title: Posttraumatic Tibiofibular Synostosis After Treatment of Distal Tibiofibular Fractures in Children.
abstract: BACKGROUND
  Posttraumatic pediatric distal tibiofibular synostosis is a rare complication following fracture. This is a retrospective, multicenter case series of synostosis of distal tibiofibular fractures in children. The purpose was to evaluate the incidence and pattern of posttraumatic distal tibiofibular synostosis in children.
  
  
  METHODS
  Of the 604 pediatric distal tibiofibular fractures, 20 patients (3.3%) with synostosis after treatment of distal tibiofibular fractures were identified at 3 tertiary referral centers. There were 12 boys and 8 girls, with a mean age of 8.4±2.0 years (range, 3.7 to 11.5 y) at the time of injury. Medical records were reviewed, and serial radiographs were analyzed to determine fracture configuration, pattern of synostosis, and changes in the relative positions of the proximal and distal tibial and fibular physes and in the alignment of the ankle.
  
  
  RESULTS
  The time from the occurrence of fracture until the recognition of the synostosis ranged from 2 to 6 months (mean, 2.8 mo). The most common fracture configuration was oblique tibial fracture combined with comminuted fibular fracture. There were 12 focal types and 8 extensive types. The proximal tibiofibular distance was decreased in 13 patients. Proximal migration of the distal fibular physis developed in all cases. Five patients exhibited ankle valgus of 10 degrees or greater with moderate or severe distal fibular shortening. Eight patients were symptomatic after synostosis and 12 patients were asymptomatic.
  
  
  CONCLUSIONS
  We identified 2 patterns of synostosis after the treatment of pediatric distal tibiofibular fracture: focal and extensive. The focal type was more prevalent than the extensive type, which was more likely to occur due to high-energy injury. When a tibiofibular cross-union develops, it creates growth abnormalities that warrant observation and potential treatment, as it may lead to progressive deformity or ankle pain.
  
  
  METHODS
  Level IV.
authors.affiliation: *Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju †Department of Orthopaedics Surgery, Chonbuk National University Medical School, Research Insitute of Clinical Medicine of Chonbuk National University-Biomedical Research Insitute of Chonbuk National University Hospital, Jeonju, South Korea ‡Department of Orthopaedics, Rady Children's Hospital and Health Center San Diego, San Diego, CA.
authors.forename: Sung Taek
authors.initials: ST
authors.lastname: Jung
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Wang
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Moon
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Mubarak
authors.forename: Jung Ryul
authors.initials: JR
authors.lastname: Kim
mesh_terms: D000843:Ankle Joint; D018771:Arthralgia / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000293:injuries*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging; D006132:Growth Plate / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013580:Synostosis / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology*; D013978:Tibial Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery