Arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the clinical effects of arthroscopic treatment of intraarticular displaced fractures of the calcaneus in children.Methods:The clinical data were analyzed retrospectively of the 11 children who had been treated for intraarticular displaced fractures of the calcaneus at Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University from January 2015 to June 2018. They were 6 boys and 5 girls, aged from 8 to 12 years (average, 10.6 years) and involving the left foot in 7 cases and the right foot in 4. By the Sanders classification, there were 10 cases of type Ⅱ and one of type Ⅲ. Preoperative evaluation of the injury was conducted by X-ray examination and three-dimensional CT reconstruction of the calcaneus. After arthroscopic prying reduction, internal fixation with mere Kirschner wire was performed for 8 cases and internal fixation with Kirschner wire plus hollow screws for 3. The affected feet were fixated with plaster bracket or brace for one month after operation. The Kirschner wires were removed 4 to 6 weeks after operation when X-ray films revealed fracture union. The clinical effects were evaluated by anatomic recovery of the calcaneus in terms of preoperative and postoperative B?hler and Gissane angles and functional recovery of the calcaneus in terms of ankle-hindfoot scores of American Orthopedic Foot Ankle Society (AOFAS) scale.Results:All the 11 pediatric patients were followed up for 12 to 19 months (average, 14 months). No bone grafting was applied. Their operation time averaged 63 min (from 50 to 75 min). Their incisions healed at one stage without infection. All their fractures healed within 2 to 3 months without any delayed union or nonunion. The B?hler angle (28.4°±2.9°) and Gissane angle (125.6°±3.1°) at the final follow-up were significantly improved than the preoperative values (11.8°±5.4° and 138.8°±6.3°) ( P< 0.05). The AOFAS ankle-hindfoot scores were 89.6 points at the final follow-up. Conclusion:Arthroscopic percutaneous prying reduction combined with internal fixation with Kirschner wire and hollow screws can effectively reduce and fixate the intraarticular displaced fracture of the calcaneus in children, leading to limited surgical trauma and fine curative effects.