Mitchell PM, O'Neill DE, Branch E, et al. - Researchers isolated 47 calcaneal avulsion fractures from a cohort of 1,365 calcaneus fractures treated over a 17-year period at two ACS Level I trauma centers, in order to describe the presentation and outcomes of these fractures. Operative treatment was provided to 41 patients, whereas 6 were treated without surgery. Either soft-tissue compromise or an open fracture necessitating urgent treatment at the time of presentation was reported in 21 patients (44.7%). Evidence of implant failure or fracture displacement was identified in 28.2% of patients treated operatively with a 3-month follow-up (11/39). The only predictor of catastrophic fixation failure was age. Findings here suggest the frequent presentation of avulsion fractures of the calcaneus with soft-tissue compromise and further these fractures have a significant rate of treatment failure and reoperation. They recommend early identification of this injury and undertaking a thoughtful approach, acknowledging that risks are high.