Pediatric Lateral Ankle Avulsion Fractures: Age-Specific Patterns and Diagnostic Clues

Area of Science:

• Pediatric Orthopedics
• Sports Medicine
• Radiology

Background:

• Lateral ankle injuries are prevalent in children.
• Avulsion fractures, a type of bony disruption, can be subtle and underdiagnosed in skeletally immature patients.
• Distinguishing avulsion fractures from other ankle injuries is crucial for appropriate management.

Purpose of the Study:

• To compare the incidence, clinical presentation, and patient-reported outcomes (PROs) of lateral ankle avulsion fractures versus non-avulsion injuries in pediatric patients.
• To investigate age-related differences in these injury patterns.
• To identify clinical indicators that may suggest an avulsion fracture.

Main Methods:

• A prospective cohort observational study was conducted involving 132 pediatric patients (ages 5-12) with acute lateral ankle injuries.
• Patients underwent clinical assessment, radiographs, and research-based lateral ankle ultrasounds.
• Participants were categorized into avulsion and non-avulsion groups, with further comparisons between younger (5-10 years) and older (11-12 years) age cohorts.

Main Results:

• Avulsion fractures were identified in 33% of patients (44 out of 132).
• Avulsion fractures were significantly more common in younger children (47%) compared to older children (16%) (P<0.001).
• Swelling and bruising were more frequent in patients with avulsion fractures (P<0.001), though initial PROs were similar across injury types.

Conclusions:

• Avulsion fractures constitute one-third of pediatric lateral ankle injuries and are more prevalent in younger, skeletally immature children.
• Clinical signs like swelling and bruising may assist in diagnosing these fractures.
• Further research is needed to assess the long-term implications, such as the development of subfibular ossicles and associated chronic pain or instability.