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This is Pediatrics week four case one and

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the diagnosis were considering is ankle fracture.

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This is a teenage patient with left ankle pain

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after injury and we have a three radiograph series

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to look at AP oblique and lateral views

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and hopefully looking right at this

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AP you can detect that there's a problem at the

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lateral aspect of the distal tibia. There's lucency. There's

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a widening at the fisces and there's displacement

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of a portion of the epiphysis and this

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is isolated just to

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the epiphysis and fisces of

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the left distal tibia. This is commonly known as a

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Tolo fracture not to be confused with a tri-plane

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fracture. So as I scroll to the oblique where

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you can also get a sense of the displacement of

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this fractured fragment and then the lateral where

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you can see the fracture line through the

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epiphysis, you'll note. There's no corresponding fracture line

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through the metaphysis of

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the distal tibia, and that's important because that rules out

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a try playing fracture.

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I tried playing of course being a fracture that extends through the

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metaphysis then jogs horizontally through

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the faces and then comes out through the epiphysis. In fact

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commonly. It's the other way. It would be back here for the

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metaphysis then along the fisces then out

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the epiphysis and that occurs in the setting of a partially fused faces

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in this case. However, the fisces

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has not closed to the degree that

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it would drive the force of injury in a

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tri-plane dimension. This is a classic Salter Harris type

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3 injury where the fracture is through the epiphysis and

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faces.

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There's widening of the ankle mortise and there's

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mild displacement of the fragment and that's important for repair. If

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there were two millimeters or less of displacement.

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We may be able to manage conservatively, but

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with this degree of displacement.

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Surgical repair is almost certainly necessary. So the

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key things to remember are to evaluate the

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degree of displacement of the fragment evaluate for

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widening and instability of the ankle mortis and evaluate

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the metaphysis to be sure to distinguish between triplane and

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isolated Salter Harris type 3

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in this case known as to low fracture. That's the

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end of the case.