fractures may be treated in the ED with a bulky posterior splint, crutches, and referral to an orthopedist as they will need cast immobilization for to weeks ( Fig 111.51 ) Open reduction and internal fixation are often needed for fractures involving both the physis and the ankle joint The articular surface can only accept minimal displacement otherwise altered joint mechanics will develop, which can lead to complications with pain, stiffness, and arthritis Displaced fractures should be referred urgently to the orthopedic surgeon, as they will require reduction under procedural sedation or anesthesia