Korean J Sports Med.  2012 Jun;30(1):34-40. 10.5763/kjsm.2012.30.1.34.

Surgical Excision of Symptomatic Non United Fragment of Anterior Process Fractures of the Calcaneus

• Kim SH
• Kim JS
• Young KW
• Kim YH
• Park YU
• Jaegal H
• Lee HS
• Lee KT

• KMID: 2288646
• DOI: http://doi.org/10.5763/kjsm.2012.30.1.34

Abstract

A fracture of the anterior process of the calcaneus has been considered unusual injury. A clinically missed diagnosis is often, that had gone on to non united fragment. Particularly if the patient has calcaneocuboid pain and disability, and that early excision of the fragment is usually advisable. There were 12 cases with performing the simple excision. The fracture characteristics were analyzed by Degan's classification; type 1 was 1case (8.3%), type 2 was 6 cases (50.0%) and type 3 was 5 cases (41.7%); and their morphology; elongation was 3 cases (50.0%) and fragmentation 3 cases (50.0%). And, the pre and post operative American Orthopedic Foot and Ankle Society midfoot score and visual analog scale was evaluated; 66.0 and 5.8 was significantly improved to 90.1 (p=0.007) and 2.2 (p=0.003), respectively. Postoperative Excellent and good satisfaction with possible return to previous sports activity was 10 cases (83.3%). Conclusively, simple excision of non united fragment of anterior process of the calcaneus is a successful clinical option.

Keyword

Anterior process of calcaneus; Non united fragment; Excision

MeSH Terms

Animals
Ankle
Calcaneus
Foot
Humans
Orthopedics
Sports

Figure

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  Fig. 1 Old anterior process fracture of calcaneus in a 22-years-old male. (A) Elongated morphology, Degan's classification type II. (B) The excised non united fracture fragment.

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  Fig. 2 Bone scan and magnetic resonance T1 weighted image is helpful for decision of a surgical excision. A typical hot uptake is demonstrated at the area of anterior process of calcaneus (A), and a bone marrow edema in the fragment (B).

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  Fig. 3 Degan reported three fracture types. Type I is an undisplaced fracture, usually involving only the tip of the process (A). Type II is a displaced fracture that does not involve the articular surface (B). Type III is a large displaced fragment that involves the calcaneo-cuboid joint (C).

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  Fig. 4 This radiographs show the Degan's classification. (A) and (B) is type I, (C) and (D) is type II, (E) and (F) is type III. Left is preoperative radiographs. Right is postoperative radiographs.

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  Fig. 5 This radiographs show the morphologic identification. (A) is an elongated type of anterior process of calcaneus. (B) and (C) belong in the fragmentation group. (D) and (E) are not fragmented, but the fracture fragment is not limited to the bifurcate ligament attachment site, expand a deeper anterior interosseous ligament attachment site.

Reference

1. Morel J. Varietes Anatomo-clinique et Prognostic des Fractures du Calcaneum. 1904. Lyon:

2. Jahss MH, Kay BS. An anatomic study of the anterior superior process of the os calcis and its clinical application. Foot Ankle. 1983. 3:268–281.

3. Petrover D, Schweitzer ME, Laredo JD. Anterior process calcaneal fractures: a systematic evaluation of associated conditions. Skeletal Radiol. 2007. 36:627–632.

4. Warrick CK, Bremner AE. Fractures of the calcaneum, with an atlas illustrating the various types of fracture. J Bone Joint Surg Br. 1953. 35:33–45.

5. Duddy RK, Donahue WE Jr, Cavolo DJ. Anterior calcaneal process fractures. Recognition and treatment. J Am Podiatry Assoc. 1984. 74:398–401.

6. Ouellette H, Salamipour H, Thomas BJ, Kassarjian A, Torriani M. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms. Skeletal Radiol. 2006. 35:833–837.

7. Degan TJ, Morrey BF, Braun DP. Surgical excision for anterior-process fractures of the calcaneus. J Bone Joint Surg Am. 1982. 64:519–524.

8. Trnka HJ, Zettl R, Ritschl P. Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture. Arch Orthop Trauma Surg. 1998. 117:300–302.

9. Agnholt J, Nielsen S, Christensen H. Lesion of the ligamentum bifurcatum in ankle sprain. Arch Orthop Trauma Surg. 1988. 107:326–328.

10. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994. 15:349–353.

11. Wulker N, Zwipp H, Tscherne H. Experimental study of the classification of intra-articular calcaneus fractures. Unfallchirurg. 1991. 94:198–203.

12. Golder WA. Anterior process of the calcaneus: a clinical-radiological contribution to anatomical vocabulary. Surg Radiol Anat. 2004. 26:163–166.

13. Robbins MI, Wilson MG, Sella EJ. MR imaging of anterosuperior calcaneal process fractures. AJR Am J Roentgenol. 1999. 172:475–479.

14. Backman S, Johnson SR. Torsion of the foot causing fracture of the anterior calcaneal process. Acta Chir Scand. 1953. 105:460–466.

15. Pouliquen JC, Duranthon LD, Glorion C, Kassis B, Langlais J. The too-long anterior process calcaneus: a report of 39 cases in 25 children and adolescents. J Pediatr Orthop. 1998. 18:333–336.

16. Pearce CJ, Zaw H, Calder JD. Stress fracture of the anterior process of the calcaneus associated with a calcaneonavicular coalition: a case report. Foot Ankle Int. 2011. 32:85–88.

17. Hodge JC. Anterior process fracture or calcaneus secundarius: a case report. J Emerg Med. 1999. 17:305–309.

18. Bradford CH, Larsen I. Sprain-fractures of the anterior lip of the os calcis. N Engl J Med. 1951. 244:970–972.