Pediatric Physeal Ankle Fracture

Abstract

Ankle fracture is the second most common fracture type in children, and physeal injury is a particular concern. Growing children have open physes that are relatively weak compared with surrounding bone and ligaments, and traumatic injuries can cause physeal damage and fracture. Tenderness to palpation over the physis can aid in the clinical diagnosis of ankle fracture. Swelling, bruising, and deformity may be identified, as well. Plain radiographs are excellent for initial evaluation, but CT may be required to determine displacement and to aid in surgical planning, particularly in the setting of intra-articular fractures. The Salter-Harris classification is the most widely used system to determine appropriate management and assess long-term prognosis. Complications of physeal injury include shortening and/or angular deformity. Tillaux and triplane fractures occur in the 18-month transitional period preceding physeal closure, which typically occurs at age 14 years in girls and age 16 years in boys. Management is determined by the amount of growth remaining, with the intent of maintaining optimum function while limiting the risk of physeal damage and joint incongruity.

Percutaneous cannulated screw fixation for pediatric epiphyseal ankle fractures

“…Traumatic ankle injuries are more likely to cause injury to the physes or bone than to ligaments during childhood (Wuerz and Gurd 2013). Ankle injuries are very common in children (Podeszwa et al 2008) and are second only to wrist and hand injuries in children between the ages of 10 and 15.…”

“…Ankle fractures account for approximately 5% of pediatric fractures and 15% of physeal injuries (Mizuta et al 1987; Peterson and Peterson 1972; Worlock and Stower 1986). The distal tibial physis accounts for 45% of tibial growth (Wuerz and Gurd 2013). When treating children with physeal ankle fractures, it is important to achieve a satisfactory reduction and avoid physeal arrest to minimize the risks of angular deformity, early arthrosis, leg length inequality, and joint stiffness (Wuerz and Gurd 2013; Kay and Matthys 2001).…”

The Foot and Ankle: Acquired Disorders

“…16.1 ) [ 9 ]. The older the child, the more lateral this vertical epiphyseal fracture line tends to be.…”

“…If the gap is less than or equal to 2 mm, the fracture may be treated conservatively with 4 weeks of nonweight bearing with a long leg cast followed by 4 weeks of relative non-weight bearing in a boot [ 9 ]. Maisonneuve fractures are considered unstable and require operative reduction.…”

Triplane Fracture: An Intricate Pediatric Injury

“…They account for 5-15% of all pediatric ankle fractures [5] and are typically more prevalent in young girls and boys, aged 14 and 16 years old respectively, videlicet at the end of the growth period [6] They are strongly associated with the circumstance of the closure of the tibial epiphyseal plate which occurs asymmetrically from a medial to a lateral direction during an 18 month to 2 year period. Moreover, they are usually the result of an external-rotation mechanism of the ankle joint [1].…”