Children ankle valgus deformity treatment using a transphyseal medial malleolar screw - 07/06/11

Doi : 10.1016/j.otsr.2011.01.014

J.C. Aurégan ^⁎ , G. Finidori, C. Cadilhac, S. Pannier, J.P. Padovani, C. Glorion
Department of Paediatric Orthopaedic surgery and Traumatology, Paris Descartes School of Medicine, Necker-Enfants Malades Hospital, Paris Public Assistance Hospitals Group, AP–HP, 149, rue de Sèvres, 75015 Paris, France

Corresponding author. Tel.: +33 1 44 49 42 38; fax: +33 1 44 38 15 22.

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Abstract

Introduction

Ankle valgus deformity is rare in children. It generally leads to difficulties wearing shoes, walking instability and mechanical pain. No medical treatment is effective and the only option is surgical correction of the deformity. Two main options are available: supramalleolar osteotomy and medial malleolar epiphysiodesis. We report our experience with epiphysiodesis using a transphyseal medial malleolar screw.

Patients and methods

This is a retrospective study of all children followed for ankle valgus and treated by transphyseal medial malleolar screw epiphysiodesis in our department. The study included 10 cases of ankle valgus deformity in seven children (four with multiple extostoses, two type 1 neurofibromatosis, one Larsen’s syndrome) who completed skeletal maturity. At surgery, median bone age was 12 years (10 to 13 years and 6 months) and the median tibiotalar angle was 17.5° (10° to 30°).

Results

At skeletal maturity, preoperative valgus was corrected in six patients (9/10 ankles). The median tibiotalar angle was 5° (0° to 25°). Valgus was not corrected in one patient (30° to 25°). No postoperative complications occurred.

Discussion

Epiphysiodesis by transphyseal medial malleolar screw is a simple, efficient and safe procedure to correct a significant or symptomatic ankle valgus deformity in children before skeletal maturity.