Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion

• Published in: The Journal of foot and ankle surgery Vol. 56; no. 1; pp. 148 - 152
• Main Authors: El Ashry, Saad R., MCh (Orth), FRCS (Tr-Orth), El Gamal, Tarek A., MCh Orth (Alex), FRCS (Tr-Orth), Platt, Simon R., FRCS (Tr-Orth), PGCert
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Ankle Joint; ankle ligament; Bone Screws; Child; Chronic Disease; Female; Fibula - diagnostic imaging; Fibula - injuries; Follow-Up Studies; Fracture Fixation, Internal - methods; Fractures, Avulsion - complications; Fractures, Avulsion - diagnostic imaging; Fractures, Avulsion - surgery; Fractures, Ununited - complications; Fractures, Ununited - diagnostic imaging; Fractures, Ununited - surgery; Humans; injury; Joint Instability - diagnostic imaging; Joint Instability - etiology; Joint Instability - surgery; Lateral Ligament, Ankle - physiopathology; Lateral Ligament, Ankle - surgery; Magnetic Resonance Imaging - methods; nonunion; Orthopedics; pediatric; Risk Assessment; Suture Anchors; Treatment Outcome; injury; 4; nonunion; ankle ligament; pediatric
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2016.04.018

Abstract Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures.