title: Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire.
abstract: Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation.
authors.affiliation: Orthopaedist, Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan. Electronic address: m1ttyd2s@msn.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyamura
authors.affiliation: Orthopaedist, Department of Orthopaedic Surgery, Itami City Hospital, Hyogo, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Ota
authors.affiliation: Orthopaedist, Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Orthopaedist, Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Namba
authors.affiliation: Orthopaedist, Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D001864:Bone Wires; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D014025:Titanium
chemical_list: D014025:Titanium
keywords: Achilles tendon; calcaneus; cannulated cancellous screw; open reduction and internal fixation; titanium wire