Open reduction and internal fixation of intra-articular calcaneal fractures in children

Calcaneal fractures are rare injuries in children and adolescents, and fractures with displaced intra-articular fracture patterns are even more rare. The purpose of this study was to report 9 intra-articular calcaneal fractures in 8 children (mean age, 12.6 years; range,10-15 years) treated with open reduction and internal fixation (ORIF) and to examine cases reported in the literature to better define the classification characteristics and operational outcomes of this uncommon fracture. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical and radiographic examinations were performed at postoperative follow-up, and functional outcome was assessed with the modified American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Mean follow-up was 47 months (range, 21-72 months). Mean time to union was 9.2 weeks (range, 8-12 weeks). Mean modified AOFAS score was 65.2 points (range, 53-68 points). One foot experienced a minor complication.After a systematic review of the literature, 4 studies with a total of 35 patients (37 fractures) were included. All fractures were caused by high-energy injuries. Based on the Essex-Lopresti classification, 40.5% (15/37) were tongue-type fractures and 59.5% (22/37) were joint depression-type fractures. Based on the Sanders classification, 62.2% (23/37) of fractures were 2 parts, 32.4% (12/37) were 3 parts, and 5.4% (2/37) showed comminution. No significant difference was found in classification information between children and adults. The authors concluded that the characteristics of intra-articular calcaneal fractures in children are similar to those in adults, and operative treatment of these fractures yields good results with few complications.