From the Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI (Dr. Yin, Dr. Englert, and Dr. Saleh) and Wayne State University, School of Medicine, Detroit, MI (Dr. Sareini).
J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 2;7(8). doi: 10.5435/JAAOSGlobal-D-22-00134. eCollection 2023 Aug 1.
Ankle fractures are among the most common fractures sustained in the pediatric population. Given the frequency of physeal involvement of the distal fragment, complications including growth arrest, overgrowth, and rotational deformities are not uncommon. This case report describes a 12-year-old adolescent boy who presented after an acute right ankle injury sustained while playing. He noted right ankle pain, swelling, and in-toeing of his foot. Radiographs of the ankle demonstrated a distal tibia Salter-Harris type II fracture that appeared nondisplaced. However, a CT scan of the ankle demonstrated a 60° difference in the rotational profile between the injured and noninjured tibias. The patient's acute rotational deformity was corrected with closed reduction and percutaneous pinning. Pediatric distal tibia physis fractures presenting with in-toeing are rare and difficult to diagnose accurately with radiographs alone. Accordingly, a detailed history, physical examination, comparison radiographs, and CT scans are imperative in making the correct diagnosis and determining the appropriate treatment.
踝关节骨折是儿童中最常见的骨折之一。由于远端碎片骺板受累的频率较高，生长停滞、过度生长和旋转畸形等并发症并不少见。本病例报告描述了一名 12 岁青少年男孩，他在玩耍时急性右踝关节受伤后就诊。他诉右踝关节疼痛、肿胀和足内翻。踝关节 X 线片显示胫骨远端 Salter-Harris Ⅱ型骨折，看似无移位。然而，踝关节 CT 扫描显示受伤和未受伤胫骨之间的旋转角度相差 60°。患者的急性旋转畸形通过闭合复位和经皮钢针固定矫正。表现为足内翻的儿童胫骨远端骺板骨折较为罕见，仅通过 X 线片很难准确诊断。因此，详细的病史、体格检查、对比 X 线片和 CT 扫描对于做出正确诊断和确定适当的治疗至关重要。
