A Clinical Analysis of the Children's Ankle Fracture

Moon, Myung Sang; Ok, In Young; Ha, Kee Yong; Kim, Yang

Abstract

The distal tibial physeal plate is the second most frequently injured physis and the percentile incidence of its injury is reported to reach 11 percent of all physeal injuries. After physeal injuries, many complications may follow such as angulatory deformity, incongruity of the joint surface, and growth disturbance, which are well recognized. Therefore, for preventing these complications, we have to know mechanism of injury and position of foot in injury. There are several published articles about classification of these injuries. The first traumatological classification of ankle injuries in children is the one proposed by Bishop. Although there were many reports about classification since Bishop, those did not mention the position of foot in injury. Recently a modified classification by Dias and Tachdjian added the postiton of the foot during injury to the direction of the force as Lauge-Hansen did. There were only few reports about epiphyseal and physeal injuries of the ankle in Korea. Also, we could not find the reports which dealt with more than forty cases. The authors have made a clinical analysis on forty cases of childrens ankle fractures, and among them twenty-two could be followed over a year, who were treated at the Department of Orthopaedic Surgery, Kang-Nam St. Marys Hospital, from June 1981 to December 1986. Children were in age of 3 to 16 years. Forty cases were classified according to modified Dias and Tachdjians. 15 out of 40 cases (37.5%) had supination and external rotation injury, which is the most frequent mechanism of injury in this series. However, one case (2.5%) which was suspected to be axial compression type could not be accommodated to this classification. Twenty-seven cases were treated by gentle closed reduction and immobillization in a plaster cast, and thirteen by open reduction and internal fixation. Among the 22 cases who were followed over a year, five cases had complications, such as angulatory deformity, incongruity of the joint surface, and growth disturbance. Three cases out of these five cases had incongruity of the joint surface.