Case report: Reconstruction of distal medial tibial epiphysis using iliac crest apophyseal autograft

BACKGROUND: Salter-Harris type VI physeal fracture is a rare injury. This case study aims to present a novel method for treating a rare entity of Salter-Harris type Salter-Harris VI physeal injury of the medial malleolus. CASE PRESENTATION: A 6-year-old boy with Salter-Harris type VI physeal injury was successfully treated using the two-stage procedure. In the first stage, the patient was treated with intravenous antibiotics, a series of debridement and lavage followed by a skin graft that left a defect in the medial malleolus. In the second stage, an autogenous iliac crest apophyseal graft was transplanted to reconstruct the medial malleolus, and the ankle joint was stabilized by an external fixator. An additional anticipatory Langenskiold procedure was performed for the physeal bar resection. Although the complete radiological development of medial malleolus compared to the contralateral side was not evident at the last follow-up, the functional and cosmetic outcomes were satisfactory. CONCLUSION: The reconstruction of medial malleolus using an autologous iliac crest apophyseal graft and stabilization of the ankle joint with an external fixator is a novel reconstruction technique in treating Salter-Harris type VI physeal injury of the medial malleolus. This technique provides satisfactory functional and cosmetic outcomes in such a fracture pattern; however, a further clinical study using a larger sample size is warranted in order to find the definitive outcome of the technique.