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Diagnosed with Solter-Harris injury. Why swelling and pain? Consider a pediatric orthopod?

12 year old female soccer player diagnosed with Solter-Harris injury resulting from having her foot stepped on in one on one soccer competition. She fell, heard a pop, and immediately had swelling and pain. Was xrayed and casted within 2 hours. Cast on for 3 weeks, followed by 4 weeks of PT, then alternating weeks of workouts with forced rest due to continued pain. Specific pain is now over ATF ligament , and and MRI was taken this week. Radiologist reported full disruption of the ligament, but we have seen 3 orthopods, all with differing opinions. One (ankle specialist) considers it full tear and wants to do a Brossman procedure on her. Another doesn t believe it is torn, and wants to cast her for 4 weeks and slowly ease back into PT and activity. Another is unclear if the lesion is complete or not. As parents, we are perplexed. Considering a pediatric orthopod, but getting feedback from doctor friends that this procedure is not commonly done in children, and that the complications are not worth the risk. Do you have input? The child is otherwise healthy, though deconditioned due to continued pain and reduced activity level. Thank you.
Asked On : Sun, 14 Oct 2012
Answers:  1 Views:  29
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Orthopaedic Surgeon 's  Response
Hi, this is a great question. You have 3 professional opinions already: here is one more...

It is unclear whether the ATFL is torn based on the imaging and the exam. One option is a repeat MRI, possibly with contrast to try to confirm the ligament integrity. If you can find a center with MSK ultrasound proficiency, that is another option for diagnosis.

With regards to treatment, that is a harder question, because we do not know if there is a tear or complete tear. However, Brostrom or modified Brostrom is usually done in patients that have recurrent sprains after rehab and return to play. At 12 yo I would favor conservative treatment and potentially follow up imaging with rehab instead of surgery.

Best wishes for your health,,,,
Answered: Thu, 22 Nov 2012
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