Management of distal tibial medial malleolus type-6 physeal fractures.

Abstract

Type 6 is an open fracture in which part of the physis is missing. It is the least common physeal fracture, but has the highest rate of complications, particularly the formation of a physeal bar. Without preemptive treatment, a physeal bar always forms, producing growth retardation and angular deformity, and excision of these physeal bars has been uniformly unsuccessful. The distal medial malleolus is a common site for the fracture. Strategies for the treatment of two varieties of acute medial malleolar type-6 fractures and two types of late deformities following type-6 fracture are given. The acute fractures were treated with either fat or cartilage applied to the exposed physis. The late deformities were treated with corrective iliac bone grafting. The acute fractures were prevented from forming physeal bars and the two late deformities were fully corrected with good outcomes. Fat applied to an acute type-6 physeal fracture has a good chance of preventing bar formation. Ankle deformities due to bars can be corrected by means of iliac bone grafting.