Edited by Amy Steele, David Evans - 7/1/2021
Descriptors
Exam Pearls
- Twisting injury or direct trauma
Physeal considerations:
- Distal tibia accounts for 35-40% of overall growth and 15-20% of all lower extremity growth at a rate of 3-4mm/year, tends to reach physeal closure at 14 in girls and 16 in boys which occurs over an 18 month period
- Distal fibular physis closes 1-2 years after the distal tibia
Workup
Radiographs: AP, lateral and mortise ankle Xrays Obtain full length tib/fib Xrays to rule out Maisonneuve injury if concerned
Other imaging: Consider CT scan to assess for intra-articular displacement or for pre-operative planning purposes
Labs: None
Management
Need for acute intervention: Yes, immobilization with reduction. Only attempt CR once to limit physeal trauma
Weight-bearing and range of motion: NWB in immobilization
Type of immobilization: Bivalved long leg cast
Admission or discharge status: Depends on if needs operative intervention
Anticoagulation: None
Antibiotics: None
Surgical Indications
Absolute: Intra-articular displacement >2mm, open injury, malreduction
Relative: Displacement ~2mm and < 2 years growth remaining