Calcaneal Insufficiency Avulsion Fracture in a Well-Controlled Type 2 Diabetic Patient: A Case Report

Seong-Tae Kim; Myung-Sang Moon; Ki-Tae Kwon; Bong-Keun Park; Chang Won Ha; Jungtae Ahn

doi:10.14193/jkfas.2015.19.2.73

Journal List > J Korean Foot Ankle Soc > v.19(2) > 1043376

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Kim, Moon, Kwon, Park, Ha, and Ahn: Calcaneal Insufficiency Avulsion Fracture in a Well-Controlled Type 2 Diabetic Patient: A Case Report

Case Report

J Korean Foot Ankle Soc 2015;19(2):73-76.

Published online: 19 June 2015

DOI: https://doi.org/10.14193/jkfas.2015.19.2.73

Calcaneal Insufficiency Avulsion Fracture in a Well-Controlled Type 2 Diabetic Patient: A Case Report

Seong-Tae Kim, Myung-Sang Moon, Ki-Tae Kwon, Bong-Keun Park, Chang Won Ha^*, Jungtae Ahn

Department of Orthopaedic Surgery and Traumatology, Jeju, Korea

^*Department of Pathology, Cheju Halla General Hospital, Jeju, Korea

Corresponding Author: Jungtae Ahn Department of Orthopaedic Surgery and Traumatology, Cheju Halla General Hospital, 65 Doryeong-ro, Jeju 690-766, Korea Tel: 82-64-740-5410, Fax: 82-64-743-3110, E-mail: jtahnos@gmail.com

Received 14 November 201427 April 2015 Accepted 3 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The calcaneal insufficiency avulsion fracture usually occurs in an area of fused apophysis in adults without significant history of trauma or overuse activities. It is an uncommon injury which has been described in patients with complicated diabetes, Charcot neuroarthropathy, amyloidosis with neuropathy, severe osteoporosis, and other conditions. Discussion of the issue of fracture location is still not sufficient. We report on a case of a 50-year-old male who experienced a non-traumatic diabetic calcaneal insufficiency fracture. Intraoperatively, a biopsy specimen was obtained from the exposed fracture site for histological study. We assume that the calcaneal fused apophyseal line is the weak point of failure due to various incomplete mixtures of trabecular bone, woven bone, and cartilaginous tissues, and may fail when repeated tensile stress is imposed.

Keywords: Diabetes mellitus, Calcaneus, Insufficiency fracture

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Figure 1.

(A) Lateral radiograph shows about 1.5 cm upwardly displaced large avulsed fragment of calcaneal tubercle. Additionally, another sclerotic insufficiency avulsion fracture was combined which slipped upwardly parallel to the fused apophyseal line. (B) Postoperative radiograph shows reposition and fixation of fracture fragment with cerclage wiring and cannulated screws. (C) Postoperative four months radiograph shows re-displaced fracture fragment. (D) Final followup radiograph shows hardware removal.

Figure 2.

Fracture was fixed with cerclage wiring, cannulated screw and non-absorbable sutures.

Figure 3.

Histologic appearance of insufficiency fracture site is shown in low-power view (H&E stain, ×100; A), high-power view (H&E stain, ×400; B). Hyaline cartilaginous chondrocytes were arranged in small clusters surrounded by large amounts of moderately violescent stained matrix. (C) Abnormally oriented trabecular bone mixed with woven bones (arrow) are seen which is indicating various osteopathies and healing callus (Masson-Trichrome stain, ×200).

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