2. 13YOM presents with the
complaint of ankle pain.
The patient was hiking
with friends and family
when his foot got caught
and he “twisted” his ankle.
He has been unable to bear
weight and is complaining
of marked swelling.
T 98.7 P 98 BP 126/84 O2
99%
Gen: WDWN, obvious pain
CV: RRR, no m/r/g
Pulm: Lungs CTA bilat
Musc: Limited active and
passive ROM R ankle;
marked swelling and TTP
of anterior R ankle; no TTP
over medial and lateral
malleolus
3.
4. Red arrow: Salter Harris III fracture involving
avulsion of anterolateral tibial epiphysis
5. Pain control
Orthopedic Consultation for possible ORIF
Displacement of >2mm requires ORIF
Stabilization/Closed Reduction
Internal rotation of ankle and supination of the foot
with pressure on fracture fragment
Stabilization in long leg cast or stirrup splint with
posterior slab
Prompt orthopedic follow-up
6. Fracture occurs in adolescents w/ relatively mature
growth plates; therefore, there is minimal potential for
deformity due to growth plate injury
Needs to be differentiated from a triplane fracture,
which is a salter harris IV fracture that extends
through the epiphysis, physis, and metaphysis