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A case of medial malleolar epiphysiodesis with 4 mm Cancellous screw to correct vulgus ankle in 9 years old child

I share with you a 9 years old girl with multiple exostoses who developed right ankle valgus. 

What do you recommend from the following two main options which are available: supramalleolar osteotomy and medial malleolar epiphysiodesis?

 If you recommend epiphysiodesis?? What do you recommend transphyseal medial malleolar screw epiphysiodesis or 8 plate as a temporary epiphysiodesis?? 

I have operated this case with transphyseal medial malleolar screw epiphysiodesis.

I would expect that this procedure will correct about 25 degrees of ankle vulgus in this 9 years old child. 
Intra operative picture shows perfectly central medial malleolus screw (Cancellous 4 mm)  that is transphyseal and extends to medial third of the metaphysis. 

preoperative X ray of both ankles of the same case showing about 33 degrees of vulgus ankle angle

3 d CT scan showing the multiple exostosis with vulgus ankle.

In conclusion, both supramalleolar osteotomy and medial malleolar epiphysiodesis techniques can result in successful correction of ankle valgus in the growing child.(1)

Epiphysiodesis by transphyseal medial malleolar screw is a simple, efficient and safe minimal invasive surgery to correct a  ankle valgus deformity in children.(2)

I will appreciate any discussion about the case. 

Reference 
(1) Driscoll MD, Linton J, Sullivan E, Scott A. Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature. Journal of Pediatric Orthopaedics. 2014 Jun 1;34(4):441-6.

(2) Aurégan JC, Finidori G, Cadilhac C, Pannier S, Padovani JP, Glorion C. Children ankle valgus deformity treatment using a transphyseal medial malleolar screw. Orthopaedics & Traumatology: Surgery & Research. 2011 Jun 1;97(4):406-9.



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