Journal List > J Korean Foot Ankle Soc > v.22(2) > 1096557

Lee, Bak, and Lim: Calcaneal Apophyseal Avulsion Fractures with Achilles Tendon Rupture in a 10-Year-Old Patient: A Case Report

Abstract

Calcaneal apophysitis is a relatively common disease in young athletes. On the other hand, if not treated properly, it can lead to apophyseal avulsion fracture in rare cases. In the case of apophyseal avulsion fractures, it is often necessary to remove or preserve the bone fragment, which often requires a suture of the Achilles tendon. A 10-year-old badminton athlete visited the outpatients’ clinic with pain in both heels from 10 months ago without any trauma history. After conservative therapy, the pain in the left heel was relived but the right heel pain persisted. After 10 months of conservative therapy, the patient visited the outpatients’ clinic showing a calcaneal apophyseal avulsion fracture with a total rupture of the Achilles tendon. In the operation room, a bone fragment needed to be removed because of its poor viability and the fragment was too thin for fixation. After removing the bone fragment, the ruptured Achilles tendon was fixed with an anchor system.

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Figure 1.
Representive T1-weighted (A) and T2-weighted (B) proton density sagittal magnetic resonance image illustrating complete rupture of Achilles tendon. Demonstrating avulsion fracture and Achilles tendon retraction.
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Figure 2.
Skin dimpling of right heel. (A) Posterior aspct of ankle. (B) Lateral view.
jkfas-22-74f2.tif
Figure 3.
Bone fragment translation. (A) Initial simple radiograph. (B) Ten months later preoperative simple radiograph.
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Figure 4.
(A, B) Operative findings with bone fragment at the proximal segment of Achilles tendon (arrows). (C) Bone fragment.
jkfas-22-74f4.tif
Figure 5.
Operative procedure with anchor system. (A) Insert anchor by pushing into calcaneal tuberosity. (B) Achilles repair by ankor suture.
jkfas-22-74f5.tif
Figure 6.
(A, B) Postoperative anteroposterior and lateral plain radiography. (C) Last follow-up, postoperative day 6 months lateral plain radiography.
jkfas-22-74f6.tif
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