Concurrent Salter-Harris type II distal tibia fracture with ipsilateral talus and calcaneus fractures in a paediatric patient

Paediatric bones exhibit greater elasticity due to their distinct biomechanical properties, enabling them to absorb and dissipate mechanical forces more effectively than adult bones. This inherent flexibility provides increased resistance to fractures under comparable loading conditions. However, despite this resilience, high-energy trauma can still result in complex injury patterns. Fractures involving the physis are of particular concern, as they carry a significant risk of growth disturbances and long-term deformities.We present a rare case of a girl in early childhood (preschool) who sustained a depressed intra-articular fracture of the calcaneus, a talar neck fracture and a Salter-Harris type II fracture of the distal tibia in the ipsilateral limb following a fall from a height of approximately 20 feet. A preoperative CT scan was obtained to delineate the fracture configuration and guide surgical planning. The depressed fragment of the calcaneus was elevated using a bone punch and stabilised with Kirschner wires (K-wires) under intraoperative fluoroscopic guidance, together with the closed reduction and percutaneous K-wire fixation of the talus and distal tibia fracture.