Session V - Foot and Ankle

Os Calcis Fractures in Children and Adolescents: Long Term Results of Operative Treatment

Nirmal C. Tejwani, MD, New York, New York, USA; Roderick Kuo, MD, Sydney, Australia; Christopher DiGiovanni, MD, Providence, Rhode Island; Sarah K. Holt, MSPH; Stephen K. Benirschke, MD; Bruce J. Sangeorzan, MD; Harborview Medical Center, University of Washington, Seattle, Washington, USA

Purpose: We reviewed the results of calcaneal fractures in children and adolescents.

Method: We studied a series of 47 calcaneus fractures in 40 children and adolescents less than 18 years of age treated at our institution from 1988 to 1998. Open reduction and internal fixation was performed by the two senior authors on 34 of the intraarticular fractures. Similar to adults, the most common mechanism causing the injury was a fall or jump from a height. Most of the fractures were intraarticular (78%) and joint depression type. Associated injuries were found in all the patients treated nonoperatively and in 11 of the operated group. We reviewed the results of all patients (average follow-up 5.2 years; range, 2 to 12 years) and calculated the AOFAS score for outcome.

Results: Our overall results were excellent (AOFAS score 80 to 100); most (95%) of our patients had regained excellent range and function by the last follow-up. Four of the operated group had complications in the form of claw toeing, and, of these, only two needed additional surgery. One patient also needed a corrective osteotomy because of valgus growth deformity of the calcaneus. Of the 12 patients whose calcanei were not fixed, 5 had an amputation due to the severity of their injuries, and 3 had skin grafting or a flap for soft tissue injury. The remaining patients were treated in a short leg cast for 4 weeks.

Conclusions: Operative treatment for displaced and comminuted intraarticular fractures with joint incongruity produces excellent results in children and adolescents. There was no major difference in the fracture pattern, mechanism of injury, clinical presentation, management and prognosis between children and adults in this fracture group.