Ankle fractures in children
- Kathy Boutis, MD, FRCPC, FAAP, MSc
Kathy Boutis, MD, FRCPC, FAAP, MSc
- Associate Professor of Pediatrics
- University of Toronto
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss the diagnosis and management of ankle fractures in children. The evaluation and causes of ankle pain in the active child or skeletally immature adolescent and the diagnosis and management of ankle sprains are discussed separately:
●(See "Ankle sprain".)
Ankle fractures are among the most common acute injuries of the lower extremity in children. They also account for up to 40 percent of all fractures in the skeletally immature athlete . Ankle fractures occur more often in boys than girls. Many fractures arise from activities such as basketball, soccer, inline skating, and riding motorized scooters [1,2].
Distal fibular physeal fractures are the most common types of pediatric ankle fracture and are associated with a relatively low risk for long-term complications . By contrast, distal tibial physeal fractures are associated with a higher risk for long-term complications .
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- CLINICAL ANATOMY
- Distal tibial physis
- Distal fibular physis
- MECHANISM OF INJURY
- Physical examination
- - Assessment of ankle stability
- Clinical decision rules for ankle radiography
- - Low Risk Ankle Rule
- - Ottawa Ankle Rule
- - Two-Part Malleolar Zone Rule
- - Plain radiographs
- - Salter-Harris classification
- Juvenile Tillaux fracture
- Triplane fracture
- - Computed tomography
- - Magnetic resonance imaging
- INITIAL MANAGEMENT
- Absent pulse
- Analgesia and initial care
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- DEFINITIVE CARE
- Distal fibula fractures
- Distal tibia fractures
- DISCHARGE AND FOLLOW-UP
- Home pain management
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS