Paediatric Ankle Fractures
Ankle fractures in children aged 15 or younger are very different from ankle fractures seen in adults. This is due to:
- The presence of soft areas called 'growth plates' (or epiphyses). These are found at the end of long bones like the tibia (shin bone) and are crucial for increased length in the bone.
- Growth plates 'close' or solidify into hard bone around the age of 15 for girls and 17-18 for boys. The closure of growth plates is responsible for the height of your child.
- For more information, see growth plate fractures.
- Ligaments around the joints tend to be stronger than the soft bone, so that fractures are more likely than ankle sprains.
Ankle fractures in children tend to be classified according to their relation to the growth plate. Interruption to the growth plate can lead to deformity or decreased growth in the affected bone, so classifying fractures by interruption to growth plate is useful in predicting the long term impacts of the fractures.
Salter Harris types 1 and 2, the most common forms of paediatric ankle fracture, tend to be associated with little growth plate interruption, while types 3, 4 and 5 have higher risks of growth complications.
Special Ankle Fractures in Children
- Tillaux fracture - this occurs in older children where the growth plate has partially closed. When the ankle and foot are twisted with enough force a small section of bone is pulled away by ligaments between the bones (the talofibular ligaments). If the bone fragment remains in place (undisplaced), this fracture can be treated with a plaster cast. Surgery is required when the bone fragment needs to be pushed back into contact with the tibia (shin bone).
- Triplane fracture - these occur when the fracture line spreads into two or more directions. These are serious fractures that often need surgery.