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Abstract
Secondary soft tissue injuries can occur from the pressure of the displaced fragment of posterior calcaneal tuberosity in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The soft tissue injury can be prevented by immediate reduction of the displaced fragments. Various techniques can be used to fix the fracture fragments, but the stability of fixation and minimal invasiveness to soft tissue should be considered. This paper reports the successful outcomes of patients with soft tissue compromises in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The fixation technique of a large cannulated screw and simple cerclage wiring is believed to be a useful surgical option for the treatment of secondary soft tissue compromised calcaneal fractures.
Figures and Tables
Figure 1
(A) Initial gross photograph showed skin breakdown on posterior heel due to displaced fragment. Initial lateral (B) and axial (C) radiographs showed displaced posterior tuberosity fragment in tongue-type calcaneal fracture. Postoperative lateral (D) and axial (E) radiographs showed reduction and internal fixation of the cannulated screw and cerclage wiring. (F) Postoperative gross photo at 1 week showed skin necrosis.
Figure 2
Surgical technique. (A) After paratendinous longitudinal incision, open reduction was done using reduction clamp and guide pin was inserted. (B) A large cannulated screw (5.0 mm or 6.5 mm sized) was inserted with a washer. (C) As an augmented reduction, cerclage wiring was done percutaneously using cruciate guide pin or wire passer. (D) The wire was tensioned, and the screw was tightened finally.
Figure 3
Postoperative lateral (A) and axial (B) radiographs at 1 year showed radiological union of calcaneus.
Figure 4
(A) Initial gross photograph showed skin tenting on posterior heel due to displaced fragment. (B) Initial lateral radiograph showed displaced posterior tuberosity fragment in calcaneal tuberosity avulsion fracture. (C) Postoperative radiograph showed reduction and internal fixation of the cannulated screw and cerclage wiring.
References
1. Gardner MJ, Nork SE, Barei DP, Kramer PA, Sangeorzan BJ, Benirschke SK. Secondary soft tissue compromise in tongue-type calcaneus fractures. J Orthop Trauma. 2008; 22:439–445.
2. Chhabra N, Sherman SC, Szatkowski JP. Tongue-type calcaneus fractures: a threat to skin. Am J Emerg Med. 2013; 31:1151.e3–1151.e4.
3. Snoap T, Jaykel M, Williams C, Roberts J. Calcaneus fractures: a possible musculoskeletal emergency. J Emerg Med. 2017; 52:28–33.
4. Brunner CF, Weber BG. Internal fixation plates with a specialized form or function. In : Brunner CF, Weber BG, editors. Special techniques in internal fixation. Berlin: Springer-Verlag Berlin Heidelberg;1982. p. 145–165.
5. Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury. 2004; 35:443–461.
6. Squires B, Allen PE, Livingstone J, Atkins RM. Fractures of the tuberosity of the calcaneus. J Bone Joint Surg Br. 2001; 83:55–61.
7. Khazen GE, Wilson AN, Ashfaq S, Parks BG, Schon LC. Fixation of calcaneal avulsion fractures using screws with and without suture anchors: a biomechanical investigation. Foot Ankle Int. 2007; 28:1183–1186.
8. Levi N, Garde L, Kofoed H. Avulsion fracture of the calcaneus: report of a case using a new tension band technique. J Orthop Trauma. 1997; 11:61–62.
9. Nagura I, Fujioka H, Kurosaka M, Mori H, Mitani M, Ozaki A, et al. Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients. J Foot Ankle Surg. 2012; 51:330–333.
10. Banerjee R, Chao JC, Taylor R, Siddiqui A. Management of calcaneal tuberosity fractures. J Am Acad Orthop Surg. 2012; 20:253–258.
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