Fixation For Calcaneal Tuberosity Fracture (Beak Fracture) Using Preformed "L-shape" Hook Plate

Abstract

Abstract Objectives: Treating calcaneal tuberosity fracture (beak fracture) is considered difficult. The ankle functions of patients may be badly affected by skin flap necrosis and/or implant failure. In this study, we propose a robust, facile, economic and safe internal fixation technique to fix the fracture fragments using preformed "L-shape" hook plate. Methods: A retrospective study is conducted to analyze patients with calcaneal tuberosity fracture who received surgical management from January 2015 to February 2020. According to Beavis classification, all of the patients were categorized into type II with larger fracture fragments, who were treated by internal fixation adopting preformed "L-shape" hook plate. The operation time, complications, and clinical healing time were recorded, Functional assessment is performed according to American Orthopedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and Visual Analog Scale (VAS) pain scores. Results: There were a total of 15 patients of calcaneal tuberosity fracture (beak fracture), who had been treated by internal fixation adopting preformed "L-shape" hook plate. Among them, six patients were female and the rest were male, with their age ranging from 29 to 69 years (average of 52.9±11.2 years). The mean duration of follow-up was 17.1±6.0 months (range: 12 to 36 months). Eleven patients underwent emergency surgery. After the operation, no complications were observed such as poor wound healing, skin flap necrosis, wound dehiscence, hematomas or infections. In addition, none of the following complications were observed, which involved plate exposure, sural nerve injuries, venous thromboembolic events, loss of reduction, and fixation failure. In this study, fifteen cases achieved clinical healing at 8-13 weeks (average 10.5 weeks) postoperatively. For functional evaluation, the preoperative VAS and AOFAS-AH scores were 5.7±0.6 and 24.0±9.9 respectively, whereas the postoperative VAS and AOFAS-AH scores at the last follow-up were 1.3±0.5 and 93.8±5.2 (p<0.001). Conclusions: Emergency open reduction and internal fixation operation should be conducted with respect to patients who have calcaneal avulsion fracture, thereby preventing flap necrosis from happening. For patients with Beavis type II beak fracture, preformed "L-shape" hook plate fixation facilitates better recovery of normal ankle functions. Performing as one of the optional treatments, this study proposes a robust, facile, and safe internal fixation technique for avulsion fractures of calcaneal tuberosity (beak fracture ). A series of follow-up case study have verified the validity and effectiveness of implementing the proposed method, paving way for treating complicated calcaneal avulsion fractures.