Calcaneal avulsion fractures: complications from delayed treatment

Calcaneal fractures represent approximately 2% of all fractures, of which 25% to 40% are classified as extra-articular in nature. Most calcaneal fractures are closed injuries that are treated nonoperatively, or if treated operatively, surgery is delayed to allow subsidence of swelling. The purpose of this article is to highlight a subset of calcaneal fractures that should be addressed urgently. Calcaneal tuberosity avulsion fractures often compromise the thin posterior skin that covers the insertion of the Achilles tendon. These patients are at risk for skin breakdown of the posterior heel and tissue necrosis if they do not receive urgent treatment. This case series presents 3 posterior tuberosity calcaneal avulsion fractures that led to skin necrosis because of a delay in treatment.