Modified Two-Stage Approach for the Surgical Treatment of Type II Calcaneal Tuberosity Avulsion “Beak” Fracture: A Case Report

Although infrequent, calcaneal tuberosity fractures pose a challenge for surgeons. The treatment goal is to establish stable fixation and restore function of the gastrocnemius-soleus-Achilles tendon complex. Type II fractures, otherwise known as "beak" fractures, are characterized by large avulsion fragments that extend from the posterior calcaneus at the Achilles tendon insertion. Without prompt diagnosis and reduction, these fractures can lead to significant soft tissue damage and severe edema, raising the risk of wound complications and making surgical fixation more difficult. While no widely accepted surgical technique exists for addressing calcaneal tuberosity fractures, clamp-assisted reduction followed by lag screw fixation across the fracture, which may or may not be reinforced by suture anchors, is frequently utilized. However, this approach frequently fails to endure the tremendous pull of the triceps surae and Achilles tendon, leading to failure and calcaneal tuberosity fragmentation. Therefore, there is a need for further research on the optimal method for reducing these types of calcaneal fractures. This report describes a modified two-stage approach used to treat a type II calcaneal tuberosity fracture. Although this treatment required two operations, it has the potential to serve as a good alternative to some of the more common surgical techniques as it negates the Achilles' pull, reduces the fractures, and re-approximates the Achilles.