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Radiographic Diagnosis of Occult Distal Fibular Avulsion Fracture in Children With Acute Lateral Ankle Sprain

Kwak, Yoon-Hae MD*; Lim, Jae-Young MD; Oh, Min-Kyung PhD; Kim, Woo-Jin MD§; Park, Kun-Bo MD, PhD

Journal of Pediatric Orthopaedics: June 2015 - Volume 35 - Issue 4 - p 352–357
doi: 10.1097/BPO.0000000000000271

Background: Skeletally immature children with ankle sprain are presumed to have distal fibula fracture than ligamentous injury. The purpose of this study is to determine the incidence of associated occult avulsion fracture in children with lateral ankle sprain and the efficacy of identifying fractures using anterior talofibular ligament view.

Methods: Patients who were diagnosed with distal fibular fracture in the initial ankle anteroposterior, lateral, and mortise were excluded and 78 patients (below 16 y of age) who had been initially diagnosed as ankle sprain were included. The initial and 4 weeks’ follow-up ankle series and additional anterior talofibular ligament view suggested by Haraguchi were evaluated.

Results: Twenty patients were diagnosed with occult distal fibular avulsion fracture. Ten patients were diagnosed in anterior talofibular ligament view and others were diagnosed in the follow-up radiography. Displacement was highest on the anterior talofibular ligament view.

Conclusions: This study found 20 (26%) of 78 ankle sprain show occult avulsion fracture in the anterior talofibular ligament view or follow-up radiography. The anterior talofibular ligament view is an appropriate radiologic view for the diagnosis of distal fibular avulsion fracture.

Level of Evidence: Level IV—diagnostic study.

*Department of Orthopaedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang

Departments of Orthopedic Surgery

§Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine

Clinical Trial Center, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Supported by the 2013 Inje University research grant. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

The authors declare no conflicts of interest.

Reprints: Kun-Bo Park, MD, PhD, Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 1435 Jwa-dong, Haeundae-gu, Busan 612-030, Korea. E-mail:

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