Sprains and Fractures of the ankle
Ankle sprains are a common sports injury. The usual mechanism is inversion, or “turning your ankle over”. This can result in varying degree of tearing to the stabilizing ligaments on the side of your ankle. Treatment decisions are based on the severity of the injury and follow the basic principles of rest, ice, compression, and elevation (“RICE”). For most sprains, rehabilitation exercises, taping, or a compressive ankle brace are adequate. More severe injuries may require casting or, rarely, surgical reconstruction of the ligaments.
Fractures around the ankle in children will often involve the growth plate. It is important to distinguish an “ankle sprain” from a true fracture of the growth plate. This is not always easy to do. All but the simplest if ankle sprains should have an x-ray to look for a fracture of the growth plate. If the fracture involves either the growth plate or the weight-bearing surface of the ankle, surgery is often required to protect from growth arrest and other problems.
This is an xray of a fractured ankle in a child. On the right side of the picture, the arrows indicate that the fracture has disrupted the growth plate of the distal fibula. On the left side of the picture the arrows indicate where the fracture has displaced the lateral malleolus. This type of fracture needs to be reduced (realigned) and the fixation should not cross the growth plate.
These two xrays demonstrate how a screw has been used to fix the fracture of the distal growth plate of the tibia without crossing or violating the growth plate, which will decrease the chance of a growth arrest occurring.
After healing, the screw is removed and the ankle has resumed its normal growth. The arrows indicate the presence of a Harris Growth Arrest Line, which is an xray finding that indicates that the bone stopped growing for a period of time, which is usually due to the trauma. The fact that the growth arrest line is parallel to the growth plate indicates that the growth of the distal tibia has resumed normally.