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Figure 1. Anteroposterior view of the ankle showing fracture line.
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Figure 2. Lateral view of injured ankle.
A 13-year-old adolescent presents with significant left ankle pain after a twisting injury while playing basketball earlier in the day. He planted his feet to make a quick move and felt the ankle give out. On physical examination, the patient has significant pain to palpation over the medial malleolus with mild swelling to the medial ankle. Radiographs of the ankle are taken (Figures 1 and 2). On the radiographs, the fracture line appears to start at the medial malleolus and a subtle fracture line extends to the epiphysis.
Ankle fractures are a very common pediatric injury, accounting for approximately 5% of pediatric fractures and 15% of physeal injuries.1 Ankle fractures only rank behind distal radius and finger injuries as the most common fracture locations involving growth plates. The...
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Ankle fractures are a very common pediatric injury, accounting for approximately 5% of pediatric fractures and 15% of physeal injuries.1 Ankle fractures only rank behind distal radius and finger injuries as the most common fracture locations involving growth plates. The distal tibial physis contributes to 40% of the growth of the tibia; therefore, an ankle injury that causes growth arrest can be devastating.1 Distal tibial physis closure generally occurs by age 16 years for boys and age 14 for girls. Before this time, the surrounding ligament structures can be stronger than the growth plates, which leads to a tendency for growth plate fractures over ankle sprains in this age group. Over a period of 18 months, the distal tibial physis closes: first in the middle of the physis, then the medial part, and lastly the lateral side.1,2
A Tillaux fracture is a Salter-Harris type III fracture of the anterolateral portion of the distal tibia, which results from an epiphyseal avulsion at the attachment site of the anterior talofibular ligament. Triplane fractures have fracture lines in 3 planes, which involve the metaphyseal fragment posteriorly, and an epiphyseal fragment is more often lateral than medial. The patient’s fracture appears to involve the epiphysis and physis, which is characteristic of a Salter-Harris type III fracture.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Kay RM, Matthys GA. Pediatric ankle fractures: evaluation and treatment. J Am Acad Orthop Surg. 2001;9(4):268-278. doi:10.5435/00124635-200107000-00007
2. Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012;94(13):1234-1244. doi:10.2106/JBJS.K.00682
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This article originally appeared on Clinical Advisor
