Background:
This study examined the effectiveness of the Taylor Spatial Frame
(TSF) in the treatment of deformity and limb shortening caused
by distal tibial physeal arrest and the effectiveness in maintaining
alignment and stability by reconstruction of the medial malleolus
and the medial collateral ligament using an autogenous iliac
crest graft and attached sartorius muscle-tendon.
Methods:
Thirteen pediatric patients with angular deformity of the distal tibia
were enrolled in this prospective study. The mean age was 8.3 yr
(range, 6 to 12 yr). All patients had open fractures with skin loss.
Ten patients had Salter-Harris type IV physeal fractures, while three
had Salter-Harris type V physeal injury. All patients had a varus
ankle deformity (range, 15 to 33 degrees) and limb shortening
(range, 1.9-cm to 3.3-cm). All patients were treated by a
supramalleolar osteotomy and TSF for deformity correction for
limb-length equalization. The absent medial malleolus was treated
by medial malleoplasty with a graft from the ipsilateral iliac crest.
Results:
The mean follow-up period was 30 mo. The mean preoperative
shortening of the tibia in relation to the fibula was 2.6 cm (range,
1.9 cm to 3.3 cm). The length of the short tibia was restored in all
patients, and correction of the ankle deformity and stability were
restored with a satisfactory outcome.
Conclusions:
TSF is highly effective in the treatment of distal tibial deformity in
pediatric patients due to traumatic physeal arrest. Reconstruction
of the medial malleolus and its ligamentous attachment is crucial
for ankle joint stability.