111.50 ) are most likely to be an ankle sprain or bone contusion, as opposed to a Salter-Harris type I fractures Of the three lateral ankle ligaments, the anterior talofibular ligament is most commonly injured and will demonstrate tenderness with palpation just anterior to the distal fibula Ankle sprains can be graded on three levels: (1) Grade injuries have stretching of the ligaments; (2) grade injuries include partial ligamentous tears without loss of stability; and (3) grade injuries are complete tears of the ligamentous complex with loss of stability Grade mild sprains may be treated with an air splint or elastic wrap along with ice and elevation for 72 hours Crutches with partial weight bearing may be used until the patient can walk without limping Grade and injuries can be immobilized either in a walking cast/boot or posterior splint for up to weeks with crutches for ambulation FIGURE 111.50 Radiograph of the left ankle of a 10-year-old boy notable only for soft tissue swelling localized to the distal fibula (arrows ) DISTAL TIBIAL AND FIBULAR FRACTURES These fractures are typically classified by anatomic classification schemes, with the Salter–Harris system being used most widely Orthopedic management depends on the child’s age, fracture type, amount of displacement, and ability to restore the ankle joint Nondisplaced