Differential Diagnosis for 14 yo Male with Right Lateral Ankle Injury
Single Most Likely Diagnosis
- Salter-Harris Type I Fracture of the Distal Fibula: This is the most likely diagnosis given the concern for a Salter-Harris I fracture of the distal fibula physis, which is a common injury in adolescents. The mechanism of injury and the location of the pain and tenderness are consistent with this diagnosis.
Other Likely Diagnoses
- Ankle Sprain: The patient's symptoms, including diffuse tenderness around the lateral malleoli and involvement of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), are also consistent with an ankle sprain. This is a common injury in individuals who participate in sports or activities that involve running or jumping.
- Distal Fibula Fracture (non-Salter-Harris): A fracture of the distal fibula that does not involve the growth plate could also be considered, especially if the patient has a higher degree of tenderness and swelling over the distal fibula.
Do Not Miss Diagnoses
- Osteomyelitis or Septic Arthritis: Although less likely, it is crucial to consider infections such as osteomyelitis or septic arthritis, especially if the patient presents with signs of infection (e.g., fever, increased redness, warmth, or swelling) or has a history of recent infection. These conditions require prompt diagnosis and treatment to prevent long-term damage.
- Compartment Syndrome: This is a serious condition that can occur after an injury, characterized by increased pressure within a muscle compartment, leading to nerve and muscle damage. It is essential to monitor for signs of compartment syndrome, such as severe pain, pallor, paresthesia, poikilothermia, and paralysis.
Rare Diagnoses
- Growth Plate Injury with Potential for Growth Arrest: While Salter-Harris fractures are well-known, the potential for growth arrest following a growth plate injury is a rare but significant complication. This could lead to leg length discrepancies or other growth abnormalities.
- Osteochondritis Dissecans: This condition involves a fragment of cartilage and bone becoming detached from the surrounding bone, typically due to repetitive stress or trauma. It is less common in the ankle compared to other joints like the knee but should be considered in the differential diagnosis of ankle pain in adolescents.