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Updated: Mar 7 2024

Ankle Fractures - Pediatric

Images
  • Summary
  • Epidemiology
  • Pathophysiology
  • Anatomy
  • Classification
  • Presentation
  • Imaging
  • Treatment
  • Techniques
  • Complications
    • Ankle pain and degeneration
      • high rate associated with articular step-off > 2mm
    • Growth arrest
      • medial malleolus SH IV fractures have the highest rate of growth disturbance
      • risk factors
        • degree of initial displacement
          • 15% increased risk of physeal injury for every 1mm of displacement
        • residual physeal displacement > 3mm
          • can represent periosteum entrapped in the fracture site
        • high-energy injury mechanism
        • SH III and IV fractures
      • types
        • partial arrests can lead to angular deformity
          • distal fibular arrest results in ankle valgus defomity
          • medial distal tibia arrest results in varus deformity
        • complete arrests can result in leg-length discrepancy
      • treatment
        • angular deformity
          • physeal bar resection
            • if < 20 degrees of angulation with < 50% physeal involvement and > 2 years of growth remaining
          • osteotomy
          • ipsilateral fibular epiphysiodesis
            • bar of >50% physeal involvement in a patient with at least 2 years of growth
            • fibular epiphysiodesis helps prevent varus deformity
        • leg-length discrepancy
          • physeal bar resection
            • if < 50% physeal involvement and > 2 years of growth remaining
          • contralateral epiphysiodesis if near skeletal maturity with significant expected leg-length discrepancy
    • Extensor retinacular syndrome
      • typically seen in posteriorly displaced fractures
    • Malunion
      • rotational deformity
        • can occur after triplane fractures, SH I or II fractures
        • usually leads to an increased external foot rotation angle
        • treatment is derotational osteotomy
      • anterior angulation or plantarflexion deformity
        • occurs after supination-plantarflexion SH II fractures
      • valgus deformity
        • occurs after external rotation SH II fractures
    • Reflex sympathetic dystrophy
      • more common in girls
      • treatment options include physical therapy, psychological counseling, drug therapy, sympathetic blockade
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Question
1 of 10
In scope icon N/A
QID 219538 (Type "219538" in App Search)
A patient presents with a mass in their anterior thigh that is biopsied and diagnosed as an undifferentiated pleomorphic sarcoma (UPS). The patient undergoes neoadjuvant radiation followed by tumor resection. Pathologic analysis demonstrates the closest margin identified in Figure A, denoted by the red line. Which of the following appropriately describes the type of resection performed?
  • A

Intralesional

14%

79/562

Marginal (through the pseudocapsule)

13%

73/562

Marginal (through the reactive zone)

17%

98/562

Wide

54%

303/562

Radical

1%

6/562

  • A

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Pediatrics⎪Ankle Fractures - Pediatric
  • Pediatrics
  • - Ankle Fractures - Pediatric
29:54 min
3/12/2020
1136 plays
4.0
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