From the Guidelines
The patient should be treated with immobilization and functional support, as surgical treatment is generally reserved for patients with chronic instability or those who have not responded to comprehensive exercise-based physiotherapy programs 1. The diagnosis of a Salter-Harris type 1 fracture of the dorsal, fibular growth plate physis, with a positive Talar Tilt Test (TTP) laterally, and injuries to the Anterior Talofibular Ligament (ATFL) and Calcaneofibular Ligament (CFL) requires careful consideration of the treatment approach. Key considerations in the treatment of this condition include:
- Immobilization with a walking boot or short leg cast for 3-4 weeks to allow for proper healing of the growth plate fracture
- Non-weight bearing or partial weight bearing as tolerated for the first 1-2 weeks, followed by gradual return to weight bearing
- Pain management with acetaminophen (650mg every 6 hours as needed) or ibuprofen (400mg every 6-8 hours with food)
- Physical therapy focusing on range of motion, strengthening, and proprioception exercises for 4-6 weeks after immobilization
- Follow-up imaging at 3-4 weeks to confirm proper healing before advancing activity The ligamentous involvement (ATFL and CFL) suggests an associated ankle sprain component that will benefit from the rehabilitation phase, and functional treatment is preferred over immobilization for ankle sprains 1. It is also important to note that the OAR criteria can be used to exclude the presence of fractures, and radiographs are indicated in patients who meet these criteria as the initial imaging study 1. Overall, the treatment approach should prioritize functional support and rehabilitation, with surgical treatment reserved for patients who do not respond to conservative management 1.
From the Research
Diagnosis
- The patient has a Salter-Harris type 1 fracture of the dorsal, fibular growth plate physis, which is a fracture that occurs at the growth plate of the bone 2, 3, 4.
- The patient also has a positive Talar Tilt Test (TTP) laterally, which indicates instability of the ankle joint.
- Injuries to the Anterior Talofibular Ligament (ATFL) and Calcaneofibular Ligament (CFL) are also present, which are common in ankle injuries 5.
Treatment
- For Salter-Harris type 1 fractures, treatment typically involves orthopedic reduction and immobilization in a plaster device 2.
- In some cases, surgical intervention may be necessary to rectify the position of the joint surface, especially if there are malunions or growth disturbances 2, 3.
- For ATFL injuries, non-surgical treatment is often the first choice, involving the "peace and love" principle, followed by personalized rehabilitation training programs 5.
- If non-surgical treatment is not effective, surgical treatment such as arthroscopic anatomical repair or anatomical reconstruction surgery may be considered 5.
- The treatment plan should be tailored to the specific injury scenario, and a combination of multiple therapies may be necessary to achieve the best results 5.
Rehabilitation
- After initial treatment, rehabilitation training programs can be started to restore limb coordination and muscle strength 5.
- Proprioception training, muscle training, and functional exercise can help restore range of motion and prevent joint stiffness 5.
- Static stretching and other techniques to loosen joints, acupuncture, moxibustion massage, and other traditional medical treatments can relieve pain and restore range of motion 5.