Periosteal tension band fixation of a pronation external rotation type fracture of the ankle in a child.

Interposed soft tissues can block the anatomical reduction of displaced physeal fractures in children and may necessitate surgical removal. The authors describe a new technique in which they surgically freed the interposed distal-based periosteal flap in an irreducible Salter-Harris type II fracture in a 6-year-old boy and then used this flap in a tension band mode to stabilize the fracture. The thick periosteal flap was held under tension and was reattached to the tibial metaphysis using a 3.5-mm cortical screw and a multi-spiked soft tissue washer. The fracture healed satisfactorily, and the patient regained his ankle function and range of motion by 2 months. Periosteal tension band fixation achieves good skeletal stabilization and avoids more than 1 surgical incision.