Skeletally immature patients with pronation-external rotation ankle fracture patterns were more likely to experience premature physeal closure associated with angular deformity than patients with supination-external rotation or supination-plantar flexion ankle fracture patterns, according to results.
Researchers subclassified confirmed ankle fractures in skeletally immature patients according to the Dias-Tachdjian classification system, including pronation-external rotation, supination-external rotation and supination-plantar flexion injuries which all tend to be Salter-Harris type II fractures. Researchers recorded rates of premature physeal closure, initial operative interventions, subsequent surgical interventions and final angular deformities of the ankle in the coronal plane. Researchers considered deformities significant if there was more than 10° in any plane as measured using the tibial shaft/joint angle.
Of the 141 patients included, researchers found 52 pronation-external rotation, 35 supination-external rotation and 54 supination-plantar flexion injuries. Results showed 28.8%, 24.1% and 11.4% premature physeal closures occurred in the pronation-external rotation, supination-plantar flexion and supination-external rotation groups, respectively. Researchers noted a statistically significant higher rate of resultant angular deformity in the pronation-external rotation group. At the latest follow-up, six patients had resultant angular deformity of the ankle in the pronation-external rotation group compared with no resultant angular deformities in the supination-plantar flexion and the supination-external rotation groups.
“We recommend close follow-up of Salter-Harris II fractures in children with 2 or more years of growth remaining, particularly in [pronation-external rotation] PER fracture patterns, to prevent clinically significant angular deformity,” the authors wrote. – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.