Paediatric Ankle Fractures: Guidelines to Management
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REVIEW ARTICLE
Paediatric Ankle Fractures: Guidelines to Management K. Venkatadass1 · G. Sangeet1 · V. Durga Prasad1 · S. Rajasekaran1 Received: 20 August 2020 / Accepted: 18 September 2020 © Indian Orthopaedics Association 2020
Abstract Introduction Paediatric ankle fractures represents about 5% of all paediatric fractures. It is the most common physis to be injured in the lower limb accounting to approximately 15–20% of all physeal injuries. This article reviews the literature on this common injury which still has many controversial areas and gives guidelines to management based on the existing evidence along with clinical experience gained from a Level I trauma center. Classification The original Salter–Harris Classification with the additional types is a good system to guide on the management. The transitional fractures form a separate group with technically two broad types—biplane and triplane injuries. Though there are many sub-types in this group with some popular eponymous fractures, the treatment principles remain the same. Management A very low threshold for CT scan is recommended when there is a clinical suspicion of fracture with a negative radiograph or an intra-articular fracture in the radiograph especially in the adolescent age group. CT scan helps in accurate quantification of the intra-articular displacement and also helps to comprehend the fracture geometry better. All the intraarticular fractures with displacement > 2 mm need perfect anatomical reduction and stabilization. Assisted closed reduction and percutaneous fixation along with arthrogram to confirm articular congruity is acceptable as long as the reduction is perfect. Irrespective of the method of treatment, in children with more than 2 years of growth remaining it is important to counsel regarding the high incidence of pre-mature physeal closure and the need for regular follow-up. Keywords Ankle · Fracture · Paediatric · Treatment · Physeal · Injury
Introduction Paediatric ankle fractures are those fractures involving the distal end of the tibia and fibula from the metaphysis to the epiphysis. With an approximate incidence of 1 in 1000 children per year, ankle fractures represent approximately 5% of all pediatric fractures [1, 2]. The incidence of paediatric ankle fractures in our trauma center is 4%, based on the data
from 2015 to 2019. Ankle fractures are the most common physeal injuries in the lower limb representing 15–20% of all physeal injuries [2]. The frequency is twice in boys as compared to girls, partially attributed to the delayed physeal closure in boys. The peak incidence is between the age of 8 and 15 years. Sports and twisting injuries are the most common mechanism followed by low energy falls and motor vehicle injuries.
* K. Venkatadass [email protected]
Ankle Anatomy
G. Sangeet [email protected]
The ankle joint or the talocrural joint is the only example of a true mortise joint in the human body where the mortise is formed by the distal tibia, fibula and the distal tibio-fibular synde
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