Pediatric calcaneal fractures

Calcaneal fractures in pediatric patients are seen infrequently. We retrosp ectively reviewed 22 skeletally immature patients with 23 fractures of the calcaneus before their distal tibial physis had fused. Eighteen (78%) of th ese fractures were intraarticular and five (22%) were extraarticular. Nine patients were followed for an average of 4.4 years. Of these nine fractures , 8 were treated nonoperatively and one was treated with open reduction and internal fixation. A modification of the American Orthopaedic Foot and Ank le Society scoring system, which focuses on residual complaints of pain, wo rk or sports restrictions, ability to walk on different surfaces and gait a bnormalities, was employed to assess their outcome. Seven of the nine patie nts were free of pain, had unrestricted foot function, and possessed no app arent gait abnormalities. Two patients had activity related and cold weathe r related pain. We believe that the excellent prognosis for both intraartic ular and extraarticular fractures, seen in this study is multi-fold. First, the immature talus and calcaneus have a superior capacity to remodel. Seco nd, pediatric calcaneal fractures are usually consequence of low energy tra uma. Lastly, a favorable intraarticular fracture pattern, unique to the ske letally immature calcaneus may exist, rendering a good prognosis.