ABSTRACT
CONTENTS I. Introduction ...................................................................................................................... 212 II. Ankle Fractures................................................................................................................. 212
A. Anatomy of the Distal Tibia and Fibula Region ....................................................... 212
B. Etiology, Prevalence, Diagnosis, and Natural History of Fractures about the Ankle Region............................................................................................................. 213
C. Classification Systems ................................................................................................ 214
D. Treatments................................................................................................................. 215
1. Distal Tibia Metaphyseal Fractures .................................................................... 215
2. Salter-Harris Type I Fractures............................................................................ 215
3. Salter-Harris Type II Fractures .......................................................................... 215
4. Salter-Harris Type III and IV Fractures............................................................. 222
5. Salter-Harris Type V Fractures .......................................................................... 228
6. Isolated Fibula Growth Plate Injuries and Fibula Fractures .............................. 229
E. Transitional Fractures ............................................................................................... 229
1. Juvenile Tillaux Fractures ................................................................................... 229
2. Triplane Fractures............................................................................................... 236
3. Adolescent Pilon Fractures ................................................................................. 243
F. Complications of Ankle Fractures............................................................................. 246 III. Pediatric Foot Fractures ................................................................................................... 247
A. Anatomy.................................................................................................................... 247
B. Talus Fractures .......................................................................................................... 247
1. General Features ................................................................................................. 247
2. Talar Neck Fractures .......................................................................................... 248
3. Body Fractures and Other Injuries of the Talus.................................................. 251
C. Calcaneus Fractures................................................................................................... 252
D. Lesser Tarsal Fractures and Tarsometatarsal Injuries ............................................... 253
E. Metatarsal Fractures.................................................................................................. 254
F. Phalanx Fractures...................................................................................................... 257 IV. Summary ........................................................................................................................... 257 References .................................................................................................................................. 257
I. INTRODUCTION
Children’s bones in general have a lower modulus of elasticity, more blood, and less mineral content than those of adults [1]. This makes children’s bones more porous than those of adults. The periosteum of children is much thicker and more vascular than that of adults [2]. Periosteum often remains at least partially attached even in displaced fractures, leading to less fracture displacement and more rapid healing times. The osteogenic inner layer of periosteum that is closest to the bone will often stay intact, leading to the rapid healing times noted in children [2]. In addition, children usually have a thicker cartilage [3]. The immature osteochondral bone absorbs and dissipates energy more evenly than adults, leading to far fewer displaced intra-articular or comminuted fractures in children [4]. In late adolescence, as body weight increases and bone is more osseous, the adult-type fracture patterns start to become more common.
