Hypothesis 3 - Fracture with physeal damage Fracture could have occurred at the distal physeal plate of metacarpal 4 causing a disruption in proper growth. Metacarpal 3 would continue to grow normally, but metacarpal 4 would have retarded growth if growth continued at all. Metacarpal 3 would end up being longer in length than metacarpal 4. Causing the limb distal to the fracture site to be displaced laterally. This would lead to the valgus presentation. The fracture site may have also been complicated by infection. This could have been introduced at delivery by chain injury or due to improper bandaging/casting techniques causing skin sloughing. This explains the swelling and draining tracts seen on the injured leg. This localized infection would also add the retarded growth of the limb. If this infection is not completely resolved, the infection will lead to further suppression of growth in the infected joint. This would cause a shortened limb over time.