title: An analysis of suboptimal outcomes of medial malleolus fractures in skeletally immature children.
abstract: We retrospectively analyzed cases of intra-articular medial malleolar fractures in skeletally-immature patients (Salter-Harris III and IV) with suboptimal outcomes at St. Louis Children's Hospital and Shriner's Hospital for Children. Common causes of poor outcome were frac­ture malunion or malreduction and physeal damage. Malreductions of only 2 mm does not appear to be toler­ated and the concept of "remodeling" does not apply to these fracture patterns. Based on this study, we "recom­mend" fracture reduction and fixation if there is greater than 1 mm of fracture step-off..
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. luhmanns@wustl.edu
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
authors.forename: Jon E
authors.initials: JE
authors.lastname: Oda
authors.forename: June
authors.initials: J
authors.lastname: O'Donnell
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Keeler
authors.forename: Perry L
authors.initials: PL
authors.lastname: Schoenecker
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Dobbs
authors.forename: J Eric
authors.initials: JE
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging* / Q000601:surgery; D005599:Fractures, Ununited / Q000000981:diagnostic imaging* / Q000601:surgery; D006776:Hospitals, Pediatric; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012042:Registries; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013639:Tarsal Bones / Q000293:injuries* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome