Fractures of the os calcis in children

Thirty-four os calcis fractures were encountered in 32 children between 1974 and 1982. As commonly occurs in adults, a fall striking the heel was the most common mechanism of injury. Both intra-articular and extra-articular fractures were noted and classified accordingly. Involvement of the posterior subtalar joint was common, occurring in 28 fractures. The joint involvement in the childhood injury was often subtle and the fracture easily overlooked on initial radiographic examination. Minor involvement of the posterior subtalar joint was usually identified by a bursting of the lateral wall of the os calcis, producing a longitudinal silver of bone noted on the axial os calcis radiograph. All cases were treated conservatively, including those with marked deformities of the subtalar joint. Follow-up assessment revealed very satisfactory results in those cases with extra-articular fractures or minor posterior subtalar joint involvement. Patients with more marked joint displacement revealed persisting limitation of subtalar joint motion, but an absence of discomfort or pain.