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Review
. 2016 Sep 13;51(6):630-639.
doi: 10.1016/j.rboe.2016.09.001. eCollection 2016 Nov-Dec.

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Stefan Rammelt  1 , Alexandre Leme Godoy-Santos  2 , Wolfgang Schneiders  1 , Guido Fitze  1 , Hans Zwipp  1
Affiliations
Review

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Stefan Rammelt et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.

As fraturas do tornozelo e do pé representam 12% de todas as fraturas pediátricas. Fraturas maleolares são as lesões mais frequentes dos membros inferiores; fraturas do retropé e mediopé são raras, mas o seu tratamento inadequado pode resultar em síndrome de compartimento, deformidades tridimensionais, necrose avascular e osteoartrose pós-traumática precoce, as quais apresentam impacto significativo na função global do tornozelo e pé. Portanto, os desafios no tratamento dessas lesões na criança são o diagnóstico adequado e tratamento preciso para se evitarem as complicações. O objetivo do tratamento é restaurar a anatomia normal e a relação articular correta entre os ossos da região. Além disso, o tratamento deve ser planejado de acordo com acometimento articular, o alinhamento dos membros inferiores, a estabilidade ligamentar e a idade. O algoritmo de tratamento dos traumas complexos do tornozelo e pé na infância é descrito. Este artigo apresenta uma revisão sobre o tema e as evidências científicas para o tratamento adequado dessas lesões.

Keywords: Ankle joint; Calcaneus; Child; Talus.

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Figures

Fig. 1
Fig. 1
(A) Profile radiography of a triaxial fracture of the right ankle. (B–D) Sagittal, coronal, and axial sections of computed tomography of the right ankle. (E and F) Anteroposterior and profile postoperative radiographs showing the fixation with compression screws.
Fig. 2
Fig. 2
(A) Medial access route for surgical treatment of talus fracture. (B) Lateral access route for surgical treatment of talus fracture.
Fig. 3
Fig. 3
(A and B) Lateral radiograph of the foot and axial radiograph of the calcaneus. (C and D) Coronal and oblique axial cut of the foot. (E and F) Anteroposterior and profile postoperative radiographs showing the fixation with plate and compression screws. (G and H) Lateral radiograph of the foot and axial radiograph of the calcaneus in the late postoperative period.
Fig. 4
Fig. 4
(A and B) Three-dimensional reconstruction of a computed tomography showing fracture with shift of transition of the neck/head of the talus and shortening of the lateral column due to cuboid fracture. (C and D) Anteroposterior and profile postoperative radiographs showing the fixation with Kirschner wire of the cuboid and talus fractures. (E, F, and G) Anteroposterior, profile, and oblique radiographs of foot in the late postoperative period.
Fig. 5
Fig. 5
Algorithm for treatment of complex foot and ankle injuries in children.
Fig. 6
Fig. 6
(A) Anteroposterior radiograph of the foot showing tarsometatarsal fracture-dislocation. (B and C) Anteroposterior and profile postoperative radiographs showing the fixation with Kirschner wire and aid of an external fixator. (D and E) Postoperative clinical aspect showing damage of skin coverage. (F and G) Lateral and anteroposterior radiographs of the foot in the late postoperative period.
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