Calcaneal tuberosity avulsion fracture fixation: a technical note and results on cases of patients

Calcaneal tuberosity avulsion fractures are more common in elderly osteoporotic populations. According to the Beavis classification, they are divided into 3 types. Types I and III have small bone fragments that are difficult to fix with screws, and traditional open surgery has a high rate of skin necrosis and poor wound healing. This article proposes a modified Bunnell suture combined with calcaneal tunnel fixation technique that can flexibly switch between minimally invasive and open approaches, and explores its short-term clinical efficacy.

From January 2024 to February 2026, 2 patients with calcaneal tuberosity avulsion fractures were enrolled. One patient with Beavis type II + I underwent open surgery, and one patient with Beavis type II underwent a minimally invasive procedure. Postoperatively, the Burwell-Charnley criteria were used to assess the quality of fracture reduction. At 6 months postoperatively, the AOFAS ankle-hindfoot scale was used, and the maximum plantarflexion angle and dorsiflexion angle of the ankle joint were recorded. Follow-up recorded incision, fracture healing, and complications, with an average follow-up of 1 year.

Both patients achieved anatomical reduction postoperatively, and all achieved bony union at 3 months postoperatively without loss of reduction. At 6 months postoperatively, the AOFAS scores were 83 and 96, respectively, and both the maximum plantarflexion and dorsiflexion angles were both within the normal range. Only the patient who underwent open surgery and had diabetes and obesity experienced delayed wound healing, which healed after regular dressing changes for 1 month. The minimally invasive case did not develop complications related to soft tissue, sural nerve, or Achilles tendon.

The modified Bunnell suture combined with calcaneal tunnel fixation technique may help balance rigid fixation and soft tissue protection. The minimally invasive approach appears to lower the risk of incision-related complications in the present series. This technique may offer a flexible alternative for selected cases of Beavis calcaneal tuberosity avulsion fractures, especially suitable for minimally invasive fixation of types I and III fractures, and may also act as an auxiliary fixation method for type II fractures. However, the sample size of this study is small, and long-term efficacy still needs to be verified by large-sample controlled studies.