Ankle fracture (peds)

Background

• More fractures and fewer sprains since physis is weaker than surrounding ligaments
• Usually Salter-Harris I or II

Diagnosis

• TTP of growth plate, soft tissue swelling
• Distinguish from lateral ligamentous sprain by presence of point tenderness over physis
• Imaging
  • May only show soft tissue swelling at lateral fibula

Types

• Salter-Harris I or II
  • Manage w/ closed reduction if any displacement present, followed by immobilization
• 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 fx
  • Usually requires surgical reduction
• 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 f/u optional

See Also

• Fractures (Main)
• Ankle (Main)
• Ankle Fracture

Source

Tintinalli