[Malunited juvenile fractures in the foot region]

Between 1971 and 1990 we treated 121 juvenile patients up to 14 years of age with fractures of the ankle joint and foot in the department of trauma surgery at Hannover Medical School. A total of 128 fractures were treated in these patients, excluding toe fractures. The distribution of fractures as referred to the anatomical-functional planes was as follows: Tibia-talar joint 69; talus 8; calcaneus 6; Chopart joint 5; Lisfranc joint 4 and metatarsal area 36. Clinical and radiological follow-up investigations were possible a mean of 8.7 years post trauma for all talar and calcaneal fractures, for 7 out of 9 Chopart/Lisfranc injuries and for 7 out of 35 of metatarsal fractures. In the case of talus fractures our results suggest that it is to restore the original length of the talus bone (medial column); this is important to prevent collapse of the longitudinal arch with subsequent early arthritis. The rare cases of sustained intraarticular damage to calcaneal fractures should be treated as in adults, i.e. by open, anatomical reconstruction. In children, Chopart/Lisfranc 2 fracture dislocations only occur if high-energy trauma is present (runover trauma in 4 out of 9 cases). Optimal treatment again is comparable to that in adults: open, anatomical reduction with Kirschner-wires followed by temporary, tibio-tarsal transfixation; this is important since no compensatory mechanisms develop if a subluxation is present after reduction. Metatarsal fractures often occur along the first and fifth rays and have a good prognosis. Conservative treatment is justified, since, according to our results, even in intraarticular fractures of the metatarsal head good remodeling to fragments occurs.