Management of ankle fractures in children

Magnetic Resonance Imaging Has Utility in Clinical Decision-Making for Children and Adolescents With Symptomatic Subfibular Ossicles

Treatment of children with chronic ankle pain, lateral instability, and the presence of a subfibular ossicle (SO) can be challenging. When will these patients respond to nonoperative management, and when will they require surgery? The purpose of this study was to investigate the utility of magnetic resonance imaging (MRI) in clinical decision-making for patients with symptomatic SOs.

METHODS

We performed a retrospective study of pediatric patients with lateral ankle pain, recurrent sprains, and radiographs showing SOs who had undergone an MRI as part of their diagnostic work-up. We identified 22 patients from the senior author's registry of pediatric patients with lateral ankle injuries. Eleven were girls, and 11 were boys, ages ranging from five to 19 years. Eleven involved the left ankle; 11 involved the right. Positive MRIs showed a high-intensity signal between the SO and the distal fibular epiphysis; negative MRIs had a low-intensity signal. The main outcome measure was operative versus non-operative treatment.

RESULTS

 Sixteen of the 22 patients had positive MRIs, and six had negative MRIs. Twelve of the 16 patients with positive MRIs had undergone an operation. All six patients with negative MRIs responded to nonoperative management.

CONCLUSIONS

MRI has utility in clinical decision-making for symptomatic patients with SOs. Patients with negative MRI sequences responded to nonoperative management. Most patients with positive MRI sequences will require surgery to alleviate their symptoms and return to full activities.

LEVEL OF EVIDENCE

IV.

Pediatric Ankle Fractures: Successful Remodeling and Restoration Through Comprehensive Diagnosis and Conservative Management in a Diverse Context

Diagnosing toddler ankle fractures, especially those that affect several bones, can be difficult. The infrequency of such complex injuries, particularly in household environments, emphasizes the importance of increased awareness in diagnosing and managing these types of injuries. We present a compelling case study of a 20-month-old toddler of a low socioeconomic background who sustained fractures in the ankle, calcaneus, tibia, and fibula after being trapped under furniture. The diagnostic process involved trauma guidelines, radiographic assessments, and axial CT scans. Conservative management, including an eight-week plaster cast, was chosen based on the careful consideration of the child's age, the nature of the fracture, and the absence of immediate surgical indications. The follow-up period involved radiographic assessments, as well as repeated regular clinical examinations, revealing consistent alignment and the absence of complications. The successful outcome underscores the importance of a comprehensive diagnostic approach, thoughtful treatment planning, and meticulous follow-up. Individualized care, considering both clinical and socioeconomic factors, proved crucial for optimal outcomes in pediatric orthopedics. The case contributes valuable insights into the evolving landscape of early childhood orthopedics, emphasizing the need for a discerning approach to diagnosing and managing complex fractures in this population. Conservative treatment could significantly assist when absolute surgical indications are lacking both in cases of minimal resources where multiple operations are not plausible and when the patient's social history raises awareness.

Analysis of Clinical Outcomes in Pediatric Distal Tibia Triplanar Fractures Treated Surgically and Conservatively

Purpose

We aimed to analyze the clinical and functional outcomes of patients who underwent surgery or received conservative treatment to look into the impact of treatment methods on clinical outcomes.

Methods

A retrospective study was performed on 25 patients with a minimum one-year follow-up. Patients were divided into two groups based on joint and physis displacement measured on preop CT images. Patients with a displacement of > 2 mm underwent surgery, while those with a displacement of < 2 mm received conservative treatment. The clinical results were assessed using the Ankle-Hindfoot Scale developed by the American Orthopedic Foot and Ankle Society (AOFAS) and the Modified Weber Protocol (MWP).

Results

The sample consisted of 14 patients who underwent surgery and 11 patients who received conservative treatment. The surgical group had a mean follow-up of 36.79±14.43 months, while the conservative group had a mean follow-up of 31.82±13.55 months. The surgical and conservative groups had a postop 1st-year AOFAS score of 96.64±3.54 and 93.64 ± 4.69, respectively. The difference was statistically insignificant (p > 0.05), but the surgical group had higher scores numerically. The surgical and conservative groups had a postop 6th-month AOFAS score of 84.64±1.64 and 80.82±2.85, respectively. The difference was statistically significant (p < 0.05).

Conclusion

The results of both surgical treatment and conservative treatment are satisfactory. Especially, surgical treatment should not be avoided in patients requiring surgery with a displacement of more than 2 mm and surgeons may consider surgery for better clinical outcomes and earlier rehabilitation in the treatment of triplane fractures.