Ankle Trauma Flashcards
What is the most commonly injured growth plate in the lower extremities?
Distal fibular physis
What is ankle trauma most likely to cause in preadolescents?
fractures of the physis and the adjacent epiphysis and/or metaphysis
What fracture do ankle inversion injuries mostly cause in preadolescents?
SH I fracture of distal fibula
How does a salter Harris I fracture of the distal fibula present in preadolescents?
swelling about the lateral malleolus and tenderness at the distal fibular physis
What kind of fracture does ankle eversion usually produce?
combination of an S-H type II fracture of the lateral tibia and a transverse fracture of the fibula
fibular fracture is often relatively high (4 to 7 cm above the fibular physis)
What type of lesion is caused by external rotation of the ankle?
Transitional fractures
What are transitional fractures?
occur during adolescence when closure of the growth plates is beginning. Closure of the distal tibial physis starts centrally and then spreads medially, posteriorly, and finally laterally. The distal tibial physis closes before the distal fibular physis. As skeletal maturity (and physeal closure) progresses, the relative strengths of various parts of the tibia change. As a result, the same mechanism of injury may cause very different fracture patterns, depending on the age of the patient. The juvenile Tillaux fracture and the triplane fractures are examples of transitional fractures.
What is a juvenile tillaux fracture?
fragment of bone is torn off the lateral border of the tibia by the anterior tibiofibular ligament
S-H type III injury of the distal tibia
In what population can a juvenile tillaux fracture be seen?
patients between the ages of 12 and 14 years.
This is because the closure of the medial aspect of the distal tibial physis begins around 12 to 14 years of age, whereas the lateral aspect remains open
What findings may be seen on an X-ray of a juvenile tillaux fracture?
If displacement is minimal, the only radiographic sign may be a slight widening of the lateral tibial physis or a faint vertical fracture line through the epiphysis on anteroposterior (AP) or oblique views
What is a triplanar fracture?
fracture line that runs in three planes: coronal, sagittal, and transverse.
What are the 2 types of triplanar ankle fractures?
- fragment of the epiphysis torn off the anterolateral quadrant of the tibia. The second fragment is the remaining medial part of the epiphysis, which is attached to a posterior spike of the metaphyseal bone. The third fragment is the tibial shaft.
- two-fragment fracture - The first fragment is again the lateral tibial epiphysis, but it is attached to a posterior spike of the metaphyseal bone. The second fragment is the remaining medial epiphysis and is attached to the tibial shaft
What is the key to diagnosis of a triplanar fracture?
appearance of an S-H type III fracture on the AP view and an S-H type II fracture on the lateral view. If only the AP view is obtained, it may be difficult to distinguish these fractures from the juvenile Tillaux fracture. The key to diagnosis is the posterior metaphyseal spike seen on the lateral film.
What are the most commonly injured structures in ankle sprains?
Lateral ligaments
Which lateral ligament is most commonly injured in ankle sprains?
ATFL