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Traumatic avulsion of the superior extensor retinaculum of the ankle as a cause of subperiosteal haematoma of the distal fibula in children. A retrospective study of 7 cases

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Abstract

Objective

To describe a new sonographic feature for a traumatic lesion of the ankle in children.

Materials and methods

We present a retrospective review of superior extensor retinaculum (SER) avulsions diagnosed by ultrasound (US) as a cause of subperiosteal haematoma (SPH) and periosteal apposition of the distal fibula in seven children (3 girls and 4 boys, mean age 13.4 years; age range 10–15 years) after an inversion trauma of the ankle. Two children were subsequently examined with magnetic resonance imaging (MRI).

Results

At the acute phases (6 children), US showed a hypoechoic collection with periosteal elevation at the fibular insertion of the SER. The fibular cortex and growth plate were unremarkable. The SPH was isolated in three cases and associated with an anterior talofibular ligament sprain in four. In two cases, MRI confirmed the SER periosteal avulsion and the integrity of the distal fibula. At the later phase (one child), US showed a periosteal apposition at the fibular insertion of the SER with hypoechoic thickening of the SER and power Doppler hyperaemia.

Conclusion

This is the first sonographic description of SER avulsion as cause of SPH of the distal fibula in children. SPH in children should not be considered as pathognomonic of a Salter-Harris type 1 lesion of the distal fibula. Later, it may be responsible for persistent ankle pain. Therefore, SER may be systematically explored in children during US examination of the ankle after trauma.

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Authors and Affiliations

  1. CHU Lille, Service de Radiopédiatrie, Hôpital Jeanne de Flandre, 59000, Lille, France

    Juliette Ding, Antoine Moraux, Élisa Amzallag-Bellenger & Nathalie Boutry

  2. Univ. Lille, 59000, Lille, France

    Juliette Ding, Antoine Moraux, Xavier Demondion, Élisa Amzallag-Bellenger & Nathalie Boutry

  3. Imagerie Médicale Jacquemars Giélée, 73 rue Jacquemars Giélée, 59000, Lille, France

    Antoine Moraux

  4. CHU Lille, Clinique de Chirurgie Orthopédique Infantile, Hôpital Jeanne de Flandre, 59000, Lille, France

    Éric Nectoux

  5. CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d’Imagerie de l’Appareil Locomoteur, 59000, Lille, France

    Xavier Demondion

  6. Laboratoire d’Anatomie, Faculté de Médecine de Lille, 59045, Lille, Cedex, France

    Xavier Demondion

Authors
  1. Juliette Ding
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  2. Antoine Moraux
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  3. Éric Nectoux
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  4. Xavier Demondion
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  5. Élisa Amzallag-Bellenger
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  6. Nathalie Boutry
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Corresponding author

Correspondence to Juliette Ding.

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The authors declare that they have no conflict of interest.

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Ding, J., Moraux, A., Nectoux, É. et al. Traumatic avulsion of the superior extensor retinaculum of the ankle as a cause of subperiosteal haematoma of the distal fibula in children. A retrospective study of 7 cases. Skeletal Radiol 45, 1481–1485 (2016). https://doi.org/10.1007/s00256-016-2454-z

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  • DOI: https://doi.org/10.1007/s00256-016-2454-z

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