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Chronic symptomatic os subfibulare in children.

Stephan G Pill¹, Michael Hatch, Julie M Linton

¹The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

The Journal of Bone and Joint Surgery. American Volume

|August 23, 2013

Summary

Surgical treatment for symptomatic os subfibulare in children effectively resolves chronic ankle pain and instability. This procedure restores ankle function, allowing a return to pre-injury activity levels with minimal complications.

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Area of Science:

Orthopedic Surgery
Pediatric Orthopedics
Sports Medicine

Background:

Persistent ankle pain and instability in children can stem from inversion injuries.
Osseous fragments near the lateral malleolus suggest anterior talofibular ligament or calcaneofibular ligament avulsion.
Symptomatic os subfibulare, a nonunion of an avulsion fragment, causes chronic pain and ligamentous laxity, distinct from asymptomatic variants.

Purpose of the Study:

To evaluate intraoperative findings and long-term outcomes of operative treatment for symptomatic avulsion injuries or os subfibulare in children.

Main Methods:

Twenty-three children with chronic ankle pain and instability underwent surgical intervention.
Procedures included excision of osseous fragments, anterior talofibular ligament reconstruction, and a modified Broström procedure.
Preoperative imaging included MRI and/or stress radiographs to confirm injury.

Main Results:

A mean delay of 3.2 years occurred between injury and surgical treatment.
At a mean follow-up of 4.5 years, the mean Foot and Ankle Outcome Score was 91.4/100.
All but one patient returned to their preinjury recreational activity level, with only one long-term complication.

Conclusions:

Surgical management of symptomatic os subfibulare in children is effective.
The combined approach restores ankle stability and eliminates pain.
Patients can achieve a return to their preinjury functional level.