Clinical and radiological outcomes of surgically treated medial malleolus fractures in skeletally immature patients.

BACKGROUND

Medial distal tibial Salter-Harris Type 3 and Type 4 epiphyseal injuries, also known as McFarland fractures, pose significant risks due to their potential to damage the growth plate and cause long-term joint deformities. Surgical treatment is commonly performed to restore joint congruity; however, there is no clear consensus on whether surgical or conservative treatment yields better outcomes. This study aimed to evaluate the mid-term clinical and radiological outcomes of surgical treatment in patients with McFarland fractures.

METHODS

This retrospective study analyzed outcomes of 13 patients, aged 6-17 years, who underwent surgical treatment for McFarland fractures between 2021 and 2023 at a Level 1 Trauma Center. Surgical methods included screw fixation, K-wire fixation, and tension wire fixation. Outcome measures included radiological deformity assessments (lateral distal tibial angle [LDTA], anterior distal tibial angle [ADTA]), range of motion (ROM), Foot and Ankle Ability Measure (FAAM) scores for functional assessment, and Visual Analogue Scale (VAS) scores for pain. Comparisons were made between the operated and non-operated limbs.

RESULTS

LDTA and ADTA values showed minimal differences between the operated and non-operated limbs, indicating successful surgical realignment (p<0.05). Although slight ROM limitations were observed in the operated limb, high FAAM scores and low VAS scores reflected good functional recovery and effective pain management. Correlation analysis revealed a moderate positive correlation (r=0.45) between FAAM scores and ROM, and a weaker correlation (r=0.32) between FAAM scores and radiological alignment.

CONCLUSION

Surgical treatment of McFarland fractures resulted in favorable clinical and radiological outcomes, with minimal limitations in ROM and significant improvements in alignment and functional recovery. However, ongoing follow-up is essential, particularly in younger patients, to monitor and manage the risk of potential growth disturbances.