View source for Radiograph-negative ankle injury (peds)

==Background==
*Pediatric ankle injuries are common (>2 million ED visits in North America per year)<ref name="JAMA RN Ankle Editorial">Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.</ref>
*Historically, there has been concern about missing a potential growth plate fracture ([[Salter-Harris]] Type 1), which can rarely result in growth arrest<ref name="JAMA RN Ankle Editorial">Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.</ref>
**It was previously taught that the weaker physis would fail before the stronger ligamentous complex.<ref>Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012; 94(13):1234-1244.</ref>
**This was commonly treated with immobilization (casting), follow-up imaging, and orthopedic referral (as opposed to adult [[ankle sprain]])
*Recent studies have questioned the need for this practice<ref name="Injury MRI Ankle">6. Boutis K, Narayanan UG, Dong FF, et al. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. Injury. 2010;41(8):852-856.</ref><ref name="JAMA RN Ankle Study">Boutis K, Plint A, Stimec J, et al. Radiograph-negative lateral ankle injuries in children: occult growth plate fracture or sprain? JAMA Pediatr. 2016; 170(1):e154114-e154114.</ref>
**There was no measurable difference in functional recovery for children with or without [[Salter Harris]] Type 1 distal fibula fractures at 1 and 3 months<ref name="JAMA RN Ankle Study">Boutis K, Plint A, Stimec J, et al. Radiograph-negative lateral ankle injuries in children: occult growth plate fracture or sprain? JAMA Pediatr. 2016; 170(1):e154114-e154114.</ref>

==Clinical Features==
*Lateral ankle pain (tenderness and/or swelling) after inversion injury in a pediatric patient
**Studies to date have not addressed medial ankle pain

==Differential Diagnosis==
*[[Ankle fracture]]
*[[Salter-Harris]] fracture
*Ligimentous injury
*Contusion of bone or soft tissue

==Evaluation==
*Consider ankle x-rays

{{Ottawa Ankle Rules}}

{{Ottawa Foot Rules}}

==Management==
*Removable ankle brace
*Return to activities as tolerated by pain

===Patients do NOT need===
*Full immobilization (cast or non-removable splint)
*Referral to orthopedics
*Repeat x-ray films (or MRI)

==Disposition==
*Discharge with PCP follow-up

==See Also==
*[[Salter-Harris fractures]]
*[[Ankle diagnoses]]
*[[Ankle fracture]]
*[[Ankle fracture (peds)]]

==External Links==

==References==
<references/>

[[Category:Radiology]]
[[Category:Pediatrics]]
[[Category:Orthopedics]]