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 patient's age, the location of the injury (lateral ankle), and the involvement of the growth plate (physis). The fact that initial X-rays were not visible due to the growth plate and the presence of a suspected Salter-Harris I fracture supports this diagnosis.
Other Likely Diagnoses
- Salter-Harris Type II fracture of the distal fibula: Although less likely than Type I, a Type II fracture could also occur in this scenario, especially if there's a fracture line through the metaphysis in addition to the growth plate disruption.
- Ankle sprain (involving ATFL and CFL): Given the symptoms of TTP (tenderness to palpation) lateral, Maioli diffuse < ATFL (anterior talofibular ligament) and CFL (calcaneofibular ligament), an ankle sprain is a plausible diagnosis, especially if the growth plate injury is not significantly displaced.
- Avulsion fracture of the fibula: This could be considered if the mechanism of injury and clinical findings suggest a fracture at the site of ligament attachment.
Do Not Miss Diagnoses
- Open fracture: Although unlikely given the description, an open fracture would be a critical diagnosis not to miss due to the high risk of infection and need for urgent surgical intervention.
- Compartment syndrome: This is a potential complication of any fracture or severe injury and can lead to serious consequences if not promptly diagnosed and treated.
- Neurovascular injury: Damage to nerves or blood vessels could occur with any significant ankle injury and must be assessed for to prevent long-term sequelae.
Rare Diagnoses
- Osteochondritis dissecans of the talus or distal fibula: This condition involves a fragment of cartilage and bone becoming detached, which could potentially occur in the setting of an ankle injury but is less common.
- Growth plate arrest: While not an immediate diagnosis, growth plate arrest is a potential long-term complication of growth plate injuries, which could lead to growth disturbances if not properly managed.
- Infection (e.g., osteomyelitis or septic arthritis): Infection is a rare but serious complication of any injury, especially if there's an open fracture or if the patient has a compromised immune system.