Seyhmus YİGİT, Emin OZKUL, Ramazan ATİC, Veysel KANDEMİR, Ali TURGUT, Azad YILDIRIM

Which one Affects More to Clinical and Radiological Outcomes in Pediatric Calcaneus Fractures? Is the Severity of Trauma or the Applied Surgical Technique?

Objective: The aim of our study is to evaluate the clinical and radiographic results of pediatric calcaneus fractures treated in our hospital in terms of age, treatment techniques and trauma severity and to compare with the literature Methods: This is a retrospective study conducted on 22 pediatric patients (28 calcaneus fractures) treated with surgery for calcaneus fractures in our hospital from March 2005 to January 2020. There were seven patients (patients between 3 and 6 years old) in group 1 and 15 patients (between 7 and 16 years old) in group 2. Results: 17 fractures were treated with the CRPP technique, 11 fractures were treated with the ORIF technique. The mean age was 11.4 months (range 3–16). Average follow-up time 81.54 months (range 12-156). There is a significant relationship between age and CRPP(p:0.000), but not with ORIF(p:0.10). The most important result of our study is that there is no significant difference between AOFAS scores with CRPP and ORIF techniques (P: 0.167 and p: 0.20, respectively). The second most important result in our study was that there was a significant relationship between Essex Lopresti and Sanders classification to AOFAS score(p: 0.013 in both.). Conclusion : Immature calcaneus fractures are rare, and those without anatomical reduction, as in adults, have poor results. In pediatric calcaneus fractures, fragmentation due to the severity of trauma, cartilage damage, cancellous bone loss and their consequence may cause circulatory disorders between the fracture parts. As a result, post-traumatic arthritis may develop even if anatomical reduction is made. The most important thing that determines the result in pediatric calcaneus fractures is how high energy the fracture occurs rather than the surgical technique to be chosen.

Anahtar Kelimeler:

Pediatric calcaneus, fracture, posttraumatic arthritis; internal fixation; percutaneous pinning

Which one Affects More to Clinical and Radiological Outcomes in Pediatric Calcaneus Fractures? Is the Severity of Trauma or the Applied Surgical Technique?

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1. Inokuchi S, Usami N, Hiraishi E, Hashimoto T. Calcaneal fractures in children. J Pediatr Orthop 1998; 18: 469–74.
2. Atilla P, Abdullah D, İbrahim A, et al. The effect of fracture type and angular deterioration on the functional outcome of calcaneal fractures. Dicle Tıp Dergisi / Dicle Medical Journal 2011; 38: 35-9.
3. Crawford H. Rockwood and Wilkins in children. 7th ed. Lippincott Williams &Wilkins; 2010. p. 1029–37
4. Ribbans WJ, Natarajan R, Alavala S. Pediatric foot fractures. Clin Orthop RelatRes 2005: 107–15.
5. Baker BI, Kinsman RG, Moss CA, et al. Structureactivity studies with fragments and analogous of salmonid melanin-concentrating hormone. Peptides 1990; 11: 1103-8.
6. Pickle A, Benaroch TE, Guy P, Harvey EJ. Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation. J Pediatr Orthop2004; 24: 178–80.
7. Ceccarelli F, Faldini C, Piras F, Giannini S. Surgical versus non-surgical treatmentof calcaneal fractures in children: a long-term results comparative study. FootAnkle Int 2000; 21: 825–32.
8. Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma 2004; 18: 1-6.
9. Brunet J. Calcaneal fractures in children. J Bone Joint Surg [Br]. 2000; 82: 211–6.
10. Mora S, Thordarson DB, Zionts LE, Reynolds RA. Pediatric calcaneal fractures. Foot Ankle Int 2001; 22: 471-7.
11. Schindler A, Mason DE, Allington NJ. Occult fracture of the calcaneus in toddlers. J Pediatr Orthop 1996; 16: 201-5.
12. Harvey E, Grujic L, Macey L. The incidence of morbidity associated with open reduction and rigid internal fixation of displaced intraarticular calcaneus fractures using a lateral approach. Foot Ankle Int. 2001; 22: 868– 73.
13. Westhues H A new treatment method for the calcaneus fracture. Arch Orthop Unfallchir 1934; 35: 121.
14. Wondrak E Treatment of petrous bone fractures by internal Wxation. Zentralbl Chir 1959; 84: 260–6.
15. Sanders R. Current concept review. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am) 2000; 82A: 225–50.
16. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating system for the ankle-hindfoot, midfoot, hallux, and lesser toes. FootAnkle Int 1994; 15: 349–53.
17. Schneidmueller D, Dietz HG, Kraus R, Marzı I. [Calcaneal fractures in childhood: a retrospective survey and literature review]. Unfallchirurg 2007; 110: 939-45. [Article in German].
18. Thomas HMK. Calcaneal fracture in childhood. Br J Surg 1969; 56: 664–6.
19. Summer H, Kramer AP, Benirschke SK. Pediatric calcaneal fractures. Orthop Rev2009; 1: 30–3.
20. Rammelt S, Schneiders W, Fitze G, Zwipp H. Foot and ankle fractures in children. Orthopade 2013; 42: 45–54.
21. Petit CJ, Lee BM, Kasser JR, Kocher MS. Operative treatment of intraar-ticular calcaneal fractures in the pediatric population. J Pediatr Orthop2007; 27: 856–62.
22. Lei T, Mingjing L, Fan L, Jian X, Tao H. A minimally invasive (sinus tarsi) approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children.J Pediatr Orthop B. 2018; Nov;27: 556-62.
23. Thermann H, Hüfner T, Schratt HE, Albrecht K, Tscherne H. Treatment of intraarticular calcaneal fractures in adults. A treatment algorithm. Unfallchirurg1999; 102: 152–66.
24. Buckingham R, Jackson M, Atkins R. Calcaneal fractures in adolescents: CT classificationand results of operative treatment. Injury 2003 Jun,34: 454–9, 2003.
25. Yu GR, Zhao HM, Yang YF, Jia-Qian Z, Hai-Feng L. Open reduction and internal fixation of intraarticular calcaneal fractures in children. Orthopedics 2012, 35: e874–e879, 2012.