Answer
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The radiographs revealed a 20˚ anteriorly (apex posterior) angulated fracture through the metaphysis of the distal tibia and fibula. Angulated distal tibia fractures in adults are usually fixed with surgery; however, in children, displaced or angulated fractures to long bones such as the tibia stimulate a significant amount of growth. In treating pediatric patients, there is a greater amount of acceptable angulation the closer a fracture is to the end of bone.1
The patient in this case was placed in a long leg cast, and the fractures were reduced with three-point fixation technique. He remained in the cast for 5 weeks; thereafter, a below-the-knee orthopedic walking boot was placed for 3 weeks. The radiographs in Figures 3 and 4, taken 8 weeks after initiation of treatment, show a healed distal tibia and fibula fracture with an acceptable 7˚ of anterior angulation.