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

Affiliations
  • 1Korea National Sport University, Seoul, Korea.
  • 2Surgery of Foot and Ankle, Eulji General Hospital, Eulji University, College of Medicine, Seoul, Korea. jins33@hanmail.net
  • 3KT Lee's Foot and Ankle Clinic, Seoul, Korea.

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

  • 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.

  • 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).

  • 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).

  • 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.

  • 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.


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