Journal article
Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures
Case reports in orthopedics, Vol.2018, pp.1-6
11/11/2018
DOI: 10.1155/2018/6207024
PMCID: PMC6252191
PMID: 30534455
Abstract
Avulsion fractures of the calcaneal tuberosity represent a rare injury pattern that is caused by a powerful tension force from the Achilles tendon and is usually seen following minor trauma, especially in elderly patients. The objective of this study is to describe a surgical technique using cerclage wiring through cannulated screws in the treatment of extra- and intra-articular avulsion fractures of the calcaneal tuberosity and to present our results in a small patient’s cohort. Through a 5.0 cm longitudinal skin incision over the posterolateral aspect of the calcaneus, after adequate debridement of the fracture fragments and while keeping the ankle in plantarflexion, the calcaneal tuberosity is anatomically reduced with the help of a periarticular reduction clamp and an accessory plantar longitudinal approach. Provisionally fixation is performed with K-wires. Definitive fixation is achieved with two parallel partially threaded 7.0 cannulated screws, which are positioned from the superior and posterior aspect of the tuberosity to the inferior and anterior aspect of the plantar surface of the calcaneus, and 1.5 mm cerclage wires that are pulled epiperiosteally to the plantar aspect of the calcaneus to avoid damage to local soft tissues. Alternatively, for smaller fracture fragments, two 3.5 mm partially threaded cannulated screws and 1.25 mm cerclage wires can be used. We also report the results of the procedure in a small cohort of four patients. All fractures healed in an anatomic position. There was no failure of fixation, loss of reduction, or need for secondary surgery, including hardware removal. At final follow-up, all patients had regained full plantar flexion range of motion and strength, with no gait or weight-bearing restrictions. In conclusion, the combination of cerclage wire and large diameter cannulated screws represents a promising option in the treatment of avulsion fractures of the calcaneal tuberosity, demonstrating good functional and radiographic results in our cohort of patients.
Details
- Title: Subtitle
- Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures
- Creators
- Vincenzo Giordano - Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, BrazilAlexandre Leme Godoy-Santos - Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, Hospital Israelita Albert Einstein, São Paulo, BrazilFelipe Serrão de Souza - Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, BrazilHilton Augusto Koch - Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilCesar de Cesar Netto - Department of Orthopedics Foot and Ankle Surgery, Hospital for Special Surgery, New York, USAStefan Rammelt - Klinik für Unfall und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
- Resource Type
- Journal article
- Publication Details
- Case reports in orthopedics, Vol.2018, pp.1-6
- DOI
- 10.1155/2018/6207024
- PMID
- 30534455
- PMCID
- PMC6252191
- NLM abbreviation
- Case Rep Orthop
- ISSN
- 2090-6749
- eISSN
- 2090-6757
- Language
- English
- Date published
- 11/11/2018
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984040539002771
Metrics
18 Record Views