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Ankle fracture (peds)
From WikEM
Contents
Background
- More fractures and fewer sprains since physis is weaker than surrounding ligaments
- Usually Salter-Harris I or II
- If assumed Salter-Harris Type I, see radiograph-negative ankle injury (peds)
Clinical Features
- Tenderness to palpation of ankle (possibly over growth plate)
- Soft tissue swelling
- Distinguish from lateral ligamentous sprain by presence of point tenderness over physis
Differential Diagnosis
Other Ankle Injuries
Distal Leg Fractures
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Ankle fracture (peds)
- Foot and toe fractures
Evaluation
- Imaging
- May only show soft tissue swelling at lateral fibula
Types
- Salter-Harris I
- Salter-Harris II
- Removable ankle brace[1]
- Salter-Harris III (25%)
- Require open reduction of any displacement
- Tillaux Fracture
- Salter-Harris type III of the anterolateral portion of the distal tibia
- ATFL avulses off the distal tibia
- May need oblique view to distinguish from triplane fracture
- Usually requires surgical reduction
- Salter-Harris type III of the anterolateral portion of the distal tibia
- Triplane Fracture
- Medial portion of distal tibia growth plate closes before lateral aspect
- While normal, this causes 18-month period of vulnerability until lateral aspect closes
- Planes
- Plane 1: Lateral side of tibia through growth plate to fused medial aspect of physis
- Plane 2: Sagittal through epiphysis
- Plane 3: Coronal through distial tibial metaphysis
- Imaging
- Appears as Salter III on AP, Salter II on lateral
- Management
- CT to delineate injury
- Ortho consult; closed reduction sufficient in most cases
Management
- If nondisplaced immobilize, ortho follow up optional
- Short-Leg Posterior Splint
Disposition
- Outpatient
See Also
References
- ↑ . Boutis K, Willan AR, Babyn P, Narayanan UG, Alman B, Schuh S. A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures. Pediatrics. 2007;119(6): e1256-e1263.
