# Clinical outcomes of nice knot combined with cannulated screws for Beavis type II posterior calcaneal tuberosity avulsion fractures in osteoporotic elderly patients

## TL;DR

This study examines a surgical technique using a Nice knot and cannulated screws for treating a specific type of ankle fracture in elderly patients with osteoporosis.

## Contribution

The study introduces a novel surgical technique combining a Nice knot with cannulated screws for Beavis Type II calcaneal fractures in elderly osteoporotic patients.

## Key findings

- All 18 patients achieved radiographic union with a mean follow-up of 13 months.
- The mean time to full weight-bearing was 10 weeks with a low complication rate.
- The AOFAS score at final follow-up showed excellent/good outcomes in 77.78% of cases.

## Abstract

To investigate the surgical technique and clinical efficacy of the Nice knot combined with cannulated screws for Beavis Type II posterior calcaneal tuberosity avulsion fractures in osteoporotic elderly patients.

A retrospective analysis was conducted on 18 osteoporotic elderly patients with Beavis Type II posterior calcaneal tuberosity avulsion fractures treated at our institution between June 2019 and December 2024. All patients underwent open reduction and internal fixation using a Nice knot combined with cannulated screws. Postoperative assessment included radiographic review supplemented by evaluation of complication rates, fracture healing time, time to full weight-bearing, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score.

All 18 patients achieved radiographic union with a follow-up of 12–18 months (mean 13.00 ± 1.85 months). Complications comprised delayed wound healing in two cases, which resolved with regular dressing changes, and periwound paraesthesia in one case that resolved after three months of mecobalamin treatment. The mean time to clinical fracture union was 12.22 ± 1.35 weeks, and the mean time to full weight-bearing was 10.00 ± 1.68 weeks. At final follow-up, the mean AOFAS ankle-hindfoot score was 85.94 ± 6.40, with an excellent/good rate of 77.78%. There were no instances of loss of reduction, implant loosening, or hardware failure.

This preliminary study suggests that the Nice knot combined with cannulated screw technique offers stable fixation, promotes early rehabilitation, and results in a low complication rate in osteoporotic elderly patients with Beavis type II avulsion fractures. However, the retrospective design, small sample size, and absence of a control group limit how broadly these findings can be applied. These preliminary results need validation through future prospective, multicenter randomized controlled trials with larger sample sizes.