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Pediatric Pronation-External Rotation Frx

- See: Adult Pronation External Rotation Frx

- Distal Tibia:
    - SH type II frx of distal tibial physis is most common pattern:
    - metaphyseal fragment is characteristically localized on lateral side or posterolaterally;
    - lateral or posterior displacement is also present;
    - SH type I frx is occassionally present;
    - look for residual valgus deformity;

- Distal Fibula:
    - fibular frx has a short oblique course and is approx 4-7 cm from tip of lateral malleolus;

- Complications:
    - Failure to Achieve Reduction:
        - due to soft tissue interposition which leads to valgus deformity;
        - a lateral or posterolateral metaphyseal fragment, may get caught behind fibula, complicating attempts at closed reduction;
              - may require anterolateral incision, to disengage the metaphyseal spike;
        - closed reduction of this frx can sometimes be difficult since this triangular fragment may become jammed between tibia & fibula;
        - up to 10 deg of spontaneous remodeling may occur in child < 10 yrs;

- Physeal Arrest:
    - may lead to leg length deformity

Pronation injuries of the ankle in children. Retrospective study of radiographical classification and treatment.

Roentgen stereophotogrammetric analysis of growth pattern after pronation ankle injuries in children.

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