Mao Fengyong, Ni Lei, Ju Li
Department of Pediatric Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, China.
Front Pediatr. 2025 Aug 21;13:1632820. doi: 10.3389/fped.2025.1632820. eCollection 2025.
Isolated sustentaculum tali fractures among pediatric cohorts represent an exceedingly uncommon entity (<1% of all calcaneal fractures), with limited published evidence regarding operative intervention in prepubescent patients. Diagnostic complexities emerge from radiographically indiscernible fracture patterns, mandating cross-sectional imaging modalities. This case study documents the youngest reported patient (7-year-old female) and introduces the first comprehensive morphometric analysis of fracture characteristics and clinical outcomes following surgical management via open reduction and internal fixation (ORIF) utilizing Kirschner wire (K-wire) stabilization.
A 7-year-old female patient presented with right foot pain following a jumping trauma. Clinical assessment demonstrated point tenderness inferior to the medial malleolus with limited subtalar joint mobility. While plain radiography was non-diagnostic, computed tomography (CT) revealed a displaced sustentaculum tali fracture with a fragment measuring 13.62 × 7.89 mm and significant articular angulation (9° in the coronal plane, 16° in the sagittal plane). Surgical management consisted of ORIF utilizing two 1.5 mm K-wires to achieve anatomic reduction. The postoperative protocol included 6 weeks of cast immobilization followed by a structured rehabilitation program. At 12-month follow-up, CT imaging demonstrated complete osseous union with restoration of articular congruity. The patient exhibited optimal functional outcomes with a maximum American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score of 100, full restoration of ankle range of motion, and complete return to age-appropriate activities without sequelae.
This case underscores the indispensability of CT in the identification of occult sustentaculum tali fractures in pediatric patients. The quantitative parameters observed herein indicate the necessity for patient-specific evaluation protocols. K-wire fixation presents distinct advantages in the pediatric population, notably minimally invasive surgical approach and subsequent facile hardware extraction. Precise anatomical reduction remains paramount for the preservation of hindfoot biomechanics in skeletally immature patients. Although this investigation offers valuable technical insights, multi-institutional prospective studies are warranted to establish definitive surgical criteria and standardized management algorithms.
小儿孤立性载距突骨折是一种极为罕见的情况（占所有跟骨骨折的比例不到1%），关于青春期前患者手术干预的已发表证据有限。由于X线片上骨折模式难以辨别，诊断存在复杂性，因此需要采用断层成像方式。本病例研究记录了报告的最年轻患者（7岁女性），并首次对采用克氏针（K线）固定的切开复位内固定术（ORIF）手术治疗后的骨折特征和临床结果进行了全面的形态学分析。
一名7岁女性患者在跳跃受伤后出现右足疼痛。临床评估显示内踝下方有压痛，距下关节活动受限。虽然X线平片未明确诊断，但计算机断层扫描（CT）显示载距突骨折移位，骨折块大小为13.62×7.89 mm，关节面有明显成角（冠状面9°，矢状面16°）。手术治疗包括使用两根1.5 mm K线进行ORIF以实现解剖复位。术后方案包括6周的石膏固定，随后是结构化康复计划。在12个月的随访中，CT成像显示骨折完全骨性愈合，关节面恢复平整。患者功能恢复良好，美国矫形足踝协会（AOFAS）后足评分最高达100分，踝关节活动范围完全恢复，完全恢复适合其年龄的活动且无后遗症。
本病例强调了CT在识别小儿隐匿性载距突骨折中的不可或缺性。本文观察到的定量参数表明需要针对患者的评估方案。K线固定在儿科人群中具有明显优势，尤其是微创手术方法及随后易于取出内固定物。对于骨骼未成熟患者，精确的解剖复位对于维持后足生物力学至关重要。尽管本研究提供了有价值的技术见解，但仍需要多机构前瞻性研究来确定明确的手术标准和标准化管理算法。
