An 8 year old boy with a history of fall from 10 feet height complains of pain in the right ankle. X-ray taken at that time are normal without any fracture line. But after 2 years, he developed a calcaneovalgus deformity. The diagnosis is:
Epiphysial fractures are more common than ligamentous injuries in children since the ligaments of the joints are generally stronger than their associated growth plates. Fractures across the growth plate may produce bony bridges that will cause premature cessation of growth or angular deformities of the extremity. These bridges are due to the trauma to the growth plate and can occur even with adequate reductions. Epiphysial fractures around the shoulder, wrist, and fingers can usually be treated by closed reduction, but fractures of the epiphyses around the elbow often require open reduction. In the lower extremity, accurate reduction of the epiphysial plate is necessary to prevent joint deformity when a joint surface is involved. If angular deformities result, corrective osteotomy may be necessary. Ref: Erickson M.A., Merritt C., Polousky J.D. (2012). Chapter 26. Ohopedics. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Undiagnosed malunited fracture
Avascular necrosis talus
Tibial epiphyseal injury
Ligamentous injury of ankle joint