Ankle fracture (peds): Difference between revisions
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*Usually [[Salter Harris|Salter-Harris]] I or II | *Usually [[Salter Harris|Salter-Harris]] I or II | ||
== | ==Clinical Features== | ||
*TTP of growth plate, soft tissue swelling | *TTP of growth plate, soft tissue swelling | ||
*Distinguish from lateral ligamentous sprain by presence of point tenderness over physis | *Distinguish from lateral ligamentous sprain by presence of point tenderness over physis | ||
==Differential Diagnosis== | |||
{{Other ankle injuries DDX}} | |||
{{Distal leg fractures DDX}} | |||
==Diagnosis== | |||
*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 or II | *Salter-Harris I or II | ||
**Manage w/ closed reduction if any displacement present, followed by immobilization | **Manage w/ closed reduction if any displacement present, followed by immobilization | ||
| Line 35: | Line 42: | ||
*If nondisplaced [[Splinting#Lower Extremity|immobilize]], ortho f/u optional | *If nondisplaced [[Splinting#Lower Extremity|immobilize]], ortho f/u optional | ||
*Short-Leg Posterior Splint | *Short-Leg Posterior Splint | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
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*[[Ankle fracture]] | *[[Ankle fracture]] | ||
== | ==References== | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 13:37, 1 April 2016
Background
- More fractures and fewer sprains since physis is weaker than surrounding ligaments
- Usually Salter-Harris I or II
Clinical Features
- TTP of 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
Diagnosis
- 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
- 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 f/u optional
- Short-Leg Posterior Splint