According to pediatric physician, Dr. Greene, ankle fractures in children may initially be mistaken sprains due to their similarities. With similar mechanisms for injury, a child's ankle injury has a higher incidence of fractures than an adult. Children still have open growth plates allowing for greater instability and weakness, which leads to a higher percentage of fractures. Children who fracture on or near growth plates may be at a higher risk of complications than those with avulsion fractures. Even when surgical repair is necessary, healing occurs quickly in most children.
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Long Bone Fractures
Fractures are breaks or cracks in a bone. They are often caused by trauma but can also be caused by overuse. Greenstick fractures in the ankle may occur on the tibia and fibula. Greenstick fracture occur on long bones and are identified by the bending and cracking of only one side of the long bone. Fractures may also occur when a long bone twists but does not break its outer layer, this is known as a buckle fracture. Avulsion fractures are a relatively common ankle injury in children. An avulsion occurs when the ligament detaches from the bone and removes a small piece of bone with it. Avulsion fractures may occur on the malleloi. Displaced fracture can be very serious and occur when the broken bone moves out of place.
Growth Plate Fractures
Growth plate fractures are categorized as type I to V by their increasing severity. Growth plate fractures may also be referred to as Salter fractures. According to Dr. Cliff Wheeless, the most common pediatric growth plate fracture is a type II tibial fracture. Separations at the growth plate are considered a lower to medium risk of complications while epiphyseal plate fractures have the highest risk of complication and may involve full disruption of the growth plate.
According to the American Academy of Orthopedic Surgeons, signs and symptoms of ankle fractures include swelling, bruising, pain, tenderness, and the inability to weight bear. Displaced fractures may also have obvious deformities.
Looking Beneath the Surface
Children with suspected fractures should be seen immediately by their pediatrician or orthopedic physician. A physician exam will be given to determine if an x-ray is necessary. If a fracture is suspected X-rays of the foot, ankle and leg may be taken. A stress text X-ray may be prescribed to confirm the need for surgery. Serious injuries may also require a CT scan. If X-rays are negative, the doctor may also prescribe an MRI to look for soft tissue damage.
Correcting the Problem
Non-operative treatment is sufficient for many fractures and includes closed reductions and immobilization. More serious injuries will require operations and may be used for open reductions or tendon reattachment. Growth plate fractures type I or II can be treated by closed reduction and immobilization. Immobilization is done by casting or splinting. Operative treatment may be necessary for growth plate fractures type III, IV, V or those that are grossly displaced.
A study done by Vahvanen and Aalto, published by Orthopaedic & Traumatic Surgery analyzed 310 children ages 2 to 14 years. Vahvanen and Aalto concluded that 71 percent of fractures occurred on the malleloi, while only 22.9 percent occurred on the growth plate. Any fracture in children may lead to leg length discrepancies or permanent deformities. According to Dr. Clifford Wheeless, leg length complications occur in an estimated 10 to 30 percent of diagnosed fractures. Because children have a higher risk of fracture, it is important to take action quickly when one is suspected.