Radiograph-negative ankle injury (peds): Difference between revisions
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**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 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> | *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> | ||
**There was no measurable difference in functional recovery for children with or without [[Salter Harris]] Type 1 distal fibula fractures at 1 and 3 months<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== | ||
*Lateral ankle pain after inversion injury in a pediatric patient | *Lateral ankle pain (tenderness and/or swelling) after inversion injury in a pediatric patient | ||
**Studies to date have not addressed medial ankle pain | **Studies to date have not addressed medial ankle pain | ||
| Line 24: | Line 25: | ||
==Management== | ==Management== | ||
*Removable ankle brace | |||
*Return to activities as tolerated by pain | |||
===Patients do NOT need=== | |||
*Full immobilization (cast or non-removable splint) | |||
*Referral to orthopedics | |||
*Repeat x-ray films (or MRI) | |||
==Disposition== | ==Disposition== | ||
* | *Discharge with PCP follow-up | ||
==See Also== | ==See Also== | ||
*[[Salter-Harris fractures]] | *[[Salter-Harris fractures]] | ||
*[[Ankle diagnoses] | *[[Ankle diagnoses]] | ||
*[[Ankle fracture]] | *[[Ankle fracture]] | ||
*[[Ankle fracture (peds)]] | |||
==External Links== | ==External Links== | ||
| Line 38: | Line 46: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Radiology]] | |||
[[Category:Pediatrics]] | |||
[[Category:Orthopedics]] | |||
Latest revision as of 20:07, 6 October 2019
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]
- There was no measurable difference in functional recovery for children with or without Salter Harris Type 1 distal fibula fractures at 1 and 3 months[4]
Clinical Features
- Lateral ankle pain (tenderness and/or swelling) after inversion injury in a pediatric patient
- Studies to date have not addressed medial ankle pain
Differential Diagnosis
- Ankle fracture
- Salter-Harris fracture
- Ligimentous injury
- Contusion of bone or soft tissue
Evaluation
- Consider ankle x-rays
Ottawa ankle rule
Ankle x-ray needed if:
- Pain near the maleoli AND
- Inability to bear weight immediately and in the ED (4 steps) OR
- Tenderness at posterior edge or tip of lateral malleolus OR
- Tenderness at posterior edge or tip of medial malleolus
Ottawa foot rules
Foot x-ray series needed if:
- Pain in the midfoot AND
- Inability to bear weight both immediately and in the ED (4 steps) OR
- Tenderness at the navicular OR
- Tenderness at the base of the 5th metatarsal
Management
- Removable ankle brace
- Return to activities as tolerated by pain
Patients do NOT need
- Full immobilization (cast or non-removable splint)
- Referral to orthopedics
- Repeat x-ray films (or MRI)
Disposition
- Discharge with PCP follow-up
See Also
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.
- ↑ 4.0 4.1 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.