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Background <p>Complex trauma of the foot with acute compartment syndrome (CS) in children is an absolute rarity for which there are barely any treatment recommendations in the literature.</p> Objective <p>Presentation of a&#xa0;staged operative management that yielded an excellent long-term result despite severe bone, joint and soft tissue injuries.</p> Material and method <p>During luge training an 8‑year-old child collided with the barrier at approximately 90 km/h with the left foot, resulting in complex trauma to the foot (6&#xa0;points&#xa0;according to Zwipp) with serial fractures of the talus, calcaneus (5&#xa0;fragments/3&#xa0;joints) with 50° varus deformity, cuboid and fifth metatarsal with acute foot CS. A 3‑stage treatment consisting of acute dorsomedial compartment release (Hanover approach) plus tibiometatarsal external fixation (day&#xa0;1), intermediate skin adaptation (day&#xa0;5) and definitive open anatomical joint reconstruction of the calcaneus (day&#xa0;8) enabled an uneventful healing process. The below knee cast and K‑wires were removed 6 weeks after the third surgery. The child was exempted from physical education for 10&#xa0;months and received intermittent physiotherapy for 12&#xa0;months.</p> Results <p>The patient, 18&#xa0;years after the complex trauma of the left foot, is working full time as an industrial master painter in a&#xa0;3-shift system. He can play soccer and do weight training without pain&#xa0;with full ankle, foot and toe function. The American Orthopaedic Foot &amp; Ankle Society (AOFAS) ankle hindfoot score at 18&#xa0;years follow-up is 100, the foot function index is 2.36, and the EuroQoL-5L5D score is 100 points. Weight-bearing computed tomography (CT) shows conservatively treated well-healed fractures of the talus, cuboid and fifth metatarsal. The anatomically realigned calcaneus is free of arthrosis with congruent posterior, medial and cuboid joint facets.</p> Discussion <p>Urgent relief of acute foot CS within 6 h of trauma is also essential in children. A&#xa0;staged surgical approach is recommended for complex foot trauma with severe soft tissue injury.</p>

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Rennrodel-Hochrasanztrauma mit Komplextrauma des Fußes und akutem Kompartmentsyndrom eines 8-jährigen Kindes

  • 期刊论文

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  • 发表日期：

    2026年6月2日

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  • Hans Zwipp,
  • Achim Biewener,
  • Guido Fitze,
  • Stefan Rammelt

摘要

Background

Complex trauma of the foot with acute compartment syndrome (CS) in children is an absolute rarity for which there are barely any treatment recommendations in the literature.

Objective

Presentation of a staged operative management that yielded an excellent long-term result despite severe bone, joint and soft tissue injuries.

Material and method

During luge training an 8‑year-old child collided with the barrier at approximately 90 km/h with the left foot, resulting in complex trauma to the foot (6 points according to Zwipp) with serial fractures of the talus, calcaneus (5 fragments/3 joints) with 50° varus deformity, cuboid and fifth metatarsal with acute foot CS. A 3‑stage treatment consisting of acute dorsomedial compartment release (Hanover approach) plus tibiometatarsal external fixation (day 1), intermediate skin adaptation (day 5) and definitive open anatomical joint reconstruction of the calcaneus (day 8) enabled an uneventful healing process. The below knee cast and K‑wires were removed 6 weeks after the third surgery. The child was exempted from physical education for 10 months and received intermittent physiotherapy for 12 months.

Results

The patient, 18 years after the complex trauma of the left foot, is working full time as an industrial master painter in a 3-shift system. He can play soccer and do weight training without pain with full ankle, foot and toe function. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot score at 18 years follow-up is 100, the foot function index is 2.36, and the EuroQoL-5L5D score is 100 points. Weight-bearing computed tomography (CT) shows conservatively treated well-healed fractures of the talus, cuboid and fifth metatarsal. The anatomically realigned calcaneus is free of arthrosis with congruent posterior, medial and cuboid joint facets.

Discussion

Urgent relief of acute foot CS within 6 h of trauma is also essential in children. A staged surgical approach is recommended for complex foot trauma with severe soft tissue injury.