Avulsion Fractures of Posterior Calcaneal Tuberosity: Identification of Prognostic Factors and Classification.

Avulsion fractures of the posterior calcaneal tuberosity are rare injuries, and little is known about the underlying factors, outcomes, and prognosis. Furthermore, classifications described previously focus on fracture morphology, with uncertain clinical utility. We present the results of a retrospective study of 21 patients treated for this pathology from January 2002 to December 2015. Features analyzed were age; sex; mechanism of injury; medical comorbidities; type of fracture, as proposed by Beavis; fracture displacement; fragment size; type of treatment; complications; need for secondary surgery; and the American Orthopaedic Foot and Ankle Society score after treatment and follow-up care. Mean age was 56.95years. A total of 61.9% were females, and 71.4% were secondary to low-energy trauma. In addition, 19% were diabetic. Mean follow-up was 57.24 months. Surgery was performed in 81%. Complications rate was 61.9%, and secondary surgery was needed in 38.1%. Mean fracture displacement was significantly higher when complications occurred (25.91mm versus 7.61 mm) (p = .03) and when soft tissues complications appeared (30.65mm versus 14.68 mm) (p = .02). Female gender was associated with the secondary loss of reduction (p = .04). The Beavis classification was not related significantly with any outcome variable. When fracture displacement was ≥2cm, complication rate increased from 30% to 90.9% (p = .008) and soft tissue compromise increased from 0% to 45.45% (p = .035). A new classification system with prognostic value is described, based on fracture displacement. We present 1 of the largest series published to date; fracture displacement is a major variable that influences the outcomes of these injuries, and a new classification attending to a prognostic factor is developed.

Resultados de la reparación quirúrgica de las roturas agudas del tendón distal del bíceps braquial a medio plazo: influencia de la vía de abordaje quirúrgica / Mid-term results of surgical repair of distal biceps rupture: influence of surgical approach

Objetivo: Describir los resultados funcionales y las complicaciones a medio plazo de la reparación quirúrgica de la avulsión del tendón distal del bíceps braquial y establecer una relación con la vía de abordaje empleada. Métodos: 17 pacientes consecutivos fueron intervenidos. Se registró la vía de abordaje empleada. Se recogieron los valores postoperatorios de rango de movilidad articular, capacidad funcional medido como puntuación del cuestionario Quick - DASH score y se registraron las complicaciones. Resultados: En 14 pacientes se reparó el tendón distal del bíceps. En 3 se confirmó su integridad. En 3 casos se empleó una vía anterior y en 11 una doble vía. Flexión media: 131'43º; extensión: - 3'21º pronación: 70'71º; supinación: 74’29º; puntuación Quick - DASH score: 17'04. Seguimiento: 25'5 meses. Aparecieron complicaciones en el 57’14%. La más frecuente fueron las parestesias locales, con resolución espontánea en todos los casos. Los pacientes intervenidos por doble vía obtuvieron resultados mejores en comparación con los intervenidos por vía única. Conclusiones: La reparación quirúrgica de las roturas agudas del tendón distal del bíceps braquial presenta aceptables resultados postoperatorios con una alta tasa de complicaciones, si bien estas últimas son en su mayoría de escasa relevancia. Estos resultados mejoran cuando se emplea la técnica de doble vía descrita por Boyd Anderson y modificada por Morrey

Purpose: Describe mid-term functional results and complications rate after surgical reattachment of acute distal biceps tendon ruptures and relate them with the surgical approach employed. Methods: 17 consecutive patients were evaluated. Surgical approach employed was registered, as well as post-operative range of motion of the elbow, physical function measured as Quick - DASH Score and complications. Results: Complete rupture of biceps tendon was observed in 14 cases during surgery. The anterior approach was used in 3, the double incision technique was used in 11. Average flexion: 131'43º; extension: -3'21º; pronation: 70'71º; supination: 74'29º; Quick - DASH Score: 17'04. Average follow - up: 25'5 months. Complication rate was 57'14%. The more frequent complications were local paresthesias which were solved spontaneously in all cases. The double incision technique group of patients had overall better results compared to the anterior approach group. Conclusions: Reattachment of acute distal biceps tendon ruptures shows acceptable postoperative results and high complications rate with low clinical relevance. These results seem to be better when the Boyd - Anderson double incision technique modified by Morrey is employed