Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Case 82 Clubfoot
- Case 83 Developmental dysplasia of the hip
- Case 84 Legg–Calve–Perthes disease
- Case 85 Slipped capital femoral epiphysis
- Case 86 Langerhans cell histiocytosis: MRI/PET for diagnosis and treatment monitoring
- Case 87 Congenital syphilis
- Case 88 Medial malleolus avulsion fracture
- Case 89 Triplane fracture
- Case 90 Fibrous dysplasia
- Case 91 Chest wall sarcoma
- Case 92 Campomelic dysplasia
- Case 93 Type II collagenopathy (hypochondrogenesis)
- Case 94 Morel-Lavallée lesions
- Case 95 Infantile myofibromatosis
- Case 96 Osteochondritis dissecans of the capitellum
- Index
- References
Case 88 - Medial malleolus avulsion fracture
from Section 9 - Musculoskeletal imaging
Published online by Cambridge University Press: 05 June 2014
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Case 82 Clubfoot
- Case 83 Developmental dysplasia of the hip
- Case 84 Legg–Calve–Perthes disease
- Case 85 Slipped capital femoral epiphysis
- Case 86 Langerhans cell histiocytosis: MRI/PET for diagnosis and treatment monitoring
- Case 87 Congenital syphilis
- Case 88 Medial malleolus avulsion fracture
- Case 89 Triplane fracture
- Case 90 Fibrous dysplasia
- Case 91 Chest wall sarcoma
- Case 92 Campomelic dysplasia
- Case 93 Type II collagenopathy (hypochondrogenesis)
- Case 94 Morel-Lavallée lesions
- Case 95 Infantile myofibromatosis
- Case 96 Osteochondritis dissecans of the capitellum
- Index
- References
Summary
Imaging description
A 13-year-old male patient had a twisting injury of the right ankle. Radiographs of the right ankle (in temporary cast) demonstrated a fracture of the right medial malleolus with a medially displaced fracture fragment (Fig. 88.1a). The fracture was noted to have metaphyseal, physeal, and epiphyseal components consistent with a Salter–Harris type IV injury. In addition, there was mild separation of the distal tibia and fibula, suggesting an injury of the tibiofibular syndesmosis. The patient was referred to orthopedic surgery for surgical fixation. A postsurgical radiograph of the right ankle demonstrated anatomic alignment of tibia and fibula with stabilizing screws in the medial malleolus and through the distal tibiofibular syndesmosis (Fig. 88.1b).
Importance
In 1931, McFarland described a pediatric fracture of the medial malleolus of the distal tibia that extended across the physis and sometimes into the metaphysis. These fractures were therefore previously described as McFarland fractures. The Salter–Harris classification has since become more frequently used to characterize pediatric fractures (Fig. 88.2). Salter–Harris I fractures extend through the physis. Type II fractures pass through the physis and metaphysis. Type III fractures extend through the physis and epiphysis. Type IV fractures pass through the epiphysis, physis, and metaphysis. Salter–Harris type V injury is a compression or crush injury of the physeal plate, associated with growth disturbance at the physis (Fig. 88.2). An avulsion fracture of the medial malleolus of the distal tibia that extends through the physis and epiphysis is therefore characterized as a Salter–Harris III or IV fracture depending upon whether there is extension of the fracture line into the metaphysis. The medial collateral ligament (MCL) of the ankle, also called the deltoid ligament, can be involved. The MCL is a strong ligamentous complex that is an important stabilizer of the ankle. The MCL components include a deep layer which courses from the medial malleolus to the talus and a deltoid-shaped superficial layer that extends from the medial malleolus to the navicular, the spring ligament, and the calcaneus. The importance of this fracture is that it often occurs in children and any disruption or damage to the developing growth plate can result in growth arrest.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Pediatric ImagingVariants and Other Difficult Diagnoses, pp. 359 - 361Publisher: Cambridge University PressPrint publication year: 2014