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Classification of ankle fractures in children

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Summary

The roentgenograms of 310 children treated for ankle fractures were evaluated for grouping according to the classifications of Ashhurst-Bromer-Weber, Lauge-Hansen, and Salter-Harris. The mean age of the children at the time of injury was 11.1 years (range 2–14 years). Two hundred twenty-one (71.3%) children had malleolar fractures, 71 (22.9%) had tibial epiphyseal fractures, and 18 (5.8%) had syndesmotic lesions. The age distribution of fractures was typical: malleolar fractures predominated among the younger children, epiphyseal fractures among the older. Only the oldest children had avulsion fractures of the syndesmosis. Grouping of the fractures according to Lauge-Hansen and Ashhurst-Bromer-Weber, classifications suited to adults, was largely unsuccessful. Epiphyseal fractures, moreover, were easily classified according to Salter-Harris. In spite of their complexity, ankle fractures in children can be roughly divided into avulsional and epiphyseal fractures. Adequately reduced avulsional fractures can be expected to heal well; epiphyseal fractures, however, may give rise to late complications. We propose, therefore, that ankle fractures in children be classified on the basis of roentgenological findings with respect primarily to epiphyseal lesions as well as on an additional simple grouping as to risk for clinical purposes: Group 1, low risk, avulsional fractures and epiphyseal separations; Group II, high risk, fractures through the epiphyseal plate.

Zusammenfasung

Es werden die Röntgenaufnahmen von 310 wegen Sprunggelenksfraktur behandelten Kindern beurteilt und nach den Klassifikationen von Ashhurst-Bromer-Weber, Lauge-Hansen und Salter-Harris eingeteilt. Das Durchschnittsalter der Kinder zum Zeitpunkt der Verletzung war 11,1 Jahre (2–14 Jahre). 221 Kinder (71,3%) hatten Malleolarfrakturen, 71 (22,9%) epiphysare Frakturen von Tibia und 18 (5,8%) Syndesmosenverletzungen. Die Altersverteilung der Frakturen war typisch: Malleolarfrakturen überwogen bei den jüngeren Kindern, epiphysäre Frakturen bei den älteren. Nur die ältesten Kinder hatten Syndesmosensprengungen.

Die Klassifizierung der Frakturen nach Lauge-Hansen und Ashhurst-Bromer-Weber, deren Einteilungen für Frakturen Erwachsener geeignet sind, war weitgehend unmöglich. Epiphysäre Frakturen waren leicht nach Salter-Harris zu klassifizieren.

Trotz ihrer Komplexität kann man Sprunggelenksfrakturen bei Kindern grob in Avulsions- und Epiphysenfrakturen einteilen. Adäquat reponierte Avulsionsfrakturen lassen ein gutes Behandlungsergebnis erwarten; Epiphysenfrakturen führen häufiger zu Spätkomplikationen. Die Autoren empfehlen deshalb, Sprunggelenksfrakturen bei Kindern sowohl auf der Grundlage des Röntgenbefundes unter besonderer Berücksichtigung der Epiphysenschädigungen als auch nach einer zusätzlichen einfachen Einteilung, die das Komplikationsrisiko für klinische Belange mit einbezieht, zu klassifizieren: Gruppe I geringes Komplikationsrisiko; Avulsionsfrakturen und Epiphysenlösungen. Gruppe II hohes Komplikationsrisiko; Frakturen durch die Epiphysenplatte.

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References

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Vahvanen, V., Aalto, K. Classification of ankle fractures in children. Arch. Orth. Traum. Surg. 97, 1–5 (1980). https://doi.org/10.1007/BF00381520

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Keywords

  • Public Health
  • High Risk
  • Young Child
  • Simple Grouping
  • Late Complication