Paediatric

Ankle
Fractures
Introduction
•Ankle Fractures are very common fractures in the pediatric population that are
usually caused by direct trauma or a twisting injury.
•Diagnosis is made with plain radiographs of the ankle. A CT scan may be
required to further characterize the fracture pattern and for surgical planning.
•Treatment may be nonoperative or operative depending on patient age, fracture
displacement, and fracture morphology.
Epidemiology
Incidence accounts for 25-40% of all physeal injuries (second most common),
accounts for 5% of all paediatric fractures

Demographics more common in males 2:1, typically occur between 8-15 years-
old

Risk factors participation in sports, increased BMI

Pathophysiology
•Mechanism of injury
1) Direct trauma
2) Twisting injury, i.e. rotation about a planted foot and ankle
Classification
Salter-Harris Classification
1) Type 1 Fracture extends through the physis (15%)
2) Type 2 Fracture extends through the physis and exits through the metaphysis
(45%)
3) Type 3 Fracture extends through the physis and exits through the epiphysis (20%)
4) Type 4 Fracture involves the physis, metaphysis and epiphysis (20%)
5) Type 5 Crush injury to the physis, Can be difficult to identify on initial
presentation (1%)
Salter-Harris Classification
Mechanism of
Injury
1) Supination (Inversion)
2) Supination-Plantarflexion
3) Supination-External
Rotation
4) Pronation (Eversion)-
External Rotation
5) Axial Compression
 Imaging
1) Radiographs recommended views AP, mortise,
lateral
optional views
full-length tibia (or proximal tibia) to rule out
Maisonneuve-type fracture
2) CT scan indications
- assess fracture displacement (best obtained post-
reduction)
- assess articular step-off
- Pre-op planning
Treatment
1) Non-operative (walking boot vs plaster)
2) ORIF