14 - Ankle Fractures

Abstract

Pediatric ankle fractures are very common injuries, accounting for approximately 5% of all pediatric fractures and up to 15% of physeal injuries. The distal tibial physis is among the most commonly injured growth plate, accounting for 10% to 20% of all physeal injuries. While the majority heal without difficulty, complications may occur and can have devastating consequences. These complications include many of the same as in adult injuries, including post-traumatic arthritis, malunion, nonunion, stiffness, and reflex sympathetic dystrophy. Perhaps more challenging to prevent and treat are those resulting from damage to the physis. This is particularly problematic, as the distal tibial physis experiences arrest in up to two-thirds of injuries involving the growth plate. Given that this accounts for up to 45% of tibial growth, such injuries can result in substantial bone and joint deformity, and limb length or alignment discrepancies. These common injuries can lead to challenging complications if not identified early in the recovery period. A thoughtful and measured approach to the individual patient’s injury, with consideration of physeal involvement, age, and remaining growth, is essential to optimizing patient outcomes and minimizing the risk of complications. Therefore treatment goals for pediatric ankle fractures include preservation or restoration of articular congruency, reduction of physeal displacement, and mechanical and anatomic alignment restoration using techniques that minimize the risk of physeal arrest or deformity.