{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:41:06Z","timestamp":1790095266234,"version":"4.0.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2014,9,8]],"date-time":"2014-09-08T00:00:00Z","timestamp":1410134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:p>Background. The purpose of this study was to evaluate prognostic predictors of complications and need for secondary surgery in a series of calcaneal avulsion fractures. Methods. Thirty-three patients who sustained extra-articular calcaneal avulsion fractures from 2002 to 2011 were retrospectively identified. Main outcome measurement was need for secondary surgical procedures. Secondary complications such as soft tissue complications and loss of fixation were noted. Prognostic factors for outcome measures were identified. Results. There was a need for secondary operations in 12 cases. Of those, 10 (83%) had wound complications and 5 (41.7%) had failure of fixation. Two subjects required below knee amputation. Of the entire cohort of 33 patients, 13 (39.4%) had soft tissue complications. Of the 22 that underwent surgery, 6 (27%) had failure of fixation. Increased age was significantly associated with wound complications (P = .029). Hypothyroidism (P = .003), peripheral vascular disease (P = .022), and presence of more than one comorbidity (P = .005) were significantly associated with need for secondary surgical intervention. Skin compromise at presentation was significantly associated with soft tissue complication (P = .036) and failure of fixation (P = .046). Conclusions. Calcaneal avulsion fractures have a high incidence of soft tissue problems, failure of fixation, and need for additional surgeries. Comorbid conditions and increased age portend a poor prognosis with a significant association with wound complications and need for additional surgeries.<\/jats:p>\n                  <jats:p>Levels of Evidence: Prognostic, Level II: Retrospective Analysis<\/jats:p>","DOI":"10.1177\/1938640014548323","type":"journal-article","created":{"date-parts":[[2014,9,9]],"date-time":"2014-09-09T23:55:43Z","timestamp":1410306943000},"page":"10-17","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":33,"title":["Calcaneal Avulsion Fractures"],"prefix":"10.1177","volume":"8","author":[{"given":"I. Leah","family":"Gitajn","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Abousayed","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rull James","family":"Toussaint","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Vrahas","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Y","family":"Kwon","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,9,8]]},"reference":[{"key":"bibr1-1938640014548323","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-20-04-253"},{"key":"bibr2-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1148\/rg.255045713"},{"key":"bibr3-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-007-0517-2"},{"key":"bibr4-1938640014548323","first-page":"95","volume-title":"Rockwood and Green\u2019s Fractures in Adults","volume":"2006","author":"Court-Brown C","edition":"6"},{"key":"bibr5-1938640014548323","first-page":"920","volume":"184","author":"Rowe C","year":"1963","journal-title":"Fractures of the os calcis"},{"key":"bibr6-1938640014548323","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2008.0000"},{"issue":"296","key":"bibr7-1938640014548323","first-page":"8","author":"Biehl WC","year":"1993","journal-title":"Clin Orthop Relat Res"},{"key":"bibr8-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.134.2.7352207"},{"key":"bibr9-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/S1056-8727(97)00052-4"},{"key":"bibr10-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2007.04.033"},{"key":"bibr11-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.180.3.1871285"},{"key":"bibr12-1938640014548323","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2012.4.2.134"},{"key":"bibr13-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.51B3.494"},{"key":"bibr14-1938640014548323","first-page":"118","volume":"51","author":"Protheroe K","year":"1939","journal-title":"J Bone Joint Surg Br"},{"key":"bibr15-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1177\/107110079801901211"},{"key":"bibr16-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(00)00026-7"},{"key":"bibr17-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199906000-00008"},{"key":"bibr18-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200304000-00001"},{"key":"bibr19-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B1.0830055"},{"issue":"290","key":"bibr20-1938640014548323","first-page":"3","author":"Essex-Lopresti P","year":"1993","journal-title":"Clin Orthop Relat Res"},{"key":"bibr21-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e31817ace7e"},{"key":"bibr22-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2011.09.006"},{"key":"bibr23-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/S1268-7731(03)00089-4"},{"key":"bibr24-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(01)00033-X"},{"key":"bibr25-1938640014548323","first-page":"111","volume":"23","author":"Krentz A","year":"1989","journal-title":"J R Coll Physicians Lond"},{"key":"bibr26-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197601292940502"},{"key":"bibr27-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1080\/15438600490277860"},{"key":"bibr28-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-0266(03)00006-8"},{"key":"bibr29-1938640014548323","first-page":"115","volume":"1","author":"Alexander R","year":"1975","journal-title":"J Hum Mov Stud"},{"key":"bibr30-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181ffe61e"},{"key":"bibr31-1938640014548323","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2007.1183"},{"key":"bibr32-1938640014548323","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2008.06.004"}],"container-title":["Foot &amp; 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