Analysis of Extreme Beak Calcaneal Fracture (Type 2-Lee) Fixed with Cannulated Cancellous Screws: An Original Research Article

Introduction: Extreme beak calcaneal fractures (Type 2 Lee’s tuberosity avulsion fractures) are rare injuries, accounting for only 1.3–3% of all calcaneal fractures. These injuries are considered as surgical emergency as they can lead to significant functional impairment and soft-tissue compromise if not promptly managed. This study evaluates the efficacy of cannulated cancellous (CC) screw fixation for these fractures. Materials and Methods: A prospective study of 14 patients with extreme beak calcaneal fracture (Type 2 Lee’s - tuberosity avulsion fractures) treated with CC screw fixation was conducted in VMMCH, Karaikal, Puducherry between June 2022 and June 2023. Patients were followed for a minimum of 12 months. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale. Results: The mean AOFAS score at the final follow-up was 89.3 (range 78–98). Radiographic union was achieved in all cases by 20 weeks with a mean union time of 13.09 weeks in closed fractures and 18 weeks in open fractures. One patient developed a superficial wound infection without any alarming signs of hardware issues, which resolved eventually. No hardware failures or need for revision surgeries were observed. Conclusion: Early intervention with CC screw fixation appears to be an effective and safe technique for the treatment of extreme beak calcaneal fracture (Type 2 Lee’s – tuberosity avulsion fractures), resulting in excellent functional outcomes and a low complication rate. Keywords: Calcaneal fracture, extreme beak, tuberosity avulsion, American orthopedic foot and ankle society scoring, cannulated cancellous screw fixation, Achilles tendon.