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: 1.47). 01/2008; 27(8):856-62. DOI: 10.1097/BPO.0b013e3181558ba2
Source: PubMed


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.

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    • "Calcaneal fractures in children are usually managed conservatively by immobilisation using a cast or splint, with open reduction and internal fixation reserved for avulsion fractures of the Achilles tendon with displacement of the posterior fracture fragment, or intra-articular fractures [4]. Good postoperative functional outcome after open reduction and internal fixation of paediatric calcaneal fractures has been documented in several case series [5, 6]; however, the low numbers of patients included in these series limits the value of these recommendations. Surgical management of calcaneal fractures in adults is common but has been associated with high rates of complications. "
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