Distal fibular lengthening after premature growth arrest: a case report.

Post-traumatic premature closure of the distal fibular growth plate is a rare entity leading to shortening of the lateral malleolus. We report on a 14-year old boy who presented with a 4-year history of worsening, diffuse discomfort and swelling of his left ankle, as well as fibular shortening and talar malreduction. He had sustained a distal tibial fracture 4 years earlier and had been treated with closed reduction. He reported instability of the ankle and difficulty with running. There was 1-cm shortening of the left fibula, 1-cm shortening of the proximal fibula, and slight widening of the medial clear space. Both tibial and fibular growth plates were already closed and the left ankle joint space was slightly narrowed. He was treated with late fibular lengthening and autogenous iliac crest tricortical bone grafting and achieved anatomic restoration of the distal tibiofibular relationship. At one-year follow-up, the ankle-hindfoot score had improved from 69 to 100.