Avulsion Fracture of the Calcaneal Tuberosity: A soft tissue complication from delayed treatment

Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

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Soft Tissue Sarcoma – a Current Review of the Diagnostic and Treatment Strategies

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0820-6366 ◽

2019 ◽

Vol 157 (06) ◽

pp. 644-653 ◽

Cited By ~ 1

Author(s):

Sebastian Scheidt ◽

Cornelius Jacobs ◽

Sebastian Koob ◽

Kristian Welle ◽

Sebastian Walter ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Treatment Algorithm ◽

Treatment Strategies ◽

Soft Tissue Sarcomas ◽

Current Evidence ◽

Delayed Treatment ◽

Current Review ◽

Soft Tissue Swelling ◽

A Current

AbstractSoft tissue sarcomas are a heterogeneous group of neoplasias that due to their often clinically silent appearance often remain undetected or experience delayed treatment. Especially soft tissue swelling is often misinterpreted by patients and doctors and trivialized or verified with an incorrect biopsy technique. The hereby evoked complications for the patients are serious and may be reduced by simply following the available guidelines. The treatment of soft tissue sarcomas requires a close interdisciplinary coordination between specialists in tumor orthopedics, oncology, radiology, pathology and radiotherapy. On the basis of a selective literature review, the following article points out the current evidence on the treatment and illustrates a treatment algorithm.

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Percutaneous Fixation of Calcaneal Tuberosity Avulsion Fracture

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001533 ◽

2019 ◽

Vol 33 ◽

pp. S44-S45 ◽

Cited By ~ 1

Author(s):

Laura E. Blum ◽

Rajbir Hundal ◽

David Walton ◽

Mark E. Hake

Keyword(s):

Avulsion Fracture ◽

Percutaneous Fixation ◽

Calcaneal Tuberosity

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Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2014.06.140 ◽

2014 ◽

Vol 39 (10) ◽

pp. 1982-1985 ◽

Cited By ~ 13

Author(s):

Egemen Altan ◽

Nazmi Bulent Alp ◽

Reyhan Baser ◽

Levent Yalçın

Keyword(s):

Soft Tissue ◽

Delayed Treatment

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Pediatric Calcaneal Tuberosity Avulsion Fracture: A Case Report and Literature Review

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i03.2072 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Ehab S Saleh ◽

Ahmed Elabd

Keyword(s):

Case Report ◽

Avulsion Fracture ◽

Present Report ◽

Pediatric Population ◽

Lymphoblastic Leukemia ◽

Operative Management ◽

Rare Injury ◽

History Of ◽

Calcaneus Fractures ◽

Calcaneal Tuberosity

Introduction: Calcaneus fractures are rare in the pediatric population, and avulsion fracture of the calcaneal tuberosity is even less common. In adults, those fractures are usually associated with poor bone quality, however, this is not the case in children. It is a fracture that requires emergent intervention to prevent devastating skin and soft-tissue-related complications. Case Report: We report a case of a 9-year-old female who had a displaced calcaneal tuberosity fracture with heel skin impending compromise, after a fall at an indoor gymnastic facility. The child had a history of acute lymphoblastic leukemia, diagnosed at age 4, she was in remission at the time of injury. In the present report, besides reporting a rare injury among the pediatric population, we also describe the operative management, the post-operative course, and we review the literature. Conclusion: Pediatric calcaneal tuberosity fractures, although rare, can lead to devastating complications if not addressed promptly, and should be treated in an expedited fashion. Keywords: Pediatric, calcaneal tuberosity, skin compromise.

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Calcaneal tuberosity avulsion fracture

10.53347/rid-1042 ◽

2008 ◽

Author(s):

Henry Knipe ◽

Frank Gaillard

Keyword(s):

Avulsion Fracture ◽

Calcaneal Tuberosity

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Clinical Evaluation and Management for Lisfranc Injury with Cuneiform Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00191 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0019

Author(s):

Wenqi Gu ◽

Hongwei Xu ◽

Zhongmin Shi ◽

Hongtao Zhang ◽

Guohua Mei ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Outcome ◽

Early Stage ◽

Plain Radiograph ◽

Ct Scanning ◽

Clinical Work ◽

Lisfranc Injury ◽

Vas Score ◽

Open Injury ◽

Soft Tissue Complication

Category: Midfoot/Forefoot Introduction/Purpose: To summarize and evaluate the treatment and clinical outcome of Lisfranc injury with cuneiform fracture retrospectively. Methods: From January 2014 to December 2017, totally 128 cases of Lisfranc injury with cuneiform fractures were treated in our department including 78 cases of male and 50 cases of female with an average of 42.2 ±10.5 years old . There were 60 left feet and 68 right feet, two of which were suffered from an open injury. From the CT scanning, The avulsion fracture of cuneiform was seen in 48 cases, while other 80 cases were cuneiform body fractures or comminuted fractures. An open reduction and internal fixation were undergone after the improvement of soft tissue condition. Final clinical outcome were evaluated by VAS score and AOFAS midfoot score. Complication were also recorded. Results: 9 cases suffered from an early stage of wound and soft tissue complication, who were cured by a dressing change. All cases were followed for a mean of 16.3 months (range: 6-36 months). The plain radiograph demonstrated that the bone union were achieved on the 12.8±1.3 weeks (range: 11-16 weeks) post-operatively on average. The VAS score at the final follow-up was 1.8±1.7 (range: 0-8), while the AOFAS midfoot score was 81.3±10.4 (range: 35-95). The excellent and good rate was 88.3%. 12 cases of post-traumatic arthritis of midfoot was manifested on the X-ray, five of which underwent a salvage arthrodesis in consequence of the severe symptom and disability. The implant of 49 cases were removed on an average of 13.5 month (9-24 months). Conclusion: The Lisfranc injury is always associated with cuneiform fractures, which should be attached importance to in clinical work. For the simple cuneiform fractures, screw fixation could be performed. The key of management is the restoration of intercunceiform joint. And an anatomical alignment and stable fixation of midfoot may facilitate an acceptable clinical outcome.

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