An incalcitrant symptomatic paediatric closed tibial medial malleolus fracture (Case report)

Purpose: In this study, we reported a rare paediatric closed medial malleolus fracture non-union (the fracture did not involve the growth plate). Methods: The fracture was initially treated with Plaster-of-Paris cast for 6 weeks followed by physiotherapy. The fracture position and union were assess...

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Main Authors: T. Al-Sadek, F.Yu-Sing Chan, A. Al-Sadek, G. Dimitrov, K. Marinov
Format: Article
Language:English
Published: Trakia University 2017-09-01
Series:Trakia Journal of Sciences
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Online Access:http://tru.uni-sz.bg/tsj/Vol15_N3_2017/17_T.Al-Sadek2.pdf
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Summary:Purpose: In this study, we reported a rare paediatric closed medial malleolus fracture non-union (the fracture did not involve the growth plate). Methods: The fracture was initially treated with Plaster-of-Paris cast for 6 weeks followed by physiotherapy. The fracture position and union were assessed regularly with X-rays. Open reduction and internal fixation with cannulated screw was performed. Intraoperatively, there were only minimal soft tissues in the fracture gap and they were cleared prior to fixation. Further regular X-rays suggested fracture position was maintained but lack of callus formation. The patients remained symptomatic. A few months following the operation, the non-invasive ultrasound bone stimulator treatment was arranged for six months in view of the non-union. On completion of the treatment, she remained painful on weight-bearing. Subsequently radiological investigations confirmed fracture non-union. Further open reduction internal fixation with autologous bone-grafting was performed. Results: The fracture was finally united a few months following the autologous bone-grafting procedure and the patient’s symptoms resolved. The fracture was also confirmed to be united radiologically. Conclusion: In this study, we reported one of these rare closed symptomatic medial malleolus non-union without growth plate involved. While following multiple treatment modalities (both conservative & invasive), fracture union was finally achieved. The union occurred over more than a year period.
ISSN:1312-1723
1313-3551