Ankle fracture (peds)

Background

More Fx and fewer sprains since physis is weaker than surrounding ligaments

Distal Fibula Fx

Background

• 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

Management

• If nondisplaced immobilize, ortho f/u optional

Distal Tibia Fx

• 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
  • Salter-Harris IV
  • Ortho consult

Source

Tintinalli