Ankle Fractures

Question 1

Which portion of the distal tibia physis closes last?

Answer 1

Anterolateral; closes from central to medial

Question 2

Which type of fixation is preferred for pediatric ankle fractures?

Answer 2

Trans-epiphyseal screws

Question 3

Which type of pediatric ankle fractures have the highest incidence of growth arrest?

Answer 3

SH IV medial malleolar fx

Question 4

Describe a Tillaux fracture?

Answer 4

SH III fracture of the distal tibial physis; caused by an avulsion of the anterior inferior tibiofibular ligament
Typical age is 12-14yo

Question 5

What is the treatment of Tillaux fractures?

Answer 5

If less than 2mm displacement after closed reduction then place in long leg cast
If >2mm displacement after closed reduction, then attempted reduction under anesthesia with perc screw vs open reduction and screw

Question 6

A juvenile Tillaux ankle fracture is caused by an avulsion injury involving what structure?

Answer 6

Anterior tibiofibular ligament

Question 7

What are the planar fractures that make up a triplane fracture?

Answer 7

1) Epiphysis in sagittal (AP view)
2) Physis separated in axial plane
3) Metaphysis fractured in coronal plane (lateral view)
Triplane fracture represents a SH IV ankle fracture