Tanpure Sanket, Date Jay, Chaughule Chandrasen, Naikwade Deepak
Department of Orthopaedics, Dr. Vithalrao Vikhe Patil Medical College, Ahmednagar, Maharashtra, India.
J Orthop Case Rep. 2022 Dec;12(12):114-117. doi: 10.13107/jocr.2022.v12.i12.3488.
Avulsion tuberosity fracture of the calcaneus is relatively unusual and occurs more frequently in elderly osteoporotic patients. Direct trauma to the heel is a rare cause in young individuals. Failure to perform early open reduction and internal fixation (ORIF) potentially leads to soft-tissue complications due to pressure necrosis of the overlying skin.
A 29-year-old male patient experienced left heel pain with swelling after the assault as he was hit by an iron rod 8 days prior. Radiographs revealed a Beavis Type 2 calcaneal avulsion fracture. An open reduction with two corticocancellous (CC) screw fixation was intended for the fracture.
The avulsed bone fragment was small causing difficulty in reduction. The result of closed reduction in such a scenario is not promising and usually requires ORIF. We performed a modified surgical procedure of CC screw fixation in which one screw was passed perpendicular to the fracture plane for reduction of the fracture and another screw was passed obliquely to nullify Achilles forces. We believe that this technique of fracture management improves patient outcome and early mobilization.
跟骨结节撕脱骨折相对少见，在老年骨质疏松患者中更为常见。年轻人中，足跟直接外伤是罕见病因。未能早期行切开复位内固定（ORIF）可能因覆盖皮肤的压迫坏死导致软组织并发症。
一名29岁男性患者在8天前被铁棍击打后，足跟部出现疼痛伴肿胀。X线片显示为比维斯2型跟骨撕脱骨折。拟对该骨折行切开复位并用两根皮质骨松质（CC）螺钉固定。
撕脱骨块较小，复位困难。在此种情况下，闭合复位效果不佳，通常需要切开复位内固定。我们实施了一种改良的CC螺钉固定手术方法，其中一枚螺钉垂直于骨折平面穿过以复位骨折，另一枚螺钉斜向穿过以抵消跟腱的力量。我们认为这种骨折处理技术可改善患者预后并实现早期活动。
