Transcription
Ankle fractures in children can lead to significant complications. The incidence of growth arrest following a physical ankle injury can be up to 50 percent.
This is the Salter-Harris classification of ankle fractures. Type 1 and type 2 Salter-Harris injuries of the distal tibia usually require closed reduction and casting. If you operate on them, that does not decrease the incidence of growth arrest.
Type 3 and type 4 fractures involve the joint, so you will do reduction and fixation of the fracture. You will use an epiphyseal screw parallel to the vices, or you can put in a metaphyseal screw if you have a large metaphyseal piece in type 4. When you do the fixation, avoid violating the joint or the growth plate.
The highest rate of growth arrest in pediatric ankle fractures will result from medial malleolar type 4 fractures. When growth arrest happens, it may result in various deformities of the ankle. If you have a fractured ankle and there is an anterior widening of the tibial physis, what causes this widening is the interposition of the periosteum.
Two important fractures in the ankle are the low fracture, which occurs due to anterior inferior tibiofibular ligament avulsion. If the fracture is minimally displaced, as seen not only in the X-rays but also in the CT scan, you do cast immobilization. If the fracture involves more than two millimeters of articular displacement, they are treated with open or closed reduction and fixation.
So the question may come: what is the ligament that attaches to the fragment and causes the displacement? It is the anterior inferior tibiofibular ligament. So why does the low fracture occur like this? Why did that small piece evolve?
It occurs because the lateral half of the distal tibia physis remains open. When you have an external rotational force, the anterior inferior tibiofibular ligament holds the lateral part of the tibia that is open. The epiphysis will separate that part at the junction of the middle and lateral open faces.
The tallow fracture commonly occurs in the 18 months before complete distal tibial physeal closure. This injury occurs with a supination-inversion mechanism.
How about triplane fracture representation in the AP view? There will be a type 3 Salter-Harris fracture with the fracture line extending into the ankle joint. In the lateral view, you will find type 2 with a posterior metaphyseal piece.
The triplane component fracture is a complex physeal injury that crosses the distal tibia physis in three different planes. When you look at that triplane fracture and that low fracture of the tibial growth plate, there's an explanation for them.
The typical growth plate fuses over 18 months, first in the central region, then posteriorly, then medially, and the lateral part closes last. The triplane and that low fracture occur during this period.
The general treatment is restoration of the articular congruity to decrease the incidence of post-traumatic arthritis.
Thank you very much. I hope that was helpful.