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Wan KL, Raghavan S, Chua Y, Shanmugam R, Ibrahim MI. A Biomechanical Study of Calcaneal Tuberosity Avulsion Fracture: A Comparison Between Three-Screw Versus Two-Screw Fixation Strength. Cureus 2024; 16:e56967. [PMID: 38665725 PMCID: PMC11044979 DOI: 10.7759/cureus.56967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
A calcaneal tuberosity avulsion fracture constitutes a sub-group of calcaneal fractures and it poses a high risk of soft tissue compromise, necessitating urgent reduction and fixation. This fracture was commonly treated with screw fixation, and fixation failure associated with this method has been reported in the literature. In light of this, we tested and compared the strength of two-screw (2S) versus three-screw (3S) fixations, where the third screw was fixed from the posterior calcaneal tuberosity towards the anterior process in addition to the two parallel screws. Synthetic calcaneum models were tested with an Instron machine to measure the maximum tensile load and stiffness. The mean maximum tensile loads for 3S and 2S were 455.8 N (SD = 47.4) and 341.0 N (SD = 30.9), respectively, and the difference was statistically significant. The mean stiffnesses for 3S and 2S were 29.2 N/mm (SD = 1.8) and 29.7 N/mm (SD = 2.0), but this difference did not reach statistical significance. Based on our findings, the added third screw increased the pull-out strength and can be inserted percutaneously to minimize soft tissue compromise.
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Affiliation(s)
- Kwong-Lee Wan
- Department of Orthopaedics and Traumatology, Raja Permaisuri Bainun Hospital, Ipoh, MYS
| | - Sugesh Raghavan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) University of Malaya, Kuala Lumpur, MYS
| | - YeokPin Chua
- Department of Orthopaedics, Sunway Medical Centre, Subang Jaya, MYS
| | | | - Mohamad Izani Ibrahim
- Department of Orthopaedics and Traumatology, Raja Permaisuri Bainun Hospital, Ipoh, MYS
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Lee HW, Kim KT, Lee S, Yoon JH, Kim JY. Fracture Severity and Triangular Fibrocartilage Complex Injury in Distal Radius Fractures with or without Osteoporosis. J Clin Med 2024; 13:992. [PMID: 38398305 PMCID: PMC10889725 DOI: 10.3390/jcm13040992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The purpose of this study was to investigate the fracture morphology of distal radius fractures (DRFs) with the status of triangular fibrocartilage complex (TFCC) foveal insertion in patients with or without osteoporosis and to identify the relationship between osteoporosis and foveal tear. Seventy-five patients who underwent surgery for DRF from January 2021 to September 2023 were included. All patients were evaluated by standard radiography and dual-energy X-ray absorptiometry and underwent a 3.0 T magnetic-resonance imaging examination of the involved wrist to identify TFCC foveal tear. Patients were allocated into two groups according to the presence of osteoporosis: patients with osteoporosis (group I) and those without osteoporosis (group II). Group I showed a significantly larger displacement of fractures compared to group II (radial inclination; 13.7 ± 5.4 vs. 17.9 ± 4.2; p < 0.001, dorsal angulation; 22.2 ± 12.1 vs. 16.5 ± 9.4; p = 0.024, ulnar variance; 4.15 ± 2.1 vs. 2.2 ± 1.9; p < 0.001). Dorsal angulation and ulnar variance were found to be independent prognostic factors for TFCC foveal tear in logistic regression analysis. Displacement of fractures was related to osteoporosis, and dorsal angulation and ulnar variance were independent prognostic factors for TFCC foveal tear. However, osteoporosis was not identified as a factor associated with TFCC foveal tears.
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Affiliation(s)
- Ho-Won Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
| | - Ki-Tae Kim
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea;
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
| | - Joon-Hyeok Yoon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
| | - Jung-Youn Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
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Liu Z, Hou G, Zhang W, Lin J, Yin J, Chen H, Huang G, Li A. Calcaneal tuberosity avulsion fractures - A review. Injury 2024; 55:111207. [PMID: 37984015 DOI: 10.1016/j.injury.2023.111207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
Calcaneal tuberosity avulsion fracture, an extra-articular injury, is a rare fracture caused internally by Achilles tendon driven following intense contraction of gastrocnemius-soleus complex, and externally by low-energy (possibly high-energy). Moreover, the risk of injuries of the skin and Achilles tendon around calcaneal tuberosity is closely related to Lee classification and Carnero-Martín de Soto Classification of calcaneal tuberosity avulsion fracture. Although the diagnosis confirmed by X-ray, digital imaging and computed tomography (CT), magnetic resonance imaging (MRI) should also be used to evaluate soft tissue. In recent years, the understanding of this fracture has witnessed the development of different internal fixation devices and surgical procedures. These advances have been further elaborated scientifically in terms of their ability to provide stable fracture reduction ad resistance to Achilles tendon forces. In order to obtain a comprehensive knowledge of the disease, this article reviewed the new understanding of the anatomy, typing, risk factors, and treatment modalities of calcaneal tuberosity avulsion fracture in recent years.
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Affiliation(s)
- Zhiyi Liu
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Guodong Hou
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wencong Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Junyan Lin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinrong Yin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Huan Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guowei Huang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
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Lou W, Liu M, Xu D, Li M, Chen J. Outcomes of U-shaped internal fixation in the treatment of avulsion fracture of calcaneal tubercle. BMC Musculoskelet Disord 2023; 24:408. [PMID: 37217900 DOI: 10.1186/s12891-023-06542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze the efficacy of U-shaped internal fixation for calcaneal tubercle fracture after nearly 3 years of case follow-up and data collection. METHOD We retrospectively analyzed the collected data from 16 patients with avulsion fracture of calcaneal tubercle between December 2018 and February 2021 at our institute. All patients were required to conform to regular follow up postoperatively. X-ray film was applied to all cases. The American Orthopaedic Foot and Ankle Association (AOFAS) score, Cedell score and the visual analog scale (VAS) were used to evaluate functional results. RESULTS All patients achieved bone union. The preoperative AOFAS score was 26.34 ± 3.34, which was significantly different from 91.38 ± 6.15 half a year after operation (p = 0.003). The preoperative Cedell score was 31.05 ± 4.18 and the score half a year after operation was 92.17 ± 5.39(p = 0.011). The VAS score was 8.91 ± 1.51 before operation and decreased to 0.58 ± 1.31 half a year after operation (p = 0.014). CONCLUSIONS In the treatments of calcaneal tubercle fracture, U-shaped internal fixation is a new attempt. Through the short-term follow-up study, we found that its therapeutic effect is excellent, which is a recommended treatment in clinic.
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Affiliation(s)
- Weigang Lou
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, Ningbo, China
| | - Min Liu
- Department of Orthopedics, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ding Xu
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, Ningbo, China.
| | - Ming Li
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, Ningbo, China
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery, Ningbo NO.6 Hospital, Ningbo, China.
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Shota M, Tachibana T, Iseki T. Avulsion fracture of the calcaneal tuberosity treated with novel surgical technique using the combination of the side-locking loop suture technique and ring pins: a case report. J Surg Case Rep 2023; 2023:rjad173. [PMID: 37124579 PMCID: PMC10132948 DOI: 10.1093/jscr/rjad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
A 78-year-old woman complained of right heel pain when tripping during walking. Radiographs revealed an avulsion fracture of the calcaneal tuberosity. Because the bone fragment was displaced, a novel osteosynthesis using the side-locking loop suture (SLLS) and ring pins was performed. At 3 months after the surgery, non-contrast computed tomography revealed complete bone union. At 2 years postoperatively, she had no symptoms and dysfunctions. Here, we describe a case of avulsion fracture of the calcaneal tuberosity in a 79-year-old female who treated with a novel surgical technique using combination the SLLS technique and ring pins. This surgical technique may be a useful option in the treatment for avulsion fractures of the calcaneal tuberosity.
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Affiliation(s)
- Morimoto Shota
- Correspondence address. Department of Orhopaedic Surgery, Hyogo Medical University, Hyogo, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Tel: +81-798-45-6452; Fax: +81-798-45-6453; E-mail:
| | - Toshiya Tachibana
- Department of Avulsion Fracture Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tomoya Iseki
- Department of Avulsion Fracture Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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Xiao J, Xin Z, Fu X, Huang J, Zhang B, Yu H. Treatment of Fracture of the Calcaneus via Bone Axial X-Ray Image-Based Minimally Invasive Approach. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3012589. [PMID: 35813425 PMCID: PMC9270132 DOI: 10.1155/2022/3012589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
To discuss the values of two bone axial X-ray image-based minimally invasive approach surgeries in the diagnosis and treatment of fracture of the calcaneus, 80 patients diagnosed with fracture of the calcaneus by bone axial X-ray examination were selected and divided equally into the minimally invasive longitudinal approach (MILA) group (40 cases) and the sinus tarsal approach (STA) group (40 cases). Besides, the duration of operation, the incidence of complications, the time-to-start weight training, and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function scoring system between the patients in the two groups were compared. The results showed that the duration of operation and incidence of complications among the patients in the MILA group (42.87 ± 5.12 minutes, 20%) were both superior to those among the patients in the STA group (60.43 ± 7.31 minutes, 32.5%). The time-to-start weight training in the MILA group was 5.2 weeks, which was obviously shorter than that in the STA group (5.7 weeks). The difference in AOFAS scores between the two groups was not significant. The walking pavement score in the MILA group (4.2 ± 0.37 points) was slightly higher than that in the STA group (3.3 ± 0.45 points), and the differences demonstrated statistical meaning (P < 0.05). To sum up, the bone axial X-ray image is an essential examination method of diagnosing fracture of the calcaneus. The two minimally invasive methods both showed good clinical therapeutic effects. The operation of MILA was relatively shorter with fewer complications and is worthy of being promoted as an effective treatment method of fracture of the calcaneus.
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Affiliation(s)
- Jie Xiao
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Zengfeng Xin
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 311000 Zhejiang, China
| | - Xiaojun Fu
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Jiaqi Huang
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Bi Zhang
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Haiping Yu
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
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Augmentation of suture anchors with magnesium phosphate cement – Simple technique with striking effect. J Mech Behav Biomed Mater 2022; 128:105096. [DOI: 10.1016/j.jmbbm.2022.105096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/20/2022]
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Doany M, Garcia A, Komatsu D, Divaris N, Kottmeier S, Paulus M. Avulsion Fractures of the Calcaneal Tuberosity: A Single-Center Review of Outcomes and Complications. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00003. [PMID: 34860733 DOI: 10.5435/jaaosglobal-d-21-00172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The goal of this investigation was to determine the incidence of complications and revision surgery after calcaneal tuberosity avulsion fractures, to describe experience with different fixation constructs, and to compare revision surgery rates between tuberosity and tongue-type fractures of the calcaneus. DESIGN This was a retrospective study at a single level 1 trauma center between 2001 and 2019, including patients with calcaneal tuberosity avulsion fractures compared with patients with calcaneal tongue-type fractures. RESULTS Twenty-nine tuberosity fractures (23 surgical and six nonsurgical) and 37 tongue-type fractures (29 surgical and eight nonsurgical) were treated during the study period. Revision surgery was more common in the tuberosity group (26% versus 7%, P = 0.013). In the tuberosity group, 35% experienced some degree of implant failure, with 13% catastrophic loss of reduction and 22% loss of initial reduction with eventual union. Fragment size and initial displacement were not associated with revision surgery. No patients with implant failure noted in the tongue-type group. DISCUSSION Calcaneal tuberosity fractures showed significantly higher rate of revision surgery and failure of fixation compared with tongue-type fractures.
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Affiliation(s)
- Michael Doany
- From the Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
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