title: Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients.
abstract: Calcaneal avulsion fractures are not uncommon, and they are probably more likely in patients with osteoporosis. Closed manipulation for this type of fracture often fails to achieve acceptable reduction, and open reduction and internal fixation are usually required. However, open reduction and internal fixation with either a lag screw or Steinmann pins do not provide satisfactory fixation in patients with diabetes and elderly patients because of the presence of porotic bone. Levi described a tension band fixation system used to treat a calcaneal avulsion fracture using a simple technique performed with a transverse Kirschner wire through the os calcaneus, securing a figure-of-8 metal tension band wiring to the fragment. We report the successful treatment of 3 patients with calcaneal avulsion fractures using a modified tension band wiring technique, resulting in satisfactory recovery. Re-displacement of the fragment during the initial follow-up period was not reported, and bony union was achieved in all patients. We believe this technique is a useful surgical option for the treatment of calcaneal avulsion fractures.
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan. surf-trip@ams.odn.ne.jp
authors.forename: Issei
authors.initials: I
authors.lastname: Nagura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujioka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mori
authors.forename: Makoto
authors.initials: M
authors.lastname: Mitani
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ozaki
authors.forename: Hideo
authors.initials: H
authors.lastname: Fujii
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nabeshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D001864:Bone Wires; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D011859:Radiography; D011877:Radionuclide Imaging