were used in this study. (B) 4.0-mm partial threaded cannulated screw. For cyclic testing at 300N, means were 1.8 1.2mm in Group A, 3.3mm 1.6mm in Group B, and 1.6 1.0mm in Group C. Data showed a significant difference between groups B and C with p = 0.048. The site is secure. Calcaneus - Extreme tongue-type (beak) fracture AuthorsAuthors Beak fracture This unusual displaced calcaneal fracture can be intra- or extraarticular. Background: The purpose of this study was to evaluate prognostic predictors of complications and need for secondary surgery in a series of calcaneal avulsion fractures. Surgical Management for Avulsion Fracture of the Calcaneal Tuberosity. The advantage of the percutaneous operative technique is the very low risk of soft tissue trauma compared to open techniques. Normally distributed data were compared using analysis of variance and the Bonferroni correction. Calcaneal Avulsion Fractures: A Multicenter Analysis of Soft-Tissue Compromise and Early Fixation Failure. We use cookies to help provide and enhance our service and tailor content and ads. Orthopedic Surgery, 01 Dec 1969, 20(15): 1577-1578 Language: jpn Surgical management of calcaneus fractures: indications and techniques. Calcaneus fractures are the most common fractured tarsal bone and are associated with a high degree of morbidity and disability. 55, 891893. The stability is inferior compared to screws. Gardner MJ, Nork SE, Barei DP, Kramer PA, Sangeorzan BJ, Benirschke SK. 15, 533. doi:10.1186/s13018-020-02009-6, Gitajn, I. L., Abousayed, M., Toussaint, R. J., Vrahas, M., and Kwon, J. Y. However, it is difficult to fix the bone fragment rigidly, because the avulsed bone fragment is small and thin, and the bone quality of the calcaneal body in the elderly is poor. However, lack of biomechanical understanding of the ideal fixation technique persists. Sustentaculum. The most important feature of this fracture is its association with significant soft-tissue injury and potential soft-tissue complications. Epub 2013 Feb 20. Pathology. The original contributions presented in the study are included in the article/Supplementary Material; further inquiries can be directed to the corresponding author. eCollection 2021. The seemingly easy extra-articular tongue-type or beak-fractures (Fig. Innovative Fixation Technique for Avulsion Fractures of the Calcaneal Tuberosity. volume 35-B, 3345. Radiographic signs of calcaneal fracture. MeSH Jordan MC, Hufnagel L, McDonogh M, Paul MM, Schmalzl J, Kupczyk E, Jansen H, Heilig P, Meffert RH, Hoelscher-Doht S. Front Bioeng Biotechnol. 8600 Rockville Pike Orthop. Foot Ankle Int. Front. Avulsion Fracture of the Calcaneal Tuberosity: a Case Report and Literature Review. The https:// ensures that you are connecting to the FIGURE 1. 1953;35(1):3345. The .gov means its official. However, the dominant cause of type II (5/20 cases) fractures a direct blow or hit directly to the bone. Careers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. If this angle remains above 15 degrees, nonoperative care can be suggested. government site. Out of 764 cases of calcaneal fractures, we examined 20 cases (2.6%) that involved the tuberosity of the calcaneus. Treatment usually requires osteosynthesis. Revised proximal femur module Surg. Before Unable to load your collection due to an error, Unable to load your delegates due to an error. This site needs JavaScript to work properly. 59-31). 8600 Rockville Pike Conclusions: The fixation device was mounted to the bottom of the testing machine, and the synthetic band simulating the Achilles tendon was affixed to a clamp connected to the load cell. SH-D received funding from Medartis for biomechanical projects not related to this work. Fractures of the calcaneum, with an atlas illustrating the various types of fracture. FIGURE 3. Our data confirm the biomechanical stability of 4.0- and 6.5-mm cannulated partially threaded screws with round washers. Note that in the tongue-type fracture the fracture exits posteriorly, splitting the posterior portion into two. Skin necrosis will occur within 6 h if not reduced. Surgical Fixation of Calcaneal Beak Fractures-Biomechanical Analysis of Different Osteosynthesis Techniques. 28, 11831186. Type I were usually caused due to an accidental trip causing a fall by the patient. JS: manuscript revision and figure modification. doi:10.1053/j.jfas.2018.09.002, Elfar, J. J., Menorca, R. M. G., Reed, J. D., and Stanbury, S. (2014). 2002;69(4):209-18. Connect with peers, learn from experts. Calcaneal Avulsion Fractures. classified these injuries into four types depending on the size of fracture and angulation of the calcaneocuboid joint with stress: type 1, no fracture and an increased angle Beak fracture - oblique fracture line runs posteriorly from most superior portion of the posterior facet. Joseph Schatzker. In: Rockwood CA, Green DP, Bucholz RW, editors. MeSH Calcaneus fractures are the most common fractured tarsal bone and are associated with a high degree of morbidity and disability. (B) Optical measuring machine. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. A p-value of <0.05 was considered statistically significant. In two cases, cut-out of the caudal screw occurred without pull-out of the cranial screw. At a load of 100N, means were 185N/mm 42N/mm in Group A, 124N/mm 28N/mm in Group B, 148N/mm 31N/mm in Group C, 44N/mm 23N/mm in Group D, and 37N/mm 7N/mm in Group E. Statistical analysis showed differences between groups C and E with p = 0.006, between groups C and D with p = 0.006, between groups A and E with p < 0.001, and between groups A and D with p < 0.001. To avoid an iatrogenic burst of the bony fragment through the use of inadequate screws, we recommend a screw-bone ratio of roughly 1:2 (Figure 7). Common causes and fracture types. (C) Band mimicking the Achilles tendon to apply tension to the fragment. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Li YP, Zhao QA, Shi FM, Xu HP, Dong P, Tang HL, Tang X. Zhongguo Gu Shang. FIGURE 5. Creative Commons Attribution License (CC BY). AO Surgery Reference. The calcaneal beak fracture is a rare avulsion fracture of the tuber calcanei characterized by a solid bony fragment at the Achilles tendon insertion. Bone Jt. The .gov means its official. The available data indicate 5, 196202. All rights reserved, avulsion injury of the bifurcate ligament, in-situ arthrodesis with preserved calcaneal height, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws. [Article in German] Authors P Schreinlechner, W Calcaneus / injuries* Group E was stabilized by a lateral 2.8mm locking plate (2.8 TriLock Grid Plate 3 + 3 hole, 43mm, t1.6, APTUS, REF A-4850.69, Medartis) and locking screws (1420mm) (Figures 2, 3, and Table 1). Treatment usually Calcaneoplasty coupled with an insertional Achilles tendon reattachment procedure for the prevention of secondary calcaneal impingement: a retrospective study. https://doi.org/10.1053/j.jfas.2020.09.001. Dec 416, 2022, Revised distal humerus module is now online, with displacement of more than a few millimeters posteriorly, present or impending posterior soft-tissue compromise. Implant material was purchased from DePuy Synthes with a 30% research discount. For cyclic testing at 300N, the means were 202N/mm 25N/mm in Group A, 114N/mm 15N/mm in Group B, and 134N/mm 22N/mm in Group C. The data showed significant differences between groups A and B and groups A and C with p < 0.001 (Figure 5). Foot Ankle Specialist 8, 1017. Acad. The .gov means its official. However, screw revision may be more difficult due to the challenge of finding the screw head under the bone level. Three specimens failed by a simultaneous cut-out of the caudal screw and pull-out of the cranial screw. We see first an example of a joint depression and in the lower image a tongue type. (2019). Hisatomi T. Seikeigeka. Important outcome. type III: infrabursal avulsed fracture by superficial fibers from the middle third of the posterior tuberosity. -, Beavis RC, Rourke K, Court-Brown C. Avulsion fracture of the calcaneal tuberosity: a case report and literature review. Orthop. Would you like email updates of new search results? For 200N, means were 1.1 0.6mm in Group A, 3.0 1.8mm in Group B, and 0.7 0.1mm in Group C. At this level, statistical differences could be seen between groups A and B with p = 0.002 and between groups B and C with p < 0.001. In contrast, the stability of plate fixation was disappointing. Despite these limitations, this study represents the largest biomechanical study to date regarding this uncommon injury. Despite this, results for the most promising fixation techniques require follow-up confirmation in a biomechanical setting with cadaver specimens. Bethesda, MD 20894, Web Policies 20, 253258. Fixation of tendo Achilles avulsion fracture. Because of ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. When such large screws cannot be applied, 4.0-mm screws also allow reasonable fixation strength. HHS Vulnerability Disclosure, Help Surg. This became most obvious under high loads. doi:10.3113/FAI.2007.1183, Lee, S.-M., Huh, S.-W., Chung, J.-W., Kim, D.-W., Kim, Y.-J., and Rhee, S.-K. (2012) Avulsion Fracture of the Calcaneal Tuberosity: Classification and its Characteristics. and transmitted securely. In Group E, the same mode of failure could be seen as in the majority of Group D. All objects failed by breakout of the fragment at the site of the screws (Figure 6; Supplementary Video S1). PMC Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. PH: conducting biomechanical tests (optical system). J Orthop Trauma. official website and that any information you provide is encrypted This site needs JavaScript to work properly. Fixation of Calcaneal Avulsion Fractures Using Screws with and without Suture Anchors: a Biomechanical Investigation. A Biomechanical Comparison of Two Operative Techniques for Tibial-Head Depression Fractures. Before Bethesda, MD 20894, Web Policies For type II fractures, the literature recommends open reduction and fixation using 4.5- or 6.5-mm partially threaded screws (Banerjee et al., 2012; Gitajn et al., 2015). Means for cyclic testing at 200N were 0.30 0.26mm in Group A, 1.99 1.66mm in Group B, and 0.38 0.15mm in Group C. Significant differences could be seen between groups A and B with p = 0.001 and between groups B and C with p = 0.016. Classification of avulsion fracture of the calcaneal tuberosity. sharing sensitive information, make sure youre on a federal Screw-to-bone ratio. Methods: Thirty eCollection 2022. eCollection 2020. 2022 Mar;53(3):1276-1282. doi: 10.1016/j.injury.2021.12.046. No use, distribution or reproduction is permitted which does not comply with these terms. Medartis provided the implant material without cost. For the load level of 300N, the means were 0.56 0.45 mm in Group A, 2.94 1.73mm in Group B, and 1.34 1.06mm in Group C. The difference between groups A and B was statistically significant, with p = 0.008 (Figure 4). Warrick CK, Bremner AE. -, Lui TH. Drop-out occurred during the cyclic loading at 300N for one specimen in Group A, three specimens in Group B, and one specimen in Group C. Biomechanical data: Means at the load level of 100N were 0.5 0.3mm in Group A, 0.8mm 0.4mm in Group B, and 0.4mm 0.2mm in Group C. There was a significant difference between Group B and C with p = 0.023. 2008;29(8):863866. In Group A, four specimens developed an anterior fracture at the screw ends. type II: "beak" fracture with oblique fracture line running posteriorly from just behind Bohler's angle. 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. Careful selection of screw sizes is vital and screw size is limited by the dimensions of the fragment. Type I (20%) J. muscle strength) -Widening of calcaneal shaft through displacement of its LATERAL margin (impinges peroneal) -VARUS deformation of calcaneal tuberosity. Would you like email updates of new search results? 772,395) attached to the fragment (EPO-X-Y, Roxolid, Germany and staples). The normal angle is 25 degrees to 40 degrees. 2020 Aug 3;11:2040622320944793. doi: 10.1177/2040622320944793. MJ: study design, establishing the test set-up, conducting biomechanical tests, funding, and manuscript development. (A) Beak fracture characterized by a solid bone part in a 61-year-old female patient. Foot Ankle Surg. FIGURE 7. and transmitted securely. More markers were attached to the fixation device as reference points (Figure 1). [The so-called duck beak fracture] [The so-called duck beak fracture] Hefte Unfallheilkd. The vertical column describes the different modes of failure. 2022 Aug 4;10:896790. doi: 10.3389/fbioe.2022.896790. 10 Articles, This article is part of the Research Topic, https://doi.org/10.3389/fbioe.2022.896790, https://www.frontiersin.org/articles/10.3389/fbioe.2022.896790/full#supplementary-material. In these and in revision cases, plate fixation may be an option. Because of marked disruption of the posterior soft tissues, if it does not present as an open fracture at the time of admission to hospital, the pressure from within on the posterior skin will soon cause it to break down and convert it into an open fracture. government site. Andermahr et al. Three specimens in Group D and one in Group E lasted the 1,000 cycles at 100N. This rendered a sufficient statistical analysis of these groups impossible. Please enable it to take advantage of the complete set of features! Furthermore, while fixation of the tension band on the tuber calcanei was challenging, the simple test set-up does not mimic the properties of in vivo Achilles tendons. There was a need for secondary operations in 12 cases. Pi Y, Hu Y, Guo Q, Jiang D, Xie X, Zhao F, Chen L, Ao Y, Jiao C. Ther Adv Chronic Dis. The beak fracture is a rare calcaneal fracture subtype of the posterior calcaneal tuberosity (Warrick and Bremner, 1953; Carnero-Martn de Soto et al., 2019). 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. MP: manuscript revision and data processing. Fragment pull-out occurred in 5.0-mm headless cannulated compression screws. 2022 Mar;53(3):1276-1282. doi: 10.1016/j.injury.2021.12.046. Severe trauma in the form of falls or jumps from great heights as well as motor vehicle accidents are the main culprits for a fractured calcaneus. Comorbid conditions and increased age portend a poor prognosis with a significant association with wound complications and need for additional surgeries. Background: [Fractures of the calcaneus--new trends in management]. doi:10.5435/00124635-201402000-00006, Fuchs, K. F., Heilig, P., McDonogh, M., Boelch, S., Gbureck, U., Meffert, R. H., et al. Beavis et al. Philadelphia: Lippincott Williams & Wilkins; 2006. pp. The injury itself is usually the result of sudden and disproportional muscular contractions, where the Achilles tendon rips a solid bony fragment out of the tuberosity. J. Orthop. Not much is known regarding avulsion fractures of the calcaneal tuberosity. 1952 Mar;39(157):395-419. Locking screws from 1420mm were used. None of the plates was able to tolerate loads above 100N. In terms of overall stability, the best results were observed with 6.5-mm cannulated partially threaded screws, followed by 5.0 headless cannulated compression screws and 4.0-mm cannulated partially threaded screws, respectively. A combination of plate and screw fixation is also possible (Yu et al., 2013). Richard Buckley, Andrew Sands. J. Patient and family education is crucial for enabling the patient to understand the significance of this injury. The test protocol was determined according to our own pretests (load range 10400N; number of test cycles 108000). Means for cyclic testing at 300N were 0.7 0.6mm in Group A, 3.1 2.3mm in Group B, and 1.4 1.1mm in Group C. There was a significant difference between groups A and B with p = 0.006. Biotechnol., 04 August 2022, View all Authors of section Authors. Few injuries are more devastating or have more long-term impact on a patients life. Computed tomographyIf there is time before skin compromise, a CT will be helpful to discern the exact amount of joint displacement. Careers. Calcaneal Avulsion Fractures: A Multicenter Analysis of Soft-Tissue Compromise and Early Fixation Failure. Prognostic factors for outcome measures were identified. Type of implant failure sorted by groups. Please enable it to take advantage of the complete set of features! Giordano V, Godoy-Santos AL, de Souza FS, Koch HA, de Cesar Netto C, Rammelt S. Case Rep Orthop. and transmitted securely. Main indications. A very low stiffness is noticeable for groups D and E, underlining the weakness of plating. Combined hindfoot injuries; Further reading 3; Open fractures, Compartment syndrome, Infections 3; Body. Epub 2021 Dec 31. Would you like email updates of new search results? (2020). (B) Cracks and bursts of the fracture can occur when the screw size is not appropriate. In cases where plates are used for surgical revision, limited postoperative mobilization is vital. 2019 Nov;33(11):e422-e426. RM is president of the International Bone and Research Association. Outcomes of operatively treated calcaneal tuberosity avulsion fractures. But the clinical advantage of these headless cannulated compression screws requires evaluation through clinical studies and cannot be confirmed by our biomechanical study. J. doi:10.1177/1938640014548323, Hoelscher-Doht, S., Jordan, M. C., Bonhoff, C., Frey, S., Blunk, T., and Meffert, R. H. (2014). articular surface - displaced. EK: data collection and processing. The purpose of this study was to evaluate prognostic predictors of complications and need for secondary surgery in a series of calcaneal avulsion fractures. Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Clin Interv Aging. The fragment in Group A was fixed using two cannulated 6.5mm threaded screws with underlying washers (length 45mm, REF 408.431, b7, DePuy Synthes, Johnson & Johnson, United States). White arrows indicate fracture. Court-Brown CM, Caesar BC. Means at 200N were 206N/mm 48N/mm in Group A, 121N/mm 26N/mm in Group B, and 151N/mm 29N/mm in Group C. There was a significant difference between groups A and B with p = 0.002. Main outcome measurement was need for secondary surgical procedures. J Bone Joint Surg Br. Most anterior process fractures of the calcaneus can be treated non-surgically. 2021 May 28;8:620964. doi: 10.3389/fsurg.2021.620964. Previous studies have shown that the biomechanical properties of synthetic bone and human specimens are similar, and our pre-tests confirmed these findings. Increased age was significantly associated with wound complications (P = .029). Surgical management of calcaneus fractures: indications and techniques. process becomes displaced upward. The available data indicate that elderly patients with osteopenic or osteoporotic bones are more likely to be affected by this fracture (Carnero-Martn de Soto et al., 2019; Beavis et al., 2008; Lee et al., 2012). Different traction force levels were applied through an Achilles tendon surrogate in a material-testing machine on all stabilized synthetic bones. HHS Vulnerability Disclosure, Help LH: conducting biomechanical tests, statistics, and data processing. Secondary complications such as soft tissue complications and loss of fixation were noted. doi:10.1053/j.jfas.2016.03.012, PubMed Abstract | CrossRef Full Text | Google Scholar, Banerjee, R., Chao, J. C., Taylor, R., and Siddiqui, A. doi:10.1097/BOT.0000000000001533, Carnero-Martn de Soto, P., Bautista-Enrique, D., Gmez-Cceres, A., Rodrguez-Len, A., Bravo-Zurita, M. J., and Santos-Maraver, M. T. (2019). Visual data: the means were 1.11 0.731mm in Group A, 5.31 2.94mm in Group B, and 3.04 1.44mm in Group C. There was a significant difference between groups A and B with p = 0.002. Given the high potential of failure with some of these methods, this study should help elucidate the most reliable technique (Gitajn et al., 2015). Displaced articular calcaneus fractures: classification and fracture scores: a preliminary study. Visual data: Means at the load level of 100N were 0.09 0.12mm in Group A, 0.26 0.25mm in Group B, and 0.22 0.13mm in Group C. At this level, there was no statistical difference. FOIA 2018 Nov 11;2018:6207024. doi: 10.1155/2018/6207024. Results: 5.0 headless cannulated compression screw, and 4.0-mm partial threaded cannulated screw can also resist high tension forces. They result from an axial load and may demonstrate varying severity, type and location of fracture type.The type of fracture is determined by position of the foot, direction and magnitude of the force and the quality of the bone. Keywords: Surg. Type III (4/20 cases) and IV (3/20 cases) fractures were likely to occur due to falling. 2013 Jun;34(6):773-80. doi: 10.1177/1071100713477607. At 200N load, the means were 0.4 0.3mm in Group A, 2.1 2.1mm in Group B, and 0.5 0.2mm in Group C. Data showed a significant difference between groups A and B with p = 0.013. 2021 Feb 15;16:275-280. doi: 10.2147/CIA.S291497. Despite this success, an open exposure and visually controlled reduction to ascertain anatomic fixation of the fragment may be necessary for more complex fractures and may be superior to percutaneous fixation (Banerjee et al., 2012; Blum et al., 2019). 2022 Aug 4;10:896790. doi: 10.3389/fbioe.2022.896790. Type I (20%) the fracture line may be through the tuberosity, the sustentaculum tali, or the anterior process of the calcaneus. 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. Acta Chir Orthop Traumatol Cech. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3. (2016). Characteristics of the avulsion fracture of the calcaneal tuberosity and recommended treatment. Before The type of fracture is determined by position of the foot, direction and magnitude of the 2007;28(11):11831186. Type I: simple extra-articular avulsion, Type II: beak fracture, Type III: infrabursal avulsion involving superficial fibers of Achilles tendon, Type IV: beak, but a small triangular fragment involoving deep fibers of Achilles tendon. FIGURE 4. Clipboard, Search History, and several other advanced features are temporarily unavailable. A comparison of different synthetic bone models showed that Synbone most closely mimics the bone structure of elderly patients (Hoelscher-Doht et al., 2014; Fuchs et al., 2020). The most caudally positioned marker on the fragment was used for visual analysis of the displacement. 4:134138. The fracture was reduced and fixed with two 1.25mm k-wires. Despite this, we do not recommend plating of beak fractures as a first-line treatment. Bookshelf Prognostic, Level II: Retrospective Analysis. The https:// ensures that you are connecting to the J. Orthop. Instr Course Lect, 39:161-165, 01 Jan 1990 Cited by: 4) Screw cut-out is mode-of-failure in partially threaded screws. (C) Early fracture dislocation after mobilization of the patient. Surgical Fixation of Calcaneal Beak Fractures-Biomechanical Analysis of Different Osteosynthesis Techniques. The size of the triangular fragment was 2.0 3.2 4.2mm. The heel can even widen, shorten, and become deformed. Yeungnam Univ J Med. Innovative Fixation Technique for Avulsion Fractures of the Calcaneal Tuberosity. Br J Surg. doi:10.1016/j.jos.2015.06.011, Warrick, C. K., and Bremner, A. E. (1953). 29, 863866. 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