What are the other Names for this Condition? (Also known as/Synonyms)

• Broken Ankle in Children
• Childhood Ankle Fracture
• Fracture of the Ankle in a Child

What is Ankle Fracture in Children? (Definition/Background Information)

• An Ankle Fracture is a break or crack, in one or more pieces of bones that make up the ankle joint
• A high percentage of Ankle Fractures in Children, normally involves both the fibula and tibia, which are the two long bones, within the lower leg. Such fractures also usually involve the growth plates (termed epiphyseal plates, located at the end of long bones in children)
• This injury is predominantly seen in young athletes, who participate in high-impact sports or is caused by motor vehicle accidents. Other reasons for an Ankle Fracture also include, fall from a substantial height

Who gets Ankle Fracture in Children? (Age and Sex Distribution)

• Children of all ages, gender, races, or ethnic groups may experience an Ankle Fracture
• Young athletes who participate in high-impact sports, have the highest rate of occurrence of such fractures

What are the Risk Factors for Ankle Fracture in Children? (Predisposing Factors)

Common risk factors associated with Ankle Fractures in Children include:

• Participation in high-risk contact sports, such as basketball, football
• Childhood obesity

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ankle Fracture in Children? (Etiology)

Some of the common causes associated with Ankle Fracture in Children include:

• A direct fall on the ankle from a significant height
• Direct trauma to the ankle, such as due to an automobile accident
• Participation in any rough or high-impact sport

What are the Signs and Symptoms of Ankle Fracture in Children?

Signs and symptoms of a Broken Ankle in a Child would include:

• Severe and immediate pain at the site, where the injury occurred
• Swelling, noticeable deformity of the ankle
• Feeling of a tender sensation when touched
• Noticeable bruising
• Inability to apply any weight, put pressure on the ankle

How is Ankle Fracture in Children Diagnosed?

Diagnostic methods that a physician may use to help diagnose Ankle Fractures in Children include:

• Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, contusions within the ankle. A parent or guardian of the child is also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history may aid in arriving at a definitive diagnosis
• X-ray: X-rays are commonly used in evaluating a fracture; to see if the bone has been displaced. This diagnostic imaging test helps provide a clear image of the bone, identify exact location of the injury, and determine the extent of the fracture
• Computerized tomography (CT) scan: A CT scan takes a series of x-ray images from several different angles. These images are then merged, to create cross-sectional images of bones and soft tissues with the body. This allows a physician to examine the ankle and surrounding structures
• Magnetic resonance imaging (MRI): An MRI scan is a more detailed scan that uses radio waves and a magnetic field, to generate thorough images of the interior bones and soft tissues
• Bone scan: A bone scan is a diagnostic method used to identify any bone abnormalities, by injecting tiny amounts of radioactive material into the bloodstream

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ankle Fracture in Children?

Complications associated with Ankle Fracture in Children include:

• Degenerative joint disease (Osteoarthritis)
• Osteonecrosis: A serious disorder characterized by the temporary or permanent disruption of blood flow, to the bones
• Abnormal deformity, permanent disability of the ankle
• Prolonged chronic pain
• If any part of the ankle joint protrudes through the skin, bacteria may cause an infection to the exposed bone. This is called osteomyelitis
• Permanent damage to nerves and blood vessels, around the ankle joint
• There may be an abnormal pressure build-up within the muscles around the ankle. This may reduce the blood flow and prevent nourishment and oxygen, from reaching the nerve and muscle cells (termed as compartment syndrome)
• A fracture within the growth plate, could interfere with the normal growth of a child

How is Ankle Fracture in Children Treated?

A high percentage of Ankle Fractures require surgical procedures to address the condition. However, this injury may also be treated non-surgically, depending on the individual’s specific circumstance.

Nonsurgical treatment measures for Ankle Fractures in Children are:

• Any activity that further aggravates the ankle condition should be avoided. The physician would normally advise to refrain from all such activities, until the symptoms stop and the bone heals
• Complete immobilization of the ankle with a cast, is required to restrict movement
• Applying ice to the ankle, can help with pain and reduce any swelling
• Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be used to treat an Ankle Fracture. These medications can help decrease the pain and swelling
• Individuals are likely to need physical therapy exercises after the cast is removed. The goal of these exercises is to strengthen the ankle muscles, improve flexibility, and decrease stiffness. It may take several months for an individual to complete the physical therapy program

Surgical treatment measures include:

• Open reduction and internal fixation (ORIF): An open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as a plate, screw, or rod) is then used to stabilize the fractured bones under the skin, until it is fully healed

How can Ankle Fracture in Children be Prevented?

To prevent an Ankle Fracture, children should be careful and consciously aware while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Ankle Fractures in Children include:

• Individuals who participate in any high-risk sports, such as football, should wear appropriate safety equipment to help prevent the possibility of an Ankle Fracture
• Wearing appropriate footwear (such as the proper shoe size), may help prevent accidents
• Consuming foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Regular diet with appropriate calcium-intake is recommended, even after an Ankle Fracture
• Perform weight-bearing exercises to strengthen bones

What is the Prognosis of Ankle Fracture in Children? (Outcomes/Resolutions)

• A high percentage of Ankle Fracture injuries in children, heal without any serious complications
• A full recovery and a return to sports or normal daily activities, may usually require a few weeks to several months. This depends on the severity of the fracture
• When properly treated and rehabilitated, usually under the guidance of a physiotherapist and a healthcare specialist, a high percentage of children regain their full strength and range of motion in the injured ankle

Additional and Relevant Useful Information for Ankle Fracture in Children:

Stress Fractures are small microfractures in the bone, associated with repetitive force and bone overuse. Acute fractures are injuries caused by unexpected and traumatic events. Over 50 percent of all stress fracture injuries occur in the lower leg.