[Rotational physeal fracture of the distal tibia : where a keen clinical eye changes everything]

Ankle fractures are among the most common pediatric fractures, especially during the transitional period. They can lead to growth arrest, which is why careful attention is required when interpreting radiographs. This article discusses the case of an 11-year-old patient who sustained a rotational injury to the left ankle. Initially protocoled as negative, a second review of the radiographs supplemented by a CT scan revealed a Salter-Harris type II fracture of the distal tibia with 90° external rotation, associated with a non-displaced fibula fracture. Treatment consisted of a closed reduction and cast immobilization. Follow-up revealed a growth arrest of the tibial physis at 6 months, leading to a preventive epiphysiodesis of the contralateral ankle. This case highlights the diagnostic challenges of rotational fractures, which are often underestimated in imaging. It also underlines the importance of clinical examination, which remains the clinician's primary tool. Finally, close monitoring of this type of fracture is essential due to its high risk of growth disturbance.