Bone Anchor Suture Tape Fixation Technique for the Treatment of Calcaneal Avulsion Fractures

CATEGORY: Hindfoot, Trauma INTRODUCTION/PURPOSE: Surgical treatment of avulsion fractures of the calcaneus has a reported fixation failure rate as high as 23%, and there is much controversy surrounding the best method of treatment for these fractures. We present a technique for fixation of calcaneal avulsion fractures utilizing a bone anchor suture tape fixation technique that can be utilized with or without additional standard internal fixation. METHODS: Five patients (2 male, 3 female), with an average age of 73 years old, presenting with a closed extraarticular avulsion fracture of the calcaneus, are included in this case series. Patients underwent bone anchor and suture tape fixation of fracture by a single foot and ankle-fellowship trained orthopaedic surgeon. Patients were additionally assessed pre-operatively, using the contralateral uninjured limb, for gastrocnemius equinus; and if present, patients underwent a gastrocnemius recession. If appropriate, a single compression lag screw and washer inserted perpendicular to fracture line was utilized for additional fixation. Outcomes observed were time to radiographic consolidation, failure of fixation, reoperation rate, presence of post-operative infection, and return to previous function. RESULTS: Of the included patient cohort, all fractures went on to union, and there were no failures of fixation. There was one removal of a compression screw and washer due to hardware pain, and one superficial infection, which resolved with local wound care. All patients went on to weight-bearing as tolerated within 8 weeks post-operatively. Radiographic consolidation was observed at approximately 12 weeks. 4 out of 5 patients returned to previous function, with 1 patient expiring due to unrelated causes prior to determination of final function. CONCLUSION: Use of a bone anchor suture tape fixation technique appears to hold promise and warrants further investigation for its potential utilization as a reliable technique for fixation for avulsion fractures of the calcaneus. Our technique increases the distribution of surface area forces over the cortical bone while incorporating multiple points of fixation, including through the Achilles tendon insertion, neutralizing the distraction forces of the tendon directly.