Minimally invasive approach with external fixator for intra-articular calcaneal fractures in children

Calcaneal fractures are rare in pediatric population, with more displaced intra-articular fractures encountered due to the increasing number of high-energy trauma. Operative interventions are gaining popularity because of the unsatisfactory outcomes of traditional conservative methods. This study investigated the clinical outcomes of a minimally invasive technique using the sinus tarsi approach and external fixator in the treatment of intra-articular calcaneal fractures in pediatric patients. Patients who underwent open reduction between January 2010 and January 2018 at our institute were included in this study and reviewed retrospectively. Radiological and clinical parameters were all recorded and analyzed. Overall, 29 patients were included in the study, including 23 boys and 6 girls (10.2 +/- 2.2 years old). The average follow-up was 29.5 months postoperatively (range, 26-72 months). Bohler angle was 15.2 +/- 3.3 degrees preoperatively, and 34.0 +/- 3.8 degrees postoperatively (P < .001); Gissane angle was 101.8 +/- 6.2 degrees preoperatively, and 129.7 +/- 6.2 degrees postoperatively (P < .001). The average length of incision was 3.4 +/- 0.7 cm. At the last follow-up, all patients showed satisfactory clinical outcomes and the score was 90.0 +/- 2.3 according to American Orthopedic Foot and Ankle Society Scale. Minimally invasive approach with external fixator is an effective method for treating displaced intra-articular calcaneal fractures in pediatric patients, with a lower incidence of wound-related complications and good cosmetic outcomes.