Fractures of the Talus and Calcaneus

Abstract

Fractures of the talus and calcaneus are very rare in children owing to the marked elasticity of the skeleton of the foot. In most cases, the accident mechanism involves severe direct violence, such as that inflicted by a fall from a great height. The resulting axial compression may also cause injury to the vertebral column. The talus and calcaneus tend to resist forces of lesser magnitude and transmit them in an upward direction, causing fracture of the less elastic tibia or fibula (Blount). Therefore, unlike an adult, a child who falls a small distance and lands on his heel is more likely to sustain a fracture of the lower leg. The older the child, the greater is the likelihood of a calcaneal fracture. An analogous age distribution of talar fractures has not been shown, and the literature contains several reports of talar fractures in small children (Chiari, Mindell). The indirect forces generated by violent supination may cause a flake fracture (osteochondral fracture) of the medial or lateral talar margins. This lesion occurs more frequently in older children and adolescents, since the thick cartilage cushion which covers the bone of a small child tends to absorb the deforming forces.