Objectives: To report the mid-term outcomes and complications of ankle Dias-Tachdjian pronation-eversion external rotation (PEER) physeal fracture in children treat by ORIF with combined medial and lateral incision.
Materials and Methods: A total of 21 children (12 male and 9 female patients with ankle Dias-Tachdjian PEER physeal fracture, underwent open reduction treatment with combined medial and lateral incision between Jan, 2015 and Oct, 2017. The surgical outcomes were assessed by X-ray film after operation. The lateral distal tibia angle (LDTA) was measured to evaluate angular deformity and the X rays was taken to evaluate the premature physeal arrest.
Result: All the patients were followed up for an average time of 20.1 months (ranging from 17 to 25 months). Bone healing was achieved in all cases. American Orthopedic Foot and Ankle Society-Ankle and Hindfoot score(AOFAS-AH) of the patients improved from median 31(11,38) before operation to median 68(63,73) post-operation, median score 91(87,96) at last follow-up. Lateral distal tibia angle (LDTA) of the patients improved from 70.5±4.9 before operation to 90.0±1.2 post-operation, measure 90.6±3.7 at last follow-up. The differences between pre and post operation and the differences between pre-operation and last follow-up in both findings were statistically significant (P<0.05). There is no premature physeal closure, ankle deformity in 19 cases. They could normally exercise and take part in normal sport activities. The remaining 2 cases had physeal bone bridge and premature physeal closure but could still carry on daily activities and thus were categorized as good.
Conclusion: ORIF with one-stage medial-lateral combined incision for ankle Dias-Tachdjian PEER physeal fracture in children can decrease the rate of premature physeal closure and has excellent efficacy for fracture union and the recovery of ankle functions.