Ankle fracture (peds): Difference between revisions
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{{peds top}} [[ankle fracture]] | |||
==Background== | ==Background== | ||
*More fractures and fewer sprains since physis is weaker than surrounding ligaments | *More fractures and fewer sprains since physis is weaker than surrounding ligaments | ||
*Usually [[Salter Harris|Salter-Harris]] I or II | *Usually [[Salter Harris|Salter-Harris]] I or II | ||
**If assumed Salter-Harris Type I, see [[radiograph-negative ankle injury (peds)]] | |||
==Clinical Features== | ==Clinical Features== | ||
* | *Tenderness to palpation of ankle (possibly over growth plate) | ||
*Distinguish from lateral ligamentous sprain by presence of point tenderness over physis | **Soft tissue swelling | ||
*Distinguish from lateral ligamentous sprain by presence of point tenderness over physis | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Distal leg fractures DDX}} | {{Distal leg fractures DDX}} | ||
== | ==Evaluation== | ||
*Imaging | *Imaging | ||
**May only show soft tissue swelling at lateral fibula | **May only show soft tissue swelling at lateral fibula | ||
===Types=== | ===Types=== | ||
*Salter-Harris I | *Salter-Harris I | ||
** | **See [[radiograph-negative ankle injury (peds)]] | ||
*Salter-Harris II | |||
**Removable ankle brace<ref>. 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.</ref> | |||
*Salter-Harris III (25%) | *Salter-Harris III (25%) | ||
**Require open reduction of any displacement | **Require open reduction of any displacement | ||
*Tillaux | *[[Tillaux fracture]] | ||
**Salter-Harris type III of the anterolateral portion of the distal tibia | **Salter-Harris type III of the anterolateral portion of the distal tibia | ||
***ATFL avulses off the distal tibia | ***ATFL avulses off the distal tibia | ||
**May need oblique view to distinguish from triplane fracture | **May need oblique view to distinguish from triplane fracture | ||
**Usually requires surgical reduction | **Usually requires surgical reduction | ||
*Triplane | *[[Triplane fracture]] | ||
**Medial portion of distal tibia growth plate closes before lateral aspect | **Medial portion of distal tibia growth plate closes before lateral aspect | ||
**While normal, this causes 18-month period of vulnerability until lateral aspect closes | **While normal, this causes 18-month period of vulnerability until lateral aspect closes | ||
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==Management== | ==Management== | ||
*If nondisplaced [[Splinting#Lower Extremity|immobilize]], ortho | {{General Fracture Management}} | ||
*Short- | |||
===Immobilization=== | |||
*If nondisplaced [[Splinting#Lower Extremity|immobilize]], ortho follow up optional | |||
*[[Short-leg posterior splint]] | |||
==Disposition== | ==Disposition== | ||
*Outpatient | |||
==See Also== | ==See Also== | ||
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*[[Ankle diagnoses]] | *[[Ankle diagnoses]] | ||
*[[Ankle fracture]] | *[[Ankle fracture]] | ||
*[[Radiograph-negative ankle injury (peds)]] | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 20:03, 22 March 2023
This page is for pediatric patients. For adult patients, see: ankle fracture
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 Fracture Types
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- 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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- 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.