Clinical features and treatment strategy of ankle supination fractures in children

Abstract

Objective To analyze the clinical characteristics and treatment strategy of ankle supination fracture in children. Methods From January 2012 through July 2014, 89 children were treated at our department for ankle fracture caused by supination sprain according to their medical history, physical examination, X-ray films and CT three-dimensional reconstruction of the ankle. Appropriate protocols were applied on the basis of Lauge-Hansen classification, type and displacement of their fractures. Of them, 52 belonged to the supination-adduction type (the extramalleolus fracture was of Odgen type Ⅶ in 51 children whose epiphyseal plate of distal fibula had not been closed) , 35 to the supination-extorsion type (32 cases had tri-plane fracture and 3 Tillaux fracture) , and the remaining 2 did not fit the Lauge-Hansen classification. Surgical treatment was applied in 32 cases and conservative treatment in 57 ones. Results All the children received outpatient follow-up from 12 to 24 months (mean, 18 months). No bone nonunion, osteoarthritis, or fracture malunion was found. The American Orthopaedic Foot & Ankle Society scores averaged 92 points (range, from 88 to 100 points) at the last follow-ups. Conclusions In children whose epiphyseal plate is nearly closed, supination-adduction sprain likely causes an extramalleolus fracture of Salter-Harris type Ⅰ or type Ⅱ, but in children whose epiphyseal plate is unclosed, an epiphyseal fracture of Odgen type Ⅶ is inclined to happen. A Tillaux fracture or tri-plane fracture at the level of distal tibiofibular syndesmosis results often from supination-extorsion sprain in children. For fractures involving epiphysis or epiphyseal plate, anatomical reduction and proper fixation are critical to functional recovery and reducing complications. Key words: Ankle joint; Fractures, bone; Epiphyseal plate; Ligament