title: Prognostic factors for premature growth plate arrest as a complication of the surgical treatment of fractures of the medial malleolus in children.
abstract: McFarland fractures of the medial malleolus in children, also classified as Salter-Harris Type III and IV fractures, are associated with a high incidence of premature growth plate arrest. In order to identify prognostic factors for the development of complications we reviewed 20 children with a McFarland fracture that was treated surgically, at a mean follow-up of 8.9 years (3.5 to 17.4). Seven children (35%) developed premature growth arrest with angular deformity. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale for all patients was 98.3 (87 to 100) and the mean modified Weber protocol was 1.15 (0 to 5). There was a significant correlation between initial displacement (p = 0.004) and operative delay (p = 0.007) with premature growth arrest. Both risk factors act independently and additively, such that all children with both risk factors developed premature arrest whereas children with no risk factor did not. We recommend that fractures of the medial malleolus in children should be treated by anatomical reduction and screw fixation within one day of injury.
authors: Aghia Sophia Children's Hospital, 2nd Orthopaedic Department, Thivon & Papadiamadopoulou, Goudi, Athens 11527, Greece.
authors: D V
authors: DV
authors: Petratos
authors: M
authors: M
authors: Kokkinakis
authors: E G
authors: EG
authors: Ballas
authors: J N
authors: JN
authors: Anastasopoulos
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000601:surgery*; D001848:Bone Diseases, Developmental / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D005596:Fractures, Closed / Q000601:surgery*; D006132:Growth Plate / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors