AVASCULAR NECROSIS OF THE DISTAL FIBULAR EPIPHYSIS - A NEW CONDITION

A 5-year-old boy was seen because of a right ankle sprain; radiographs showed a marginal anterior avulsion of the distal fibular epiphysis. After plaster immobilization, the patient continued with pain and subj ective instability. New radiographs showed a lytic area in the same zo ne of the avulsion with surrounding sclerosis and a detached bone frag ment. Biopsy showed bone necrosis. Two years later, without any trauma tic event, the patient began to have a similar pain in the left ankle. Radiographs showed fragmentation of the anterior portion of the dista l fibular epiphysis with surrounding sclerosis. Surgical treatment was performed by curettage and cancellous bone grafting; biopsy showed co nnective tissue, mucoid degeneration, and necrotic bone. After excludi ng any general disease, we believe that this bone necrosis could be co nsidered an epiphyseal idiopathic avascular necrosis in children.