Treating Ankle Fractures In Children, From Diagnosis to Follow-Up
Posted by Jenn F. on Friday, October 4th, 2013
Nothing breaks our hearts more than an injured child. Sadly, we see many children come in with broken ankles. “Athletics are becoming an increasingly regular part of children’s lives,” says NYC Podiatrist Dr. Ryan Minara, “so we are seeing a corresponding increased incidence of injuries, such as ankle fractures.” He adds, “Due to potential damage to open growth plates, it is imperative that a foot and ankle specialist evaluate ankle injuries for the presence of fractures. A sports medicine podiatrist is ideal to evaluate these types of injuries.”
Anatomy of a Broken Ankle
Following rigorous play that includes a twisting force, your child’s broken ankle may have snapped along the tibia, fibula, or talus. Our younger patients usually exhibit a break in the tibia (shinbone) or fibula (the long lower leg bone), rather than the short talus bone in the foot.
We are especially concerned to see fractures at the ends of the tibia and fibula, because these are near the “growth plates,” an area of developing cartilage tissue that affects the overall length and shape of the adult bones. Once full-grown, these plates will become hardened bone, but they are fairly malleable in a young child’s life — and, as a result, susceptible to fracture. In children ages 10-15, the only injuries more common than ankle fractures are wrist and hand fractures.
“With children, the important thing is to educate the parents on the potential risks of affecting the growth plates and the risk of a future limb length difference,” explains Dr. Nadia Levy of The Center for Podiatric Care and Sports Medicine. “It does not always occur, but we will discuss this issue in a delicate and sensitive manner to let parents know what is at stake here.”
Diagnosing Ankle Fractures In Children
An x-ray is necessary to determine whether your child has sprained or fractured the ankle. Both sport injuries cause immediate pain, inflammation, and bruising, so it can be nearly impossible to tell by merely assessing symptoms. However, we can usually be fairly certain it is a fracture if a “snapping” sound was heard and/or the child cannot put any weight on the injured ankle. Open skin wound fractures are also very apparent, although these cases usually go straight to the emergency room.
As with any visit, we’ll discuss your child’s medical history and perform a careful examination to assess swelling, tenderness, bruising, deformity, and skin wounds. The type of treatment we recommend will depend upon the location of the fracture, the degree of damage to the growth plate, the ankle positioning at the time of injury, and the direction of the force at the time of injury.
Types Of Ankle Fractures
The Salter-Harris system describes several types of fractures and treatment options:
– Type I and II: When a bone is cracked at the growth plate, separating the bone end from the shaft (Type I), or when the growth plate and the shaft are both fractured (Type II), the shattered bones will need to be pieced back together in a procedure called a closed reduction, performed under sedation or anesthesia. A cast will keep the bones in place for four to six weeks while they heal. The risk for impaired growth is low.
– Type III: When the fracture crosses through the growth plate and breaks off a piece of bone end, damaging the growth plate, there is a long-term risk that the joint will not heal properly. A closed reduction procedure will align the bones at first. If there is more than 2 mm of displacement, surgery using pins or screws will be recommended.
– Type IV: When a fracture breaks through the shaft, growth plate, and end of bone, we’ll do a closed reduction, followed by a non-weight-bearing, long-leg cast, followed by a short-leg walking cast. Again, if the bones are displaced more than a few millimeters, we’ll need an open reduction with pins or screws.
– Type V: When there is a crushing blow, we have the most growth concerns. Though rare, these fractures may not be diagnosed until deformity has already developed.
“Due to potential damage to open growth plates, it is imperative that a sports medicine podiatrist evaluate ankle injuries over the course of treatment,” says ankle specialist Dr. Ryan Minara. Regular follow-ups for one to two years after the injury will be necessary to ensure that the bones are not growing unevenly or crookedly. The most important thing is that kids take the time to heal properly.
If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. Geldwert, Dr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.