OTA 2002 - Session 5 Session V - Foot and Ankle Sat., 10/12/02 Foot & Ankle, Paper #36, 10:00 AM 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.