Prognostic factors for premature growth plate arrest as a complication of the surgical treatment of fractures of the medial malleolus in children

D. V. Petratos, M. Kokkinakis, E. G. Ballas, J. N. Anastasopoulos


McFarland fractures of the medial malleolus in children, also classified as Salter–Harris Type III and IV fractures, are associated with a high incidence of premature growth plate arrest. In order to identify prognostic factors for the development of complications we reviewed 20 children with a McFarland fracture that was treated surgically, at a mean follow-up of 8.9 years (3.5 to 17.4). Seven children (35%) developed premature growth arrest with angular deformity. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale for all patients was 98.3 (87 to 100) and the mean modified Weber protocol was 1.15 (0 to 5). There was a significant correlation between initial displacement (p = 0.004) and operative delay (p = 0.007) with premature growth arrest. Both risk factors act independently and additively, such that all children with both risk factors developed premature arrest whereas children with no risk factor did not. We recommend that fractures of the medial malleolus in children should be treated by anatomical reduction and screw fixation within one day of injury.

Cite this article: Bone Joint J 2013;95-B:419–23.


  • The authors would like to thank Mr M. Kyprianou for the statistical analysis.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    This article was primary edited by D. Jones and first-proof edited by J. Scott.

  • Supplementary material. Three tables, detailing i) the demographics and ii) the clinical and radiological outcomes of all 20 patients, and iii) the relationship between risk factors and growth arrest, are available with the electronic version of this article on our website

  • Received February 22, 2012.
  • Accepted December 10, 2012.
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