Leg and Ankle Injuries

From a shattered tibia bone to a sprained ankle, this area represents one of the most common areas of injury for children of all ages. 

Anatomy of the Leg and Ankle:

ACUTE INJURIES

Tibia Shaft Fractures:

The treatment of tibia fractures depends on both the age of your child and the location and severity of the fracture. Fractures can occur from a simple twist and fall in the young child. They are so common that they have the name "toddler fracture" associated with it. These fractures heal very quickly. Often time, your provider will place your child in a cast for about three to four weeks and that is usually the only treatment necessary.

In older children, the force required to break the bone is greater, and it is more difficult to hold the fracture in place with just a cast. However, most of the time a cast is all that is needed for treatment. The time it takes for a tibia fracture to heal in an adolescent is much longer than a toddler. While a toddler can be treated in a cast for three to four weeks, it often takes about three months of casting for a tibia fracture to heal in older children and adults.

If the fracture cannot be held in a cast, your physician may advise a surgery to better align the bones. Typically, some type of rod is placed inside the bone – either a series of 2 flexible rods or 1 rigid rod that is used in adults. It depends on if your child is still growing or not.

The single rigid rod is left in permanently while the flexible rods need to come out surgically approximately one year after surgery.

Once the fracture is healed, physical therapy is often necessary because the calf muscle becomes quite weak and the ankle is typically stiff. Nevertheless, most children make a complete recovery without any consequences.


Toddler's Fracture:

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Distal Fibula Fractures:

Ankle fractures are a common injury in children. Most of the time, these "fractures" involve the growth area of the small fibula bone. In children, the growth areas of bone are made of cartilage and this cartilage is weaker than the bone as well as the surrounding ligaments. So, while the average twenty-five year old female may "sprain" her ankle (i.e. injure a ligament) when she rolls her ankle in, a ten year old female who did a similar thing would not sprain, but would rather "break" the ankle at the growth area. Thankfully, these common injuries heal quite readily with little consequence. Growth arrest is extremely rare.

These fractures occur when the ankle turns in, and pain and swelling occur on the outer portion of the ankle near the outer bump (see picture).

Most of the time, your child will be placed in either a walking boot or a short leg walking cast for several weeks. When the cast comes off, the bone is usually healed and your child is ready to get back into activities as soon as the strength and range of motion improve.  Physical therapy is sometimes recommended based on the severity of the injury and the activity level of your child.

If your child has recently been diagnosed with one of these injuries, the team at COA can help.  Schedule an appointment today.


Triplane Fractures:

Triplane fractures are known as "transitional fractures" because they happen at a time when a portion of the growth area of the distal tibia bone is closing while other portions are open.  They typically occur during some type of twisting maneuver.  If the bones are displaced (separated), then surgery will likely be recommended in order for the bone to heal in a straight position.  After the surgery, your child will likely be in a short cast for 4-6 weeks.  

If the bones are not separated from each other (non-displaced), then the fracture can likely be treated in a cast alone.  The cast, however, is often a long cast above the knee.  Typically, your COA provider will have your child in a long cast for 3-4 weeks, followed by a short cast for 2-3 weeks.  Total cast time is typically 6 weeks.  

After these injuries, physical therapy will likely be prescribed to help regain ankle strength and range of motion.  Since there is a risk of permanent injury to the growth are, your COA provider will typically want to see your child for at least 1 year from the time of injury to ensure that the ankle continues to grow straight.


Tillaux Fractures:

Similar to triplane fracture, Tillaux fractures occur exclusively in the adolescent.  There is approximately an eighteen month window for adolescents to be predisposed to this fracture pattern.  This distal tibia growth area closes asymmetrically.  The center part closes first, then the medial (inner portion), and lastly the lateral (outer portion) of the growth area.

  • Central: closes between ages 13-14 yrs
  • Medial: closes between ages 14-15 yrs
  • Lateral: closes between ages 14.5-16 yrs

The fracture occurs when the ankle is twisted outward (externally rotated).  At this time, only the lateral (outer) growth area is still open, and the other parts of the growth area are already fused to the remainder of the tibia bone.  Since the growth area is made of cartilage, it represents a weak area, and when a child turns his ankle in just the right fashion, a ligament that pulls this piece away from the tibia bone.