Schmidt T L, Weiner D S
Clin Orthop Relat Res. 1982 Nov-Dec(171):150-5.
The traditional view of calcaneal fractures in children is that this injury and its consequences are generally less severe than its adult counterpart. The validity of this conception and other ways in which children's fractures differ were examined by a retrospective review of children's injuries. The fracture patterns encountered in children 15 years of age or older resembled those of adults. Intra-articular Type 5 fractures were predominant. Children 14 years of age or younger had predominantly extra-articular fracture patterns, a possible reflection of less frequent mechanisms of vertical compression loading in children and their ability to absorb compression loading. Extra-articular and intra-articular Type 4 fractures were characteristically nondisplaced injuries, with normal calcaneal articulations being preserved in all cases. Unrecognized calcaneal fractures were frequent, reflecting both the difficulty of detecting minimal osseous injury and the benign nature of the unrecognized fracture. Associated fractures of the extremities, twice as frequent in children as adults, and axial skeletal injuries, half as frequent as in adults, should not be overlooked. The prognosis for a normally functioning calcaneus without the presence of post-traumatic arthrosis should be expected in most cases due to the nature of the fracture in children.
关于儿童跟骨骨折的传统观点认为，这种损伤及其后果通常不如成人跟骨骨折严重。通过对儿童损伤的回顾性研究，检验了这一观点的正确性以及儿童骨折的其他不同之处。15岁及以上儿童的骨折类型与成人相似，关节内5型骨折最为常见。14岁及以下儿童主要为关节外骨折类型，这可能反映出儿童垂直压缩负荷机制较少见，以及他们吸收压缩负荷的能力。关节外和关节内4型骨折的特点是无移位损伤，所有病例中跟骨关节均保持正常。未被识别的跟骨骨折很常见，这既反映了检测轻微骨损伤的难度，也反映了未被识别骨折的良性性质。四肢相关骨折在儿童中的发生率是成人的两倍，而轴向骨骼损伤的发生率是成人的一半，不应被忽视。由于儿童骨折的性质，在大多数情况下，预计跟骨在无创伤后关节炎的情况下功能正常的预后良好。
