PEDIATRIC ANKLE FRACTURES

Pediatric ankle fractures are common injuries during childhood, and their unique biological and me-chanical properties require diagnostic and treatment approaches that differ from those in adults. This chapter comprehensively discusses the anatomy, classifications, diagnostic methods, treatment strat-egies, and current literature regarding pediatric ankle fractures. In the pediatric population, the distal tibial physis accounts for 11-38% of physeal injuries and is responsible for 45% of tibial growth. The most frequent mechanisms of injury include sports activities, falls, and sprains, although high-energy trauma also plays an important role. The Salter-Harris classification is widely used, with Type I and II fractures often managed conservatively, while Type III and IV fractures frequently require surgical intervention. Transitional fractures such as Tillaux and triplanar fractures should be evaluated in detail with CT imaging, and surgical planning is advised when intra-articular step-off exceeds 2-2.5 mm. Clinical examination, plain radiographs, and advanced imaging modalities such as CT and MRI are crucial for diagnosis. Additionally, syndesmotic injuries accompanying pediatric ankle fractures may require surgical fixation, potentially prolonging the return-to-sport timeline. Recent literature high-lights that surgical treatment is preferred for anatomical reduction and physeal preservation, whereas conservative treatment achieves good outcomes in non-displaced fractures. Various clinical studies have evaluated complications including physeal closure, recurrent sprains, and deformities, empha-sizing that high-energy trauma significantly increases the risk of long-term poor prognosis. In conclu-sion, the primary goal in managing pediatric ankle fractures is to preserve the physis and ensure joint integrity, optimizing long-term functional outcomes. This chapter provides a comprehensive, litera-ture-based guide from diagnosis to treatment, aiming to assist clinicians in the management of these unique fractures.