The presence of osteoporosis, diabe

The presence of osteoporosis, diabetes, and neuropathy may facilitate the appearance of the fracture (2,4,9). A broader insertion of theAchilles tendon in the posterior tuberosity, which has been seen inabout 20% of population in cadaveric studies (10), has also been proposed as an underlying factor for the classically described “beak” fractures (11), and sets the basis for the morphologic classifications of theavulsion fractures of the posterior calcaneal tuberosity (11,12).The thin soft tissue envelope and poor vascular supply at this areapredispose complications after treatment. Increased age, medicalcomorbidities such as hypothyroidism and vascular peripheral disease,and skin compromise at presentation have also been identified as badprognosis factors (13). However, the influence of specific characteristicsof the fracture such as fragment size and displacement has not beenstudied. Furthermore, classifications described previously are exclusively based on the morphologic features of the fracture, with no demonstrated prognostic value (13). The primary goals of this study were todetermine if fragment size or fracture displacement were associatedwith higher complications and to develop a new classification system