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AI-Generated response:

What is the preferred treatment for a posterior calcaneus fracture in a fourteen-year-old?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

The preferred treatment for a posterior calcaneus fracture in a fourteen-year-old is conservative management with a walking boot or cast, and limited activity, complemented by heel cups and stretching of the calf musculature.

Surgical intervention, such as percutaneous reduction and cannulated screw fixation assisted by 3D printing technology, may be considered if conservative measures are insufficient or if the fracture is severe.[1-2]

  • Initial conservative treatment includes immobilization using a walking boot or cast to allow the fracture to heal while minimizing movement.

  • Heel cups can be used to alleviate pressure and provide cushioning to the heel area, aiding in pain management and comfort.

  • Stretching exercises for the calf muscles are recommended to maintain flexibility and prevent stiffness during the immobilization period.

  • Regular follow-up appointments are necessary to monitor the healing process and adjust treatment as needed.

  • If conservative treatment fails or the fracture is complex, surgical options like percutaneous reduction and cannulated screw fixation, potentially enhanced by 3D printing technology for precise intervention, can be considered.[2]

Additional info

In the context of treating a posterior calcaneus fracture in a young patient, it's crucial to balance the need for effective healing with the minimization of long-term mobility issues. Conservative treatment is typically preferred to avoid the risks associated with surgery, such as infection or complications from anesthesia. However, the use of advanced surgical techniques like 3D printing-assisted percutaneous reduction and cannulated screw fixation has shown promising results in terms of functional recovery and minimal complications, making it a viable option when conservative measures are inadequate.[2] Regular monitoring and adjustments based on the patient's progress are essential components of the treatment plan to ensure optimal recovery.

References

Reference 1

1.

Elsevier ClinicalKey Derived Clinical Overview

• Except for high-risk stress fractures, most can be treated initially with conservative management that involves discontinuing any painful activities (such as running) • Middle metatarsal shaft stress fractures: hard-soled shoe or fixed ankle walker with gradual return to activity when symptomatically improved (approximately 6 weeks) • Calcaneal stress fractures: walking boot or cast, limited activity, heel cups, and stretching of the calf musculature • Talus, navicular, and fifth metatarsal base: short leg non–weight-bearing cast for 6 to 8 weeks or primary surgical consideration • If any deformity (varus or valgus foot) or mechanical abnormality is present, appropriate orthotics should be used to prevent recurrence

Reference 2

2.

Miao K, Wang J, Yu K, Hong J, Lu X. Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2024;29(1):236-242. doi:10.1016/j.jos.2022.12.004.

Publish date: January 1, 2024.

CT scan showed good reduction of the posterior facet according to Goldzak index. The average subjective AOFAS hindfoot score was 94.1. Both patients and surgeon made sense of the 3D printed model that can help them getting more information about the factures and making preoperative plans. No wound complication was found in this study. CONCLUSION: This study indicated that percutaneous reduction and cannulated screw fixation (PR + CSF) assisted by 3D printing technology in the treatment of calcaneal fractures in pediatric patients achieve good outcomes, with specific preoperative preparation, satisfactory functional recovery and fewer complications. LEVEL OF EVIDENCE: III.

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