Rotational displacement of the distal epiphysis of the tibia without fracture

Abstract

CASE REPORT In October 1085 a heavy Y-year-old girl fell while wearing roller boots injuring the right ankle. The ankle and foot lay 60” externally rotated in relation to the knee but there was no other obvious deformity and little swelling (Fig. 1). There was no wound and no vascular or nerve complication. Radiographs of the right ankle (Fig. 2) showed no fracture and no obvious displacement of the lower epiphysis of the tibia. There was, however, some mismatching of the diameters of the metaphysis and epiphysis as well as some broadening of the space and incongruity between the structures visible in both views. Full length radiographs of the lower leg were not taken as it was clinically apparent that the injury was one of external rotation of the distal epiphysis of the tibia with its attached intact fibula. Under general anaesthesia the foot and ankle were turned easily to the reduced position, there being an audible and palpable click as the fibula snapped back into the fibular notch of the tibia. The reduction was found to be very stable and a toes to knee plaster cast was applied. For 2 weeks she did not bear weight on the right leg and used crutches followed by 2 further weeks in a short leg walking plaster. At 4 weeks the plaster was discarded and radiographs taken (Fig. 3) showed slight ‘beaks’ of bone formation at the metaphyseal margins of the tibia and a layer of periosteal new bone on the lateral aspect of the distal tibia. The girl made a progressive return to normal activities over a few weeks. When reviewed at I.5 months there were no symptoms and no clinical deformity; the foot was in normal rotational relationship to the knee and lower leg. The radiographs were normal.