Objective: To explore the clinical efficacy and technical advantages of subtalar arthroscopy-assisted percutaneous lever reduction combined with metal bone pin internal fixation for displaced intra-articular calcaneal fractures in children, and to provide a reference for minimally invasive treatment of such fractures.

Methods: The clinical data of a 13-year-old female with left intra-articular calcaneal fracture was retrospectively analyzed. The patient had left heel swelling, pain and limited mobility due to a fall from height. CT 3D reconstruction showed comminuted calcaneal fracture with posterior articular facet collapse. Preoperative Böhler angle was 8°, Gissane angle 103°, and VAS pain score 5 on the affected side. Subtalar arthroscopy-assisted percutaneous reduction and internal fixation was performed: the joint cavity was cleaned and fracture explored under arthroscopy, the posterior articular facet was levered to anatomical reduction, calcaneal deformity was corrected, and multiple metal bone pins were implanted for intramedullary cross fixation. Postoperative staged rehabilitation training and regular imaging and functional evaluations were conducted.

Results: No postoperative complications such as wound infection or neurovascular injury occurred, and early pain-free rehabilitation was available. Postoperatively, Böhler angle was 30°, Gissane angle 122°, VAS score 1. Imaging showed satisfactory fracture reduction and restored calcaneal anatomical morphology. Bony union was achieved at 2 months postoperatively, and full weight-bearing walking was resumed after implant removal. At 3-month follow-up, the AOFAS ankle-hindfoot score was 95, the affected foot function returned to normal for daily activities.

Conclusion: Subtalar arthroscopy-assisted percutaneous reduction and internal fixation is safe and effective for pediatric intra-articular calcaneal fractures involving the posterior facet. It can achieve accurate articular facet reduction with minimal soft tissue trauma, fewer complications and favorable early exercise. It effectively restores calcaneal anatomical angles, promotes foot function recovery, and has high clinical application value.

Wang Ye, chief physician, serves as the department head of the Bone and Joint Rehabilitation Center at Xiangya Boai Rehabilitation Hospital. Major in clinical and basic research in orthopedics for 15 years, proficient in minimally invasive techniques for the diagnosis and treatment of limb and joint injuries, as well as bone and joint diseases. Obtained 3 national invention patents and 4 utility model patents.