Supination-Eversion Injuries of the Ankle in Children

Summary: In a retrospective investigation of 919 fractures of the lower leg or of the ankle in 903 children up to 18 years, 457 ankle fractures (453 cases) were classified traumatologically according to Gerner-Smidt (juvenile fracture pattern) and Lauge-Hansen (adult fracture pattern). Anatomically, the fractures were classified according to Salter and Harris in cases with open growth plates. A total of 176 (39%) ankle fractures were classified as supination-eversion injuries. The number of boys was slightly higher than the number of girls (90/86). Most cases were more than 9 years of age. The mean age for girls (11.9) was lower than for boys (13.2) with open growth plates. The intraarticular fracture type occurred at a higher age than the extraarticular. The intraarticular fracture type of the distal tibia (55 fractures) showed a high degree of complexity, and the exact anatomical configuration could not always be determined from routine roentgenograms. The extraarticular fracture type of the distal tibia (71 fractures) always showed a posterior metaphyseal fragment in combination with a separation through the anterior part of the growth plate. The metaphyseal fragment could be situated dorsomedially, straight dorsally, or dorsolaterally. One fracture type not described earlier in the literature was difficult to classify according to Salter-Harris. This fracture, starting medially in the medial malleolus and running upward to and through the growth plate, without entering the ankle joint but detaching a posterior metaphyseal fragment, was observed in two children. Three types of isolated fibular injuries (20 fractures) engaging the growth plate were identified. The first type had a posterior metaphyseal fragment, the second a posterior epiphyseal fragment, and the third type showing a zigzag pattern. The results of the study indicate that the traumatological and the anatomical classifications in combination are of value in recognizing different fracture types of the ankle in children and of importance for the treatment of these fractures.