Ankle Fractures In Children - Everything You Need To Know - Dr. Nabil Ebraheim
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2 سال پیش
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Dr. Ebraheim’s educational animated video
Dr. Ebraheim’s educational animated video describes ankle fractures in children.
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The incidence of growth arrest following physeal ankle injury can be up to 50%. This is the Salter - Harris Classification of ankle fractures. Type I & Type II Salter - Harris injuries of the distal tibia are usually treated with closed reduction and casting. If you operate on them, this does not decrease the incidence of growth arrest. Type III & Type IV Salter - Harris injuries involve the joint and you will do reduction and fixation of the fracture. You will do epiphyseal screw fixation parallel to the physis or you put metaphyseal screw if you have a large metaphyseal piece in Type IV. When you do the fixation, avoid violating the joint or the growth plate. The highest rate of growth arrest in pediatric ankle fractures will result from medial malleolar Type IV fracture and when growth arrest happens, it may result in varus deformity of the ankle. If you have a fracture of the ankle and there is an anterior widening of the tibial physis, what causes this widening is the interposition of the periosteum.
Two important fractures in the ankle:
Tillaux Fracture
Occurs due to anterior inferior tibiofibular ligament avulsion. If the fracture is minimally displaced as seen not only in the x-rays but in CT scans, you will do cast immobilization. If the fracture involves more than 2 mm of articular displacement, they are treated with open or closed reduction and fixation. So the question may come, what is the ligament that is attached to the fragment and causes the displacement?
Anterior inferior tibiofibular ligament
Why does the Tillaux fracture occur like this? Why is that small piece avulsed? It occurs because the lateral half of the distal tibia physis remains open. When you have an external rotational force, the anterior inferior tibiofibular ligament holds the lateral part of the tibia that is open. The epiphysis will separate that part at the junction of the middle closed physis and the lateral open physis. The Tillaux fracture commonly occurs in the 18 months before complete distal tibial physeal closure. This injury occurs with supination / eversion mechanism.
Triplane Fracture
The presentation in the AP view x-ray is that there will be Type III Salter – Harris fracture with the fracture line extending into the ankle joint. In the lateral view, you find a Type II fracture with a posterior metaphyseal piece. The triplane component fracture is a complex physeal injury that crosses the distal tibia physis in three different planes. When you look at the Triplane fracture and the Tillaux fracture of the tibial growth plate, there is an explanation for them that the tibial growth plate fuses over 18 months, first in the central region, The Triplane fracture and the Tillaux fracture occurs during this period and the general treatment is restoration of the articular congruity to decrease the incidence of post-traumatic arthritis.then posteriorly, then medially, and the lateral part closes last.
Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC
Find me on Instagram @OrthoInitiative
The incidence of growth arrest following physeal ankle injury can be up to 50%. This is the Salter - Harris Classification of ankle fractures. Type I & Type II Salter - Harris injuries of the distal tibia are usually treated with closed reduction and casting. If you operate on them, this does not decrease the incidence of growth arrest. Type III & Type IV Salter - Harris injuries involve the joint and you will do reduction and fixation of the fracture. You will do epiphyseal screw fixation parallel to the physis or you put metaphyseal screw if you have a large metaphyseal piece in Type IV. When you do the fixation, avoid violating the joint or the growth plate. The highest rate of growth arrest in pediatric ankle fractures will result from medial malleolar Type IV fracture and when growth arrest happens, it may result in varus deformity of the ankle. If you have a fracture of the ankle and there is an anterior widening of the tibial physis, what causes this widening is the interposition of the periosteum.
Two important fractures in the ankle:
Tillaux Fracture
Occurs due to anterior inferior tibiofibular ligament avulsion. If the fracture is minimally displaced as seen not only in the x-rays but in CT scans, you will do cast immobilization. If the fracture involves more than 2 mm of articular displacement, they are treated with open or closed reduction and fixation. So the question may come, what is the ligament that is attached to the fragment and causes the displacement?
Anterior inferior tibiofibular ligament
Why does the Tillaux fracture occur like this? Why is that small piece avulsed? It occurs because the lateral half of the distal tibia physis remains open. When you have an external rotational force, the anterior inferior tibiofibular ligament holds the lateral part of the tibia that is open. The epiphysis will separate that part at the junction of the middle closed physis and the lateral open physis. The Tillaux fracture commonly occurs in the 18 months before complete distal tibial physeal closure. This injury occurs with supination / eversion mechanism.
Triplane Fracture
The presentation in the AP view x-ray is that there will be Type III Salter – Harris fracture with the fracture line extending into the ankle joint. In the lateral view, you find a Type II fracture with a posterior metaphyseal piece. The triplane component fracture is a complex physeal injury that crosses the distal tibia physis in three different planes. When you look at the Triplane fracture and the Tillaux fracture of the tibial growth plate, there is an explanation for them that the tibial growth plate fuses over 18 months, first in the central region, The Triplane fracture and the Tillaux fracture occurs during this period and the general treatment is restoration of the articular congruity to decrease the incidence of post-traumatic arthritis.then posteriorly, then medially, and the lateral part closes last.
2 سال پیش
در تاریخ 1401/01/29 منتشر شده
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