Supination-adduction injuries of the ankle in children--radiographical classification and treatment

Diagnostical and therapeutical problems associated with supination-adduction injuries are presented. 457 ankle fractures were collected from a retrospective material of 919 children aged 0-18 years with fractures of the tibio-fibular shaft or the ankle. The ankle fractures were classified anatomically according to Salter and Harris and traumatologically according to Gerner-Smidt. 147 fractures were classified as due to supination-adduction, of which 128 had open growth plates. The first stage, a Salter-Harris type I, II, or III fracture through the lateral malleolus or only epiphyseal fracture without fracture through the growth plate, is easily overlooked and is probably more common than earlier registered. The stage II injury with, an addition, a vertical or oblique fracture of the medial malleolus sometimes continuing through the physis and metaphysis is often more easily recognized at the radiographical examination. The mean age of supination-adduction injuries is lower than for supination-eversion injuries. The supination-adduction injuries are the second most common type of ankle fractures in children (32%) only exceeded by injuries due to supination-eversion (39%). Early recognition of the fracture pattern of supination-adduction injuries is important as growth disturbance and joint problems are not uncommon when there is fracture through the medial malleolus. The need for correct diagnosis and treatment is stressed by the risk for late problems.