title: Ankle deformity secondary to acquired fibular segmental defect in children.
abstract: BACKGROUND
  The authors report the long-term effect of acquired pseudoarthrosis of the fibula on ankle development in children during skeletal growth, and the results of a long-term follow-up of Langenskiold's supramalleolar synostosis to correct an ankle deformity induced by an acquired fibular segmental defect in children.
  
  
  METHODS
  Since 1980, 19 children with acquired pseudoarthrosis of the fibula were treated and followed up for an average of 11 years. Pseudoarthrosis was the result of a fibulectomy for tumor surgery, osteomyelitis of the fibula and traumatic segmental loss of the fibula in 10, 6, and 3 cases, respectively. Initially, a Langenskiold's operation (in 4 cases) and fusion of the lateral malleolus to the distal tibial epiphysis (in 1 case) were performed, whereas only skeletal growth was monitored in the other 14 cases. After a mean follow-up of 11 years, the valgus deformity and external tibial torsion of the ankle joint associated with proximal migration of the lateral malleolus needed to be treated with a supramallolar osteotomy in 12 cases (63%). These ankle deformities were evaluated using the serial radiographs and limb length scintigraphs.
  
  
  RESULTS
  In all cases, early closure of the lateral part of the distal tibial physis, upward migration of the lateral malleolus, unstable valgus deformity and external tibial torsion of the ankle joint developed during a mean follow-up of 11 years (range, 5 to 21 years). The mean valgus deformity and external tibial torsion of the ankle at the final follow-up were 15.2 degrees (range, 5 degrees to 35 degrees) and 10 degrees (range, 5 degrees to 12 degrees), respectively. In 12 cases (12/19, 63%), a supramalleolar corrective osteotomy was performed but three children had a recurrence requiring an additional supramalleolar corrective osteotomy 2-4 times.
  
  
  CONCLUSIONS
  A valgus deformity and external tibial torsion are inevitable after acquired pseudoarthrosis of the fibula in children. Both Langenskiöld supramalleolar synostosis to prevent these ankle deformities and supramalleolar corrective osteotomy to correct them in children are effective initially. However, both procedures cannot maintain the permanent ankle stability during skeletal maturity. Therefore any type of prophylactic surgery should be carried out before epiphyseal closure of the distal tibia occurs, but the possibility of a recurrence of the ankle deformities and the need for final corrective surgery after skeletal maturity should be considered.
authors.affiliation: Department of Orthopaedic Surgery, St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea.
authors.forename: Soo Hwan
authors.initials: SH
authors.lastname: Kang
authors.forename: Seung Koo
authors.initials: SK
authors.lastname: Rhee
authors.forename: Seok Whan
authors.initials: SW
authors.lastname: Song
authors.forename: Jin Wha
authors.initials: JW
authors.lastname: Chung
authors.forename: Yoon Chung
authors.initials: YC
authors.lastname: Kim
authors.forename: Kyung Hwan
authors.initials: KH
authors.lastname: Suhl
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000254:growth & development / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016916:Joint Deformities, Acquired / Q000209:etiology* / Q000601:surgery; D008297:Male; D010027:Osteotomy; D011542:Pseudarthrosis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
references.citation: Clin Orthop Relat Res. 1991 May;(266):162-9
references.pmid: 2019046
references.citation: J Pediatr Orthop B. 2005 Nov;14(6):436-8
references.pmid: 16200021
references.citation: Bull Hosp Jt Dis. 1997;56(3):149-53
references.pmid: 9361915
references.citation: J Bone Joint Surg Am. 1972 Apr;54(3):595-606
references.pmid: 5055156
references.citation: J Bone Joint Surg Am. 1956 Oct;38-A(5):1056-76
references.pmid: 13367082
references.citation: J Bone Joint Surg Am. 1972 Apr;54(3):585-94
references.pmid: 4560073
references.citation: J Pediatr Orthop. 2003 Jan-Feb;23(1):55-9
references.pmid: 12499944
references.citation: J Bone Joint Surg Am. 1971 Apr;53(3):507-13
references.pmid: 5580009
references.citation: J Pediatr Orthop. 1985 Mar-Apr;5(2):176-80
references.pmid: 3872882
references.citation: Surg Gynecol Obstet. 1952 Dec;95(6):694-700
references.pmid: 13005344
references.citation: J Bone Joint Surg Am. 1967 Apr;49(3):463-70
references.pmid: 6022355
references.citation: J Bone Joint Surg Am. 1974 Apr;56(3):503-10
references.pmid: 4605429
references.citation: J Pediatr Orthop B. 2002 Oct;11(4):298-301
references.pmid: 12370580
references.citation: Clin Orthop Relat Res. 1968 Jul-Aug;59:137-46
references.pmid: 4874880
references.citation: J Bone Joint Surg Am. 1983 Oct;65(8):1157-62
references.pmid: 6630260
references.citation: J Pediatr Orthop. 2006 Jul-Aug;26(4):449-54
references.pmid: 16791060