Operative Indications and Treatment for Chronic Symptomatic Os Subfibulare in Children.

INTRODUCTION

When used for strict surgical indications, operative management of chronic symptomatic os subfibulare in children involving fragment excision and ligament repair can significantly improve visual analog scale pain scores and result in high Foot and Ankle Outcome Scores.

STEP 1 INDICATIONS AND PREOPERATIVE PLANNING: Operative indications are chronic pain at the distal part of the fibula, symptoms of instability at the anterior talofibular ligament and/or calcaneofibular ligament, and a radiographic finding of an os fibulare.

STEP 2 OSSICLE EXCISION: Perform an approach to the lateral malleolus and excise the fragment while preserving the anterior talofibular ligament and calcaneofibular ligament.

STEP 3 ANKLE EXAMINATION: Examine the ankle for loose bodies or other associated damage.

STEP 4 PREPARATION FOR LIGAMENT REPAIR: Repair the anterior talofibular ligament and calcaneofibular ligament to the debrided distal part of the fibula.

STEP 5 PREPARATION FOR MODIFIED BROSTRÖM PROCEDURE: Imbricate the lateral capsule to secondarily reconstruct and reinforce the ligaments, adding to the strength of the repair.

STEP 6 REPAIR RECONSTRUCTION AND CLOSURE: Reduce the ankle joint and tie down the sutures.

STEP 7 CASTING: Patients wear a cast and remain non-weight-bearing for six weeks postoperatively.

STEP 8 POSTOPERATIVE PROTOCOL: Patients advance to full weight-bearing in a CAM boot and start physical therapy at six weeks.

RESULTS

We performed a retrospective case study of the first twenty-three patients treated with our procedure for symptomatic os subfibulare.IndicationsContraindicationsPitfalls & Challenges.