Acute Fractures and Dislocations of the Ankle and Foot in Children

Chaturvedi, Apeksha; Mann, Laura; Cain, Usa; Chaturvedi, Abhishek; Klionsky, Nina

doi:10.1148/rg.2020190154

Cited by 14 publications

(11 citation statements)

References 78 publications

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“…In a posttraumatic setting, this ossicle can be mistaken for an anterior process fracture of the calcaneus, and it is a relevant differential diagnosis in persistent pain after a supination trauma. 9,16 In such cases, further investigation with CT or MRI should be performed to detect signs of fracture.…”

Section: Os Calcaneus Secundariusmentioning

confidence: 99%

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Imaging of Bone Anatomical Variants Around the Foot and Ankle

Daffinà

Ricci

Arrigoni

et al. 2023

Semin Musculoskelet Radiol

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Different anatomical variants can be found in the ankle and foot, generally as occasional findings, although they can be the cause of diagnostic pitfalls and difficulties, especially in radiographic interpretation in trauma. These variants include accessory bones, supernumerary sesamoid bones, and accessory muscles. In most cases, they represent developmental anomalies found in incidental radiographic findings. This review discusses the main bony anatomical variants, including accessory and sesamoid ossicles, most commonly found in the foot and ankle that can be a cause of diagnostic challenges.

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Section: Os Calcaneus Secundariusmentioning

confidence: 99%

“…Found in various locations, they are a major issue to consider in the foot and ankle. 3,4,[6][7][8][9] Accessory bones are usually small, and they can be ovoid, triangular, or nodular in shape. They may be bipartite or multipartite, unilateral or bilateral, and usually are located close to a bone or a joint.…”

mentioning

confidence: 99%

Imaging of Bone Anatomical Variants Around the Foot and Ankle

Daffinà

Ricci

Arrigoni

et al. 2023

Semin Musculoskelet Radiol

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“…The Dias-Tachdjian classification is an adaptation of the Lauge-Hansen classification developed for adult ankle fractures to skeletally immature patients in conjunction with the SH classification [5]. This system is the only classification that defines pediatric ankle fracture patterns based on both the physeal involvement and injury mechanism characterized by the foot position at the time of injury with the direction of deforming force (Table 1) [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…The clinical relevance of the Dias-Tachdjian classification is to facilitate closed reduction by inverting the deforming force and to assist in the detection of accompanying fractures. Furthermore, recognizing the fracture pattern and injury mechanism can help clinicians predict the aforementioned complications associated with physeal injury [4,6]. However, as far as the authors know, there is no solid evidence regarding the reliability of the Dias-Tachdjian classification.…”

Section: Introductionmentioning

confidence: 99%

Intra- and inter-observer reliability of Dias-Tachdjian classification in pediatric ankle fractures: do clinical experience and expertise matter?

Demіrel

Yenigün

Mert

et al. 2023

Journal of Pediatric Orthopaedics B

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The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician’s experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician’s experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77–0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86–0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71–0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53–0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47–0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37–0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.

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“…Distal tibial physeal fractures (DTPFs) account for one-third of physeal injuries, and physeal injuries constitute 20% to 30% of all fractures in children 1 . It is critical to properly manage these fractures, as the distal tibial physis accounts for 40% of tibia growth and 17% of total lower extremity growth 2 . Moreover, the ankle is a weight-bearing joint and less tolerant to residual deformity compared with upper extremity fractures 3 .…”

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confidence: 99%

A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures

Onay,

Çelen,

Bayhan

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Pediatric physeal ankle fractures carry a high risk of complications. This study aimed to (1) investigate the effect of anatomic reduction of the physis on mid to long-term functional outcomes in Salter-Harris type II and triplane distal tibial physeal fractures (DTPFs) and (2) compare the outcomes of 3 different surgical techniques applied in these fractures. Methods: The database of a single level-I trauma center was retrospectively reviewed for DTPFs between 2012 and 2022. A total of 39 eligible patients with operative Salter-Harris type II and triplane fractures between 2012 and 2022 were included. Surgical treatment methods were closed reduction-percutaneous fixation (CR-PF), open reduction-screw fixation, or open reduction-plate fixation. Patients were further divided into subgroups for fractures reduced anatomically (<1 mm) or nonanatomically (1 to 3 mm). The primary outcome measures were the American Orthopaedic Foot and Ankle Society Score, ankle range of motion, presence of premature physeal closure and angular deformities, and Takakura ankle osteoarthritis grade. Results: A total of 39 patients were included, with an average age of 12.9 ± 2.2 years. The mean follow-up time was 68.9±38.0 months. The CR-PF group had higher postoperative fracture displacement (P = 0.011). American Orthopaedic Foot and Ankle Society scores were excellent in all groups, statistically similar between surgical techniques, and similar between anatomic and nonanatomic reduction groups. The CR-PF group (P =0.030) and nonanatomic reduction (P = 0.030) provided a significantly lower ankle osteoarthritis rate. All 4 patients with premature physeal closure were observed in patients treated with open techniques. Conclusions: CR-PF for the treatment of DTPFs should be preferred in suitable cases as it is less invasive and provides satisfactory mid to long-term functional outcomes without increasing complications compared with anatomic reduction and open techniques. Level of Evidence: Level III.

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Acute Fractures and Dislocations of the Ankle and Foot in Children

Cited by 14 publications

References 78 publications

Imaging of Bone Anatomical Variants Around the Foot and Ankle

Imaging of Bone Anatomical Variants Around the Foot and Ankle

Intra- and inter-observer reliability of Dias-Tachdjian classification in pediatric ankle fractures: do clinical experience and expertise matter?

A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures

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