- Discussion:
- w/ foot in full supination, ankle is submitted to plantar flexion force;
- most often causes a SH type II frx (less often SH I) of distal tibia;
- fibular fracture may or may not be present;
- Radiograph:
- on lateral x-ray look for posterior metaphyseal fragment displaced posteriorly;
- on lateral radiographs, the SH II frx w/ the posteromedial metaphyseal fragment may resemble a
supination-external rotation frx;
- the distinction between the 2 frx is made on the AP view;
- Non Operative Treatment:
- long leg cast for 4-6 weeks;
- Closed Reduction:
- best performed under GEA;
- ankle must be distracted inorder to disengage the fracture surfaces;
- in some cases, external fixation (spanning the ankle) is utilized to not only assist with temporary distraction, but also to maintain the reduction;
- foot must be dorsiflexed to counteract the deforming force of the Achlles tendon;
- in some cases with a signficant tight heel cord, the knee will have to be flexed (too relax the gastroc) so that the reduction can procede;
- in this frx pattern, periosteum may become entraped into anterior aspect of frx;
- requires, removal of periosteum via anteromedial incision, followed by closed reduction;
Fixation:
- consider fixation with a single anterior to posterior cannulated screw;
- fixation of the fibula if there is displacement, especially on the lateral view;
Plantar flexion injuries of the ankle. An experimental study.
Compartment syndrome with an isolated Salter Harris II fracture of the distal tibia.
Irreducible Salter-Harris type II fracture of the distal tibial epiphysis.
