%0 Journal Article
%T Plantar Medial Avulsion Fragment Associated With Tongue
%A Jaydev B. Mistry
%A John S. Hwang
%A Kenneth L. Koury
%A Mark R. Adams
%A Reza Firoozabadi
%A William Braaksma
%J Foot & Ankle International
%@ 1944-7876
%D 2019
%R 10.1177/1071100719830948
%X The plantar fascia attaches to the tuberosity of the calcaneus, which produces a distinct plantar medial avulsion (PMA) fracture fragment in certain calcaneal fractures. We hypothesized that tongue-type fractures, as described by the Essex-Lopresti classification, were more likely to be associated with this PMA fracture than joint depression fractures. A retrospective chart review was performed at 2 distinct Level I trauma centers to identify patients sustaining calcaneal fractures. Radiographs were then reviewed to determine the Essex-Lopresti classification, OTA classification, and presence of a PMA fracture. The review yielded 271 total patients with 121 (44.6%) tongue-type (TT), 110 (40.6%) joint depression (JD), and 40 (14.8%) fractures not classifiable by the Essex-Lopresti classification. In the TT group, 73.6% of the patients had the PMA fracture whereas only 8.2% of JD and 15.0% of nonclassifiable fractures demonstrated a PMA fragment (P < .001). Plantar medial avulsion fractures occurred in 38.4% of the calcaneal fractures reviewed with a significantly greater proportion occurring in TT (73.6%) as opposed to JD (8.2%). Given the plantar fascia attachment to the PMA fragment, there may be clinical significance to identifying this fracture and changing treatment management; however, this requires further investigation. Level III, comparative study
%K calcaneus fracture
%K calcaneal fracture
%K plantar medial avulsion
%K gastrocnemius equinus
%K Essex-Lopresti Classification
%K tongue-type calcaneus
%K joint depression calcaneus
%K windlass mechanism
%K plantar fascia
%U https://journals.sagepub.com/doi/full/10.1177/1071100719830948