Ankle Case #5

History and Physical13YOM presents with

the complaint of ankle pain. The patient was hiking with friends and family when his foot got caught and he “twisted” his ankle. He has been unable to bear weight and is complaining of marked swelling.

T 98.7 P 98 BP 126/84 O2 99%

Gen: WDWN, obvious pain

CV: RRR, no m/r/gPulm: Lungs CTA bilatMusc: Limited active and

passive ROM R ankle; marked swelling and TTP of anterior R ankle; no TTP over medial and lateral malleolus

Images

Diagnosis: Tillaux Fracture

Red arrow: Salter Harris III fracture involving avulsion of anterolateral tibial epiphysis

Pain controlOrthopedic Consultation for possible ORIF

Displacement of >2mm requires ORIFStabilization/Closed Reduction

Internal rotation of ankle and supination of the foot with pressure on fracture fragment

Stabilization in long leg cast or stirrup splint with posterior slab

Prompt orthopedic follow-up

ED Management

Fracture occurs in adolescents w/ relatively mature growth plates; therefore, there is minimal potential for deformity due to growth plate injury

Needs to be differentiated from a triplane fracture, which is a salter harris IV fracture that extends through the epiphysis, physis, and metaphysis

Pearls

Additional Images

http://www.radpod.org/2007/07/20/tillaux-fracture/

http://radiologyschools.com/Radiology-Courses/ext/8ankle/33.html

http://www.wheelessonline.com/ortho/tillaux_fracture

http://www.joint-pain-expert.net/tillaux-fracture.html

Pediatric Emergency Medicine. Chapter 38 Injuries of the Pelvis and Lower Extremities

References