Realignment of the ankle joint in distal tibial growth disorder

a clinical case

Abstract

Fractures of the distal tibial physis in children and adolescents may lead to growth plate damage withstopping at the physis growth and subsequent physeal bar, angular deformity or leg length discrepancy. Treatment options include physeal bar excision, contralateral and ipsilateral epiphysiodesis, andangular correction osteotomy at the physis closure. Clinical case: Female, 23 years old, healthy. She used the orthopedic consultation due to ankle deformity with associated mechanical pain,with no significant change in gait. She reported a history of ankle trauma during adolescence, inneed of plaster immobilization, but could not specify the diagnosis. The observation showed valgusdeviation of the ankle, with no significant discrepancy in leg length, without ankle-width arches andno crepitus. The radiograph showed valgus deviation of the ankle (10° of deformity). The patientunderwent wedge supramalleolar osteotomy of internal subtraction of the tibia, osteotomy of thefibular lengthening and plication of the internal collateral ligament. Follow-up at 18 months revealedsignificant improvement in pain with an increase of the AOFAS score of 23 points.The reportedclinical case is of particular interest in demonstrating the importance of follow-up in the physeallesions of the distal tibia. Early detection of growth stops facilitates surgical intervention with adecrease in the need for major corrective procedures, as was necessary in this case.