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Pediatric Physeal Ankle Fracture

Wuerz, Thomas H. MD, MSc; Gurd, David P. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 2013 - Volume 21 - Issue 4 - p 234–244
doi: 10.5435/JAAOS-21-04-234
Review Article

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.

From the Cleveland Clinic Foundation, Cleveland, OH.

Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Wuerz and Dr. Gurd.

© 2013 by American Academy of Orthopaedic Surgeons
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