| Introduction |
 Pediatric ankle fractures can be described anatomically or by the mechanism of injury- Epidemiology
- most common in ages 11-13 years
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| Classification |
- Anatomic classification
- SH I and II fractures
- SH III
- tillaux fractures
- medial malleolus fractures
- SH IV
- triplane fractures
- medial malleolus shear fractures
- Diaz and Tachdjian classification
 (patterned off adult Lauge-Hansen classification)
- supination-inversion
- supination-plantar flexion
- supination-external rotation
- pronation/eversion-external rotation
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| Presentation |
- Symptoms
- ankle pain, inability to bear weight
- Physical exam
- swelling, focal tenderness
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| Imaging |
- Radiographs
- obtain AP, oblique, and lateral views to delineate fracture pattern
- CT scan
- useful to assess joint space involvement or articular congruency post reduction
- >2mm of joint displacement indication for reduction and fixation
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| Treatment |
- Nonoperative
- Operative
- CRPP vs ORIF
- indications
- >2mm displacement
- intra-articular fractures
- irreducible reduction by closed means
- may have interposed periosteum, tendons, neurovascular structures
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| Techniques |
- CRPP vs ORIF
- reduction
- percutaneous manipulation with k-wires may aid reduction
- fixation
- transepiphyseal fixation best if at all possible
- cannulated screws parallel to physis
- tillaux and triplane fractures
- 2 parallel epiphyseal screws
- medial malleolus shear fractures
- transphyseal fixation
- smooth wire fixation typically used
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| Complications |
- Ankle pain and degeneration
- Growth arrest
- medial malleolus SH IV have highest rate of growth disturbance of any fracture
- Extensor retinacular syndrome
- displaced fracture leads to compartment syndrome of EHL and deep peroneal nerve
- LLD
- Rotational deformity
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