Correction of Post-Traumatic Medial Growth Arrest of the Distal Tibia (Common Problem, but Often Neglected)

Varus deformity of the ankle joint secondary to epiphyseal fractures of the distal tibia is quite common. Damage to the medial part of the distal tibial physis may lead to partial growth arrest that can cause a varus deformity with some shortening of the tibia. In the long term, malalignment of the ankle joint can lead to irreversible damage due to ankle and subtalar arthritis. Several options to correct this deformity were described in the literature. The proposed surgeries usually include a supramalleolar osteotomy, which can be either a medial open wedge or lateral closing wedge of the distal tibia, and fixation with a variety of internal and external fixation devices. External fixation devices can be used to perform acute as well as gradual correction. Completion of the closure of the affected physis should be done as early as possible, to prevent progression of angular as well as rotational deformity of the distal tibia. In addition, closure of the physis of the distal fibula should be performed to prevent fibular overgrowth and lateral impingement of the ankle. In immature patients epiphysiodesis of the contralateral distal tibia and fibula should be considered, to prevent development of leg length discrepancy. Our correction protocol includes medial opening wedge supramalleolar osteotomy with insertion of structural cortical allograft, to restore normal ankle orientation, and fixation with anatomic locking plate. An oblique distal fibular osteotomy is a crucial part of the procedure, to prevent the talus being squeezed between the medial and the lateral malleolus at the time of correction.