Ultrasound Assessment and Conservative Management of Inversion Injuries of the Ankle in Children

Abstract

We studied 45 children who presented with an inversion injury of the ankle. The clinical signs suggested injury to the distal growth plate of the fibula, but the plain radiographs appeared normal. Ultrasound examination of the joint in 40 patients showed a subperiosteal haematoma consistent with a growth-plate injury in 23 (57.5%). Children who had been treated with a tubular bandage and crutches by random selection had a mean time to return of normal activity of 14.22 days compared with 21.60 days for those treated with a plaster-of-Paris cast (t = 3.60, p = 0.0032; d = 7.38, 95% CI 3.0 to 11.8).We conclude that children with inversion ankle injuries who have clinical signs of injury to the distal fibular growth plate but a normal radiological appearance, should be treated with a tubular bandage and crutches.

Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study

“…Stable fractures of the ankle in children have been successfully treated with double Tubigrip devices, and outcomes are superior to those treated with plaster cast immobilisation [8].…”

The proportion of distal fibula Salter–Harris type I epiphyseal fracture in the paediatric population with acute ankle injury

“…Disadvantages of the traditional treatment protocol (cast immobilization for 3-4 weeks) include a delay in returning to normal activities, patient discomfort, too tight cast, skin ulceration and rarely compartment syndrome [5,6,12,13]. Theoretically, a wellmoulded cast provides greater protection than alternative immobilization such as a removable ankle brace or walking boots.…”

“…Theoretically, a wellmoulded cast provides greater protection than alternative immobilization such as a removable ankle brace or walking boots. But as the fibula is rarely prone to refracture, some investigators have questioned the need of this rigid and prolonged immobilization of these relatively minor injuries [5,6,12].…”

Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

“…17 More recent literature on this subject suggests that ankle bracing or tubular bandaging of SH-1 ankle injuries results in similar outcomes to plaster immobilization. 18 There is also increasing evidence that many SH-1 ankle injures do not have demonstrable fractures on magnetic resonance imaging. 19,20 In light of this recently published data, the results of our study suggest that current management of SH-1 fractures may be more aggressive than required.…”