Radiograph-negative ankle injury (peds): Difference between revisions
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*Pediatric ankle injuries are common (>2 million ED visits in North America per year)<ref name="JAMA RN Ankle Editorial">Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.</ref> | *Pediatric ankle injuries are common (>2 million ED visits in North America per year)<ref name="JAMA RN Ankle Editorial">Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.</ref> | ||
*Historically, there has been concern about missing a potential growth plate fracture ([[Salter-Harris]] Type 1), which can rarely result in growth arrest<ref name="JAMA RN Ankle Editorial">Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.</ref> | *Historically, there has been concern about missing a potential growth plate fracture ([[Salter-Harris]] Type 1), which can rarely result in growth arrest<ref name="JAMA RN Ankle Editorial">Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.</ref> | ||
**It was previously taught that the weaker physis would fail before the stronger ligamentous complex.<ref>Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012; 94(13):1234-1244.</ref> | |||
**This was commonly treated with immobilization (casting), follow-up imaging, and orthopedic referral (as opposed to adult [[ankle sprain]]) | **This was commonly treated with immobilization (casting), follow-up imaging, and orthopedic referral (as opposed to adult [[ankle sprain]]) | ||
*Recent studies have questioned the need for this practice<ref="Injury MRI Ankle">6. Boutis K, Narayanan UG, Dong FF, et al. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. Injury. 2010;41(8):852-856.</ref><ref="JAMA RN Ankle Study">Boutis K, Plint A, Stimec J, et al. Radiograph-negative lateral ankle injuries in children: occult growth plate fracture or sprain? JAMA Pediatr. 2016; 170(1):e154114-e154114.</ref> | *Recent studies have questioned the need for this practice<ref name="Injury MRI Ankle">6. Boutis K, Narayanan UG, Dong FF, et al. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. Injury. 2010;41(8):852-856.</ref><ref name="JAMA RN Ankle Study">Boutis K, Plint A, Stimec J, et al. Radiograph-negative lateral ankle injuries in children: occult growth plate fracture or sprain? JAMA Pediatr. 2016; 170(1):e154114-e154114.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 17:04, 17 February 2017
Background
- Pediatric ankle injuries are common (>2 million ED visits in North America per year)[1]
- Historically, there has been concern about missing a potential growth plate fracture (Salter-Harris Type 1), which can rarely result in growth arrest[1]
- It was previously taught that the weaker physis would fail before the stronger ligamentous complex.[2]
- This was commonly treated with immobilization (casting), follow-up imaging, and orthopedic referral (as opposed to adult ankle sprain)
- Recent studies have questioned the need for this practice[3][4]
Clinical Features
- Lateral ankle pain after inversion injury
Differential Diagnosis
- Ankle fracture
- Salter-Harris fracture
- Ligimentous injury
- Contusion of bone or soft tissue
Evaluation
- Consider ankle x-rays
Management
Disposition
- Outpatient
See Also
- Salter-Harris fractures
- [[Ankle diagnoses]
- Ankle fracture
External Links
References
- ↑ 1.0 1.1 Gill PJ, Klassen T. Revisiting radiograph-negative ankle injuries in children: is it a fracture or a sprain? JAMA Pediatr. 2016; 170(1):e154147-e154147.
- ↑ Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012; 94(13):1234-1244.
- ↑ 6. Boutis K, Narayanan UG, Dong FF, et al. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. Injury. 2010;41(8):852-856.
- ↑ Boutis K, Plint A, Stimec J, et al. Radiograph-negative lateral ankle injuries in children: occult growth plate fracture or sprain? JAMA Pediatr. 2016; 170(1):e154114-e154114.