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An Analysis of Suboptimal Outcomes of Medial Malleolus Fractures in Skeletally Immature Children

The American Journal of Orthopedics. 2012 March;41(3):113-116
March 1, 2012|The American Journal of Orthopedics
Luhmann SJ;Oda JE;O'Donnell J;Keeler KA;Schoenecker PL;Dobbs MB;Gordon JE
Author and Disclosure Information

Scott J. Luhmann, MD, Jon E. Oda, MD, June O'Donnell, MPH, Kathryn A. Keeler, MD, Perry L. Schoenecker, MD, Matthew B. Dobbs, MD, and J. Eric Gordon, MD

Dr. Luhmann is Associate Professor, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri; Attending Surgeon, St. Louis Children’s Hospital, St. Louis, Missouri; and Attending Surgeon/Chief of Spine Service, St. Louis Shriners Hospital, St. Louis, Missouri.

Dr. Oda is in private practice, San Jose, California.

Mrs. O’Donnell is Research Coordinator, Department of Orthopaedic Surgery, Washington University School of Medicine.

Dr. Keeler is Assistant Professor, Department of Orthopaedic Surgery, Washington University School of Medicine; Attending Surgeon, St. Louis Children’s Hospital; and Attending Surgeon, St. Louis Shriners Hospital.

Dr. Schoenecker is Professor, Department of Orthopaedic Surgery, Washington University School of Medicine; Attending Surgeon, St. Louis Children’s Hospital; and Chief of Staff, St. Louis Shriners Hospital.

Dr. Dobbs is Associate Professor, Department of Orthopaedic Surgery, Washington University School of Medicine; Attending Surgeon, St. Louis Children’s Hospital; and Attending Surgeon, St. Louis Shriners Hospital.

Dr. Gordon is Associate Professor, Department of Orthopaedic Surgery, Washington University School of Medicine; Attending Surgeon, St. Louis Children’s Hospital; and Attending Surgeon, St. Louis Shriners Hospital.

We retrospectively analyzed cases of intra-articular medial malleolar fractures in skeletally-immature patients (Salter-Harris III and IV) with suboptimal outcomes at St. Louis Children’s Hospital and Shriner’s Hospital for Children. Common causes of poor outcome were frac­ture malunion or malreduction and physeal damage. Malreductions of only 2 mm does not appear to be toler­ated and the concept of “remodeling” does not apply to these fracture patterns. Based on this study, we recom­mend fracture reduction and fixation if there is greater than 1 mm of fracture step-off.

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