Ankle fracture (peds): Difference between revisions
No edit summary |
No edit summary |
||
| (3 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{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 | ||
| Line 25: | Line 26: | ||
*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 | ||
| Line 44: | Line 45: | ||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Immobilization=== | |||
*If nondisplaced [[Splinting#Lower Extremity|immobilize]], ortho follow up optional | *If nondisplaced [[Splinting#Lower Extremity|immobilize]], ortho follow up optional | ||
*Short-Leg Posterior Splint | *Short-Leg Posterior Splint | ||
Revision as of 22:35, 28 November 2019
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.