From the Guidelines
The diagnosis for this 14-year-old male with a suspected Salter-Harris type 1 fracture of the distal fibular physis, tenderness to palpation on the lateral aspect of the ankle, and involvement of the ATFL and CFL, should be confirmed with radiography, specifically three standard views: anteroposterior, lateral, and mortise views, as recommended by the American College of Radiology 1. The patient's symptoms, including tenderness to palpation on the lateral aspect of the ankle and involvement of the ATFL and CFL, are consistent with a Salter-Harris type 1 fracture, which is a growth plate injury where the fracture line passes through the growth plate without extending into the bone. Some key points to consider in the diagnosis and treatment of this patient include:
- The Ottawa Ankle Rules (OAR) criteria should be used to determine the need for radiography, as they have been validated in children over 5 years of age and have a high sensitivity for detecting ankle fractures 1.
- Weight-bearing radiographs, if possible, can provide important information about the stability of the fracture, particularly in cases where the stability is uncertain 1.
- Special views, such as the anterior talofibular ligament view radiograph, may be useful in diagnosing distal fibular avulsion fractures in children with lateral ankle sprain 1.
- Ultrasound may be useful in some cases, but it is not typically considered the first line of imaging for acute trauma to the ankle with positive OAR criteria 1. The treatment for a Salter-Harris type 1 fracture typically involves immobilization with a cast or walking boot for 3-4 weeks, followed by gradual return to activities, with weight-bearing status depending on pain tolerance, and physical therapy may be recommended after immobilization to restore strength and range of motion.
From the Research
Diagnosis of Salter-Harris Type 1 Fracture
- The diagnosis for a 14-year-old male with a right lateral ankle injury, suspected of having a Salter-Harris type 1 fracture of the distal fibular physis, involves tenderness to palpation (TTP) on the lateral aspect of the ankle and involvement of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) 2, 3.
- The patient's symptoms, such as tenderness to palpation on the lateral aspect of the ankle, are consistent with a Salter-Harris type 1 fracture of the distal fibular physis 3.
- Involvement of the ATFL and CFL may indicate a more complex injury, and further evaluation is necessary to determine the extent of the injury 2.
Treatment Options
- Treatment for Salter-Harris type 1 fractures typically involves immobilization, such as casting or bracing, to allow for proper healing 4, 2.
- In some cases, surgical intervention may be necessary to rectify the position of the radial joint surface or to address complications such as malunions or osteomyelitis 4, 5.
- The choice of treatment depends on the severity of the injury, the patient's age, and the presence of any complications 2, 3.
Complications and Prognosis
- Complications from Salter-Harris type 1 fractures can include malunions, growth arrest, and osteonecrosis 4, 5.
- Rare complications, such as distal fibular growth arrest, infection, nonunion, late fracture displacement, and recurrent fracture, can also occur 2.
- Prompt diagnosis and treatment are essential to minimize the risk of complications and ensure proper healing 2, 3.