Post-Traumatic Growth Disturbance of the Ankle Treated by the Langenskiöld Procedure: Evaluation by Radiography, Roentgen Stereophotogrammetry, Scintimetry and Histology: Case Report

Abstract

Progressive growth retardation and varus tilting were observed in a child with an ankle fracture of supination-adduction type initially treated by closed reduction and pinning. the patient was later operated with the Langenskiöld procedure.

Preoperatively, roentgen stereophotogrammetric analysis showed decreasing growth rates especially medially in the distal tibia, radionuclide scintimetry manifested reduced activity on the injured side, and tomograms showed a bony bridge medially. the evidence of growth in the distal tibia indicated the existence of an osseofibrous bridge between the epiphysis and the metaphysis. This was also confirmed by the findings at the operation and partly by microscopical investigation of the removed osseofibrous bridge.

Postoperative stereophotogrammetric analysis showed reduction of the varus position in two steps. Roentgen stereophotogrammetry permits early detection of a growth disturbance, and evaluation of the effects of therapy.

Key Words:

• ankle fracture
• children
• epiphysis
• growth plate
• roentgen stereophotogrammetry
• surgery