Ankle fractures in children

Ankle fractures are common in children, and they have specific implications in that patient population due to frequent involvement of the physis in a bone that has growth potential and unique biomechanical properties. Characteristic patterns are typically evident in relation to the state of osseous development of the segment, and to an extent these are age-dependent. In a specific type known as transitional fractures – which occur in children who are progressing to a mature skeleton –a partial physeal closure is evident, which produces multiplanar fracture patterns. Computed tomography should be routine in injuries with joint involvement, both to assess the level of displacement and to facilitate informed surgical planning. The therapeutic objectives should be to achieve an adequate functional axis of the ankle without articular gaps, and to protect the physis in order to avoid growth alterations. Conservative management can be utilized for non-displaced fractures in conjunction with strict radiological monitoring, but surgery should be considered for fractures involving substantial physeal or joint displacement, in order to achieve the therapeutic goals. Cite this article: EFORT Open Rev 2021;6:593-606. DOI: 10.1302/2058-5241.6.200042