Broken Ankles and Growth Plates

Question for those in the know

21 to 32 of 32 messages
13/07/2008 at 11:22

That's funny -I was thinking about you and wondering how he was getting on

I'm glad he's on the mend. Now please don't boing this thread again (reminding everyone of my appalling maternal abilities......tsk)   

13/07/2008 at 13:46

Great news that little Mint is on the mend

Broken ankles are no fun! 

13/07/2008 at 14:01

Thanks Beebs, Mrs Pig and Broken Bones.

Mrs Pig, I thought I'd provided you with some comfort with my own tales of mismanaged maternal skills!  I don't get any better either.

13/07/2008 at 14:56
Only just seen this thread. I hope you've had all your worries answered by the orthopods ttreating your son, but if you've any queries left, I'd be happy to try to answer them! (I'm a paediatric orthopaedic surgeon)
13/07/2008 at 19:59

<jumps up and down in excitement>  Thanks joddly and yes please.

His foot is still slightly turned outwards.  There doesn't appear to be any prospect of physio and perhaps it doesn't matter.  My main concern is having him fit enough to go back to playing full contact rugby in September.  We were told no contact sport now for 2-4 weeks but Little Mint feels he can walk perfectly well (even without the crutches he's been advised to use) and even says he's okay to run ... although I'm not encouraging that just yet.  We were told to wait at least 2 weeks before he can cycle but he feels he's okay to do that now (five days on from operation).  When is it okay and when is it not okay - should pain be the barometer or should we wait for the all clear from the surgeons? 

13/07/2008 at 21:31

Hi - I need a bit more information, but generally speaking, if it feels OK then it is OK.

 How old is Little Mint, and can you be as specific as possible about the fracture "pattern" and in which direction the screw went?

Growth plate injuries usually heal quickly. The screw would have been to hold the fragments together while this took place, and would only be removed if the surgeons were happy that the fracture was united. IAny further wait would probably simply be to allow the wound to heal up properly.

You can email me if you'd prefer patient confidentiality!

13/07/2008 at 23:46

Thanks joddly. 

Little Mint is 12.  It was a 'salter harris' (sp?) type fracture and a few other technical terms which I can no longer remember.  All I remember is that they wanted to manipulate the ankle and the growth plate under general anaesthetic but when they got him into theatre it was worse than they thought and so they opened him up and screwed him back together. Sorry I don't know which direction the screw went.  Possibly upwards given the scar was low down on his ankle.  Any more than that I just don't know.

Collected my post this evening (we have a mail box and I regularly forget to check it).  The letter was there with his two week follow up appointment for this Friday (which is actually only a week and a half).

He doesn't feel the need for the crutches but the surgeon did say that he wanted him to use them as a reminder to himself and others that his ankle is a bit delicate for the time being - he suggested two weeks.  Less than a week after the operation, I'm struggling to persuade him to use them. 

Like most kids, Little Mint tends to bounce back very quickly.  Apparently he was the quickest kid ever to eat again after having his appendix out.  I think it was less than three hours after the operation!

13/07/2008 at 23:51
Just looked at salter harris fractures on google and I think Little Mint had a type III.
14/07/2008 at 12:19

Salter Harris III would make sense. At this stage, if the wound is healing well there should be no need to rest it as long as he feels fine, so don't worry that he's not using crutches.

At 12, as you know, there is a small risk of growth arrest. It is only a small risk if the fracture has been put back ("reduced") anatomically (ie perfectly aligned) and has healed, which sounds as if is the case. Signs of growth arrest may be evident at this stage (?4months) as incomplete or sloping Harris lines (also called growth arrest lines) which they can show you  (or rather, the normal complete ones, I hope) when you're in clinic on Friday. You can probably Google that for a bit more info.

Good Luck.

14/07/2008 at 19:31

Persuaded him to take the crutches into school.  The sheer crush at lesson change probably worried him slightly and the crutches will hopefully make people leave a wider gap so as not to shove him.

Thanks for the reassurance re the crutches though.  I won't worry so much when he runs up the stairs now.

So, do I ask the question 'is it perfectly aligned?' when we're in clinic on Friday?  

What happens to those who do suffer a growth arrest?  Do they end up with one leg longer than the other?  Do they have to have reconstructive surgery?

I feel a strange sense of relief now that the screw has been removed.  I didn't realise it was bothering me until it was no longer there if that makes any sense.  He never did walk properly while it was there and his walking appears much more normal now that it's been removed.  Apart from the one incident mentioned earlier in this thread when he accidentally put weight on the leg, he did completely immobilise it for the whole recovery period and so I'm hopeful of a positive outcome. 

14/07/2008 at 21:01

Re perfectly aligned - I would assume that by opening the joint up, they were able to visualise the fracture and make sure it was aligned. So the question might be met with a shocked "of course", but then again, it's nice to be reassured.

Re growth arrest. With this type of fracture, if growth arrest occurs it tends to be in the pattern of a "bar". This means that the growth plate stops growing along this bit, but the rest of the growth plate carries on, leading to malalignment of the joint surface. You can stop this happening either by trying to chop out the bar (tricky and not always successful), or by stopping the rest of the growth plate (easier but leaves you with some shortening). The resultant leg length discrepancy actually wouldn't be too great as the tibia grows more from the top end.

BUT this is all HIGHLY unlikley to be needed as the most likely outcome BY FAR is normal healing, normal growth, and normal alignment!

I do think it's worth asking questions and making sure you understand the Xrays in clinic, even if people seem a bit rushed.

Glad you're happier about the crew - it's interesting that he's walking better,

19/07/2008 at 14:48

Hi joddly

Well, true to form, I forgot to ask all those questions.  I did ask about the Salter Harris though and apparently it was a type II.  The surgeon said it could have been manipulated without opening him up but when they attempted this under xray, they discovered something attached to some ligaments (bone I think?)  had actually broken away and they had to operate to sort that out.

The x-ray yesterday looked absolutely fine and they don't want to see him again which I should think indicates that there are no concerns over growth.

No contact sports for a few more weeks.  Walking is fine.  Cycling can begin soon (so long as he doesn't fall off .... not sure how to ensure that one - although he doesn't usually fall off).  I asked if he's allowed to run up and down stairs (because he does) and the answer was 'no'.  They just want the internal bit where the screw was to heal first which will take a few more weeks.

Anyway, he seems fine and I am enormously relieved.  Thanks for the advice. 

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