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Pediatric calcaneal fractures
Hobie Summers1, Patricia Ann Kramer, Stephen K Benirschke
1Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Insights
Operative treatment of displaced, intra-articular calcaneal fractures in children yields results comparable to adults. This study shows open reduction and internal fixation is a safe and effective method for pediatric calcaneal fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Operative treatment for displaced, intra-articular calcaneal fractures in adults is standard.
- Treatment for similar fractures in skeletally immature patients remains controversial.
- Previous studies confounded fracture types and severity in pediatric cases.
Purpose of the Study:
- To evaluate the outcomes of operative fixation for displaced, intra-articular calcaneal fractures in skeletally immature patients.
- To compare these outcomes to those typically seen in adult patients.
- To assess the safety and efficacy of using an adult surgical protocol in children.
Main Methods:
- Review of 21 displaced, intra-articular calcaneal fractures in 18 skeletally immature patients.
- Treatment involved open reduction and internal fixation using an adult protocol.
- Pre-operative and post-operative Böhler's angle measurements were used to assess displacement and reduction.
- Follow-up radiographs were used to confirm union and maintenance of reduction.
Main Results:
- Average pre-operative Böhler's angle was -5°, indicating significant displacement.
- No post-operative infections or wound healing complications occurred.
- All but one fracture achieved union, with an average follow-up of 1.5 years.
- Post-operative Böhler's angle averaged 31°, demonstrating successful maintenance of reduction.
Conclusions:
- Operative fixation using an adult protocol is a safe and effective treatment for displaced, intra-articular calcaneal fractures in skeletally immature patients.
- Outcomes are comparable to those reported in adult populations.
- This approach can restore calcaneal anatomy and achieve union without significant complications.
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.
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