J Korean Foot Ankle Soc.  2021 Dec;25(4):177-180. 10.14193/jkfas.2021.25.4.177.

Operative Treatment for Fibular Shortening after Trauma: A Case Report

• Kim J
• Kim GL
• Lee CH

• KMID: 2523299
• DOI: http://doi.org/10.14193/jkfas.2021.25.4.177

Abstract

Pediatric ankle fractures can cause physeal injuries which can lead to the shortening of the fibula. This induces a lateral shift of the talus, valgus tilt, and instability of the ankle joint, which can result in an arthritic change in this joint. Patients with a shortening of the fibula may complain of constant pain and restricted movements in their daily lives and during sports activities. Ankle reconstruction with fibula lengthening Z-osteotomy can provide excellent results if arthritis is absent or minimal, especially in young and active patients. To the best of the authors’ knowledge, this is the first report in South Korea regarding the treatment of fibula shortening following a growth arrest due to injury.

Keyword

Ankle reconstruction; Physeal closure; Shortening of the fibula; Fibular lengthening; Z-osteotomy

Figure

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  Figure. 1 Anteroposterior (A), lateral (B), and mortise (C) radiographs of right ankle joint. A Salter–Harris type-II bimalleolar fracture, the ankle was treated with closed reduction and casting.

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  Figure. 2 One year after the initial injury, anteroposterior (A), lateral (B), and mortise (C) radiographs of the right ankle joint. Axial T2- (D) and coronal T1-weighted (E) magnetic resonance images showing injury of anterior talofibular ligament and calcaneofibular ligament.

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  Figure. 3 Five years after the initial injury, mortise view radiographs of right (A) and left (B) ankle joints. (A) There is 12-mm shortening of the lateral malleolus (arrow) and lateral shift of the talus with a widening of the medial clear space, disruption of the Shenton’s line of the ankle and lateral part of the articular surface of the talus to the distal fibula. Coronal T1- (C) and T2-weighted (D) magnetic resonance images showing premature growth arrest of distal physis and subsequent shortening of the lateral malleolus.

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  Figure. 4 Gross intraoperative image (A) and intraoperative C-arm image (B) of fibula lengthening Z-osteotomy. Immediate postoperative anteroposterior (C), lateral (D), and mortise (E) radiographs of right ankle joint. (A) The Mosquito is pointing a damaged calcaneofibular ligament and a Z-shaped osteotomy was performed at 10 cm above the distal tip of the fibula. (B) The fibula was slowly lowered distally to the lateral articular surface of the talus. (C~E) After Z-osteotomy, the plated was fixated with screws followed by temporary fixation of the ankle joint with Kirschner wire.

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  Figure. 5 Anatomic restoration of fibular length and the tibiofibular relationship. Follow-up at 3 months, anteroposterior (A), lateral (B), and mortise (C) radiographs show graft incorporation.

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