title: Varus Deformity of the Distal Tibia From Physeal Growth Arrest Treated Using a Titanium Metal Porous Wedge.
abstract: During a cheerleading event, a 14-year-old female sustained a right ankle physeal fracture that was treated nonoperatively with casting. She developed a distal medial tibial physeal arrest, and as the onset of menses was at age 16, she subsequently developed a varus distal tibial deformity. At the age of 19, she was no longer able to participate in collegiate cheerleading due to lateral ankle pain, ankle instability, and peroneal subluxation. After failing conservative treatment, she underwent an ankle arthroscopy, Broström-Gould procedure, peroneal retinacular repair with peroneal tenolysis, and a distal tibial medial opening wedge osteotomy using a porous titanium metal wedge and a one-third tubular plate. At 6-month follow-up, her osteotomy site showed abundant callus formation, and her lateral ankle pain had almost completely resolved. At 22-month follow-up, there were no residual ankle instability or pain complaints, and she had returned to collegiate cheerleading. This case report highlights a very useful, previously not described, application of porous titanium metal wedges for medial supramalleolar opening wedge osteotomies of the tibia. Such wedges are familiar to many foot and ankle orthopaedic surgeons and continue to have expanding indications.
  
  
  METHODS
  Therapeutic, Level IV: Case report.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia AB4CH@hscmail.mcc.virginia.edu.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Bridgforth
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: M Tyrrell
authors.initials: MT
authors.lastname: Burrus
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D064386:Ankle Fractures / Q000150:complications / Q000601:surgery*; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001182:Arthroscopy; D001860:Bone Plates; D005260:Female; D006130:Growth Disorders / Q000150:complications / Q000209:etiology* / Q000601:surgery; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D010027:Osteotomy / Q000295:instrumentation*; D019736:Prostheses and Implants; D013710:Tendons / Q000601:surgery; D013977:Tibia / Q000254:growth & development / Q000601:surgery*; D014025:Titanium
chemical_list: D014025:Titanium
keywords: ankle instability; osteotomy; physeal arrest; porous wedge; varus deformity