title: Distal tibial physeal arrest after meningococcal septicaemia: management and outcome in seven ankles.
abstract: Survivors of infantile meningococcal septicaemia often develop progressive skeletal deformity as a result of physeal damage at many sites, particularly in the lower limb. Distal tibial physeal arrest typically occurs with sparing of the distal fibular physis leading to a rapidly progressive varus deformity. There have been reports of isolated cases of this deformity, but to our knowledge there have been no papers which specifically describe the development of the deformity and the options for treatment. Surgery to correct this deformity is complex because of the patient's age, previous scarring and the multiplanar nature of the deformity. The surgical goal is to restore leg-length equality and the mechanical axis at the end of growth. Surgery should be planned and staged throughout growth in order to achieve the best functional results. We report our experience in six patients (seven ankles) with this deformity, who were managed by corrective osteotomy using a programmable circular fixator.
authors.affiliation: Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK. fergal.monsell@uhbristol.nhs.uk
authors.forename: F P
authors.initials: FP
authors.lastname: Monsell
authors.forename: J R
authors.initials: JR
authors.lastname: Barnes
authors.forename: R
authors.initials: R
authors.lastname: Kirubanandan
authors.forename: A M B
authors.initials: AM
authors.lastname: McBride
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D006132:Growth Plate / Q000254:growth & development / Q000601:surgery; D006801:Humans; D016916:Joint Deformities, Acquired / Q000382:microbiology / Q000601:surgery*; D007870:Leg Length Inequality / Q000382:microbiology / Q000601:surgery; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D018805:Sepsis / Q000150:complications*; D013977:Tibia / Q000254:growth & development; D016896:Treatment Outcome