title: Reconstruction of the Pediatric Lateral Malleolus and Physis by Free Microvascular Transfer of the Proximal Fibular Physis.
abstract: Traumatic injury to the pediatric growth plate can result in growth disturbances, late angular deformity, and limb length inequalities. Complete traumatic loss the entire growth plate complex (physis, epiphysis, and distal metaphysis) of the ankle can lead to severe joint instability and loss of function. In the growing child, physeal preservation is paramount; however, the reconstructive options are limited. We report a case of post-traumatic loss of the distal fibular physis resulting in severe ankle valgus in a pediatric patient after a Gustilo grade 3B open injury. Ankle valgus secondary to post-traumatic necrosis of the lateral ankle physeal complex was successfully managed by microvascular free transfer of the ipsilateral proximal fibula physis. The 24-month follow-up examination demonstrated continued growth of the free vascularized physeal graft and a stable ankle. The donor site had healed without incident. The patient was able to return to age-appropriate play, sports, and social integration.
authors.affiliation: Chief, Foot and Ankle, Limb Preservation/Microsurgery, Department of Orthopaedics, Marshfield Clinic, Marshfield, WI. Electronic address: bibbo.christopher@marshfieldclinic.org.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bibbo
authors.affiliation: Clinical Assistant Professor, Department of Surgery, Division of Plastic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: David A
authors.initials: DA
authors.lastname: Ehrlich
authors.affiliation: Associate Professor, Department of General Surgery, Division of Plastic Surgery and Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006085:Graft Survival; D006132:Growth Plate / Q000098:blood supply* / Q000637:transplantation*; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000379:methods; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery
keywords: free flap; free physis transfer; microsurgery; pediatric ankle valgus; sural flap; trauma