Differential Diagnosis for 14-year-old Male with Lateral Ankle Injury
- Single most likely diagnosis
- Salter-Harris Type I fracture of the distal fibula: This is the most likely diagnosis given the clinical presentation of a lateral ankle injury in a pediatric patient with suspected involvement of the growth plate (physis) and initial X-rays not showing the growth plate clearly. The mechanism of injury and age of the patient align with this type of fracture.
- Other Likely diagnoses
- Ankle sprain (involving ATFL and CFL): The patient's symptoms of lateral ankle pain and instability could also suggest a severe ankle sprain, especially with the mention of TTP (tenderness to palpation) lateral and involvement of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
- Salter-Harris Type II or III fracture: Although less likely than Type I due to the specifics of the growth plate involvement, other types of Salter-Harris fractures could be considered, especially if there are any signs of fracture line or growth plate disruption visible on further imaging.
- Do Not Miss diagnoses
- Osteomyelitis or septic arthritis: Although less common, infections such as osteomyelitis or septic arthritis can present with similar symptoms of pain, swelling, and tenderness, especially in the absence of clear radiographic evidence of a fracture. Missing these diagnoses could lead to severe consequences.
- Pathological fracture: A fracture through a pre-existing bone lesion (e.g., cyst, tumor) could present similarly and would require prompt identification and treatment.
- Rare diagnoses
- Triplane fracture: This is a rare type of fracture that occurs in adolescents, involving the distal tibia and potentially the fibula, with components in the sagittal, coronal, and transverse planes. It's less likely but could be considered if initial X-rays are not conclusive and clinical suspicion remains high for a complex fracture.
- Stress fracture: While more common in older athletes, stress fractures could occur in younger individuals, especially those engaged in repetitive stress activities. However, the acute presentation and specific location might make this less likely in this scenario.