Operative Treatment of Intraarticular Calcaneal Fractures in the Pediatric Population

Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA 02115, USA.
Journal of Pediatric Orthopaedics (Impact Factor: 1.43). 01/2008; 27(8):856-62. DOI: 10.1097/BPO.0b013e3181558ba2
Source: PubMed

ABSTRACT Calcaneal fractures in children are rare injuries, and those with displaced intraarticular fracture patterns are found even less frequently. Recent data in the adult literature have suggested operative treatment of displaced intraarticular calcaneal fractures leads to a more favorable outcome. Most pediatric calcaneal fractures are due to low-energy trauma and are therefore minimally displaced and extraarticular. However, some children are exposed to high-energy trauma, leading to severe intraarticular injuries. Operatively treated calcaneal fractures in children have been poorly described in the literature. The purpose of this study was to analyze the outcomes of surgically treated displaced intraarticular calcaneal fractures in children.
All children with closed displaced intraarticular calcaneal fractures treated with open reduction internal fixation at 1 institution were reviewed at an average of 67 months postoperatively. Preoperative and postoperative radiographs and preoperative computed tomographic scans were used to classify fractures. Functional outcome was assessed by the use of the subjective portions of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score.
Fourteen fractures in 13 patients who met the inclusion criteria were treated with open reduction internal fixation. We found 7 tongue-type and 7 joint depression-type fractures based on the Essex-Lopresti classification. Based on the Sanders classification, we found 9 type II (2-part) fractures and 5 type III (3-part) fractures. The average preoperative and postoperative Bohler angles were 11.8 and 28.4 degrees (P < 0.0001), respectively. The average subjective AOFAS hindfoot score was 64 of a possible 68 points. Of 14 fractures, 13 were fixed with a buttressing plate laterally. One patient was fixed with a single 3.5-mm cortical screw and had the lowest AOFAS hindfoot score. Four minor complications in 3 patients were encountered.
We found that most children with displaced intraarticular calcaneal fractures treated with open reduction and internal fixation at 1 institution had a good clinical outcome with few complications.

  • Der Unfallchirurg 11/2012; 116(11):1030-1032. DOI:10.1007/s00113-012-2291-z · 0.61 Impact Factor
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    ABSTRACT: Calcaneal fractures are considered uncommon accounting for 0.005- 0.41% of all children fractures. Few reports concerning treatment are available. Most of these fractures are non-displaced/minimally displaced and are associated with a fall of less than 1 m. The aim of this case report was to discuss the diagnosis and treatment of a child calcaneal fracture, an atypical presentation despite the high energy mechanism of trauma. A 7-year-old child fell from a 5-m ladder with all his weight on his right heel. Significantly hind-foot reduced range of motion associated with a lateral/plantar calcaneal swelling and pain was found. Neurovascular examination and other parts of the body were normal. Radiograph showed an undisplaced calcaneal body fracture and computed tomography confirmed no subtalar joint involvement. A splint followed by plaster was applied. Weight bearing and deambulation were not allowed. After 4 weeks, no pain and limping was reported by the child’s parents. Plaster was removed and radiograph showed fracture consolidation. Patient had no complaints of pain, no restrictions in range of motion and normal walking. Limping in children is a difficult complaint to assess. Differential diagnoses of a calcaneal fractures should be performed, even without a history of trauma or a history of trivial trauma.
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    ABSTRACT: Wir berichten über einen 12-jährigen Jungen, der sich im Rahmen eines einfachen Umknicktraumas eine Kalkaneusfraktur zuzog. Magnetresonanztomographisch zeigte sich eine undislozierte, extraartikuläre Fraktur, so dass keine Operationsindikation bestand. Die konservative Therapie erfolgte mittels einer Kalkaneusfrakturorthese unter Vollbelastung. Hierdurch wurde eine bequeme Fortbewegung ohne Gehstützen und Gipsruhigstellung verbunden mit einer raschen Rückkehr des verletzten Kindes in seinen gewohnten Tagesablauf ermöglicht.
    Der Unfallchirurg 01/2013; 116(11). · 0.61 Impact Factor