Correction of Posttraumatic Medial Growth Arrest of the Distal Tibia in Adolescents

Abstract

Background Partial growth arrest of the medial part of the distal tibial physis following fractures that penetrated the epiphysis is relatively common. We present the results of treatment, based on a protocol of supramalleolar tibial and fibular osteotomy for ankle alignment correction, and contralateral epiphysiodesis of distal tibia and fibula to balance leg length discrepancy (LLD). Methods This case series study describes the results of 7 patients with a median age of 14 years (range = 10-15 years) who were operated in our institution. All were treated by closed or open reduction and internal fixation after Salter-Harris (SH) types 3 and 4 fractures of the distal tibia. All patients had a partial medial growth arrest, distal tibial varus, relative overlengthening of the distal fibula, and slight leg shortening. Treatment Protocol Contralateral distal tibial and fibular epiphysiodesis to prevent significant LLD, completion of closure of the ipsilateral epiphysis, supramalleolar osteotomy of the distal tibia and fibula, and insertion of a triangular wedge cortical allograft into the tibial osteotomy creating a normal ankle joint orientation. The osteotomy was supported by a medial anatomically contoured locking plate. The fibula was fixed with an intramedullary wire. Results All patients had uneventful healing of the osteotomy after 6 weeks. At the latest follow-up (mean 3 years, range 1.5-5 years), 6 out of 7 patients reached maturity, and the lateral distal tibial angle was within normal limits. The LLD in all patients was less than 8 mm. Conclusions Our protocol provides anatomic correction with the restoration of the ankle joint and prevents the progression of LLD. Levels of Evidence: Level IV

Efficacy of supramalleolar osteotomy in the treatment of traumatic ankle joint varus deformity in adolescents

“…In this study, we confirmed that SMOT is equally good in correcting TAVD in adolescents, and we chose open medial wedge osteotomy over closed medial wedge osteotomy because it does not lead to shortening of the tibia in developing adolescents and the simple surgical approach makes it easier to accurately osteotomize the bone [ 23 ]. Our results showed that the mean preoperative TAS improved from 61.53 ± 3.74° in 32 patients to 88 ± 1.72° at 12 months postoperatively, the mean preoperative TT decreased from 2.25 ± 1.32° to 0.5 ± 0.57° at 12 months postoperatively, the mean preoperative TLS improved from 76.72 ± 0.21° to 79.34 ± 1.52° at 12 months postoperatively, all the radiographic outcomes were significantly improved, the mean preoperative AOFAS score improved from 65.5 ± 9.40 to 92.34 ± 4.00, the mean preoperative VAS score decreased from 2.44 ± 1.24 to 0.78 ± 0.75 at 12 months postoperatively, and the mean preoperative ROM of ankle improved from 50.16 ± 7.46 to 55.78 ± 4.77 at 12 months postoperatively, all of which were also significant improvements in clinical outcomes.…”

“…It has also been studied in much younger patients. Kotlarsky et al [ 23 ] performed supra-ankle osteotomy in seven patients with traumatic ankle varus deformity at a median age of 14 years (10–15 years), and the results demonstrated that SMOT can safely and effectively correct adolescent ankle varus deformity, and provided an anatomical correction of post-traumatic distal tibial varus deformity and restored ankle joint alignment. However, the number of patients included was limited, so more patients are needed to enrich the findings.…”