PMC8096571_01
Anteroposterior and lateral radiographs of the ankle fracture at time of presentation.
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fig1
Radiographs showed a displaced distal tibia SH type II physeal fracture and a transverse fracture of the fibula with valgus angulation (Figure 1).
Anteroposterior and lateral radiographs of the ankle following attempt of closed redcution.
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fig2
An initial attempt at closed reduction performed in the ED under conscious sedation was unsuccessful; the fracture could not be moved from its displaced position after sustained traction and manipulation (Figure 2).
Intraoperative photo showing interposition of tibialis posterior tendon (*) at the fracture site between the metaphysis and epiphysis.
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fig3
The tendon was bowstringing around the metaphyseal fragment from the proximal-posterior to distal-anterior direction between the metaphysis and epiphysis (Figure 3).
Mildly frayed tibialis posterior tendon (dashed arrow) repositioned and fracture reduction temporarily fixed by K-wire fixation.
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fig4
The tendon had mild fraying but did not show any laceration or tear (Figure 4).
Postoperative radiograph in the anteroposterior and lateral views with fixation by screws.
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fig5
The fracture reduction was confirmed on fluoroscopic evaluation, and two 4 mm partially threaded cannulated screws were used for fracture compression and fixation across the large Thurston-Holland metaphyseal fragment (Figure 5).
Anteroposterior and lateral radiographs of the ankle at 18-month follow-up.
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The radiographs showed complete healing of the fracture with no deformity and closing physis (Figure 6).