Ankle fracture (peds)

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This page is for pediatric patients. For adult patients, see: ankle fracture

Background

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 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
  • 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
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Immobilization

  • If nondisplaced immobilize, ortho follow up optional
  • Short-Leg Posterior Splint

Disposition

  • Outpatient

See Also

References

  1. . 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.

Authors:

Ross Donaldson