Avascular necrosis of the distal fibular epiphysis: a new condition?

Abstract

A 5-year-old boy was seen because of a right ankle sprain; radiographs showed a marginal anterior avulsion of the distal fibular epiphysis. After plaster immobilization, the patient continued with pain and subjective instability. New radiographs showed a lytic area in the same zone of the avulsion with surrounding sclerosis and a detached bone fragment. Biopsy showed bone necrosis. Two years later, without any traumatic event, the patient began to have a similar pain in the left ankle. Radiographs showed fragmentation of the anterior portion of the distal fibular epiphysis with surrounding sclerosis. Surgical treatment was performed by curettage and cancellous bone grafting; biopsy showed connective tissue, mucoid degeneration, and necrotic bone. After excluding any general disease, we believe that this bone necrosis could be considered an epiphyseal idiopathic avascular necrosis in children.