Bone graft augmentation with screws for Calcaneal avulsion fractures reduces post operative complications: study

Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. CAvFs are more common in older women with osteoporosis or diabetes mellitus. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. The study by Yu Takahashi et al aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs.

The study was conducted at Nagoya University, Nagoya, Japan. It has been published in “JBJS Open Access” journal.

In the multicenter retrospective study, the authors collected data of patients with CAvFs treated at 9 hospitals. They performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified.

Key findings of the study were:

• The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically.

• The mean age of patients was 68.5 years; 67% of the patients were female.

• Nineteen percent of the patients had diabetes, and 19% had osteoporosis.

• The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%.The reoperation rate was 22%.

• Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases.

• Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%.

• CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments.

The authors concluded that – “CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small.”

Level of Evidence: Therapeutic Level III.

Further reading:

Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically A Retrospective Multicenter Study Yu Takahashi et al JBJS Open Access 2024:e23.00127. http://dx.doi.org/10.2106/JBJS.OA.23.00127