Radiology, Vol 180, 725-729, Copyright © 1991 by Radiological Society of North America

ARTICLES

Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus

MH Kathol, GY el-Khoury, TE Moore and JL Marsh
Department of Radiology, University of Iowa College of Medicine, Iowa City 52242.

Radiographs and clinical records of 61 patients with calcaneal fractures were studied. Twenty-one patients had diabetes mellitus, and 40 were nondiabetic. All diabetic patients were insulin dependent for more than 5 years and had clinically evident peripheral neuropathy. Eighteen of the diabetic patients had no history of significant trauma. Fourteen had calcaneal insufficiency avulsion (CIA) fractures limited to the posterior third of the calcaneus. The fracture pattern in this group occurred in the same plane as a fatigue-type calcaneal fracture. Fragments of the posterior tuberosity were usually displaced 10-30 mm and were frequently rotated. The mean time from diagnosis of diabetes mellitus to CIA fracture was 20 years. Fractures in the nondiabetic group and in the three diabetic patients with a history of trauma did not resemble the CIA pattern. In the nondiabetic group, there were no insufficiency fractures; 39 fractures occurred with significant force (eg, motor vehicle accident or fall from height), and 33 had extension to subtalar or calcaneocuboid joints.

This article has been cited by other articles:

				P L Tan and J Teh MRI of the diabetic foot: differentiation of infection from neuropathic change Br. J. Radiol., November 1, 2007; 80(959): 939 - 948. [Abstract] [Full Text] [PDF]

				T F Platts-Mills, M D Burg, and Z T Pollack Calcaneal avulsion fracture Emerg. Med. J., March 1, 2007; 24(3): 231 - 231. [Full Text] [PDF]

				A. Daftary, A. H. Haims, and M. R. Baumgaertner Fractures of the Calcaneus: A Review with Emphasis on CT RadioGraphics, September 1, 2005; 25(5): 1215 - 1226. [Abstract] [Full Text] [PDF]

				S. Masala, R. Fiori, A. Marinetti, L. Uccioli, L. Giurato, and G. Simonetti Imaging the Ankle and Foot and Using Magnetic Resonance Imaging International Journal of Lower Extremity Wounds, December 1, 2003; 2(4): 217 - 232. [Abstract] [PDF]

				A. V. Schwartz, D. E. Sellmeyer, K. E. Ensrud, J. A. Cauley, H. K. Tabor, P. J. Schreiner, S. A. Jamal, D. M. Black, and S. R. Cummings Older Women with Diabetes Have an Increased Risk of Fracture: A Prospective Study J. Clin. Endocrinol. Metab., January 1, 2001; 86(1): 32 - 38. [Abstract] [Full Text]

				Z. S. Rosenberg, J. Beltran, and J. T. Bencardino MR Imaging of the Ankle and Foot RadioGraphics, October 1, 2000; 20(90001): 153S - 179. [Abstract] [Full Text]

				M. A. Stevens, G. Y. El-Khoury, M. H. Kathol, E. A. Brandser, and S. Chow Imaging Features of Avulsion Injuries RadioGraphics, May 1, 1999; 19(3): 655 - 672. [Abstract] [Full Text] [PDF]