Indian J Orthop. 2020 Oct 06;55(1):35-46. doi: 10.1007/s43465-020-00270-9. eCollection 2021 Feb.
Paediatric Ankle Fractures: Guidelines to Management.
Indian journal of orthopaedics
K Venkatadass, G Sangeet, V Durga Prasad, S Rajasekaran
Affiliations
Affiliations
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Main Road, Coimbatore, Tamilnadu India.
PMID: 33569097
PMCID: PMC7851308 DOI: 10.1007/s43465-020-00270-9
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 intra-articular 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.
© Indian Orthopaedics Association 2020.
Keywords: Ankle; Fracture; Injury; Paediatric; Physeal; Treatment
Conflict of interest statement
Conflict of interestThe authors declare that they have no conflict of interest.
References
- J Bone Joint Surg Am. 2020 Apr 15;102(8):679-686 - PubMed
- J Pediatr Orthop. 1988 Sep-Oct;8(5):585-9 - PubMed
- Orthopedics. 2012 Feb 17;35(2):e208-12 - PubMed
- J Bone Joint Surg Am. 1978 Dec;60(8):1040-6 - PubMed
- Int Orthop. 2010 Apr;34(4):547-52 - PubMed
- J Bone Joint Surg Am. 1978 Dec;60(8):1046-50 - PubMed
- J Pediatr Orthop. 1999 Jan-Feb;19(1):14-21 - PubMed
- J Pediatr Orthop B. 2018 Nov;27(6):551-555 - PubMed
- Skeletal Radiol. 1981;6(4):237-53 - PubMed
- J Trauma. 1981 Nov;21(11):991-5 - PubMed
- J Pediatr Orthop. 2018 Nov/Dec;38(10):e593-e596 - PubMed
- Injury. 2015 Nov;46(11):2177-80 - PubMed
- J Pediatr Orthop. 2006 May-Jun;26(3):322-8 - PubMed
- J Pediatr Orthop. 2002 Jan-Feb;22(1):31-5 - PubMed
- Surg Radiol Anat. 2007 Jun;29(4):303-11 - PubMed
- J Pediatr Orthop. 2001 Mar-Apr;21(2):162-4 - PubMed
- J Pediatr Orthop. 1982 Jun;2(2):161-4 - PubMed
- J Bone Joint Surg Am. 2015 Jun 17;97(12):995-1002 - PubMed
- J Pediatr Orthop. 2009 Jun;29(4):356-61 - PubMed
- Orthopedics. 2015 Mar;38(3):e189-95 - PubMed
- J Bone Joint Surg Am. 1984 Jun;66(5):647-57 - PubMed
- Eur J Orthop Surg Traumatol. 2018 Apr;28(3):503-509 - PubMed
- Injury. 2010 Aug;41(8):852-6 - PubMed
- J Pediatr Orthop. 2013 Jul-Aug;33(5):524-9 - PubMed
- J Pediatr Orthop. 1996 Jan-Feb;16(1):113-8 - PubMed
- J Pediatr Orthop. 2003 Nov-Dec;23(6):733-9 - PubMed
- J Bone Joint Surg Am. 1985 Jun;67(5):687-98 - PubMed
- J Bone Joint Surg Am. 2012 Jul 3;94(13):1234-44 - PubMed
- Med J Malaysia. 2001 Jun;56 Suppl C:66-9 - PubMed
- Eur J Trauma Emerg Surg. 2014 Feb;40(1):37-43 - PubMed
- Injury. 2007 Feb;38(2):201-5 - PubMed
- Clin Orthop Surg. 2010 Mar;2(1):34-8 - PubMed
- Injury. 2005 Nov;36(11):1371-8 - PubMed
- J Pediatr Orthop. 1997 May-Jun;17(3):352-5 - PubMed
- J Pediatr Orthop. 2014 Mar;34(2):139-43 - PubMed
- AJR Am J Roentgenol. 2004 Nov;183(5):1489-95 - PubMed
- J Bone Joint Surg Br. 2002 Jan;84(1):11-4 - PubMed
- J Am Acad Orthop Surg. 2013 Apr;21(4):234-44 - PubMed
- Foot Ankle Clin. 2015 Dec;20(4):705-19 - PubMed
- J Orthop Trauma. 2008 Feb;22(2):148-50 - PubMed
- Wien Klin Wochenschr. 2017 Mar;129(5-6):169-175 - PubMed
- Ann Emerg Med. 1992 Apr;21(4):384-90 - PubMed
- J Foot Ankle Surg. 1995 Nov-Dec;34(6):556-9; discussion 594-5 - PubMed
- J Orthop Sci. 2018 Jul;23(4):658-664 - PubMed
- J Am Acad Orthop Surg. 2007 Dec;15(12):738-47 - PubMed
- JAMA Pediatr. 2016 Jan;170(1):e154114 - PubMed
- J Pediatr Orthop. 1995 Jul-Aug;15(4):479-81 - PubMed
- J Pediatr Orthop. 2012 Jun;32 Suppl 1:S69-73 - PubMed
- J Pediatr Orthop B. 2011 Jul;20(4):242-8 - PubMed
Publication Types