L'entorse de cheville de l'enfant

Abstract

Objective. – To review the literature on sprained ankle in children. We can describe our clinical experience but not statistical analysis because of the few cases. Materials and methods. – We searched MedLine with sprain, ankle, children, talo-fibular ligament, ligament injury as key words. Results. – We found few and no results from a prospective or randomized trial. We analyzed three surgical publications: Vahvanen (1983, 1984), and Chaumien (1986). Vahvanen’s studies concerned 50 ankles treated nonoperatively and 40 treated operatively, and Chaumien described 19 patients. Vahvanen’s results suggest that sprained ankle is surprisingly common in children and that primary repair of the ligament will resolve symptoms and lead to a stable ankle joint. Chaumien’s description revealed severe lesions defined by radiographic criteria. Sixteen of the 18 patients who underwent surgery healed without any complications. The surgical repair of acute ankle sprain in children has generated much controversy. Conclusion. – Ankle sprain is a common injury in children and probably underestimated. Clinical evaluation and pain on pressure at the anterior talo-fibular ligament are used in diagnosis. Radiographic studies are necessary to eliminate fractures or an avulsion fragment. Ultrasound can be helpful. Most practitioners and orthopedic surgeons prefer to treat ankle sprains in children nonoperatively.