Management of surgical management of beak-type avulsion fractures of the posterior calcaneal tuberosity: a systematic narrative review.
J Olucha Puchol, L Díaz Aviñó, F Forriol Brocal
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In 30 seconds
This systematic review synthesised evidence on surgical management of beak-type avulsion fractures of the posterior calcaneal tuberosity, comparing open reduction and internal fixation (ORIF) with closed reduction and percutaneous fixation (CRIF), particularly for skin complications. It included 14 observational studies involving 268 patients; methodological heterogeneity meant results were synthesised narratively. Comparative series consistently suggested a trend toward fewer skin complications with CRIF than ORIF. Surgery within 48 hours and fragment displacement greater than 2 cm were identified as relevant prognostic factors.
Key findings
- Fourteen observational studies included 268 patients; comparative series consistently showed a trend toward fewer skin complications with CRIF than ORIF.
- Time to surgery under 48 hours and fragment displacement greater than 2 cm were identified as relevant prognostic factors.
Why it matters
These fractures are vulnerable to skin complications because of Achilles tendon traction and limited soft-tissue coverage. The review highlights that fixation approach and fracture characteristics may be relevant when weighing skin risk against the need to address displacement or comminution. Its findings help frame surgical decision-making, while the observational evidence does not establish comparative effectiveness.
What to keep in mind
All included studies were observational, and methodological heterogeneity required narrative synthesis, limiting the strength of comparisons between approaches.