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I would like opinions / ideas and help on possible treatments for a ten year old boy who has suffered multiple fractures of his left tarsal bones. There are comminuted fractures involving the talus with numerous fracture lines extending into the subtalar, dorsal and medial cortices. A linear fragment has been seperated from the anterior calcaneum medially. There are also linear fractures of the cuboid anteriorly and laterally. There is a severely comminuted fracture involving the 3rd cuneiform. There is a further fracture with minor displacement involving the base of the 3rd metatarsal. There is a more subtle fracture involving the lateral metaphysis of the distal 2nd metatarsal. The majority of trauma appears to involve the talus and the 3rd cuneiform.

Current treatment through the general hospital is conservative with non weight bearing and review in two months when the fracture sites have "healed"

Any ideas????

 

Hi Daina:
It is difficult to answer your question considering the complexity of the boys apparent injuries. These types of severe injuries to the rearfoot and midfoot, particularly with open epiphyses and apophyses, are always challenging.

The first concern is always assessing the vascularity. In general, without seeing this patient and just trying to visualize it, your main area of concern (after vascular studies) will be necrosis of the talus and loss of the Ankle/STJ.

With any severe injury it is always best to have a trauma surgeon assess it. If you have concerns as to whether the patient is receiving proper treatment then you can always ask if the physician making treatment decisions is experienced in this type of pediatric orthopedic trauma. I do not think this is an issue that a forum like this can help with on an acute “treatment” level.
Good luck
DrSArbes