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Single-center study indicates calcaneal avulsion fractures carry high risk of complications

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VANCOUVER, British Columbia —  A presenter at the Orthopaedic Trauma Association Annual Meeting said calcaneal avulsion fractures treated at a level 1 trauma center had a 60% complication rate.

“Soft tissue compromise was common in 43% and should be addressed early to optimize outcomes in an area at high risk of complications,” Phillip M. Mitchell, MD, said during his presentation. “[Calcaneal] avulsion fractures should be identified early, acknowledging that risks are high.”

Mitchell and colleagues reviewed calcaneal fractures treated at their institution between 2000 and 2017. Using imaging and clinical data, they identified 35 patients with calcaneal avulsion fractures. Patient demographics, comorbidities, mechanism of injury, the presence of soft tissue compromise, the fixation construct, incidence of hardware failure or fracture displacement, and need for additional procedures were collected. Investigators used univariate analysis to determine patient factors that correlated with fracture displacement or hardware failure.

At the time of presentation, 15 patients had either an open fracture or soft tissue compromise. Overall, investigators noted the complication rate was 60%. Eight operatively treated patients with 3-month follow-up had catastrophic hardware failure and loss of fixation. Among patients with fracture displacement without loss of fixation, 44.4% had radiographic evidence of fracture displacement. Secondary surgery was needed in eight patients. Patient factors did not correlate with an increased chance of failure. The incidence of failure was not different between high-energy fractures and low-energy fractures. The failure rate was not significantly impacted by the use of a washer or additional soft tissue procedure. – by Monica Jaramillo

Reference:

Mitchell PM, et al. Paper #79. Presented at: Orthopaedic Trauma Association Annual Meeting. Oct. 11-14, 2017; Vancouver, British Columbia.

Disclosure: Mitchell reports no relevant financial disclosures.