Der Unfallchirurg
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Fractures of and near the epiphysis occur much less frequently in the lower extremities than in the upper extremities. The time required for consolidation of lower extremity fractures is twice as long as for fractures of the arm or hand. ⋯ Additionally, deformities of the lower extremity skeleton result in a more severe functional impairment than would result from epiphyseal fractures of the arm or hand (with the exception of injuries to the elbow). Therefore, proper radiographic diagnostics with precise projection of the required planes are mandatory to accurately determine all further treatment options.
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The treatment of fractures of the medial malleolus in juveniles is of particular relevance. In patients under 10 years old fractures of the distal tibia affect almost exclusively the medial malleolus in the extension line of the medial talus edge in a proximal direction. ⋯ When fractures of the medial malleolus remain unrecognized or are treated inadequately, growth disturbances can occur (e.g. excessive or reduced growth, axis deviation). The diagnostics, indications (conservative or surgical treatment), treatment and follow-up care must be discussed and the corresponding legal aspects must be taken into consideration.