AVULSION FRACTURES OF INSERTION OF ACHILLES TENDON -A STUDY OF 3 CASES-

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  • アキレス腱不着部裂離骨折型踵骨骨折の3例

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Among the 78 patients in our hospital with calcaneal fractures over the past 10 years, three (3.8 %) had avulsion fractures of the insertion of Achilles tendon. These cases are reported here. Case 1 was a 56-year-old female who been injured by a strong blow to her left heel. A 2.5 cm bone fragment of the calcaneal tuberosity was recognized with rotation of 90°. Fixation was performed using screws and a plaster cast. Range of motion exercise was started 4 weeks after surgery. Case 2 was a 60-year-old male whose heel was injured by a strong blow. He had a so-called beak fracture. Fixation was performed using Kirschner's wires, a soft wire and a plaster cast. Range of motion exercise was started 2 weeks after surgery. Case 3 was a 45-year-old female who had contracture resembling talipes equinus due to poliomyelitis in the past. She fell from a chair and landed on her forefoot. Her ankle joint was forced to dorsiflexed position, and a triangular bone fragment was displaced upward with the Achilles tendon. Fixation was performed using Kirschner's wires, a soft wire and a plaster cast. An ankle-foot orthrosis was used, which was removed 4 months postoperative. Bone union was complete in all three cases and all postoperative courses were good. Various factors have been reported in the literature to cause such fractures, and traction force of Achilles tendon is frequently the cause. Other factors include direct external force and bone fragility. In our patients, the fractures were caused by direct external force in cases 1, 2, and bone fragility was involved in case 3. It was assumed that traction force of the Achilles tendon was applied in all cases.

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