Floating ankle injury in children:one case report

YU Tie-qiang; ZUO Yu-ming; LIAN Xiao-jing; LIU Hong-da

doi:10.3969/j.issn.2095-252X.2025.04.014

Abstract：Objective To report a case of floating ankle injury in a child, and summarize the treatment experience. Methods In December 2015, a 9-year-old boy with open fracture (type Gustilo II) of the right distal tibia and fibula with ipsilateral calcaneus fracture caused by a traffic accident was admitted. In the emergency department, debridement, anastomosis of the peroneus longus and brevis muscles, manual reduction of the fracture and plaster fixation were performed under nerve block anesthesia. Limited open reduction plate fixation of the right tibial fracture was performed under general anesthesia on December 18, 2015. Due to obvious shortening of the fracture end, the fibula shortened after the reduction of the tibia. The plate was removed on November 14, 2016. In March 2017, the tibia fractured again due to trauma and was treated with plaster fixation. Results The postoperative follow-up was 8 years and 2 months. The tibial fracture united 4 months after surgery. The calcaneal fracture was completely remodeled 11 months after the injury. The X-ray films showed that the fibula was gradually shortened and the medial space of the ankle joint was widened. The AOFAS score was 95 points. Conclusions Floating ankle injuries are mostly high-energy injuries, with serious soft tissue damage. For open fractures, external fixators are recommended to restore the length of the fracture. The distal tibiofibular syndesmosis should be observed when the fibula is shortened, and the fibula should be reduced and fixed when the distal tibiofibular dissociation occurs. Extra-articular calcaneal fracture remodeling has greater potential for children under 10 years old.