An incalcitrant symptomatic paediatric closed tibial medial malleolus fracture (Case report)

Abstract

Purpose: In this study, we reported a rare paediatric closed medial malleolus fracture non-union (the fracture did not involve the growth plate). Methods: The fracture was initially treated with Plaster-of-Paris cast for 6 weeks followed by physiotherapy. The fracture position and union were assessed regularly with X-rays. Open reduction and internal fixation with cannulated screw was performed. Intraoperatively, there were only minimal soft tissues in the fracture gap and they were cleared prior to fixation. Further regular X-rays suggested fracture position was maintained but lack of callus formation. The patients remained symptomatic. A few months following the operation, the non-invasive ultrasound bone stimulator treatment was arranged for six months in view of the non-union. On completion of the treatment, she remained painful on weight-bearing. Subsequently radiological investigations confirmed fracture non-union. Further open reduction internal fixation with autologous bone-grafting was performed. Results: The fracture was finally united a few months following the autologous bone-grafting procedure and the patient’s symptoms resolved. The fracture was also confirmed to be united radiologically. Conclusion: In this study, we reported one of these rare closed symptomatic medial malleolus non-union without growth plate involved. While following multiple treatment modalities (both conservative & invasive), fracture union was finally achieved. The union occurred over more than a year period.

Keywords

• Incalcitrant
• Paediatric
• Closed
• Tibial
• Medial
• Malleolus
• Fracture