J Korean Foot Ankle Soc.  2015 Jun;19(2):73-76. 10.14193/jkfas.2015.19.2.73.

Calcaneal Insufficiency Avulsion Fracture in a Well-Controlled Type 2 Diabetic Patient: A Case Report

• Kim ST
• Moon MS
• Kwon KT
• Park BK
• Ha CW
• Ahn J

• KMID: 1794887
• DOI: http://doi.org/10.14193/jkfas.2015.19.2.73

Abstract

The calcaneal insufficiency avulsion fracture usually occurs in an area of fused apophysis in adults without significant history of trauma or overuse activities. It is an uncommon injury which has been described in patients with complicated diabetes, Charcot neuroarthropathy, amyloidosis with neuropathy, severe osteoporosis, and other conditions. Discussion of the issue of fracture location is still not sufficient. We report on a case of a 50-year-old male who experienced a non-traumatic diabetic calcaneal insufficiency fracture. Intraoperatively, a biopsy specimen was obtained from the exposed fracture site for histological study. We assume that the calcaneal fused apophyseal line is the weak point of failure due to various incomplete mixtures of trabecular bone, woven bone, and cartilaginous tissues, and may fail when repeated tensile stress is imposed.

Keyword

Diabetes mellitus; Calcaneus; Insufficiency fracture

MeSH Terms

Adult
Amyloidosis
Biopsy
Calcaneus
Diabetes Mellitus
Fractures, Stress
Humans
Male
Middle Aged
Osteoporosis

Figure

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  Figure 1. (A) Lateral radiograph shows about 1.5 cm upwardly displaced large avulsed fragment of calcaneal tubercle. Additionally, another sclerotic insufficiency avulsion fracture was combined which slipped upwardly parallel to the fused apophyseal line. (B) Postoperative radiograph shows reposition and fixation of fracture fragment with cerclage wiring and cannulated screws. (C) Postoperative four months radiograph shows re-displaced fracture fragment. (D) Final followup radiograph shows hardware removal.

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  Figure 2. Fracture was fixed with cerclage wiring, cannulated screw and non-absorbable sutures.

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  Figure 3. Histologic appearance of insufficiency fracture site is shown in low-power view (H&E stain, ×100; A), high-power view (H&E stain, ×400; B). Hyaline cartilaginous chondrocytes were arranged in small clusters surrounded by large amounts of moderately violescent stained matrix. (C) Abnormally oriented trabecular bone mixed with woven bones (arrow) are seen which is indicating various osteopathies and healing callus (Masson-Trichrome stain, ×200).

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