Pediatric calcaneal fractures

Abstract

Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular) and severity (displaced vs. nondisplaced) have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was −5° (range: −35 – +35) compared to 31° (range: +22 – +47) on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30–4.3 years). Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 – +49). We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

“…Ceccarelli et al, 51 when assessing adolescents aged 15–17 years with deviated intra-articular fractures, observed significantly worse results in the conservative treatment when compared with surgical treatment.…”

“…Up to 5 years of age, the mean value was 15°; between 5 and 10 years, a significant increase to 55° was observed, reaching up to 37° at 13, which is very similar to the adult value. Two retrospective series indicated good long-term results from conservative treatment of deviated intra-articular fractures 50, 51. However, degenerative changes in the subtalar joint and significant shortening of the calcaneus were observed after 12 years 47 …”

“…Therefore, surgical treatment of diverted fractures of the cuboid is usually performed to prevent the shortening of the lateral column, joint incongruity, abduction deformities, and post-traumatic arthritis 27, 42, 51…”

An Atypical Calcaneal Fracture in a Child: A Literature Review Concerning the Treatment

“…Undoubtedly for all non-displaced or minimally displaced extra-articular calcaneal fractures (minimally displaced fractures can be considered those with 1 - 2 mm of deviation between the fragments [12]), the conservative treatment is the choice [12, 13, 16, 23]. Several authors have reported good outcomes in these cases [9, 12, 15, 23].…”

Bilateral Calcaneal Fractures in a Twelve Year Old Boy

“…Although the scientific literature is supporting operative management of calcaneal fractures in adults, there are few studies in children as calcaneal fractures are rare in this age group [2,3]. While calcaneal fractures constitute 1 to 2% of all fractures in adulthood, this occurrence rate drops sharply to 0.005% in childhood [3].…”