Fibular lengthening for the management of translational talus instability in hereditary multiple exostoses patients.
Hereditary multiple exostoses (HME) patients frequently present with ankle valgus deformity and marked fibular shortening. Loss of the lateral buttress may cause translational talus instability (TTI) that manifests as ankle pain after physical exercise, medial clear space widening on plain radiographs, and gross translational movement of the talus within the mortise. Among 123 HME patients examined and/or surgically treated, 10 patients (14 ankles) with symptomatic TTI underwent fibular lengthening with osteochondroma excision. Twelve ankles of 9 patients were followed for >1 year after surgery. Total fibular length gain averaged 15.3 mm and distal migration of the distal fibular fragment averaged 5.5 mm. The mean medial clear space decreased from preoperative 6.7 mm to postlengthening 3.5 mm. Gross instability of the talus within the ankle mortise disappeared in all cases. AOFAS ankle-hindfoot score improved from preoperative 80.3 to 97.3 at the latest follow-up. The current study showed the fibular lengthening improved lateral ankle stability by providing lateral buttress on the talus and providing favorable short-term result by ameliorating exercise-induced ankle pain in TTI of HME. The authors carefully conclude that TTI is a rare but potentially disabling condition in HME patients, requiring special attention during follow-up of HME patients.


METHODS
Level IV.
*Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul †Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Dong Yeon
DY
Lee
Joong Il
JI
Kim
Mi Hyun
MH
Song
Eun Seok
ES
Choi
Moon Seok
MS
Park
Won Joon
WJ
Yoo
Chin Youb
CY
Chung
In Ho
IH
Choi
Tae-Joon
TJ
Cho
D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001852:Bone Lengthening / Q000379:methods*; D001915:Braces; D002370:Casts, Surgical; D002648:Child; D005097:Exostoses, Multiple Hereditary / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013628:Talus / Q000601:surgery*; D058971:Tenotomy / Q000379:methods; D016896:Treatment Outcome