Pediatric emergency medicine trisk 0794 0794

CHAPTER 40 ■ INJURY: ANKLE FRANCES TURCOTTE BENEDICT, ANGELA C ANDERSON INTRODUCTION Approximately 26% of sports-related injuries in school-aged children involve the ankle It is often difficult for children to localize pain, therefore young children with ankle injuries may complain of pain anywhere from their mid-calf to their toes Conversely, pathology in the lower leg and foot can cause referred pain to the ankle The ankle joint is composed of three bones: the tibia, the fibula, and the talus The bony prominence of the distal fibula constitutes the lateral malleolus, whereas the prominence of the distal tibia forms the medial malleolus The physes are located to fingerbreadths above the distal ends of the tibia and the fibula The ankle ligaments are attached to the epiphyses The distal fibular physis is the most commonly injured growth plate in the lower extremities It is second only to the distal radius in the incidence of physeal injuries Growth plates and bones are weaker than ligaments Consequently, ankle trauma in preadolescent children is more likely to cause fractures of the physis and the adjacent epiphysis and/or metaphysis than ligamentous injuries or sprains, although recent MRI-based studies have had conflicting findings DIFFERENTIAL DIAGNOSIS A number of traumatic injuries may cause ankle pain (Table 40.1 ) Although trauma is the most common cause of ankle pain in children, infectious, rheumatologic, inflammatory, neoplastic, and hematologic abnormalities also should be considered (Table 40.2 ) because in some cases trauma may merely exacerbate pain in children with underlying conditions Again, keep in mind that a complaint of ankle pain may result from a lesion anywhere between the knee and the toe, particularly in preverbal children The most common injuries vary according to age (Table 40.3 ) ANKLE FRACTURES Ankle fractures are among the most common injuries of the lower extremity in children Fractures of the ankle account for up to 40% of all injuries in skeletally immature athletes The system used to classify ankle fractures in children differs from the one used in adults because of the presence of growth plates and the