Calcaneal Fractures In Children Research Articles

Percutaneous reduction and cannulated screw fixation assisted by 3D printing technology of calcaneal fractures in children

BackgroundPercutaneous reduction and cannulated screw fixation (PR + CSF) for treatment of calcaneal fractures in pediatric patients has been proven to achieve satisfactory outcomes with few complications. But it is also a difficult technology due to the limited exposure and surgeons are unable to reduce articular surface under direct vision. The purpose of this study was to analyze the outcomes of applying 3D printing technology to preoperative preparation and Intraoperative operating for the treatment of calcaneal fractures in children. MethodsPediatric patients with calcaneal fractures from January 2010 to December 2018 were reviewed during study period. Preoperative radiographs and computed tomography scans were collected to classify the fractures, reconstruct 3D printed model and evaluate postoperative outcomes. The blood loss, operative time, number of fluoroscopies, surgeon and patient satisfaction were used to assess the effectiveness, feasibility and safety of 3D printing technology. Functional results were measured by American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Result12 patients (10 boys and 2 girls) with 17 fractures were involved in our study. There were significant differences in the average Böhler angle before operation compared with that after operation and at last follow-up (P < 0.001). Similarly, the calcaneal height and length postoperatively and at the end of follow-up time were proved to have significant difference (P < 0.05) compared to preoperative. CT scan showed good reduction of the posterior facet according to Goldzak index. The average subjective AOFAS hindfoot score was 94.1. Both patients and surgeon made sense of the 3D printed model that can help them getting more information about the factures and making preoperative plans. No wound complication was found in this study. ConclusionThis study indicated that percutaneous reduction and cannulated screw fixation (PR + CSF) assisted by 3D printing technology in the treatment of calcaneal fractures in pediatric patients achieve good outcomes, with specific preoperative preparation, satisfactory functional recovery and fewer complications. Level of evidenceIII.

Minimally invasive approach with external fixator for intra-articular calcaneal fractures in children.

Calcaneal fractures are rare in pediatric population, with more displaced intra-articular fractures encountered due to the increasing number of high-energy trauma. Operative interventions are gaining popularity because of the unsatisfactory outcomes of traditional conservative methods. This study investigated the clinical outcomes of a minimally invasive technique using the sinus tarsi approach and external fixator in the treatment of intra-articular calcaneal fractures in pediatric patients.Patients who underwent open reduction between January 2010 and January 2018 at our institute were included in this study and reviewed retrospectively. Radiological and clinical parameters were all recorded and analyzed.Overall, 29 patients were included in the study, including 23 boys and 6 girls (10.2 ± 2.2 years old). The average follow-up was 29.5 months postoperatively (range, 26–72 months). Bohler angle was 15.2 ± 3.3° preoperatively, and 34.0 ± 3.8° postoperatively (P < .001); Gissane angle was 101.8 ± 6.2 degrees preoperatively, and 129.7 ± 6.2° postoperatively (P < .001). The average length of incision was 3.4 ± 0.7 cm. At the last follow-up, all patients showed satisfactory clinical outcomes and the score was 90.0 ± 2.3 according to American Orthopedic Foot and Ankle Society Scale.Minimally invasive approach with external fixator is an effective method for treating displaced intra-articular calcaneal fractures in pediatric patients, with a lower incidence of wound-related complications and good cosmetic outcomes.

A minimally invasive (sinus tarsi) approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children.

The aim of this study was to analyze the management of displaced intra-articular calcaneal fractures in children at our pediatric orthopedic and to determine the results following open reduction via minimally invasive sinus tarsi approach and fixation with Kirschner wires (K-wires). Overall, 25 available cases of calcaneal fractures in children with mean age of 9.8 years were treated by open reduction from January 2010 to December 2015. All patients were followed up from 12 to 30 months (mean: 19 months). Clinical functional outcomes were graded using the American Orthopedic Foot and Ankle Society hindfoot scores. Radiographic evaluation included measurement of the Bohler’s angle and Gissane’s angle of the calcaneus on the lateral view. All fractures healed within 3 months. According to the American Orthopedic Foot and Ankle Society foot scoring system, the mean scores of type II fractures were 92.7±2.1, type III 90.2±1.8, and type IV 89.7±2.7 at the latest follow-up. The preoperative and postoperative Bohler’s angles were 17.1°±10.7° and 35.9°±6.7° in Sanders type II fractures, 14.4°±11.5° and 34.7°±8.5° in type III, 9.3°±9.7° and 35.1°±4.9° in type IV, respectively. The preoperative and postoperative Gissane’s angles were 102.6°±11.5° and 125.7°±7.8° in Sanders type II fractures, 101.7°±9.1° and 117.5°±10.8° (P<0.05) in type III, and 104.7°±5.1° and 122.8°±9.1° (P<0.05) in type IV, respectively. No secondary arthrosis has been observed so far. No deep infection and wound necrosis occurred. One patient had superficial infection around K-wires that was managed using dressings. Treatment of calcaneal fractures in children by open reduction by sinus tarsi approach and K-wires fixation is a safe and effective method with low incidence of complications.

Intra-Articular Calcaneal Fracture in Patient of 11 Years, What Treatment is the Most Adequate?

Calcaneal fractures in children are uncommon injuries. Most of such injuries are due to low impact traumas, and are usually slightly displaced and extra-articular. However, in the case of high impact trauma (a fall from a high place or a traffic accident), displaced intra-articular injuries can occur. Currently, there is no consensus about the most appropriate treatment for such injuries. We present the case of an 11-year-old patient who suffered a fall from 2 m high, having pain and functional impotence in the left foot. After a radiological study by simple radiography and CT, he is diagnosed of intra-articular fracture of displaced calcaneus. It was decided to apply a conservative treatment by immobilization and discharge during 8 weeks, obtaining satisfactory clinical and functional results after more than one year of follow-up.

Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.].

“ORIF” for displaced intra-articular calcaneal fractures in children

BackgroundCalcaneal fractures in children are rare injuries, and those with displaced intra-articular fracture patterns are found even less frequently. Recent data in the adult literature have suggested operative treatment of displaced intra-articular calcaneal fractures leads to a more favorable outcome. ObjectiveThe aim of this study is to analyze the outcomes of displaced intra-articular calcaneal fractures in children treated by open reduction and internal fixation. MethodsTen displaced intra-articular calcaneal fractures in 10 patients were treated by open reduction and internal fixation. Mean age was 10.2 (6–12 years). According to Sanders’ classification, there were 8 patients who had Sanders’ Type II fractures, and 2 children sustained Type III fracture. All patients were followed up with a mean 20.3 months (range 6–30). Clinical score according to the (AOFAS) was 95.8 (range 78–100). ConclusionThe characteristics of intra-articular calcaneal fractures in children are similar to those in adults and, from our experience, operative treatment of these fractures, to restore calcaneal anatomical alignment yields good short-term results.

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.

Operative Treatment of Intraarticular Calcaneal Fractures in the Pediatric Population

Calcaneal fractures in children are rare injuries, and those with displaced intraarticular fracture patterns are found even less frequently. Recent data in the adult literature have suggested operative treatment of displaced intraarticular calcaneal fractures leads to a more favorable outcome. Most pediatric calcaneal fractures are due to low-energy trauma and are therefore minimally displaced and extraarticular. However, some children are exposed to high-energy trauma, leading to severe intraarticular injuries. Operatively treated calcaneal fractures in children have been poorly described in the literature. The purpose of this study was to analyze the outcomes of surgically treated displaced intraarticular calcaneal fractures in children. All children with closed displaced intraarticular calcaneal fractures treated with open reduction internal fixation at 1 institution were reviewed at an average of 67 months postoperatively. Preoperative and postoperative radiographs and preoperative computed tomographic scans were used to classify fractures. Functional outcome was assessed by the use of the subjective portions of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Fourteen fractures in 13 patients who met the inclusion criteria were treated with open reduction internal fixation. We found 7 tongue-type and 7 joint depression-type fractures based on the Essex-Lopresti classification. Based on the Sanders classification, we found 9 type II (2-part) fractures and 5 type III (3-part) fractures. The average preoperative and postoperative Bohler angles were 11.8 and 28.4 degrees (P < 0.0001), respectively. The average subjective AOFAS hindfoot score was 64 of a possible 68 points. Of 14 fractures, 13 were fixed with a buttressing plate laterally. One patient was fixed with a single 3.5-mm cortical screw and had the lowest AOFAS hindfoot score. Four minor complications in 3 patients were encountered. We found that most children with displaced intraarticular calcaneal fractures treated with open reduction and internal fixation at 1 institution had a good clinical outcome with few complications.

Calcaneal fractures in children. Long-term results of treatment.

The late results of treatment of calcaneal fractures in 17 children (19 fractures) were reviewed at a mean of 16.8 years after injury. With the exception of one patient, all fractures had been treated conservatively. At follow-up there were few complaints. All but two patients had full or slightly reduced mobility of the subtalar joint and unrestricted foot function, including the ability to walk comfortably on uneven surfaces. Minor radiological abnormalities of the hindfoot were common; there were two cases of post-traumatic osteoarthritis. Clinical scoring of the ankle and hindfoot using the American Orthopaedic Foot and Ankle Society rating system averaged 96.2 points. The results suggest that up to 16.8 years after injury almost all children achieve excellent long-term functional results with conservative treatment of fractures of the os calcis. Open management may only be appropriate for adolescents with severe displacements.

Toddler's fracture of the calcaneum

Calcaneal fractures in very young children are thought to be rare. We report on seven calcaneal fractures in children under the age of 36 months in the absence of a history of significant injury. In five cases plain radiology was normal, but the diagnosis was reached using scintigraphy. We suggest that this is not such a rare injury, and that wider use of scintigraphy will assist in making the diagnosis. The prognosis of this injury is excellent.

Irreducible Fracture of the Calcaneus in a Child

Displaced fractures of the calcaneus are rare in children, and most do not require open reduction as a treatment modality. The case of a 4-year 8-month-old boy who sustained a fracture of the anterior process of the calcaneus requiring open reduction is presented; no similar fracture in childhood has been previously reported. Treatment guidelines for calcaneal fractures in children are reviewed.

Calcaneal Fractures in Children An Evaluation of the Nature of the Injury in 56 Children

The traditional view of calcaneal fractures in children is that this injury and its consequences are generally less severe than its adult counterpart. The validity of this conception and other ways in which children's fractures differ were examined by a retrospective review of children's injuries. The fracture patterns encountered in children 15 years of age or older resembled those of adults. Intra-articular Type 5 fractures were predominant. Children 14 years of age or younger had predominantly extra-articular fracture patterns, a possible reflection of less frequent mechanisms of vertical compression loading in children and their ability to absorb compression loading. Extra-articular and intra-articular Type 4 fractures were characteristically nondisplaced injuries, with normal calcaneal articulations being preserved in all cases. Unrecognized calcaneal fractures were frequent, reflecting both the difficulty of detecting minimal osseous injury and the benign nature of the unrecognized fracture. Associated fractures of the extremities, twice as frequent in children as adults, and axial skeletal injuries, half as frequent as in adults, should not be overlooked. The prognosis for a normally functioning calcaneus without the presence of post-traumatic arthrosis should be expected in most cases due to the nature of the fracture in children.

Fractures of the calcaneum, with an atlas illustrating the various types of fracture.

Fractures of the calcaneum, with an atlas illustrating the various types of fracture.