• Robert Eberl, Elke M Ruttenstock, Georg Singer, Peter Brader, and Michael E Hoellwarth.
• Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria. robert.eberl@meduni-graz.at
• Injury. 2011 Oct 1; 42 (10): 1171-8.

BackgroundComplex injuries of the foot in the paediatric population present difficult treatment challenges. While standardised protocols exist for the adult population to achieve an optimal result in the treatment of such injuries, therapy in paediatric patientsmust be managed without a firm treatment algorithm.MethodsMedical records of all patients with a complex trauma of the foot treated at our Department over a period of 13 years were evaluated. A complex trauma of the foot was defined using the scoring system developed by Zwipp et al. (1997).24 Treatment and outcome were analysed. Additionally, our treatment algorithm of complex injuries of the foot in paediatric patients is presented.ResultsTwenty-nine patients were included in the study (79%m; 21% f, average age 12.1 years, ranging 2–16 years). Traffic accidents were the most common mechanism (n = 14; 48.3%), followed by a fall from a height in five patients (17.2%). Lawnmower injuries were found in another 3 patients (10.3%) and other mechanisms of injury in 7 patients (24.2%). The mean score according to Zwipp et al. (1997)24 was 5.8 points (range 5–8 points). While closed fractures were diagnosed in 20 (69%) patients, 9 patients (31%) presented open fractures. Operative intervention was necessary in 24 patients (82.8%). Fracture stabilisation could be realised using K-wires in 13 cases (54.2%), screws in 3 cases (12.5%) and plate fixation in 1 case (4.2%). Combined techniques including external fixation were applied in another 7 (29.1%) cases. The mean time between injury and latest follow-up examination was 5.7 years (range 13 months to 13 years). The mean functional outcome was 47.6 (29–56) points for the OAFQ, 15.1 (0–69) points for the FFI and 82.3 (59–100) points for the AOFAS Score.DiscussionTo regard the maxims in treating complex injuries and open fractures in the growing skeleton we developed a simple treatment algorithm for complex foot injuries in order to provide preservation of the soft tissue envelope, avoidance of infection, restoration of the axis and the articular surface.ConclusionA complex trauma of the paediatric foot is a rare and challenging injury. Avoidance of infection, preservation of the soft tissue envelope and fracture healing will provide good functional outcome despite the severity of trauma. Long time follow-up is essential to detect complications.

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