Post-physeal deformity around the ankle treated by acute or gradual correction

Abstract

Introduction: Post traumatic distal tibial deformities can cause long term complications. Type 3,4,&5 Salter harris physeal injuries have higher propensity for deformities and limb length discrepancy. Furthermore, altered mechanical alignment in these patients can lead to arthritis in adjacent joints. Management options are varied from acute correction using internal fixation to gradual correction using ringed external fixators. In this study we have detailed the outcomes of patients with post-physeal injury deformity around the ankle treated by acutre and gradual correction.Methodology: Fifteen patients with fractures involving the distal tibial epiphysis injury and deformity, presenting at Government medical college, Kozhikode, Kerala, India between 2010 and2018, were reviewed. All patients in age group of 5 to 15 years, both males and females, varus and valgus deformity of the ankle were included. Demographic data and hospital records were obtained, radiological records were taken from the patients at subsequent follow-ups at union and 2 years from last surgery.Results: There were nine boys and six girls with an average age at presentation of deformity was 14+ 0.528 years (range 9–15) years. 10 injuries were low energy type (sports/Running/slip and fall), while five were high energy type (motor vehicle accidents).Average duration of follow-up was 3.933 + 0.566 years with a range 2-10 years. Gradual correction of the deformity was done in 11 cases using a circular external fixator with hinges while acute correction was done in 4 cases. Average pre-operative deformity of the ankle was 30.4+7.17 degrees. Range -20 to 40 degrees (20 degrees). AOFAS was used to assess the improvement in the functionality of the ankle. The average improvement in the ankle score was 18 points after surgery. There was no significant difference between the varus and valgus ankles. On analysis of pre-operative and post-operative deformity, higher correction was achieved in varus ankles (27.11 degrees- p value-0.00087) as compared to average correction of 21.17 degrees (p value-0.0004) in Valgus ankles.Conclusion: From our study we concluded that Salter harris 3 and 4 have higher propensity for physeal bar formation, greater degree of deformity and limb length discrepancy. In case of gross deformities (>20degrees) gradual correction with an Ilizarov has better clinical, functional and radiological outcomes. In case of smaller deformities (