OBJECTIVE

To evaluate the characteristics, treatment, and effectiveness of grade III spoke heel injury in children.

METHODS

Between January 2007 and June 2013, 31 children with grade III spoke heel injuries were treated. There were 19 boys and 12 girls, aged from 3 to 12 years (mean, 5.2 years). The time from trauma to operation was 2 hours to 26 days (mean, 4.4 days). The soft tissue defects of the heels ranged from 3.5 cm x 2.5 cm to 8.0 cm x 4.5 cm, which all complicated with Achilles tendon and calcaneus tuberosity defects. In 16 cases of large Achilles tendon defects which can not be stretched straightly to calcaneus tuberosities, repair with sliding gastrocnemius musculocutaneous flaps (16 cm x 5 cm to 21 cm x 10 cm) and insertion reconstruction of the tendon were performed. In 15 cases of Achilles tendon defects which can be stretched straightly to calcaneus tuberosities, repair with reversed pedicled flap (4.0 cm x 2.5 cm to 8.0 cm x 4.5 cm) and insertion reconstruction of the tendon were given. Nerve anastomosis was not performed. The donor site was covered with split-thickness skin graft.

RESULTS

All children were followed up 6 months to 4 years (mean, 13 months). The other flaps survived except 3 cases having partial necrosis. The color and appearance of the flaps were satisfactory, with no impact on wearing shoes and walking. The flaps recovered sensory function. As more follow-up time, the angle of dorsal flexion was gradually improved. Heel raising on one leg was restored. The bone amount of calcaneus tuberosity increased slowly based on X-ray films.

CONCLUSION

Grade III spoke heel injury in children possesses peculiar features, surgical methods should be based on defects of Achilles tendon and soft tissue. Dorsal flexion of the ankle is obviously limited; as follow-up time goes on, the ankle function is progressively improved. However, long-term follow-up is needed.