The hidden adolescent ankle fracture.

Ankle injuries are common in adolescence, seldom initially seen by orthopaedists, and often treated primarily by emergency department personnel. It is often not appreciated that the distal tibial growth plate fuses in a mediolateral direction, leaving it open and vulnerable to growth plate injuries for a longer period during adolescence. Fractures of the lateral plafond of the tibia are often not appreciated due to overlap of the fibula. A review of the injuries at the Winnipeg Children's Hospital has revealed these are not as uncommon as often supposed. A 3 year experience yielded 26 patients with so-called "Tillaux fractures" of which 9 could be diagnosed only by the oblique view and 5 were initially missed. Knowledge of the anatomical behavior of the fusing tibial growth plate in the ankle-injured adolescent plus mandatory oblique views of the ankle in this age group should enable the casualty officer in a busy emergency department to bring this fracture out of hiding and make the diagnosis in every instance.