title: Calcaneal avulsion fractures: a case series of 33 patients describing prognostic factors and outcomes.
abstract: BACKGROUND
  The purpose of this study was to evaluate prognostic predictors of complications and need for secondary surgery in a series of calcaneal avulsion fractures.
  
  
  METHODS
  Thirty-three patients who sustained extra-articular calcaneal avulsion fractures from 2002 to 2011 were retrospectively identified. Main outcome measurement was need for secondary surgical procedures. Secondary complications such as soft tissue complications and loss of fixation were noted. Prognostic factors for outcome measures were identified.
  
  
  RESULTS
  There was a need for secondary operations in 12 cases. Of those, 10 (83%) had wound complications and 5 (41.7%) had failure of fixation. Two subjects required below knee amputation. Of the entire cohort of 33 patients, 13 (39.4%) had soft tissue complications. Of the 22 that underwent surgery, 6 (27%) had failure of fixation. Increased age was significantly associated with wound complications (P = .029). Hypothyroidism (P = .003), peripheral vascular disease (P = .022), and presence of more than one comorbidity (P = .005) were significantly associated with need for secondary surgical intervention. Skin compromise at presentation was significantly associated with soft tissue complication (P = .036) and failure of fixation (P = .046).
  
  
  CONCLUSIONS
  Calcaneal avulsion fractures have a high incidence of soft tissue problems, failure of fixation, and need for additional surgeries. Comorbid conditions and increased age portend a poor prognosis with a significant association with wound complications and need for additional surgeries.
  
  
  METHODS
  Prognostic, Level II: Retrospective Analysis.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts igitajn@partners.org.
authors.forename: I Leah
authors.initials: IL
authors.lastname: Gitajn
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Abousayed
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Rull James
authors.initials: RJ
authors.lastname: Toussaint
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mark
authors.initials: M
authors.lastname: Vrahas
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: John Y
authors.initials: JY
authors.lastname: Kwon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D015897:Comorbidity; D048909:Diabetes Complications; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007037:Hypothyroidism / Q000150:complications; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016491:Peripheral Vascular Diseases / Q000150:complications; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
keywords: beak fracture; calcaneus fracture; posterior tuberosity avulsion fracture