1Department of Orthopedics and Traumatology, Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey
2Department of Orthopedics and Trauma, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
3Department of Orthopedics and Traumatology, Sanliurfa Education and Training Hospital, Sanliurfa, Turkey
4Department of Orthopedics and Trauma, Faculty of Medicine, Istanbul University, Istanbul, Turkey
Aim: The aim of this study was to analyze the cause of out-toeing gait pattern in children who underwent anatomic reduction and internal fixation for distal tibial physeal injury.
Material and Methods: This IRB-approved, Level IV review study included traumatic distal tibia epiphyseal injury treated surgically at a single institution between 2010 and 2015. Patients were called back to return for additional follow-up. All clinical (foot progression angle-FPA, hip rotations, thigh foot angle-TFA) and radiological (distal tibial measurements) evaluations were done by 2 independent observers to assess inter- and intra-observer reliability using intraclass correlation coefficients (ICC).
Results: There were 38 patients with an average age of 11.4±3.8. There was a non-significant trend noted towards externally in FPA on the injured side. TFA was similar in both extremities (p: 0.56). Hip external rotation was significantly high in injured side, whereas hip internal rotation was similar. Hip external rotation was significantly high.
Conclusion: Anatomic joint reduction is mandatory to prevent growth arrest and to maintain lower extremity alignment. Considering that there is no pathology of the hip and no radiologic signs of mal-alignment of the ankle, we think that hip external rotators may shortened due to post-operative resting position, which was ended up with out-toeing gait pattern on the injured side.
Keywords: Ankle fracture; out-toeing; pediatric fractures; physeal fractures