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Hospital Base de Valdivia, Valdivia, Chile
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Universidad Austral de Chile, Valdivia, Chile
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Ankle fractures are common in children, and they have specific implications in that patient population due to frequent involvement of the physis in a bone that has growth potential and unique biomechanical properties.
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Characteristic patterns are typically evident in relation to the state of osseous development of the segment, and to an extent these are age-dependent.
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In a specific type known as transitional fractures – which occur in children who are progressing to a mature skeleton –a partial physeal closure is evident, which produces multiplanar fracture patterns.
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Computed tomography should be routine in injuries with joint involvement, both to assess the level of displacement and to facilitate informed surgical planning.
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The therapeutic objectives should be to achieve an adequate functional axis of the ankle without articular gaps, and to protect the physis in order to avoid growth alterations.
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Conservative management can be utilized for non-displaced fractures in conjunction with strict radiological monitoring, but surgery should be considered for fractures involving substantial physeal or joint displacement, in order to achieve the therapeutic goals.
Cite this article: EFORT Open Rev 2021;6:593-606. DOI: 10.1302/2058-5241.6.200042
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AO Foundation, PAEG Expert Group, Davos, Switzerland
Hospital Base de Valdivia, Valdivia, Chile
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Hospital Base de Valdivia, Valdivia, Chile
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Universidad del Desarrollo, Santiago, Chile
Hospital Clínico Mutual de Seguridad, Santiago, Chile
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Fractures of the anterior tibial tuberosity during childhood are an infrequent pathology (around 3% of all proximal tibial fractures), but the incidence of this injury has risen over recent years, likely due to the increased involvement of this age group in sports activities.
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This fracture is more commonly seen in children 12–14 years old.
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It is vital to identify the anatomical structures associated with this type of fracture, along with the pathophysiological mechanisms involved.
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Treatment includes non-operative and operative options, with the goal of achieving articular congruency, restoring the extensor mechanism function, and avoiding damage to the proximal tibial physis.
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Understanding the management of this fracture, and the complications that might arise, is critical. The provision of an appropriate clinical management plan and the avoidance of complications are vital in the prevention of disability.
Cite this article: EFORT Open Rev 2020;5:260-267. DOI: 10.1302/2058-5241.5.190026
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AO Foundation, PAEG Expert Group, Davos, Switzerland
Hospital Base de Valdivia, Valdivia, Chile
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Universidad del Desarrollo, Santiago, Chile
Hospital Clínico Mutual de Seguridad, Santiago, Chile
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AO Foundation, PAEG Expert Group, Davos, Switzerland
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Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population.
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The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears.
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Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined.
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Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus.
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Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears.
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Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus.
Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023
Hospital Base de Valdivia, Valdivia, Chile
AO Foundation, PAEG Expert Group, Davos, Switzerland
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Hospital Base de Valdivia, Valdivia, Chile
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Hospital Base de Valdivia, Valdivia, Chile
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Hospital Base de Valdivia, Valdivia, Chile
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The physis of the distal femur contributes to 70% of femoral growth and 37% of the total limb growth; therefore, physeal injury can lead to important alterations of axes and length.
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Distal metaphyseal corner-type fracture prior to walking is classically associated with child abuse. In children aged >10 years, sports-related fractures and car accidents are significant contributors.
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Imaging includes a two-plane radiographic study of the knee. It is recommended to obtain radiographs that include the entire femur to rule out concomitant injuries. In cases of high suspicion of distal metaphyseal fractures and no radiographic evidence, CT or MRI can show the existence of hidden fractures.
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Fractures with physeal involvement are conventionally classified according to the Salter–Harris classification, but the Peterson classification is also recommended as it includes special subgroups.
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Conservative and surgical management are valid alternatives for the treatment of these fractures. Choosing between both alternatives depends on factors related to the fracture type.
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As there is a high risk of permanent physeal damage, long-term follow-up is essential until skeletal maturity is complete.
Hospital Base de Valdivia, Valdivia, Chile
AO Foundation, LEGEC Expert Group, Davos, Switzerland
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Hospital Base de Valdivia, Valdivia, Chile
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Clínica Puerto Montt, Puerto Montt, Chile
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Hospital Base de Valdivia, Valdivia, Chile
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Brachymetatarsia involves a reduction in length of one or more metatarsals.
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The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola.
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In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia.
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A possible association with genetic disorders needs to be investigated during clinical evaluation.
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Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.
