Differential Diagnosis for 14-year-old Male with Right Lateral Ankle Injury
- Single most likely diagnosis
- Salter-Harris Type I fracture of the distal fibular physis: This is the most likely diagnosis given the patient's age, the location of the injury (right lateral ankle), and the specific concern mentioned (Salter-Harris 1 of distal fibular physis). The mechanism of injury and the patient's symptoms align with this type of fracture, which involves a slip of the epiphyseal plate.
- Other Likely diagnoses
- Ankle sprain (involving the ATFL and CFL): The patient's symptoms and the mention of TTP (tenderness to palpation) lateral and involvement of the ATFL (anterior talofibular ligament) and CFL (calcaneofibular ligament) suggest a significant ligamentous injury, which is common in lateral ankle injuries.
- Distal fibular physeal fracture (other types, e.g., Salter-Harris II, III): While a Salter-Harris Type I fracture is specifically mentioned, other types of physeal fractures could also be considered, especially if the fracture pattern or displacement does not perfectly fit a Type I description.
- Do Not Miss diagnoses
- Osteomyelitis or septic arthritis: Although less likely given the acute presentation following a trauma, infections can present with similar symptoms and are critical to diagnose early to prevent long-term damage.
- Compartment syndrome: This is a medical emergency that can occur after trauma to the ankle. It requires prompt recognition and treatment to avoid serious complications.
- Neurovascular injury: Damage to nerves or blood vessels can occur with severe ankle injuries and must be identified and addressed promptly.
- Rare diagnoses
- Avascular necrosis of the distal fibula: This could be a rare complication of a distal fibular fracture, especially if there is significant disruption of the blood supply.
- Growth arrest: A potential long-term complication of physeal fractures, where the growth plate is damaged, leading to premature closure and potential limb length discrepancy.
- Osteochondritis dissecans: A condition where a piece of cartilage and a thin layer of the bone beneath it become damaged, potentially due to trauma. It's less common in the ankle compared to other joints like the knee.