Ankle fracture (peds): Difference between revisions

Revision as of 04:52, 27 June 2011

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

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 ==Background==
--more Fx and fewer sprains since immature bone is more fragile than the surrounding ligaments.
+More Fx and fewer sprains since physis is weaker than surrounding ligaments
--just always get an x-ray.
+===Distal Fibula Fx===
+====Background====
+*Usually Salter-Harris I or II
+====Diagnosis====
-==Tillaux Fx==
+*TTP of growth plate, soft tissue swelling
--ave age 11-15 yrs.
+*Distinguish from lateral ligamentous sprain by presence of point tenderness over physis *Imaging
+**May only show soft tissue swelling at lateral fibula
--more common in girls
+====Management====
+*If nondisplaced immobilize, ortho f/u optional
-salter-harris type 3 Fx that avulses the anterolateral tibial epiphysis (distal to the growth plate).
--caused by ext rotation of the leg with the foot fixed, the ATFL avulses off the distal tibia.
--oblique films are often necessary to distinguish a tillaux from the more common triplane fx.
--more than 2mm of displacement after reduction requires surgical intervention.
--since most of the growth plate has closed at this age, leg length discrepancies and rotational deformities are rare.
-==Triplane Fx==
--more common and serious than tillaux Fx.
--10% of all pediatric ankle Fx.
--mechanism is a combination of external rotation and axial loading in a foot in plantarflexion.
--occur about one year prior to growth plate closure usually.
--more common in boys.
--can be 2 part, 3 part, or 4 part fractures-if the distal tibula is also fractured do not count it as part of the triplane Fx.
-- 2 part Fx is a salter-Harris 4 Fx. One Fx line is transverse through the tibial epiphysis (growth plate). The medial portion of the plate is already closed, so the fracture doesn't extend through the plate. second fracture plane extends up the tibia (coronal plane-up the metaphysis). the third fracture line (sagittal) extends distally into the joint.
--the three and four part fractures are similar in that there are fractures in all three planes, but the distal tibia is in two or three parts respectively.
--can be treated with closed reduction if less than 2mm of displacement can be achieved.
--unfortunately, this Fx has a lot of swelling and if the cast accommodates the swelling then there is enough room for the reduction to slip off when the swelling subsides.
--most three or four part Fxs are treated with ORIF.
--growth arrest is uncommon since the growth plate is near closure at the time of injury.
+===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
 ==See Also==
-Ortho:  Ankle (Fracture)
+Ankle (Fracture)
 [[Category:Peds]]
 [[Category:Ortho]]